Browsing by Author "Neuhaus, Peter"

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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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    Late Fulminant Posterior Reversible Encephalopathy Syndrome After Liver Transplant
    (Başkent Üniversitesi, 2009-09) Heidenhain, Christoph; Neuhaus, Peter; Puhl, Gero
    Objectives: Posterior leukoencephalopathy due to calcineurin-inhibitor–related neurotoxicity is a rare but severe complication that results from treament with immunosuppressive agents (primarily those administered after a liver or kidney transplant). The pathophysiologic mechanisms of that disorder remain unknown. Case: We report the case of a 46-year-old woman who received a liver transplant in our center as treatment for alcoholic cirrhosis and in whom either a fulminant course of posterior leuko¬encepha¬lo¬¬pathy or posterior reversible encephalopathy syndrome developed 110 days after transplant. After an initially uneventful course after the transplant, the patient rapidly fell into deep coma. Results: Cerebral MRI scan showed typical signs of enhancement in the pontine and posterior regions. Switching the immunosuppressive regimen from tacrolimus to cyclosporine did not improve the clinical situation. The termination of treatment with any calcineurin inhibitor resulted in a complete resolution of that complication. Conclusions: Posterior reversible encephalopathy syndrome after liver transplant is rare. We recommend a complete cessation of any calcineurin inhibitor rather than a dose reduction.