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1. Rituximab Rescue Therapy for Refractory Early Acute Rejection after Liver Transplantation

Author

T. Vogel, H.H. Wolters, J. Hölzen, H.H. Schmidt, C. August, C. Dahrenmöller, N. Senninger, and J.G. Brockmann

Subjects
Medicine
Abstract

Rejection of a liver transplant is a rare but serious event which can be life threatening. T-cells were supposed to be the major, if not the only key player in allograft rejection. However, during recent years B-cell function has regained attention. A chimeric monoclonal antibody against CD20 protein (rituximab) successfully reversed a multi-drug resistant rejection in a liver transplant recipient. Following an uncomplicated postoperative course, the patient showed biopsy-confirmed acute rejection on postoperative day 28. Despite treatment with steroids, increased tacrolimus doses and anti-thymocyte globulin (ATG) the rejection could not be resolved. Repeated biopsies confirmed ongoing acute cellular rejection; however, a humoral component of rejection could not be fully excluded and rituximab treatment was initiated. Liver function showed a subsequent melioration accompanied by convalescence of the patient. No adverse side effects associated to rituximab administration were observed. Promising results with rituximab were reported for heart and kidney transplant recipients suffering from humoral rejection. To our knowledge this is the first report of a successful rescue therapy of a multi-drug-resistant liver allograft rejection with rituximab. The addition of rituximab might be a valuable option to overcome severe, multi-drug-resistant rejection, although humoral nature of rejection is not proven by histology.

Published
2010
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2. Improved technique of heterotopic auxiliary rat liver transplantation with portal vein arterialization

Author

Samir Tawadros, J. Hölzen, K. Schleimer, Dirk L. Stippel, K. Tobias E. Beckurts, and Arnulf H. Hölscher

Subjects
Male, medicine.medical_specialty, Transplantation, Heterotopic, Orthotopic liver transplantation, medicine.medical_treatment, Portal vein, Anastomosis, Liver transplantation, medicine, Animals, Portal Vein, business.industry, Anastomosis, Surgical, Liver Transplantation, Rats, Cardiac surgery, Surgery, Transplantation, Portal System, Regional Blood Flow, Rat liver, Models, Animal, Stents, Liver function, business, Vascular Surgical Procedures, Liver Circulation
Abstract

In acute, potentially reversible hepatic failure, auxiliary liver transplantation is a promising alternative approach. Using the auxiliary partial orthotopic liver transplantation (APOLT) method--the orthotopic implantation of auxiliary segments--most of the technical problems (lack of space for the additional liver mass, the portal vein reconstruction, and the venous outflow) are avoided, but extensive resections of the native liver and the graft are necessary. Erhard described the heterotopic auxiliary liver transplantation (HALT) with portal vein arterialization (PVA). Initial clinical results demonstrated that an adequate liver function can be achieved using this technique. We developed and improved a technique of HALT with flow-regulated PVA in the rat to perform further investigations. The aim of this paper is to explain in detail this improved experimental surgical technique.Liver transplantations were performed in 122 male Lewis rats: After a right nephrectomy, the liver graft, which was reduced to about 30% of the original size, was implanted into the right upper quadrant of the recipient's abdomen. The infrahepatic caval vein was anastomosed end-to-side. The donor's portal vein was completely arterialized to the recipient's right renal artery in stent technique. Using a stent with an internal diameter of 0.3 mm, the flow in the arterialized portal vein was regulated to achieve physiologic parameters. The celiac trunk of the graft was anastomosed to the recipient's aorta, end-to-side. The bile duct was implanted into the duodenum.After improvements of the surgical technique, we achieved a perioperative survival of 90% and a 6-week survival of 80% in the last 112 transplantations.We developed a standardized and improved technique, which can be used for experiments of regeneration and inter-liver competition in auxiliary liver transplantation. Furthermore, this technique is suitable for the investigation of the influence of portal vein arterialization and portal hyperperfusion on liver microcirculation, function, and morphology.

