Following liver transplantation, the effect of postoperative parenteral nutrition with MCT/LCT fatty emulsions on the recovery of RES function in the allograft was investigated in a randomised prospective study of three groups of patients (group I: 50 g MCT/LCT fats twice weekly, group II: 0.7 g/kg body weight per day MCT/LCT fats, group III: 1.5 g/kg body weight per day MCT/LCT fats). RES function was assessed using 99mTc-HSA-MM clearance. There were no statistically significant differences in the recovery of RES function after transplantation between the three groups. A negative effect on RES function as a result of the administration of MCT/LCT fats up to 1.5 g/kg body weight per day can therefore be excluded.
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.
O448 Aims: Preoperative assessment and postoperative restoration of liver volume in both donors and recipients are essential prerequisites for living donor liver transplantation, indicating hepatic function and adequate regeneration. Methods: To compare the recovery of residual left lobes (LL, S.1-4) and right lobe grafts (RL, S.5-8) a consecutive series of 21 donors (age 22-69 yrs) and their corresponding recipients (age 15-61 yrs) were included in a prospective study following right hemihepatectomy and partial liver transplantation, respectively. Immunosuppression was Tacrolimus based in all cases. Serial volumetry by MR imaging was done before, 3, 7, 14, 28, 60, 90, 180 and 360 days after surgery. The following parameters were determined: calculated and actual liver volume (LV) in ml, and in relation to preoperative donor LV (defined as 100%), liver to body weight ratio (LWR, %), and regeneration rate (RR, ml/d). Results: In donors, the mean residual LL was 45 % (LV 757 ml, LWR 1 %), and increased to 50, 59, 61, 67, 69, 75, 83 and 94 % after 3, 7, 14, 28, 60, 90, 180, and 360 days, respectively. 7/21donors showed a significant initial liver volume decrease with a nadir at 3-7 days. The donor with the smallest residual liver (LV 266 ml, 21 %; LWR 0.36 %) had the fastest recovery within the first week (RR 71 ml/d). In contrast, the mean volume of RL grafts (LV 892 ml, LWR 1.18 %) increased much faster, reaching 110 % on day 7, and decreased to 98 % after one year (LWR 2.19 %). Maximum RR in recipients was 243 ml/d within 3 days. Four patients with small-for-size grafts (LWR < 0.8 %) had significantly higher morbidity and mortality. Conclusions: These data confirm the triphasic liver volume restoration after partial hepatectomy as well as transplantation with rapid early increase within 30 days, an intermediate phase, and slow adaptation to the original donor liver volume between 90 and 360 days. In contrast to previous observations we found a significant difference between the residual LL and the RL, demonstrating a 2-3-fold faster and stronger early recovery in the graft. Obviously, it takes longer than a year for both parts of the liver to regenerate to the original donor liver size. The individual liver regeneration process seems to be accelerated by small residual liver volume in the donor, and various factors including portal hypertension, hemodynamic status, immunosuppressive drugs and others in the recipient.
Einleitung: Die simlutane systematische Lymphadenektomie ist obligat bei der Resektion maligner Tumoren. Dabei wird die Anzahl der resezierten Lymphknoten oft auch als Gradmesser des chirurgischen Könnens und der bei der Operation ausgeübten Sorgfalt angesehen, denn die Prognose lässt sich nur dann valide beurteilen, wenn eine ausreichende Anzahl an Lymphknoten in das histo-pathologische TNM-staging eingegangen sind. Darüber hinaus kann eine radikale und weitreichende systematische Lymphadenektomie manchmal die Prognose günstig beeinflussen, selbst wenn es bereits zu lymphogener Metastasierung gekommen ist. Neue chirurgische Resektionstechniken werden daher oft skeptisch gesehen. Dies gilt auch für die minimalinvasive Ösophagektomie beim Ösophaguskarzinom.
