Karin Jandt

Impact of stable PGI2 analog iloprost on early graft viability after liver transplantation: a pilot study

Bärthel E, Rauchfuß F, Hoyer H, Habrecht O, Jandt K, Götz M, Voigt R, Heise M, Marx G, Settmacher U. Impact of stable PGI2 analog iloprost on early graft viability after liver transplantation: a pilot study. 
Clin Transplant 2012: 26: E38–E47. 
© 2011 John Wiley & Sons A/S.

The PRAISE study: a prospective, multi-center, randomized, double blinded, placebo-controlled study for the evaluation of iloprost in the early postoperative period after liver transplantation (ISRCTN12622749).

BackgroundLiver graft dysfunction can deteriorate to complete organ failure and increases perioperative morbidity and mortality after liver transplantation. Therapeutic strategies reducing the rate of graft dysfunction are of current clinical relevance. One approach is the systemic application of prostaglandins, which were demonstrated to be beneficial in reducing ischemia-reperfusion injury. Preliminary data indicate a positive effect of prostacyclin analogue iloprost on allograft viability after liver transplantation. The objective of the study is to evaluate the impact of iloprost in a multi-center trial.Methods/DesignA prospective, double-blinded, randomized, placebo-controlled multicenter study in a total of 365 liver transplant recipients was designed to assess the effect of intravenous iloprost after liver transplantation. Primary endpoint will be the primary graft dysfunction characterized as presentation of one or more of the following criteria: ALAT or ASAT level > 2000 IU/ml within the first 7 postoperative days, bilirubine ≥ 10 mg/dl on postoperative day 7; INR ≥ 1.6 on postoperative day 7 or initial non-function. Secondary endpoints are parameters of post-transplant morbidity, like rates of infections, biliary complications, need of clotting factors or renal replacement therapy and the graft and patient survival.DiscussionA well-established treatment concept to avoid graft dysfunction after liver transplantation does not exist at the moment. If the data of this research project confirm prior findings, iloprost would improve the general outcome after liver transplantation.Trial RegistrationGerman Clinical Trials Register: DRKS00003514. Current Controlled Trials Register: ISRCTN12622749.

Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter

PurposeWe investigated possible instances where the standard bilateral neck exploration for parathyroid adenoma may be omitted in primary hyperparathyroidism (pHPT) if preoperative diagnostics for the location have been performed.MethodsTen patients underwent surgical treatment for pHPT and multinodular goiter between October 2006 and October 2008. Identification of the parathyroid adenomas’ location with cervical ultrasound and 99mtechnetium-sestamibi nuclear scanning (99mTc-MIBI) was not possible in any of these patients. An extirpation of the parathyroid adenomas was performed with intraoperative use of the 99mTc-MIBI-guided probe technique. The median follow-up time was 17.5 months (range 2–30).ResultsTen patients underwent an elective operation for solitary (n = 9) or dual (n = 1) parathyroid adenomas and concomitant thyroid disease. Definitive proof of the parathyroid adenomas was achieved in all of the patients without further neck exploration. The adenomas were 1.3 cm (range 1–2) in diameter. Calcium and parathyroid hormonal levels were reduced on the first postoperative day (P = 0.003). There were no postoperative complications. All patients were free from recurrence.ConclusionThe intraoperative probe technique is feasible in patients with pHPT and limited diagnostics for the location of parathyroid adenomas with concomitant goiter. This diagnostic technique identified the parathyroid adenoma in all cases, and thus rendered a bilateral neck exploration obsolete.

Relationship between Degree of Chromosomal Aberration and Survival in Intestinal-Type Gastric Cancer - a Preliminary Report Based on Three Cases of Hepatic Metastasized Gastric Cancer with Long-Time Survival

Background: Gastric cancer is one of the most frequent malignancies worldwide. More than 50% of all patients present with advanced stage of disease, with long-time survival of less than 5%. In selected subgroups, palliative gastric resection seems to be beneficial for survival and improved quality of the remaining life time, but is still controversially discussed. Patients and Methods: We report 3 cases of patients with intestinal-type advanced gastric cancer. All patients presented preoperatively with stage IV disease with liver metastases. The patients underwent palliative gastric resection and subsequent palliative chemotherapy. We performed a genome-wide DNA analysis of 9 gastric cancer tissue specimens using the DNA microchip array technique. Results: 4 and 6 years after palliative surgery and chemotherapy, 2 of the patients show no signs of recurrence, while the third patient shows stable disease under third-line chemotherapy 4 years after the initial diagnosis. Comparative genetic analysis of 9 gastric cancer tissue specimens suggested that the degree of chromosomal aberration was closely related to survival for intestinal-type gastric cancers. Conclusions: Palliative gastric resection is beneficial for survival and quality of life in selected patients. Determination of the degree of chromosomal aberrations might be helpful in predicting the response on multimodal treatment in intestinal-type gastric cancer. A better understanding of molecular biology is needed to define prognosis markers and molecular targets.

IgG4-related systemic disease – a rare indication for multi-visceral transplantation

Multivisceral transplantations (MVT) are rarely performed procedures. In this case report, we present a 37‐year‐old male patient with a large retroperitoneal tumor. After exclusion of malignancy, we performed MVT (distal stomach, liver, pancreas, and small bowel). After a follow‐up of 1 year, the patient is in good clinical condition. Histologic examination revealed a chronic sclerosing IgG4‐associated disease. Our case shows that MVT can be successfully performed in this rare disease.

Future Perspectives in the Treatment of Incurable Gastric Cancer

Gastric cancer is the second most frequent malignancy in the Western world [1]. The prognosis remains poor despite of advances in diagnostic techniques and therapeutic management: approximately 800.000 new cases und 620.000 cancer related deaths are reported worldwide per year [2]. More than 50% of gastric cancer patients and approximately 40% of esophageal cancer patients either die from a primary unresectable tumor or from tumor recurrence after radical treatment within five years [3]. The main reasons for this are the late onset of predominantly unspecific symptoms and the aggressive biological behavior [4]. Palliative chemotherapy, best supportive care and the interdisciplinary management of severe tumor-related complications (tumor bleeding, tumor perforation, complete obstruction, treatment-refractory pain) are well accepted treatment options whereas non-curative resections of the primary tumor as well as resection of secondary tumor lesions are controversially discussed [5]. However, there is growing evidence that non-curative tumor resections can prolong the remaining life time with acceptable perioperative morbidity [6-8]. Furthermore, the quality of life can be improved by reducing the incidence of severe tumor-related complications [9].