Published
2006
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3. Interventional Stenting for Ruptured Iliac Aneurysm Following Transplant Nephrectomy

Author

S. Kramer, R. Diller, J. Hölzen, and N. Senninger

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Nephrectomy, Postoperative Complications, Aneurysm, Cadaver, medicine, Humans, cardiovascular diseases, Iliac Aneurysm, Transplantation, Vascular disease, business.industry, Stent, medicine.disease, Kidney Transplantation, Tissue Donors, Surgery, surgical procedures, operative, medicine.anatomical_structure, Stents, Radiology, Complication, business, Artery
Abstract

Surgical removal of a failed kidney graft may lead to a variety of postoperative complications, development of an aneurysm being a relatively rare complication. We report the case of a 34-year-old man who developed an iliac aneurysm 13 years after transplant nephrectomy. Interventional stenting was performed upon the rupture of the aneurysm. Postintervention the function of the contralateral transplanted kidney was stable and the patient recovered. An endoleak was diagnosed after 1 week, which was also stented. No operative procedure was necessary. In conclusion, even in an emergency situation interventional stenting of a false iliac aneurysm after transplant nephrectomy may be a therapeutic option.

Published
2006
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4. Autorenverzeichnis

Author

W. Domschke, M. Berger, W. Hohenberger, T. Meinertz, C. Vogelmeier, T. Sauerbruch, H.J. Kramer, S.C. Müller, H. Serve, M.M. Weber, B. Göke, J.R. Kalden, B. Manger, W. Rascher, B. Appenrodt, J. Atta, C. Auernhammer, I.B. Autenrieth, W. Avenhaus, M. Backmund, C. Bausewein, J. Behr, A. Behrens, R. Berner, F. Berr, N. Blank, E. Blind, M. Bockhorn, D. Bokemeyer, M. Böhm, G. Bönner, G.D. Borasio, K. Bork, J. Braun, H.-P. Bruch, T.H. Brümmendorf, U. Brunnberg, M. Brüwer, M.W. Büchler, C. Detter, S. Diederich, C. Diehm, J. Distler, D. Domagk, T. Dörner, H.-G. Dörr, H. Dralle, M. Dreyling, I. Ehlebracht-König, C. Ell, W. Enzensberger, H.-J. Epple, M. Fassnacht, H. Feußner, P. Fiegel, C. Fisang, D. Filipas, W. Fischbach, C.H. Flamme, J. Floege, U.R. Fölsch, C. Fottner, W. Frank, N. Frey, K. Friese, A. Frilling, M. Fröhner, P. Frühmorgen, P.R. Galle, S. Geidel, E. Genth, A. Gingelmaier, F.