Browsing by Author "Bahra, Marcus"

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    Donor Influence on Outcome in Patients Undergoing Liver Transplant for Primary Biliary Cirrhosis
    (Başkent Üniversitesi, 2010-06) Jacob, Dietmar A.; Bahra, Marcus; Neuhaus, Peter; Neumann, Ulf P.; Pratschke, Johann; Klein, Fritz; Haase, Elena
    Objectives: Risk factors for survival after liver transplant owing to primary biliary cirrhosis have been extensively investigated, whereas the donor-specific influence and particularly, the histologic data, has not been sufficiently analyzed. Patients and Methods: Donor data of 121 patients who underwent liver transplant for primary biliary cirrhosis and histologic findings of 69 donor liver grafts were assessed according to preoperative status and histologic criteria. Findings were correlated with the histologic and clinical course up to 20 years after orthotopic liver transplant. Results: Risk factors for death were a longer stay in intensive care units (> 7 days) (P < .02), a hypotensive period > 60 minutes (P < .03), and the administration of red blood cells (P < .04). Grafts from donors with liver fibrosis (P < .03), fatty degeneration (P < .04), and liver cell hydrops (P < .04) resulted in a significantly higher risk of primary biliary cirrhosis recurrence. Log rank analysis revealed a significant decreased survival for patients if donors had a prolonged hypotensive period (P < .02) and administration of epinephrine (P < .03) and red blood cells (P < .05). Conclusions: Our results show that donor histology can affect disease recurrence, especially the grade of inflammation, fibrosis, and fatty degeneration. In addition, prolonged intensive care hospitalization for donors should be avoided.
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    Treatment of Hepatitis C-Virus–Reinfection After Liver Transplant with Silibinin in Nonresponders to Pegylated Interferon-based Therapy
    (Başkent Üniversitesi, 2011-02) Eurich, Dennis; Neumann, Ulf; Neuhaus, Peter; Neuhaus, Ruth; Biermer, Michael; Boas-Knoop, Sabine; Berg, Thomas; Bahra, Marcus
    Objectives: Hepatitis C-virus–persistence after orthotopic liver transplant leads to reduced patient and graft survival compared to other indications. Current interferon-based antiviral therapy of hepatitis C-virus–infection posttransplant provides a sustained response rate of 30% to 40%. This study, performed in an hepatitis C-virus-reinfected liver transplant population, examines the antiviral effect of intravenously administered silibinin, recently reported to exhibit strong antiviral properties in the natural setting of hepatitis C-virus–related liver disease. Patients and Methods: Four patients after orthotopic liver transplant with hepatitis C-virus–recurrence, previously having not responded to peg-interferon-ribavirin therapy, were treated with intravenous silibinin and additionally, after the 10th day, with standard interferon-based therapy. Aminotransferases and hepatitis C-virus–RNA were measured during treatment. Results: All patients demonstrated normalization of liver enzymes and significant decline of hepatitis Cvirus–RNA measured at day 10 (mean 2.8 logarithmic levels: 1.7, 2.3, 2.9, and 4.3) during silibinin monotherapy. One patient cleared hepatitis C-virus–RNA under silibinin monotherapy and another patient eliminated hepatitis C virus under subsequent interferon-based therapy. No adverse effects were observed during silibinin application. Conclusions: Intravenous silibinin is an effective therapeutic approach for treating hepatitis C-virus–reinfection after liver transplant and should be evaluated further.