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| 1 | Biliary complications following liver transplantation: Singlecenter experience over three decades and recent risk factors显示文摘AIM To identify independent risk factors for biliary complications in a center with three decades of experience in liver transplantation.METHODS A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease(MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logisticregression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate. RESULTS Biliary complications were observed in 227 cases(14.1%). Four hundred and seventeen(26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21%(n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46%(n = 41)], anastomotic strictures [25%(n = 22)], cholangitis [8%(n = 7)] and non-anastomotic strictures [3%(n = 3)]. The remaining 18%(n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation(P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively(P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation(P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of 0.702.CONCLUSION The parallel occurrence of high recipient MELD and impaired donor kidney function should be avoided. Risk is especially increased when post-transplant hepatic artery thrombosis occurs. | Alexander Kaltenborn André Gutcke Jill Gwiasda Jürgen Klempnauer Harald Schrem | 2017 | World Journal of Hepatology2017，9，3： | 6 |
| 2 | Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR)显示文摘 | René Adam Vincent Karam Valérie Delvart John O’Grady Darius Mirza Jurgen Klempnauer Denis Castaing Peter Neuhaus Neville Jamieson Mauro Salizzoni Stephen Pollard Jan Lerut Andreas Paul Juan Carlos Garcia-Valdecasas Fernando San Juan Rodríguez Andrew Burro | 2012 | Journal of Hepatology2012，，3： | 6 |
| 3 | Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation显示文摘AIM To investigate the impact of hepatic encephalopathybefore orthotopic liver transplantation(OLT) and neurological complications after OLT on employment after OLT.METHODS One hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-SyndromeTest yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS), completed a questionnaire concerning their occupation and filled in the short form 36(SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight(59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45(66.2%) male], and 46(40.4%) patients were included directly after OLT. RESULTS Before OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics(employed: Academic/non-academic 16(34.0%)/31 vs not employed 10(17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy(HE)(yes/no; employed 15(30.6%)/34 vs not employed 32(49.2%)/33, P = 0.05) and achieved worse results in psychometric tests(RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients(18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median(range, min-max) employed 47(42, 18-60) vs not employed 50(31, 29-60), P = 0.01], achieved better results in the psychometric tests(RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life(SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT(P < 0.001), age(P < 0.01) and SF-36 sum score 12 mo after OLT(P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT.CONCLUSION HE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT. | Henning Pflugrad Anita B Tryc Annemarie Goldbecker Christian P Strassburg Hannelore Barg-Hock Jürgen Klempnauer Karin Weissenborn | 2017 | World Journal of Hepatology2017，9，10： | 3 |