-D. Goebel, N. Gökbuget, R. Göke, K. Grabitz, M. Grünke, S. Hahner, W. Handrick, C. Hasslacher, E. Heidbreder, W. Heindel, V. Heinemann, J. Heitmann, H.W. Heiß, H. Hof, L. Hering, E. Hiller, A. Hirner, W.-K. Hofmann, E. Holler, A.H. Hölscher, G. Holtmann, J. Hölzen, J. Honegger, S. Hörle, K. Hörmann, R. Hörmann, I. Hornke, R.M. Huber, J. Hübner, R. Hummel, S. Irmscher, T. Jelinek, S. Jonas, E. Jost, H.H. Jung, G.J. Kahaly, M. Karaus, S. Katsoulis, H. Katus, H.P. Kessler, K. Kiehne, W. Kiess, M. Kindermann, Y. von Kodolitsch, H. Köhler, L. Köhler, M. Köhler, E. Kohne, H.-J. Kolb, J. Köninger, K. Koop, R. Köster, I. Kötter, H.J.J. Kramer, B. Kremer, P. Kroll, J.G. Kuipers, F. Lammert, M. Langer, M. Laukötter, H. Lehnert, B. Lembcke, M.M. Lerch, S. Liebe, A. Lieber, R. Loddenkemper, M. Löhr, H.-M. Lorenz, J. Lorenz, T. Löscher, M. Luster, G. Lux, K. Mann, J. Mayerle, U. Merle, H.-J. Meyer, C. Möbius, M. Moehler, H. Mönnikes, J. Mössner, S.A. Müller, T.J. Musholt, J. Nattermann, M. Neubrand, P. Neuhaus, B. Neundörfer, T. Nicolai, J. Nolde, H. Olschewski, J. Ostermeyer, C. Ott, S. Pahernik, U. Pankratius, K.G. Parhofer, B. Passlick, O. Pech, B. Pfaffenbach, T. Pfeiffer, A. Pilatz, T. Pohle, A. Pohl-Koppe, Katharina A. Ponto, H. Prange, A. Pruß, J. Rädle, B. Rauch, F. Raue, C. Reichel, C. Reindl, C. Reißfelder, Dipl.-Phys. J. Rendl, E. Rietschel, E. Rijcken, R. Roos, G. Rudofsky†, W. Samtleben, W. Sandmann, G. Sauter, K.P. Schaal, J.R. Schaefer, U. Schäfer-Graf, W. Schepp, M. Schlemmer, S. Schliep, H. Schmidt, B. Schmied, W. Schmiegel, A. Schießl, A. Schmid, A. Schneider, T. Schneider, J. Schölmerich, H. Scholz, U. Schönermarck, J. Schopohl, H. Schrezenmeier, H. Schulze-Koops, D. Schuppan, V. Schuster, G. Schüßler, O. Schwandner, T.F. Schwarz, R. Secknus, N. Senninger, O. Sezer, B.R. Simmen, U. Spengler, U. Stabenow-Lohbauer, R. Stebler, D. Steven, M. Sticherling, U. Strauch, C. Stremmel, W. Stremmel, B.A. Stuck, H. Stürz, C. Taube, O. Thulesius, K. Thurau, J.W. Thüroff, C. Tomiak, W. Uhl, D. Vallböhmer, T. Vogel, P. von den Driesch, F.M.E. Wagenlehner, A. Wagner, U. Wagner, K. Weber, W. Weidner, T. Weinke, B.T. Weis-Müller, M. Weiß, S. Willems, U. Wintergerst, M. Wirth, G.W. Wolkersdörfer, and M. Zeitz

