Dietmar Öfner - Academia.edu (original) (raw)

Papers by Dietmar Öfner

Research paper thumbnail of Ex Vivo Mesenchymal Stem Cell Therapy to Regenerate Machine Perfused Organs

International Journal of Molecular Sciences

Transplantation represents the treatment of choice for many end-stage diseases but is limited by ... more Transplantation represents the treatment of choice for many end-stage diseases but is limited by the shortage of healthy donor organs. Ex situ normothermic machine perfusion (NMP) has the potential to extend the donor pool by facilitating the use of marginal quality organs such as those from donors after cardiac death (DCD) and extended criteria donors (ECD). NMP provides a platform for organ quality assessment but also offers the opportunity to treat and eventually regenerate organs during the perfusion process prior to transplantation. Due to their anti-inflammatory, immunomodulatory and regenerative capacity, mesenchymal stem cells (MSCs) are considered as an interesting tool in this model system. Only a limited number of studies have reported on the use of MSCs during ex situ machine perfusion so far with a focus on feasibility and safety aspects. At this point, no clinical benefits have been conclusively demonstrated, and studies with controlled transplantation set-ups are urge...

Research paper thumbnail of Lessons Learned in 11 Years of Experience With Open Abdomen Treatment With Negative-Pressure Therapy for Various Abdominal Emergencies

Frontiers in Surgery, 2021

Introduction: Open abdomen (OA) treatment with negative-pressure therapy (NPT) was initiated for ... more Introduction: Open abdomen (OA) treatment with negative-pressure therapy (NPT) was initiated for perforated diverticulitis and subsequently extended to other abdominal emergencies. The aim of this retrospective study was to analyze the indications, procedures, duration of NPT, and the outcomes of all our patients.Methods: All consecutive patients treated with intra-abdominal NPT from January 1, 2008 to December 31, 2018 were retrospectively analyzed.Results: A total of 438 patients (44% females) with a median (range) age of 66 (12–94) years, BMI of 25 (14–48) kg/m2, and ASA class I, II, III, and IV scores of 36 (13%), 239 (55%), 95 (22%), and 3(1%), respectively, were treated with NPT. The indication for surgery was primary bowel perforation in 163 (37%), mesenteric ischemia in 53 (12%), anastomotic leakage in 53 (12%), ileus in 53 (12%), postoperative bowel perforation/leakage in 32 (7%), abdominal compartment in 15 (3%), pancreatic fistula in 13 (3%), gastric perforation in 13 (3%...

Research paper thumbnail of Myogenic Progenitor Cell Transplantation for Muscle Regeneration Following Hindlimb Ischemia and Reperfusion 

BackgroundMuscle is severely affected by ischemia/reperfusion injury (IRI). Quiescent satellite c... more BackgroundMuscle is severely affected by ischemia/reperfusion injury (IRI). Quiescent satellite cells differentiating into myogenic progenitor cells (MPC) possess a remarkable regenerative potential. We herein established a model of local application of MPC in murine hindlimb ischemia/reperfusion to study cell engraftment and differentiation required for muscle regeneration.MethodsA clamping model of murine (C57b/6J) hindlimb ischemia was established to induce IRI in skeletal muscle. After 2 hours (h) warm ischemic time (WIT) and reperfusion, reporter protein expressing MPC (TdTomato or Luci-GFP, 1x106 cells) obtained from isolated satellite cells were injected intramuscularly. Surface marker expression and differentiation potential of MPC were analyzed in vitro by flow cytometry and differentiation assay. In vivo bioluminescence imaging and histopathologic evaluation of biopsies were performed to quantify cell fate, engraftment and regeneration.Results 2h WIT induced severe IRI on ...

Research paper thumbnail of Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality

Frontiers in Surgery, 2021

Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of th... more Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival.Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels ≥10mg/dL or (iii) international normalized ratio (INR) ≥1.6 on postoperative day 7.Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly (P = 0.092; log rank-test = 2.87), graft survival was significantly higher in non-EAD patients (P = 0.008; log rank-test = 7.13). Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors (Bilirubin HR = 1.71 [1.34, 2.16]; INR HR = 2.69 [0.51, 14.31]), in contrast to AST (HR = 0.91 [0.75, 1.10]). S...

