Biomedical subjects
W Lauchart
Publications and source records attributed to W Lauchart.
Modified patterns of major histocompatibility complex-antigen expression in human liver grafts during rejection.
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[Liver transplantation in childhood].
From 1977 to 1985 altogether 143 children were referred to our hospital for liver transplantation. These children were aged 6 months to 15 years. According to the results of a defined examination protocol liver transplantation was indicated in 102 of these children. Contraindications were observed in 17 patients. In 14 children liver transplantation was not yet indicated. Parents of 8 children refused transplantation. Only 30 children have been transplanted so far. Out of these, 21 actually survive. The cumulative 5-year survival rate after transplantation is calculated to be 60.5%.
Developments in liver transplantation.
Liver transplantation has gained increasing interest. While liver grafting for tumor is successful over prolonged periods only in its early course, liver grafting for end-stage cirrhosis may lead to a long survival. Liver grafting in children is the most successful indication; in adults the results depend largely on timing and indication. Actual developments are mainly seen in the following points: a. Improvement in immunosuppression by use of Cyclosporin A. The resorption and metabolism of the drug, in relation to liver function, have to be carefully observed. b. The tendency to perform liver grafting electively instead of in emergency. c. Improvement in operative management, particularly the use of veno-venous bypass. d. The best possible anaesthesiological and intensive care management for the patients. It can be expected, that these developments will enable continuous improvement of results, particularly in an elective situation. One hundred and forty liver grafts have been done in our institution and the results are discussed herein. Progress in liver transplantation is marked by steadily growing numbers of liver grafts performed, and of centers performing grafts, as well as by improved success rates and the recommendation of the U.S. National Institutes of Health, based on discussions at a liver transplantation consent meeting, held in June 1983. This interest is also reflected in discussions among the medical and non-medical community. The first section of this paper will deal with the present state and results of liver grafting particularly, at our own institution and some actual developments in this field will be discussed.
HBV-vaccination in recipients of kidney allografts.
Recipients of renal transplants were vaccinated with 20 ng hepatitis B surface antigen aluminium-adsorbed vaccine in order to gauge their resistance to hepatitis B infection, to which these patients are at high risk. The patients were given three 40 micrograms doses of the vaccine over a period of six months and their antibody titres were measured. Only 9% of patients developed antibodies to hepatitis B and it was established that if possible all patients should receive at least one injection of hepatitis B vaccine prior to surgery.
Active hepatitis B vaccination in immunosuppressed patients.
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Results of biliary reconstruction after liver transplantation.
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Liver transplantation in children.
Liver transplantation in children is still rarely performed although the prognosis for children with benign and final-stage liver disease and individual cases with unresectable hepatomas is acceptable. This report is based on the cases of eight children who underwent liver transplantation, in five cases for end-stage cirrhosis and in three cases for hepatoma. There was early mortality in only one case while in all the others development and rehabilitation were remarkable. For patients with malignancies, tumour recurrence is a limiting factor. Transplantation in biliary atresia is complicated when carried out at late stages of the disease. In cases where the time of indication is sufficiently early, a long waiting period for a suitable donor organ must be expected, during which several potential candidates may succumb to the underlying disease. Increasing experience and improved immunosuppressive therapy signify that liver transplantation can be considered more often in end-stage liver diseases.
[Premedication with buprenorphine hydrochloride. A clinical study].
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Prevention of reflux after gastro resection in the pig.
In 48 pigs the duodenogastric reflux of bile acids and lysolecithin is studied after different types of gastroduodenostomy, jejunal interposition and Roux-Y-gastroenterostomy. The intragastric concentrations of bile acids and lysolecithin were found to be pathologically elevated after gastroduodenostomy. There was no difference between end-to-end, end-to-side or supraduodenal end-to-side anastomoses. An effective reflux prevention was possible by interposition of 25 cm of isoperistaltic jejunum or by Roux-Y. A shorter (15 cm) interposition with or without an isoperistaltic invagination valve was not sufficient in normalizing reflux amounts.
Only B lymphocytes induce active enhancement of rat cardiac allografts.
LEW rats were immunized 7 days before (LEW X BN)F1 heart transplantation with 10(7) BN donor cells, either purified erythrocytes (RBC), peripheral blood (PBL), splenic, nylon-wool-adherent (B-enriched) or nylon-wool-nonadherent (T-enriched) lymphocytes. Allograft rejection was only significantly enhanced in animals pretreated with lymphocyte populations containing surface immunoglobulin (SIgG)-positive cells (PBL, splenic, or B-enriched lymphocytes). Recipients immunized with RBC or T-enriched lymphocytes containing few, if any, SIgG-bearing B lymphocytes showed no significant graft prolongation.
[Active enhancement using B-lymphocytes].
B-lymphocytes given 7 days prior to auxiliary heterotopic heart transplantation significantly delay transplant rejection. T-lymphocytes or purified erythrocytes have no effect at all on the subsequent heart graft. The beneficial effect of blood transfusions could be due to the transfusion of B-lymphocytes, which create a state of active enhancement in the transplant recipient.