Published
2011
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5. Autorenverzeichnis

Author

V. Andresen, J. Angenendt, C. Anthoni, B. Appenrodt, M. Arbogast, G. Arco, J. Atta, M. Auer, C. Auernhammer, I.B. Autenrieth, W. Avenhaus, R. Bachem, M. Backmund, D. Bänsch, A. Ballauff, J. Baltzer, J. Barth, A. Batra, M.A. Bazarra-Castro, S. Beck, K. Becker, Karsten Becker, J. Behr, A. Behrens, O. Belyaev, Ch. Bender-Götze, J. Bengel, M. Benz, von Haunerschen, J. Berberich, M. Berger, R. Berner, F. Berr, null S.C., N. Blank, C. Bleh, Eberhard Blind, H.E. Blum, N. Bock, M. Bockhorn, J. Böhler, M. Böhm, D. Bokemeyer, G. Bönner, K. Bork, G. Born, Thomas Brandt, J. Braun, H.-P. Bruch, T.H. Brümmendorf, M. Brüwer, U. Brunnberg, M. Buchfelder, G. Buchkremer, M.W. Büchler, H.-D. Carl, S. Castell, C. Daniels, S. Daum, C. Detter, G. Deuschl, E. Dieckmann, S. Diederich, C. Diehm, T. Diemer, H.C. Diener, H. Diepolder, J. Distler, T. Dörner, null Prof. Dr., D. Domagk, W. Domschke, A. Dragu, H. Dralle, M. Dreyling, P. van, T. Dürk, D. Ebert, I. Ehlebracht-König, C.E. Elger, C. Ell, J. Ellinger, G. Emons, O. Engel, W. Enzensberger, H.-J. Epple, R. Erbel, M. Fassnacht, Hubertus Feußner, M. Fichter, P. Fiegel, D. Filipas, C. Fisang, M. Fisch, W. Fischbach, N. Fischer, M. Fischer, C.H. Flamme, K. Fleckenstein, J. Floege, G. Fluhr, U.R. Fölsch, M. Forsting, C. Fottner, W. Frank, N. Frey, H. Freyberger, K. Friese, A. Frilling, PD. Dr. habil, U. Frommberger, P. Frühmorgen, Johannes Fuss, R. Gätje, P.R. Galle, S. Geidel, H.-Ch. Geiß, Ekkehard Genth, J.M. Gilsbach, A. Gingelmaier, F.-D. Goebel, J. Göhl, N. Gökbuget, R. Gold, M.A. Gonzalez-Carmona, F. Gossé, K. Grabitz, M. Greetfeld, F.A. Gries, I. Grosch-Wörner, N. Grüner, M. Grünke, A. Grüters-Kieslich, V. Gülberg, T. Haak, R. Häfner, M. Härter, T. Hagenacker, S. Hahn, S. Hahner, G. Haidl, M. Hammer, F. Hammersen, W. Handrick, F. Hanisch, M.P. Hansen, Sara Hanke, J. Haschka, C. Hasslacher, Th. Hauer, A. Hauptmann, M. Heckmann, E. Heidbreder, U. Heim, W. Heindel, J. Heitmann, U. Hegenbart, W. Hermann, J.M. Herrmann, B. Herpertz-Dahlmann, B. Heßlinger, D. Heuß, P. Heußner, E. Hiller, A. Hirner, A.H. Hölscher, J. Hölzen, W.H. Hörl†, S. Hörle, H. Hof, W.-K. Hofmann, W. Hohenberger, U. Hohenfellner, E. Holler, G. Holtmann, J. Honegger, H.C. Hopf, R.E. Horch, I. Hornke, T. Hornung, R.M. Huber, A. Hueber, J. Hübner, R. Hummel, S. Irmscher, O.E. Janßen, T. Jelinek, K.A. Jendrissek, S. Jonas, E. Jost, H.H. Jung, G.J. Kahaly, J.R. Kalden, J. Kalff, T. Kapellen, M. Karaus, O. Kastrup, S. Katsoulis, H. Katus, C.P. Kaudel, R. Kaulitz, C. Keck, F. Keller, S. Kellnar, K. Kiehne, W. Kiess, M. Kindermann, A. Kirschbaum, M. Klein, A. Kleindienst, C. Kneitz, Y. von Kodolitsch, D. Köhler, H.P. Kessler, G. Köhler, H. Köhler, L. Köhler, M. Köhler, M. Köhnke, C. Königs, J. Köninger, D. Könsgen-Mustea, R. Köster, I. Kötter, E. Kohne, H.-J. Kolb, S. Koletzko, R. Kollmar, S. Konstantinidis, K. Koop, H.G. Kopp, T. Koschinsky, H.J. Kramer, J. Krauss, M.E. Kreis, B. Kremer, H.K. Kroemer, B. Kröner-Herwig, P. Kroll, A.K. Külz, H. Kuhl, J.G. Kuipers, M. Laaser, U. Lamla, F. Lammert, M. Langer, M. Laß, M. Laukötter, P. Layer, M. Leffler, H. Lehnert, M. Lehrke, B. Lembcke, M.M. Lerch, S. Liebe, A. Lieber, V. Limmroth, H. Lochs, R. Loddenkemper, J.