Max Götz

Albumin Dialysis in Liver Failure: Comparison of Molecular Adsorbent Recirculating System and Single Pass Albumin Dialysis—A Retrospective Analysis

Despite improvement in critical care, liver failure is still associated with high mortality. Therapeutic concepts are aimed at restoring endogenous liver function or to bridge the time to liver transplantation. In addition to standard medical treatment, extracorporeal liver support with albumin dialysis is used for this purpose. The aim of this study was to analyze the efficacy of single pass albumin dialysis (SPAD) in comparison to the molecular adsorbent recirculating system (MARS) in patients treated at our university hospital intensive care unit between July 2004 and August 2008. In this retrospective analysis we studied patients presenting with liver failure who were treated with albumin dialysis. Laboratory parameters, daily health scoring, the number of transfusions, and mortality were recorded. The (paired) t‐test, Mann–Whitney U‐test, and Wilcoxon test were used for statistical analysis. In all, 163 albumin dialysis treatments, 126 with MARS and 37 with SPAD, in 57 patients were performed. MARS resulted in a significant decrease in bilirubin (−38 ± 66.5 µmol/L from a baseline of 301 ± 154.6 µmol/L), γ‐glutamyltransferase (γ‐GT), alanine aminotransferase, creatinine, and urea. SPAD resulted in a significant decrease in bilirubin (−41 ± 111.2 µmol/L from a baseline of 354 ± 189.4 µmol/L) and γ‐GT, while lactate levels increased. No differences in the need for blood transfusion, health scoring, or mortality between the two treatment modalities were detected. This retrospective analysis suggests equal efficacy of MARS and SPAD; however, prospective assessment to further define the role of SPAD in the treatment of acute or acute‐on‐chronic liver failure is needed.

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.

Living donor liver transplantation in adults in the MELD era in Germany – a multi‐center retrospective analysis

The aim of this analysis was to provide an update on the current trend in living donor liver transplantation (LDLT) for adult recipients in the model of end stage liver disease (MELD) era in Germany and to encourage a wider implementation of LDLT. We descriptively analysed the data of LDLTs in Germany from 15 December 2006 to 31 December 2009 using a multi‐center retrospective analysis via a questionnaire and data provided by Eurotransplant. Ten German centers performed LDLTs in adults. Eighty four transplantations in 50 male recipients and 34 female recipients were performed during the review period, ranging from 1 to 16 LDLTs per center. Hepatocellular carcinoma in cirrhosis (15/84) was the most common transplantation indication. The recipient mean lab‐MELD score was 15 (±8). Six re‐transplantations were necessary after initial LDLTs. The 1‐year patient survival was 81%. We obtained data of 79/84 donors. The incidence of complications was 30.4% (n = 24). There were no grade 5 complications according to the Clavien classification. LDLT is an established treatment option that may reduce the waiting time, provides high quality split liver grafts and should be advocated in the MELD era to reduce organ shortage and ‘death on the waiting list’.

Damage control concept in liver trauma. Package strategies and secondary measures

ZusammenfassungLeberverletzungen können sowohl isoliert oder im Rahmen von Polytraumata auftreten. Indikationen zur umgehenden chirurgischen Versorgung sind kreislaufinstabile Patienten mit dem Nachweis von freier intraabdomineller Flüssigkeit in der Bildgebung. Für diese Patienten wurde ein „Damage-control-Konzept“ zur Senkung der Frühmortalität nach Trauma entwickelt. Dabei unterbleiben aufwendige rekonstruktive Eingriffe in der Initialphase. Kernpunkt dieses Therapieverfahrens ist die Stabilisierung des Patienten durch Therapie der „tödlichen Trias“ bestehend aus Hypothermie, Koagulopathie und metabolischer Azidose. Gegebenfalls notwendige Rekonstruktionen oder andere größere Operationen erfolgen nach Stabilisierung des Patienten im Intervall. Das „packing“ zur temporären Versorgung von Leberverletzungen ist Bestandteil des Damage-control-Konzepts.AbstractLiver injuries may occur alone as well as within the broader context of polytrauma. Immediate surgical intervention is indicated in hemodynamically instable patients with detection of free intra-abdominal fluid as demonstrated by imaging studies. For these patients, a damage control concept has been devised in order to decrease early mortality after trauma. With this strategy complex reconstructive interventions are avoided during the initial phase. Stabilization of the patient by treatment of the lethal triad consisting of hypothermia, coagulopathy and metabolic acidosis is at the core of this therapeutic concept. Should there be a need for reconstructions or other major surgical interventions these will be performed with delay after stabilization of the patient. Packing for the temporary treatment of liver injuries is part of the damage control concept.Liver injuries may occur alone as well as within the broader context of polytrauma. Immediate surgical intervention is indicated in hemodynamically instable patients with detection of free intra-abdominal fluid as demonstrated by imaging studies. For these patients, a damage control concept has been devised in order to decrease early mortality after trauma. With this strategy complex reconstructive interventions are avoided during the initial phase. Stabilization of the patient by treatment of the lethal triad consisting of hypothermia, coagulopathy and metabolic acidosis is at the core of this therapeutic concept. Should there be a need for reconstructions or other major surgical interventions these will be performed with delay after stabilization of the patient. Packing for the temporary treatment of liver injuries is part of the damage control concept.