Research paper thumbnail of Post-Transplant Malignancies following Pancreas Transplantation: Incidence and Implications on Long-Term Outcome from a Single-Center Perspective

Journal of Clinical Medicine, 2021

Chronic immunosuppression is associated with an increased risk of malignancy. The main objective ... more Chronic immunosuppression is associated with an increased risk of malignancy. The main objective of this study is to evaluate the incidence and effect of post-transplant malignancies (PTMs) following pancreas transplantation. The 348 first pancreas transplants performed between 1985 and 2015 were retrospectively analyzed in this study. Incidences of PTMs, as well as patient and graft survival, were evaluated. Out of 348 patients, 71 (20.4%) developed a PTM. Median time to diagnosis was 130 months. Thirty-six patients (50.7%) developed skin cancers (four patients with melanoma, 32 with NMSCs). Solid organ malignancy occurred in 25 (35.2%), hematologic malignancy in ten patients (14.1%). Affected patients were transplanted earlier [2000 (IQR 1993−2004) vs. 2003 (IQR 1999−2008); p < 0.001]. No differences in induction therapy were seen, both groups demonstrated comparable patient and graft survival. Pancreas transplant recipients with solid organ and hematologic malignancies had a t...

Research paper thumbnail of Influence of early biliary complications on survival rates after pediatric liver transplantation—A positive outlook

Pediatric Transplantation, 2021

BackgroundEarly biliary complications (EBC) constitute a burden after pediatric liver transplanta... more BackgroundEarly biliary complications (EBC) constitute a burden after pediatric liver transplantation frequently requiring immediate therapy. We aimed to assess the impact of EBC on short‐ and long‐term patient and graft survival as well as post‐transplant morbidity.MethodsWe analyzed 121 pediatric liver transplantations performed between 1984 and 2019 at the Medical University of Innsbruck for the occurrence of early (<90 days) biliary complications and investigated the influence of EBC on patient and graft survival.ResultsEarly biliary complications occurred in 30 (24.8%) out of the 121 pediatric liver transplant recipients. Patient survival at 15 years (89.2% vs. 84.2%, p = .65) and all‐cause (82.5% vs. 74.0%) and death‐censored graft survival (82.5% vs. 75.1%, p = .71) at 10 years were similar between the EBC and the non‐EBC group. The EBC group had a significantly longer ICU (25 vs. 16 days, p < .001) and initial hospital stay (64 vs. 42 days, p = .002). Livers of patient...

Research paper thumbnail of Delaying surgery for patients with a previous SARS-CoV-2 infection

British Journal of Surgery, 2020

Research paper thumbnail of A Retrospective Propensity Score Matched Analysis Reveals Superiority of Hypothermic Machine Perfusion over Static Cold Storage in Deceased Donor Kidney Transplantation

Journal of Clinical Medicine, 2020

Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage ... more Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage (SCS) in kidney transplantation, but its true benefit in the clinical routine remains incompletely understood. The aim of this study was to assess the effect of HMP vs. SCS in kidney transplantation. All kidney transplants performed between 08/2015 and 12/2019 (n = 347) were propensity score (PS) matched for cold ischemia time (CIT), extended criteria donor (ECD), gender mismatch, cytomegalovirus (CMV) mismatch, re-transplantation and Eurotransplant (ET) senior program. A total of 103 HMP and 103 SCS instances fitted the matching criteria. Prior to PS matching, the CIT was longer in the HMP group (17.5 h vs. 13.3 h; p < 0.001), while the delayed graft function (DGF) rates were 29.8% and 32.3% in HMP and SCS, respectively. In the PS matched groups, the DGF rate was 64.1% in SCS vs. 31.1% following HMP: equivalent to a 51.5% reduction of the DGF rate (OR 0.485, 95% CI 0.318–0.740). DGF ...

Research paper thumbnail of A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms: An International Multicenter Cohort Study

Cancers, 2020

Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) ... more Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients...

Research paper thumbnail of Early response evaluation during preoperative chemotherapy for colorectal liver metastases: Combined size and morphology‐based criteria predict pathological response and survival after resection

Journal of Surgical Oncology, 2019

BackgroundShort treatment‐duration with early restaging is crucial to avoid liver injury after pr... more BackgroundShort treatment‐duration with early restaging is crucial to avoid liver injury after preoperative chemotherapy (preopCTX) for colorectal liver metastases (CRLM). Response evaluation according to response evaluation criteria in solid tumors (RECIST) criteria implies several limitations. Early tumor shrinkage (ETS; ≥20% size reduction <6‐12 weeks) or morphological criteria (MC) may better predict oncological outcome.MethodsIn patients undergoing resection after preopCTX between 2003–2017 pathological and radiological response was reassessed according to Blazer classification, ETS, MC, and RECIST within 90 days and correlated with survival.ResultsSeventy‐two patients were included, with a median of two (1‐10) liver lesions, 53% bilobar involvement, and 7% extrahepatic disease. PreopCTX was applied for 3 months in median (1‐6). During restaging after a median of 62 days, presence of ETS was associated with improved median overall survival (OS; 57.1 vs 33.7 months; P = .010)...