-M. Löhr, T. Löscher, A. Loh, H.-M. Lorenz, J. Lorenz, N. Lügering, M. Luster, G. Lux, O. Luzar, A. Maercker, K. Magdorf, P. Mallmann, T. Marth, K. May, J. Mayerle, T. Meinertz, V. Melichar, U. Merle, H.J. Meyer, Th. Meyer, H. Meyer-Lehnert, A. Meyer-Marcotty, H. Michels, C. Möbius, G. Möddel, M. Möhler, H. Mönnikes, J. Mössner, M.G. Mohaupt, S.C. Müller, S.A. Müller, S. Müller-Lissner, J. Müller-Quernheim, A. Muntau, T.J. Musholt, W. Nacimiento, J. Nattermann, G. Nelles, M. Neubrand, C. Neuhäuser, P. Neuhaus, P.-A. Neumann, B. Neundörfer, T. Nicolai, W.-B. Niebling, T. Niehues, G. Nilius, J. Nolde, J. Noth, H. Olschewski, J. Ostermeyer, C. Ott, S. Pahernik, D. Palmes, U. Pankratius, K. Parhofer, R. Paschke, B. Passlick, O. Pech, F.W. Pelster, E.E. Petersen, E. Petri, B. Pfaffenbach, M. Pfeifer, T. Pfeiffer, H.W. Pfister, null Diplom-Gesundheitswirt, J. Pickel, A. Pilatz, M. Pirlich, E. Polykandriotis, B. Pontz, K. Possinger, A. Pohl-Koppe, T. Pohle, H. Prange, A. Prasse, A. Pruß, J. Rädle, K. Raile, W. Randerath, W. Rascher, B. Rauch, F. Raue, B. Raziorruh, J. Rech, A.C. Regierer, C. Reichel, C. Reindl, D. Reinhardt, C. Reißfelder, J. Rendl, M. Reuss-Borst, P. Rieckmann, C. Riedner, E. Rietschel, E. Rijcken, M. Rister, K. Rödder, S. Rogenhofer, F.C. Roos, R. Roos, D. Rosskopf, S. Rudnik-Schöneborn, G. Rudofsky†, M. Ruhnke, M. Ruß, C.F. Rust, F. Saborowski, M. Sailer, M. Sedigh Salakdeh, Walter Samtleben, W. Sandmann, T. Sauerbruch, K.P. Schaal, G. Schackert, U. Schäfer-Graf, M. Schäfers, A. Schalhorn, W. Schepp, J. Schetelig, M. Schifferdecker, J. Schipper, A. Schießl, U. Schlegel, S. Schliep, A. Schmid, P. Schmid, F. Schmidt, B. Schmied, W. Schmiegel, A. Schneider, T. Schneider, C. Schneider-Gold, H.-G. Schnürch, J. Schölmerich, U. Schönermarck, B. Schönhofer, S. Schönland, H. Scholz, J. Schopohl, G. Schott, J. Schrader, A. Schraml, H. Schrezenmeier, A. Schuchert, G. Schüßler, H. Schulze-Koops, D. Schuppan, V. Schuster, S. Schwab, O. Schwandner, C.H.M. Schwarz, T.F. Schwarz, K.W. Schweppe, R. Secknus, S.E. Segerer, N. Senninger, H. Serve, U. Seybold, O. Sezer, B. Siegmund, W. Siegmund, G. Siemon, B.R. Simmen, G. Simonetti, C. Sommer, U. Spengler, H. Sprott, U. Stabenow-Lohbauer, M. Stahl, G. Stalla, A. Stallmach, T. Stammschulte, R. Stebler, R. Stein, D. Steven, M. Sticherling, M. Stöhr, U. Strauch, A. Strauss, H.-G. Strauß, C. Stremmel, W. Stremmel, M. Strupp, E. Stüber, H. Stürz, U. Sure, B. Swoboda, C. Taube, K. Thiel, C. Thomssen, K. Thurau, J. Thöne, J. Thüroff, C. Tomiak, K.V. Toyka, H. Tröger, R.M. Trüeb, M. Tryba, W. Uhl, H. Ullerich, L. Unger, D. Vallböhmer, D. van Calker, T. Vloet, U. Voderholzer, Thomas M.K. Völkl, T. Vogel, P. Vogt, F.E.M. Wagenlehner, A. Wagner, U. Wagner, V. Wahn, C.W. Wallesch, F. Watzka, K. Weber, L. Weber, M.M. Weber, T. Wehrmann, W. Weidner, T. Weinke, M. Weiß, B.T. Weis-Müller, Michael Weller, F. Wenz, K. Werdan, M. Wettstein, M. Wick, I. Wiegratz, S. Willems, H. Wilke, U. Wintergerst, M. Wirth, G.W. Wolkersdörfer, C. Wüster, F. Zabel, H. Zeidler, M. Zeitz, K. Zerres, G. Ziemer, S. Zierz, T. Zimmermann, and J. Zwerina