[Reflux-preventing gastric resection. An animal experiment study].
In 30 pigs the prevention of duodenogastric reflux following distal gastrectomy through different types of jejunal transposition or Roux-en-Y-gastroenterostomy was studied. The reflux was measured by determination of the intragastric amounts of bile acids and lysolecithin, and by the total number of glycerophosphatids. After distal gastrectomy and proximal selective vagotomy, isoperistaltic jejunal segments of different lengths were transposed between gastric remnant and duodenum. The reflux was normalized by 25-cm segments. Shorter segments led to no significant decrease of the reflux. The jejunal invagination of additional isoperistaltic valve did not have a significant effect. The same protection as from 25-cm segments was obtained by Roux-en-Y-gastrojejunostomy. The role of the duodenogastric reflux following gastrectomy for the gastric mucosa is disucssed. The necessity of the reparation of the pyloric function is shown.
[Gastroduodenostomy and duodenogastric reflux (author's transl)].
In 36 pigs the intragastric C14 bile acid reflux and the concentration of lysolecithin is measured following different types of hemigastrectomy and gastroduodenostomy. Termino-terminal, termino-lateral and supraduodenal termino-lateral anastomosisses were as well studied as an isoperistaltic jejunal transposition of 15 cm resp. 25 cm length.-After all types of direct gastroduodenostomy the amounts of intragastral C14 bile acids and lysolecithin were significantly elevated. An additional jejunal transposition decrease the reflux in relation to the length of the transposed jejunal segment. The importance of the duodenogastric reflex of bile acids and lysolecithin for the development of alkaline reflux gastritis and carcinoma of the gastric stump is discussed. For clinical purpose a replacement of the pyloric reflux barrier by a primary jejunal transposition in case of pylorectomy has to be discussed.
[SLA-testing and MCL-reaction in swine and their reaction to rejection of skin and liver transplants].
After porcine skin allografts there is a regular rejection within 6 - 12 days with a characteristic pattern of humoral antibodies corresponding to the histocompatibility testing. The rejection of skin allografts may be due to weak histocompatibility antigens which are not measured by the SL-A and MLC typing. A porcine liver allograft induces an immunological reaction of moderate degree. This state of hyporeactivity i. e. partial tolerance could be induced and maintained by the release of tolerogenic antigens from the porcine liver.
[Morphological findings in pig liver allografts after orthotopic and auxiliary heterotopic transplantation (author's transl)].
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The radiological management of biliary complications following liver transplantation.
PURPOSE: Biliary complications contribute significantly to morbidity and mortality in the liver transplant recipient. Surgery has been the mainstay of therapy, but interventional radiological techniques have made significant progress. METHODS: Diagnostic percutaneous transhepatic cholangiography (PTC) was performed in 12 patients; percutaneous transhepatic drainage (PTD) was performed in 10 patients. Additional interventional procedures included laser lithotripsy, biopsy, dilatation, and stent implantation. RESULTS: In 6 patients PTC revealed anastomotic, and in 6 patients nonanastomotic biliary strictures. Four patients had intrahepatic stones. Biliary strictures were treated by implantation of Palmaz stents in 5 of 6 patients with anastomotic strictures, and in 3 of 6 patients with nonanastomotic strictures. The intrahepatic stones were fragmented with dye laser lithotripsy under cholangioscopic control in 3 of 4 patients. One spontaneous stent migration after 24 months and one stent occlusion were observed; the remaining stents are still patent. Patients with anastomotic strictures had a more favorable outcome: 5 of 6 of these patients are still alive and symptom-free after an average of 27.4 months, but only 3 of 6 patients with nonanastomotic strictures are alive after an average of 9.8 months. CONCLUSION: The different outcomes in patients with anastomotic versus nonanastomotic strictures may be explained by the different causes of these types of stricture.
Embolization of renal vascular lesions: clinical experience with microcoils and tracker catheters.
After biopsy (n = 6) and nephrostomy (n = 1) of three native and four transplanted kidneys, gross hematuria, hypertension, and deterioration of function necessitated performance of transarterial embolization. Angiography revealed five arteriovenous fistulas (AVFs), one pseudoaneurysm, and one arteriocaliceal fistula. Superselective catheterization was accomplished using 5 Fr standard diagnostic catheters and 3 Fr coaxial Tracker catheters. Four of five AVFs were embolized successfully by inserting unfibered (2 patients) and fibered (2 patients) platinum coils (diameters 2 mm and 4 mm, respectively). For one AVF, additional injection of butylcyanoacrylate was necessary. The pseudoaneurysm was embolized successfully by such injection, and the arteriocaliceal fistula was occluded using one unfibered 2-mm coil. Embolization stopped the bleeding in all patients. One week after treatment, renal function was improved in 5 patients and remained unaffected in 2. Superselective embolization using Tracker catheters and fibered microcoils is an effective, safe treatment of renal vascular lesions.