B. Sattler

Systemic mycoses during prophylactical use of liposomal amphotericin B (Ambisome®) after liver transplantation

We investigated the prophylactical administration of liposomal amphotericin B (Ambisome®) in the early phase after liver transplantation (LTx). Fifty‐eight patients received Ambisome® prophylactically after LTx. Ambisome® (1 mg kg−1 day−1) was given intravenously for 7 days after LTx. Immunosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. Forty‐seven patients had a tacrolimus‐based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150–250 ng ml−1 (EMIT) and 5–15 ng ml−1 (MEIA II) respectively. Three patients died from sepsis due to Aspergillus fumigatus infection. Reasons for a fatal outcome were foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post‐operative day (pod) 8; Aspergillus sepsis with severe endocardidtis in a patient with two retransplantations for graft non‐/dysfunction on pod 24; and disseminated aspergillosis due to Aspergillus fumigatus in a patient retransplanted for primary non‐function (pod 19). All three patients underwent haemofiltration for renal failure. One patient with Candida albicans sepsis (pod 4) recovered under increased dosage of Ambisome® (3 mg kg−1 per day). Ambisome® (1 mg kg−1 per day) seems to be beneficial against systemic Candida infections. However, the onset of systemic Aspergillus infections could not be prevented. Obviously, higher Ambisome® doses appear to be necessary against Aspergillus. We recommend the use of Ambisome® (3 mg kg−1 per day) for patients with risk factors such as graft dys‐/non‐function, retransplantation, haemofiltration and complicated acute liver failure to prevent invasive aspergillosis.

Technik, Risiko und Ergebnisse der zusätzlichen Pfortaderresektion bei der chirurgischen Therapie des proximalen Gallengangscarcinoms

Die Pfortaderinfiltration stellt keine absolute Kontraindikation fur die Resektionsbehandlung von proximalen Gallengangstumoren dar. Pfortaderresektionen und -rekonstruktionen konnen ohne zusatzliches perioperatives Risiko nach Hilusre-sektion mit anatomischer Leberresektion durchgefuhrt werden. Die aus dem Leberresek-tat isolierte Vena hepatica ist ein geeigneter Gefasersatz fur die Pfortaderrekonstruktion. Patienten mit zusatzlicher Pfortaderresektion wegen Gefasinfiltration profitieren in unserem Patientenkollektiv, da hierdurch eine Resektionsbehandlung moglich wird und sich das mediane Uberleben gegenuber den Patienten gleicher Tumorstadien ohne Gefasresektion angleicht.