Research paper thumbnail of Outcomes following pancreatic resections—results and challenges of an Austrian university hospital compared to nationwide data and international centres

European Surgery, 2019

Background Despite clear advances in decreasing postoperative mortality below 4% after pancreatic... more Background Despite clear advances in decreasing postoperative mortality below 4% after pancreatic resections in experienced centres, specific morbidity according to standardized definitions still remains high. While some recent multicentre studies have reported on complications after pancreatic surgery in Austria, detailed outcome data from single highvolume centres over longer time-periods are scarce. This study provides an in-depth picture of patient characteristics, indications, morbidity and mortality after pancreatic surgery in an Austrian tertiary referral centre. Methods All patients undergoing curative intent resection between 2010 and 2017 at the Medical University of Innsbruck were evaluated. Patient characteristics and procedural details, overall and specific complications including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and postpancreatectomy haemorrhage (PPH) rates according to accepted definitions are reported. Outcomes after pancreatic head resections, distal pancreatectomy and other types of resections are compared. Factors associated with severe and overall morbidity are evaluated by logistic regression modelling. Results A total of 343 patients underwent pancreatic resection, at a median of 64 years (53% males). Most

Research paper thumbnail of Intensified preoperative chemoradiation by adding oxaliplatin in locally advanced, primary operable (cT3NxM0) rectal cancer

Strahlentherapie und Onkologie, 2017

Purpose The major goals of preoperative treatment for locally advanced rectal cancers (LARCs) are... more Purpose The major goals of preoperative treatment for locally advanced rectal cancers (LARCs) are improvement of local tumor control, tumor downsizing, and downstaging. Modifications with respect to standardized chemoradiation protocol, e. g., integrating oxaliplatin, are realized with the aim of improving primary tumor response and patient outcome. Patients and methods In this phase II multicenter study, patients with LARC of the mid-or lower rectum, cT3cNxcM0 as staged by MRI, were included and treated preoperatively with a combination of capecitabine and oxaliplatin following a standardized protocol during radiation. The focus of this long-term analysis was overall (OS) and disease-free survival (DFS). ClinicalTrials.gov number, NCT00297141 The investigators participating in the Tyrolean Oncology Working Group Trial 05 (TAKO 05) and Austrian Breast and Colorectal Cancer Study Group Trial R-02 (ABCSG R-02) are listed in the appendix.

Research paper thumbnail of Interventional management after complicated pancreatic surgery

European Surgery, 2019

Background Despite technical advances in surgical resection and postoperative management of the p... more Background Despite technical advances in surgical resection and postoperative management of the pancreas, surgical procedures of the pancreas are associated with a high rate of complications, resulting in a relevant morbidity and mortality. Early diagnosis and management of complications associated with pancreas surgery is mandatory, favoring a multidisciplinary approach. Methods Interventional radiology offers minimal invasive techniques to manage post-surgical complications. These procedures are highlighted in this review, including percutaneous drainage of fluid collections, percutaneous transhepatic biliary interventions, arterial embolisation and fistula embolisation. Results Post-surgical complications of pancreatic surgery are effectively managed by radiological procedures, offering a feasible and safe treatment with low morbidity rates. Accurate patient selection is key to an effective management of clinical situations where these interventions represent the first line approach. Conclusions Radiologic procedures allow for minimal invasive treatment of postoperative complications af

Research paper thumbnail of Impact of bile leakage on perioperative and long-term oncological outcome