| 4 | 老年供体肝移植的临床经验显示文摘目的:供肝来源的短缺日益成为肝移植的突出问题,本文旨意在探讨老年供体肝移植的疗效。方法:收集2004年3月至9月德国汉诺威医学院施行的69例肝移植的临床资料。供体年龄>60岁的肝移植有11例,占同期肝移植总数的15.9%,其中包括急诊肝移植2例,再移植1例,供体的平均年龄为66.7岁,年龄最大者为75岁。而供体年龄≤60岁的肝移植共58例,供体平均年龄为36.3岁,年龄最小者为10岁。结果:老年供体组病人肝移植的总体效果令人满意,两组病人的1年生存率分别为81.8%(9/11)和87.9%(51/58),移植肝1年存活率为72.7%(8/11)和82.7%(48/58),两组间无显著差异。结论:在审慎的选择下,老年供体的肝脏是能够安全运用的,供体年龄并非是影响肝移植预后的因素。 | 严佶祺 Thomas Becker 彭承宏 李宏为 Juergen Klempnauer | 2006 | 外科理论与实践2006，11，4： | 3 |
| 5 | Liver Transplantation for Neuroendocrine Tumors in Europe—Results and Trends in Patient Selection: A 213-Case European Liver Transplant Registry Study显示文摘 | Yves Patrice Le Treut Emilie Grégoire Jürgen Klempnauer Jacques Belghiti Elisabeth Jouve Jan Lerut Denis Castaing Olivier Soubrane Olivier Boillot Georges Mantion Kia Homayounfar Manuel Bustamante Daniel Azoulay Philippe Wolf Marek Krawczyk Andreas Pasche | 2013 | Annals of Surgery2013，，5： | 3 |
| 6 | Split liver transplantation: a reliable approach to expand donor pool显示文摘Orthotopic liver transplantation as a successful treatment of end-stage liver disease is hampered by a persistent lack of cadaveric organs. Split liver transplantation, which was first successfully performed by Medical School of Hannover in 1988, has become a mature surgical technique to expand the donor pool. Between 1993 and 1999, split liver transplantation activities have increased in Europe from 1. 2% to 10. 4% in all performed liver transplantations. Current data have strongly supported that the survival rate of patients after split liver transplantation is not significantly different from that of patients after whole-size orthotopic liver transplantation. The most important step of donor graft selection is surgeon’ s observation judged by the experience of individual transplant center. The paper aims to provide the guideline of donor selection, hepatic graft splitting, and recipient management as well. DATA SOURCES: Medical School of Hannover has accumulated plentiful experience of split liver transplantation for more than 10 cases ever since 1998. Besides that, we also reviewed a variety of literatures from other famous European and American centers specialized in this field for many years. RESULTS:According to our experience combined with the view points of others, the donor should meet the following criteria as well: (1) age less than 50 years; (2) hemodynamics stable; (3) ICU less than 5 days; (4) Na less than 170 mmol/L or better if less than 150 mmol/L. In 1996 and 1997, the Hamburg group and the UCLA group separately introduced a breakthrough technique performing split liver transplantation in situ. Evidently, the in situ technique has been limited by prolonged time of donor organ procurement , coordination with other organ procurement teams, and even extra burden on donor hospital. Some groups, therefore, have restored the ex situ or bench splitting technique , and fortunately the transplant outcomes of the ex situ technique are equivalent to those of the in situ one. Recently some new techniques have been introduced to split the liver for two adult patients, including the split-cava technique. CONCLUSIONS:It is clear that the most important factor for determining the prognosis of the patient is the time of receiving liver transplantation, not the type of liver transplantation. We still need to pay close attention to the graft to recipient weight ratio (GRWR) and the UNOS classification or MELD score before the patient is subjected to split liver transplantation. | Ji-Qi Yan, Thomas Becker, Cheng-Hong Peng, Hong-Wei Li and Juergen Klempnauer Department of Surgery, Ruijin Hospital Affiliated to Shanghai Second Medical University, Shanghai 200025, China ( Yan JQ, Peng CH and Li HW) Department of Abdominal and Transplant Surgery, Medical School of Hannover, Carl-Neuberg-Str. 1 , 30625 Hannover, Germany | 2005 | Hepatobiliary & Pancreatic Diseases International2005，4，3： | 3 |