Published
2007
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6. Impact of rapamycin on liver regeneration.

Author

Palmes D, Zibert A, Budny T, Bahde R, Minin E, Kebschull L, Hölzen J, Schmidt H, and Spiegel HU

Subjects
Actins metabolism, Animals, Apoptosis drug effects, Hepatectomy, Hepatocytes cytology, Hepatocytes drug effects, Hepatocytes metabolism, Liver cytology, Liver drug effects, Liver metabolism, Liver Regeneration physiology, Male, Models, Animal, Neovascularization, Physiologic drug effects, Rats, Rats, Inbred Lew, Vascular Endothelial Growth Factor A metabolism, Vascular Endothelial Growth Factor Receptor-1 metabolism, Cell Proliferation drug effects, Immunosuppressive Agents pharmacology, Liver Regeneration drug effects, Sirolimus pharmacology
Abstract

The remarkable capacity of the liver to regenerate after injury and the prospects of organ self-renewal have attracted much interest in the understanding and modulation of the underlying molecular events. We investigated the effect of mammalian target of rapamycin (mTOR) inhibitor rapamycin (RAPA) on liver by correlating intravital microscopy, immunohistochemistry, and reverse transcriptase polymerase chain reaction in a rat model of 2/3 hepatectomy. RAPA significantly retarded proliferation of hepatocytes, endothelial cells, and hepatic stellate cells (HSCs) mostly between days 2 and 4 after hepatectomy and downregulated major cytokines and growth factors (tumor necrosis factor alpha, hepatocyte growth factor, platelet-derived growth factor, platelet-derived growth factor receptor, insulin-like growth factor-1, transforming growth factor beta 1) important for liver regeneration. These effects were almost absent at later time points. RAPA also had a transient, but broad effect on angiogenesis, and impaired sinusoidal density as well as mRNA levels of vascular endothelial growth factor, vascular endothelial growth factor receptor 1, vascular endothelial growth factor receptor 2, and angiopoietin-1. Activation of HSC was also transiently suppressed as observed by smooth muscle protein 1 alpha protein expression and intercellular adhesion molecule-1 mRNA levels. The rate of apoptosis in liver was significantly increased by RAPA between day 3 and day 7. The effect of RAPA on liver repair, angiogenesis, and HSC activation is confined to the phase of active cell proliferation. This transient effect might allow further exploration of mTOR inhibitors in clinical situations that involve liver regeneration, and seems to have implications beyond immunosuppression.

Published
2008
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7. Organ-specific metastatic tumor cell adhesion and extravasation of colon carcinoma cells with different metastatic potential.

Author

Schlüter K, Gassmann P, Enns A, Korb T, Hemping-Bovenkerk A, Hölzen J, and Haier J

Subjects
Animals, Carcinoma blood, Carcinoma physiopathology, Cell Adhesion, Colonic Neoplasms blood, Colonic Neoplasms physiopathology, Liver Neoplasms blood, Liver Neoplasms physiopathology, Liver Neoplasms secondary, Lung Neoplasms blood, Lung Neoplasms physiopathology, Lung Neoplasms secondary, Neoplasm Invasiveness, Neoplasm Metastasis, Neoplasms, Experimental blood, Neoplasms, Experimental physiopathology, Organ Specificity, Rats, Rats, Nude, Rats, Sprague-Dawley, Carcinoma pathology, Colonic Neoplasms pathology, Liver Neoplasms pathology, Lung Neoplasms pathology, Neoplasms, Experimental pathology
Abstract