HPB, 2018

Introduction: Hydatidosis is an endemic zoonosis, caused by the parasite Echinoccocus granulosus.... more Introduction: Hydatidosis is an endemic zoonosis, caused by the parasite Echinoccocus granulosus. The liver is the most commonly affected organ. The disease is slowly progressive and may remain asymptomatic for several years. When symptomatic, the clinical presentation may vary from abdominal pain, jaundice and even anaphylactic shock in extreme cases. One of the most common complications of disease is the fistulization of a hydatid cyst into the biliary tree. However, other intrahepatic structures may be rarely involved. The purpose of this study is to report a case of liver hydatid cyst with direct portal vein invasion, an unusual complication of this condition. Methods: case report. Results: A 62-year-old man comes to the outpatient clinic referring abdominal pain in the right hypocondrium for 3 months. He denies jaundice and weight loss. He claims to have been travelling in South America for several months. CT scan shows multiple confluent cysts in segments VII and VIII, with heterogeneous content and parietal calcifications, measuring about 13 x 6.5 cm. Two other cystic images with the same characteristics are present in segment V. There is thrombosis of the right portal branch. The thrombus has attenuation similar to the cystic lesions described above, corresponding to the portal extension of the hydatid cyst. The patient underwent an open right hepatectomy and gross examination of the surgical specimen confirmed the presence of hydatid material inside the right portal branch. Conclusion: Although rarely, hydatid cysts may directly involve the portal vein.

Research paper thumbnail of Major vascular resection and reconstruction combined with liver resection for primary and metastatic hepatic tumors

Research paper thumbnail of Impact of primary tumour location on long-term survival after hepatic resection for colorectal liver metastasis

HPB, 2018

The impact of primary tumour location (sidedness) in colorectal cancer has been thoroughly invest... more The impact of primary tumour location (sidedness) in colorectal cancer has been thoroughly investigated in first-lineand palliative chemotherapystudies. While in these patients, right-sided tumours were associated with worse outcome, data on impact of sidedness concerning postoperative long-term survival after resection for colorectal liver metastasis (CRLM) are scarce. Methods: All patients undergoing hepatic resection for newly diagnosed CRLM in two Austrian high-volume centres between 2003e2016 were analysed. Influence of patient, treatment and tumour characteristics on postoperative survival was evaluated. Results: A total of 252 patients (40% female; median 64a) underwent resection with a 90-day-mortality of 1.2% (31% major resections, 55% received preoperative chemotherapy). Primary tumour characteristics were: 25% rightsided, 57% nodal positive. Metastasis characteristics were: synchronous metastasis in 64%, 38% bilobar hepatic

Research paper thumbnail of Surgical techniques and strategies for the treatment of primary liver tumours: hepatocellular and cholangiocellular carcinoma

European Surgery, 2018

Background Owing to remarkable improvements of surgical techniques and associated specialities, l... more Background Owing to remarkable improvements of surgical techniques and associated specialities, liver surgery has become the standard of care for hepatocellular carcinoma and cholangiocarcinoma. Although applied with much greater safety, hepatic resections for primary liver tumours remain challenging and need to be integrated in a complex multidisciplinary treatment approach. Methods This literature review gives an update on the recent developments regarding basics of open and laparoscopic liver surgery and surgical strategies for primary liver tumours. Results Single-centre reports and multicentre registries mainly from Asia and Europe dominate the surgical literature on primary liver tumours, but the numbers of randomized trials are slowly increasing. Perioperative outcomes of open liver surgery for hepatocellular and cholangiocellular carcinoma have vastly improved over the last decades, accompanied by some progress in terms of oncological outcome. The laparoscopic approach is increasingly being applied in many centres, even for patients with underlying liver disease, and may result in decreased morbidity. Liver transplantation represents

Research paper thumbnail of Intraductal tubulopapillary neoplasm (ITPN) of the pancreas associated with an invasive component: a case report with review of the literature