| 7 | 劈离式肝移植中供肝分离的手术经验显示文摘目的探讨劈离式肝移植中供肝分离的手术经验.方法自2004年3月1日至9月1日,共计施行了10例体外供肝的劈离,将其分为左肝外侧叶(Ⅱ、Ⅲ段)和扩大右半肝(Ⅰ、Ⅳ~Ⅷ段)两部分,并为19位病人施行了劈离式肝移植.供体的平均年龄为32.7岁(15~51岁),平均体重64.5kg(45~75kg),ICU平均救治时间为2.4 d(1~8 d).结果劈离前整体供肝和劈离后左肝外侧叶的平均重量分别为1322.6 g(956~1665 g)和281.8 g(198~373 g),后者与前者的平均比值为0.215(0.178~0.274).左肝外侧叶部分的移植物与受体重量比(GRWR)的平均值为2.44%(1.22%~5.41%),而扩大右半肝部分GRWR的平均值为1.73%(1.31%~2.30%).供肝劈离平均花费的时间为105 min(85~135 min).共出现5例解剖变异,包括左肝静脉变异2例、肝动脉变异2例、胆管变异1例.结论劈离式肝移植已经成为扩大供肝来源的一种成熟的外科技术,且效果满意.在供肝劈离中需要正确应对各种可能的解剖变异,尤其是左肝静脉、左肝动脉和胆管的变异. | 严佶祺 Thomas Becker 彭承宏 李宏为 Juergen Klempnauer | 2005 | 中华肝胆外科杂志2005，11，11： | 3 |
| 8 | Evolution of liver transplantation in Europe: Report of the European Liver Transplant Registry显示文摘 | René Adam Paul McMaster John G. O’Grady Denis Castaing Jurgen L. Klempnauer Neville Jamieson Peter Neuhaus Jan Lerut Mauro Salizzoni Stephen Pollard Ferdinand Muhlbacher Xavier Rogiers Juan Carlos Garcia Valdecasas Joaquin Berenguer Daniel Jaeck Enrique M | 2003 | Liver Transplantation2003，，12： | 2 |
| 9 | Liver transplantation for HBV-related cirrhosis in Europe: An ELTR study on evolution and outcomes显示文摘 | Patrizia Burra Giacomo Germani Renè Adam Vincent Karam Alfredo Marzano Pietro Lampertico Mauro Salizzoni Franco Filipponi Jurgen L. Klempnauer Denis Castaing Murat Kilic Luciano De Carlis Peter Neuhaus Sezai Yilmaz Andreas Paul Antonio D. Pinna Andrew K. | 2012 | Journal of Hepatology2012，，： | 2 |
| 10 | Evolution of liver transplantation in Europe: Report of the European Liver Transplant Registry显示文摘 | René Adam Paul McMaster John G. O’Grady Denis Castaing Jurgen L. Klempnauer Neville Jamieson Peter Neuhaus Jan Lerut Mauro Salizzoni Stephen Pollard Ferdinand Muhlbacher Xavier Rogiers Juan Carlos Garcia Valdecasas Joaquin Berenguer Daniel Jaeck Enrique M | 2003 | Liver Transplantation2003，，12： | 2 |
| 11 | 肝细胞肝癌肝移植的预后因素分析显示文摘目的评价肝细胞肝癌(hepatocellular carcinoma,HCC)原位肝移植后的预后相关因素。方法回顾性分析1993年11月到2006年5月期间汉诺威医科大学对117例HCC进行肝移植的经验。结果经多因素分析,肿瘤大小和肿瘤数量(米兰标准或加州标准)、微血管侵犯、移植前治疗和肿瘤复发是影响患者生存预后的重要因素。结论原位肝移植是治疗HCC的理性术式;合适的选择标准,积极的移植前治疗,复发的有效控制,是患者获得良好预后的关键。 | 赵泽明 Thomas Becker 范跃祖 Bastian Ringe Jürgen Klempnauer | 2014 | 同济大学学报(医学版)2014，35，1： | 2 |
| 12 | Benign Liver Tumors: Differential Diagnosis and Indications for Surgery显示文摘 | Arved Weimann Burckhardt Ringe Jürgen Klempnauer Peter Lamesch Klaus F. Gratz Mathias Prokop Hansj?rg Maschek Günter Tusch Rudolf Pichlmayr | 1997 | World Journal of Surgery1997，，9： | 2 |
| 13 | The Place of Liver Transplantation in the Treatment of Hepatic Epitheloid Hemangioendothelioma: Report of the European Liver Transplant Registry显示文摘 | Jan P. Lerut Giuseppe Orlando Rene Adam Marcello Schiavo Jurgen Klempnauer Darius Mirza Emmanuel Boleslawski Andrew Burroughs Carlos Fernandez Sellés Daniel Jaeck Robert Pfitzmann Mauro Salizzoni Gunner S?derdahl Rudi Steininger Andre Wettergren Vincenzo | 2007 | Annals of Surgery2007，，6： | 2 |
| 14 | Review: Surgical Shunts and Encephalopathy显示文摘 | Jürgen Klempnauer Harald Schrem | 2001 | Metabolic Brain Disease (-)2001，，1： | 2 |
| 15 | 肝细胞肝癌肝移植术后复发因素分析——汉诺威经验显示文摘目的探讨肝细胞肝癌(hepatocellular carcinoma,HCC)原位肝移植后的复发特性及相关影响因素。方法回顾性分析1993年11月至2006年5月汉诺威医科大学对117例合并肝硬化HCC行原位肝移植的临床资料和随访结果,应用Kaplan.Meier作术后累积存活率分析,Log.Rank检验作相关临床病理因素分析。结果63例(58.3%)HCC原位肝移植患者符合米兰标准,45例(41.7%)超米兰标准,而符合和超加州大学标准分别为73例(67.6%)和35例(32.4%);尸体供肝肝移植(cadaveric donor liver transplantation, CDLT)103例,活体供肝肝移植(living donor liver transplantation,LDLT)14例;两组术后生存率比较差异无统计学意义(P=0.911)。移植后肿瘤复发与否与患者年龄(P=0.048)、有无微血管侵犯(P=0.001)、是否超出加州标准(P=0.013)和肿瘤分化程度(P=0.015)密切相关。结论合适的选择标准、围手术期的综合治疗及复发的有效控制,是提高肝癌肝移植患者生存率的关键。 | 赵泽明 范跃祖 Becker Thomas Ringe Bastian Klempnauer Jtirgen | 2017 | 中华普通外科杂志2017，32，11： | 2 |
