S IRS, We read with great interest the review article by Stedman and Barclay1 on the comparison of proton pump inhibitors. We want to add some novel findings to complete Table 3 showing interactions between proton pump inhibitors with other drugs via CYP 450 metabolism. The immunosuppressive drugs cyclosporine and tacrolimus are metabolized by the cytochrome P450 3A4 (CYP3A4) enzyme in the liver.2, 3 Recently we demonstrated in transplant patients that pantoprazole (40 mg orally once daily) does not affect cyclosporine blood levels when dosed in the evening. 4 Furthermore, no effects of pantoprazole on cyclosporine or tacrolimus blood concentrations were observed when the proton pump inhibitor was administered together with cyclosporine or tacrolimus in the morning. 5 These findings indicate that pantoprazole is a safe drug in combination with immunosuppressants such as cyclosporine and tacrolimus.
Introduction: Liver transplantation is the standard treatment for endstage liver cirrhosis as well as for certain primary and secondary tumours. However, the reperfusion technique of the liver graft after transplantation has not been standardized. It is still unclear from the literature which method of revascularization is the best in terms of the development of complications and quality of liver graft function. Aim: To compare the experience of different European transplantation centres concerning the sequence of reperfusion of the liver graft at transplantation. Methods: An online survey was sent to 37 European transplantation centres in order to collect information about the centre-specific technique of liver reperfusion and the reason for the adopted technique. Results: By the end of January 2012, 28 European transplantation centres (75,7%) had responded to our survey, which was sent per e-mail in November 2011. 26 of the 28 responses could be included in this study. 10 centres from 26 (38,5%) perform simultaneous reperfusion; 16 centres (61,5%) perform sequential reperfusion, 13 (81,25%) of which are anterograde and 3 (18,75%) retrograde. 12 of the 13 (92,3%) centres performing the sequential anterograde reperfusion first revascularize the portal vein, one centre (7,7%) first revascularizes first the hepatic artery. One (8,3%) of the centres performing the sequential anterograde reperfusion first using the portal vein does not use this technique on children; in this case simultaneous reperfusion is performed. In 20 of the 26 (77%) centres, the technique and order of reperfusion is standardized. In 19 (95%) of these centres, this standard is based on personal/institutional experience; only in 1 (5%) centre the technique used is based on available literature. In 6 (23%) centres, the technique is not standardized and is left at the discretion of the surgeon performing the procedure. Most of the 26 (73%) centres agree on the need for randomized controlled trials (RCT) in this field and would participate in a multicenter RCT. Conclusion: The most frequently used reperfusion technique (46,1%) in European transplantation centres is the anterograde sequential reperfusion via the portal vein first. In 20 of the 26 centres (77 %), the procedure used is standard. Only 1 (3,8%) centre based the decision of how to reperfuse on available literature. These results confirm a lack of evidence-based data and therefore a lack of consensus on the optimal reperfusion techniques. Almost all European transplantation centres base their decision on personal/institutional experience. These results demonstrate the need for RCTs, which most of the centres would support.
14507 Background: As shown recently (JCO 2005; 23:6763–70), a single application of RAIT improved both, median overall survival (OS), and 5-year survival rates of colorectal cancer (CRC) patients (pts) post salvage resection of liver metastases (LM) compared to controls without RAIT (P=0.004). In an ongoing phase II trial we are evaluating the safety and efficacy of repeated RAIT at doses of 2x 40–50 mCi/m 2 (3 mos apart) post salvage resection of LM. Methods: To date, 26 pts (8x f, 18x m; age: 63 ± 9 ys) who underwent surgery for CRC-LM have received the first dose of 131I-labetuzumab (Immunomedics, In., NJ, USA), a humanized monoclonal antibody against CEA, within 2 months of LM surgery. Three months after the first RAIT, a second infusion of 40–50 mCi/m 2 has been applied to all pts after completion of standardized re-staging procedures. Results: The primary tumor sites were 17 colonic and 9 rectal cancers; primary tumor stages were 5x UICC-II, 7x UICC-III, 14x UICC-IV. 13 pts received adjuvant therapy. In 11 pts preoperative chemotherapy (FOLFOX or FOLFIRI) was given to achieve resectability of bilobular LM. After resection of LM (y)mTNM tumor stages were 1x mTNM-I, 6x mTNM-II, 6x mTNM-III and 4x mTNM-IV, respectively. After first RAIT, hematologic Grade 3 and 4, toxicity (WBC/platelet count) occurred in 8/14 and 5/3 pts, respectively. No cumulative toxicity was seen after repeated RAIT, with complete bone marrow recovery observed in all cases so far. To date, all pts are alive. Of the total, 17 pts received RAIT with adjuvant intention (as classified by FDG-PET and CT scans at pre-RAIT re-staging). In these, DFS was 70% post salvage resection of LM during ongoing follow-up of 15 months (median; range: 4–23 mos). As of Dec. 20, 2006, cancer recurrence was detected in 5/17 pts (3x pulmonary, 1x intrahepatic, 1x both) and in 4 pts R0-resection of distant metastases was done. 1 patient with pulmonary and intrahepatic relapses receives polychemotherapy with palliative intention. The pts‘ compliance to repeated RAIT has been 100%. Conclusion: RAIT re-treatment to date appears to be safe, feasible, and well accepted. Extended follow-up of the encouraging survival data will be presented. No significant financial relationships to disclose.
Xenotransplantationen könnten eine Lösung für das Mißverhältnis zwischen Organangebot und Anzahl der notwendigen Transplantationen darstellen. Deshalb untersuchten wir die Möglichkeit ein klinikrelevantes Modell für die Xenotrans-plantation vom Miniaturschwein zum nicht humanen Primaten zu entwickeln.
