Eb Haagsma

COMPOSITION OF BILE AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

In 20 adult patients undergoing orthotopic liver transplantation (OLT), we studied longitudinally for the first 3 weeks after OLT the composition of bile with regard to differences between surviving and non-surviving patients and between patients with more or less rejection and the relation between bile and serum concentrations. The analyzed biliary components were bilirubin, cholesterol, bile acids, phospholipids, copper, iron, glucose, urea, creatinine, ammonia, protein, sodium, potassium, chloride, pH, bicarbonate, calcium and phosphate. After the 1st day the composition of bile was often different from reference values. In most patients deviations of the hepatic excretion function were found. Especially, a sharp fall was noticed in the biliary concentrations of cholesterol and copper. The composition of bile was not helpful in predicting the histologic degree of rejection or the ultimate outcome of the patients. Changes in bile glucose, electrolyte, urea, and creatinine concentrations were positively related to serum concentrations. We conclude that for the compounds analyzed the composition of bile after OLT is not only influenced by the state of the liver but also by the overall metabolic state of the patient.

Anti-neutrophil cytoplasmic antibodies (ANCA) in autoimmune liver disease.

ANCA were detected in 67% of sera from patients with primary sclerosing cholangitis (n = 15), in 83% of sera from patients with autoimmune chronic active hepatitis (n = 18) and in 35% of sera from patients with primary biliary cirrhosis (n = 20). ANCA were not detected in non-autoimmune chronic liver diseases. Characterization studies of the antigens involved showed that ANCA in autoimmune liver disease are not directed against myeloperoxidase (mpo), proteinase 3 (pr3) or elastase (hle), but the ANCA in autoimmune liver disease show reactivity with lactoferrin, a 67/66 kD protein combination or a 63/54 kD protein combination on Western Blots.

ORTHOTOPIC LIVER-TRANSPLANTATION - 9 YEARS EXPERIENCE IN GRONINGEN, THE NETHERLANDS

In The Netherlands a liver transplantation programme was started in 1979. Since then, 81 orthotopic liver transplantations (OLT) have been performed in 72 patients— 61 adults and 11 children. Nine patients underwent retransplantation. A survey is given of the general work-up, the procedure leading to OLT, the indications, and the results. Additionally, the postoperative management is described.