| 16 | Mapping of liver-enriched transcription factors in the human intestine显示文摘AIM: To investigate the gene expression pattern of hepatocyte nuclear factor 6 (HNF6) and other liverenriched transcription factors in various segments of the human intestine to better understand the differentiation of the gut epithelium. METHODS: Samples of healthy duodenum and jejunum were obtained from patients with pancreatic cancer whereas ileum and colon was obtained from patients undergoing right or left hemicolectomy or (recto)sigmoid or rectal resection. All surgical specimens were subjected to histopathology. Excised tissue was shock-frozen and analyzed for gene expression of liver-enriched transcription factors by semiquantitative reverse transcription polymerase chain and compared to the human colon carcinoma cell line Caco-2. Protein expression of major liver-enriched transcription factors was determined by Western blotting while the DNA binding of HNF6 was investigated by electromobility shift assays. RESULTS: The gene expression patterning of liverenriched transcription factors differed in the various segments of the human intestine with HNF6 gene expression being most abundant in the duodenum (P < 0.05) whereas expression of the zinc finger protein GATA4 and of the HNF6 target gene ALDH3A1 was most abundant in the jejunum (P < 0.05). Likewise, expression of FOXA2 and the splice variants 2 and 4 of HNF4α were most abundantly expressed in the jejunum (P < 0.05). Essentially, expression of transcription factors declined from the duodenum towards the colon with the most abundant expression in the jejunum and less in the ileum. The expression of HNF6 and of genes targeted by this factor, i.e. neurogenin 3 (NGN3) was most abundant in the jejunum followed by the ileum and the colon while DNA binding activity of HNF4α and of NGN3 was conf irmed by electromobility shift assays to an optimized probe. Furthermore, Western blotting provided evidence of the expression of several liver-enriched transcription factors in cultures of colon epithelial cells, albeit at different levels. CONCLUSION: We describe significant local and segmental differences in the expression of liver-enriched transcription factors in the human intestine which impact epithelial cell biology of the gut. | Frank Lehner Ulf Kulik Juergen Klempnauer Juergen Borlak | 2010 | World Journal of Gastroenterology2010，16，31： | 2 |
| 17 | Common and epithelioid variants of hepatic angiomyolipoma exhibit clonal growth and share a distinctive immunophenotype显示文摘 | Peer Flemming Ulrich Lehmann Thomas Becker Jürgen Klempnauer Hans Kreipe | 2000 | Hepatology2000，，： | 2 |
| 18 | Daxx Is a Transcriptional Repressor of CCAAT/Enhancer-binding Protein显示文摘 | Wethkamp N Klempnauer KH | 2009 | J Biol Chem2009，284，28： | 1 |
| 19 | Prognostic factors after resection of ampullary carcinoma: multivariate survival analysis in comparison with duetal cancer of the pancreatic head显示文摘 | Klempnauer J Ridder | 1995 | Br J Surg1995，82，： | 1 |
| 20 | Prediction of survival after liver transplantation by pre-transplant parameters显示文摘 | Tobias J. Weismüller Jana Prokein Thomas Becker Hannelore Barg-Hock Jürgen Klempnauer Michael P. Manns Christian P. Strassburg | 2008 | Scandinavian Journal of Gastroenterology2008，，6： | 1 |
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