Hepatozelluläres Karzinom und Cholangiokarzinom

ZusammenfassungDas hepatozelluläre Karzinom und das Cholangiokarzinom sind relativ seltene Tumoren des Gastrointestinaltrakts, sie treten allerdings in Westeuropa in den letzten Jahren mit steigender Inzidenz auf. Neu diagnostizierte intrahepatische Herdbefunde oder eine intrahepatische Cholestase bedürfen einer ausgiebigen laborchemischen und bildgebenden Diagnostik, um die Diagnose eines hepatozellulären Karzinoms oder eines intra- bzw. extrahepatischen Cholangiokarzinoms zu sichern. Das therapeutische Spektrum reicht von der kurativen Behandlungsintention durch Leberteilresektion oder Lebertransplantation bis zu supportiven Maßnahmen im Fall der Nichtresektabilität. Die vorliegende Übersichtsarbeit soll einen Überblick über die diagnostischen Möglichkeiten und die sich daraus ableitenden Therapien geben.AbstractHepatocellular carcinoma and cholangiocarcinoma are relatively rare tumors of the gastrointestinal tract in western Europe but their incidence has been increased in recent years. Newly diagnosed intrahepatic lesions or intrahepatic cholestasis require extensive laboratory tests and imaging studies in order to confirm the diagnosis of hepatocellular carcinoma, intrahepatic or extrahepatic cholangiocarcinoma. The treatment options range from liver resection or liver transplantation to conservative measures (in cases of non-resectable lesions). This review article aims to provide an overview on the diagnostic options and the subsequent treatment.

Hepatocellular carcinoma and cholangiocarcinoma

ZusammenfassungDas hepatozelluläre Karzinom und das Cholangiokarzinom sind relativ seltene Tumoren des Gastrointestinaltrakts, sie treten allerdings in Westeuropa in den letzten Jahren mit steigender Inzidenz auf. Neu diagnostizierte intrahepatische Herdbefunde oder eine intrahepatische Cholestase bedürfen einer ausgiebigen laborchemischen und bildgebenden Diagnostik, um die Diagnose eines hepatozellulären Karzinoms oder eines intra- bzw. extrahepatischen Cholangiokarzinoms zu sichern. Das therapeutische Spektrum reicht von der kurativen Behandlungsintention durch Leberteilresektion oder Lebertransplantation bis zu supportiven Maßnahmen im Fall der Nichtresektabilität. Die vorliegende Übersichtsarbeit soll einen Überblick über die diagnostischen Möglichkeiten und die sich daraus ableitenden Therapien geben.AbstractHepatocellular carcinoma and cholangiocarcinoma are relatively rare tumors of the gastrointestinal tract in western Europe but their incidence has been increased in recent years. Newly diagnosed intrahepatic lesions or intrahepatic cholestasis require extensive laboratory tests and imaging studies in order to confirm the diagnosis of hepatocellular carcinoma, intrahepatic or extrahepatic cholangiocarcinoma. The treatment options range from liver resection or liver transplantation to conservative measures (in cases of non-resectable lesions). This review article aims to provide an overview on the diagnostic options and the subsequent treatment.