Adhesive and invasive characteristics appear to be crucial for organ-specific metastasis formation. Using intravital microscopy we investigated the relation between the metastatic potential of colon carcinoma cells and their adhesive and invasive behavior during early steps of metastasis within microvasculatures of rat liver, lung, intestine, skin, muscle, spleen, and kidney in vivo. Colon carcinoma cells with low (HT-29P), intermediate (KM-12C), and high (HT-29LMM, KM-12L4) metastatic potential were injected into nude or Sprague-Dawley rats. Initial interactions with host organ microvasculatures were semiquantitatively analyzed throughout 20 to 30 minutes. Circulating cells passed microvessels in all observed organs without size restriction. All cell lines showed high adhesion rates, independent from their metastatic potential, within liver and lung but very rarely in other organs. Diameters of involved microvessels were larger than diameters of adherent tumor cells. Cell extravasation of highly metastatic HT-29LMM and KM-12L4 cells into liver parenchyma was significantly higher compared to low metastatic cells (P<0.05). Our results indicate that colon carcinoma cells can arrest in target organs without size restriction. Cell adhesion of circulating tumor cells occurred in metastatic target organs only, likely attributable to specific interactions. Migration into target organs correlated with their metastatic potential.

Published
2006
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8. Improved technique of heterotopic auxiliary rat liver transplantation with portal vein arterialization.

Author

Schleimer K, Stippel DL, Tawadros S, Hölzen J, Hölscher AH, and Beckurts KT

Subjects
Anastomosis, Surgical, Animals, Liver Circulation, Male, Models, Animal, Portal System, Rats, Regional Blood Flow, Stents, Transplantation, Heterotopic, Vascular Surgical Procedures methods, Liver Transplantation methods, Portal Vein surgery
Abstract

Background and Aims: In acute, potentially reversible hepatic failure, auxiliary liver transplantation is a promising alternative approach. Using the auxiliary partial orthotopic liver transplantation (APOLT) method--the orthotopic implantation of auxiliary segments--most of the technical problems (lack of space for the additional liver mass, the portal vein reconstruction, and the venous outflow) are avoided, but extensive resections of the native liver and the graft are necessary. Erhard described the heterotopic auxiliary liver transplantation (HALT) with portal vein arterialization (PVA). Initial clinical results demonstrated that an adequate liver function can be achieved using this technique. We developed and improved a technique of HALT with flow-regulated PVA in the rat to perform further investigations. The aim of this paper is to explain in detail this improved experimental surgical technique., Materials and Methods: Liver transplantations were performed in 122 male Lewis rats: After a right nephrectomy, the liver graft, which was reduced to about 30% of the original size, was implanted into the right upper quadrant of the recipient's abdomen. The infrahepatic caval vein was anastomosed end-to-side. The donor's portal vein was completely arterialized to the recipient's right renal artery in stent technique. Using a stent with an internal diameter of 0.3 mm, the flow in the arterialized portal vein was regulated to achieve physiologic parameters. The celiac trunk of the graft was anastomosed to the recipient's aorta, end-to-side. The bile duct was implanted into the duodenum., Results: After improvements of the surgical technique, we achieved a perioperative survival of 90% and a 6-week survival of 80% in the last 112 transplantations., Conclusion: We developed a standardized and improved technique, which can be used for experiments of regeneration and inter-liver competition in auxiliary liver transplantation. Furthermore, this technique is suitable for the investigation of the influence of portal vein arterialization and portal hyperperfusion on liver microcirculation, function, and morphology.

Published
2006
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9. Interventional stenting for ruptured iliac aneurysm following transplant nephrectomy.

Author

Diller R, Hölzen J, Senninger N, and Kramer S

Subjects
Adult, Cadaver, Humans, Male, Tissue Donors, Iliac Aneurysm surgery, Kidney Transplantation pathology, Nephrectomy adverse effects, Postoperative Complications surgery, Stents
Abstract

Surgical removal of a failed kidney graft may lead to a variety of postoperative complications, development of an aneurysm being a relatively rare complication. We report the case of a 34-year-old man who developed an iliac aneurysm 13 years after transplant nephrectomy. Interventional stenting was performed upon the rupture of the aneurysm. Postintervention the function of the contralateral transplanted kidney was stable and the patient recovered. An endoleak was diagnosed after 1 week, which was also stented. No operative procedure was necessary. In conclusion, even in an emergency situation interventional stenting of a false iliac aneurysm after transplant nephrectomy may be a therapeutic option.

Published
2006
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