Hepatozelluläres Karzinom und Cholangiokarzinom@@@Hepatocellular carcinoma and cholangiocarcinoma

ZusammenfassungDas hepatozelluläre Karzinom und das Cholangiokarzinom sind relativ seltene Tumoren des Gastrointestinaltrakts, sie treten allerdings in Westeuropa in den letzten Jahren mit steigender Inzidenz auf. Neu diagnostizierte intrahepatische Herdbefunde oder eine intrahepatische Cholestase bedürfen einer ausgiebigen laborchemischen und bildgebenden Diagnostik, um die Diagnose eines hepatozellulären Karzinoms oder eines intra- bzw. extrahepatischen Cholangiokarzinoms zu sichern. Das therapeutische Spektrum reicht von der kurativen Behandlungsintention durch Leberteilresektion oder Lebertransplantation bis zu supportiven Maßnahmen im Fall der Nichtresektabilität. Die vorliegende Übersichtsarbeit soll einen Überblick über die diagnostischen Möglichkeiten und die sich daraus ableitenden Therapien geben.AbstractHepatocellular carcinoma and cholangiocarcinoma are relatively rare tumors of the gastrointestinal tract in western Europe but their incidence has been increased in recent years. Newly diagnosed intrahepatic lesions or intrahepatic cholestasis require extensive laboratory tests and imaging studies in order to confirm the diagnosis of hepatocellular carcinoma, intrahepatic or extrahepatic cholangiocarcinoma. The treatment options range from liver resection or liver transplantation to conservative measures (in cases of non-resectable lesions). This review article aims to provide an overview on the diagnostic options and the subsequent treatment.

Damage-control-Konzept bei Leberverletzungen@@@Damage control concept in liver trauma: Package-Strategien und sekundäre Maßnahmen@@@Package strategies and secondary measures

ZusammenfassungLeberverletzungen können sowohl isoliert oder im Rahmen von Polytraumata auftreten. Indikationen zur umgehenden chirurgischen Versorgung sind kreislaufinstabile Patienten mit dem Nachweis von freier intraabdomineller Flüssigkeit in der Bildgebung. Für diese Patienten wurde ein „Damage-control-Konzept“ zur Senkung der Frühmortalität nach Trauma entwickelt. Dabei unterbleiben aufwendige rekonstruktive Eingriffe in der Initialphase. Kernpunkt dieses Therapieverfahrens ist die Stabilisierung des Patienten durch Therapie der „tödlichen Trias“ bestehend aus Hypothermie, Koagulopathie und metabolischer Azidose. Gegebenfalls notwendige Rekonstruktionen oder andere größere Operationen erfolgen nach Stabilisierung des Patienten im Intervall. Das „packing“ zur temporären Versorgung von Leberverletzungen ist Bestandteil des Damage-control-Konzepts.AbstractLiver injuries may occur alone as well as within the broader context of polytrauma. Immediate surgical intervention is indicated in hemodynamically instable patients with detection of free intra-abdominal fluid as demonstrated by imaging studies. For these patients, a damage control concept has been devised in order to decrease early mortality after trauma. With this strategy complex reconstructive interventions are avoided during the initial phase. Stabilization of the patient by treatment of the lethal triad consisting of hypothermia, coagulopathy and metabolic acidosis is at the core of this therapeutic concept. Should there be a need for reconstructions or other major surgical interventions these will be performed with delay after stabilization of the patient. Packing for the temporary treatment of liver injuries is part of the damage control concept.Liver injuries may occur alone as well as within the broader context of polytrauma. Immediate surgical intervention is indicated in hemodynamically instable patients with detection of free intra-abdominal fluid as demonstrated by imaging studies. For these patients, a damage control concept has been devised in order to decrease early mortality after trauma. With this strategy complex reconstructive interventions are avoided during the initial phase. Stabilization of the patient by treatment of the lethal triad consisting of hypothermia, coagulopathy and metabolic acidosis is at the core of this therapeutic concept. Should there be a need for reconstructions or other major surgical interventions these will be performed with delay after stabilization of the patient. Packing for the temporary treatment of liver injuries is part of the damage control concept.