World Journal of Surgical Oncology, 2017

Background: Intraductal tubulopapillary neoplasm (ITPN) depicts a distinct entity in the subgroup... more Background: Intraductal tubulopapillary neoplasm (ITPN) depicts a distinct entity in the subgroup of premalignant epithelial tumors of the pancreas. Although the histomorphological and immunophenotypical characterization of ITPN has been described by several authors in terms of report of case series in the past, the rarity of that tumor subtype and similarity to other entities still makes identification of ITPN a challenge for radiologists and pathologists. To date, little is known about tubulopapillary carcinoma that can evolve from ITPN. Case presentation: In the present work, we analyze one case of ITPN associated with an invasive component and discuss the results involving the current literature. Collected patient data included medical history, clinical symptoms, laboratory tests, radiological imaging, reports of interventions and operation, and histopathological and immunohistochemical examinations. The patient initially presented with acute pancreatitis. A solid tumor obstructing the main pancreatic duct and sticking out of the papilla of Vater was detected and caught via endoscopic intervention. Histopathological examination of the specimen revealed mainly tubular growth pattern with back to back tubular glands. Immunohistochemically, the tumor was strongly positive for keratin 7 (CK7) and pankeratin AE1/AE3, and alpha 1 antichymotrypsin; negative for synaptophysin and chromogranin A, CDx2, CK20, S100, carcinoembryonic antigen (CEA), MUC 2, MUC5AC, and somatostatin; and in part positive for CA19-9. Extended pancreatoduodenectomy was performed, the final diagnosis was tubulopapillary carcinoma grown in an ITPN. Conclusion: The identification of an ITPN of the pancreas can be a challenging task. Endoscopic retrograde cholangiopancreaticography is an excellent tool to directly see and indirectly visualize the intraductal solid tumor and to take a biopsy for histopathological evaluation at the same time. Together with a thorough immunohistochemical workup, differential diagnoses can be ruled out quickly. To date, reports of ITPN are rare and little is known about the potential for malignant transformation and the prognosis of tubulopapillary carcinoma grown from an ITPN. Radical surgical resection following oncologic criteria is recommended; however, more data will be needed to assess an adequate treatment and follow-up standard.

Research paper thumbnail of Good Results with Individually Adapted Long-Term Immunosuppression Following Alemtuzumab Versus ATG Induction Therapy in Combined Kidney-Pancreas Transplantation: A Single-Center Report

Annals of Transplantation, 2019

Departmental sources Retrospective analysis of the long-term results of a randomized controlled t... more Departmental sources Retrospective analysis of the long-term results of a randomized controlled trial comparing alemtuzumab (ALEM) and antithymocyte globulin (ATG) as induction therapy in simultaneous pancreas-kidney transplantation (SPK) to address individualized long-term immunosuppression. Between 2006 and 2010 a total of 30 SPKs were randomized to treatment with ALEM plus tacrolimus (TAC) monotherapy (Group A, n=14) versus ATG induction plus TAC, mycophenolate mofetil (MMF) and steroids (Group B, n=16), followed by individualized long-term immunosuppression. We here present the long-term results for graft survival, graft function, and major complications. The 9-year patient survival rates in Groups A and Group B were 92.9% and 86.7% respectively; pancreas graft survival was 75.0% and 65.0% respectively; renal graft survival was 83.1% and 93.8% respectively. Long-term graft function was excellent with a creatinine of 1.5 mg/dL and 1.4 mg/dL, fasting glycemia of 104 mg/dL and 102 mg/dL, hemoglobin (Hb) A1c of 5.4 g% and 5.6 g% in Group A and Group B, respectively. Major complications were comparable in both groups. Good long-term results for patient, pancreas graft and kidney graft survival were achieved in both groups with individually adapted maintenance immunosuppression. ALEM is a valid induction therapy.

Research paper thumbnail of Sex differences in disease presentation, surgical and oncological outcome of hepatic resection for primary and metastatic liver tumours

52. Jahrestagung & 30. Fortbildungskurs der Österreichischen Gesellschaft für Gastroenterologie & Hepatologie (ÖGGH), 2019

patients who underwent laparoscopic or open cholecystectomies for acute or chronic cholecystitis ... more patients who underwent laparoscopic or open cholecystectomies for acute or chronic cholecystitis and suspicious gall bladder neoplasia. Methods: A retrospective chart review was conducted for patients who underwent laparoscopic or open cholecystectomies for acute or chronic cholecystitis and suspicious gall bladder neoplasia between September 2009 to November 2018. The study outcomes included the prevalence of Florid XCG, Clinical, Radiological, Intraoperative Characteristics, and Clinical Outcomes. Results: A total of 1963 patients were included in final data analysis, of whom 5 (0.25%) cases were diagnosed as florid XGC. The florid XGC mean age was (54.2; range: 33-63), and the majority 4 cases (80%) were males. Abdominal pain, Nausea, and Vomiting were the most frequent presenting clinical symptoms. Intraoperative findings included invasion to the liver, Adjacent pylorus, First part of the duodenum, and Colon. Postoperative complications occurred in (60%) with no mortality being observed in the patients. Conclusion: Florid XCG is a rare condition affecting the gall bladder however misdiagnosis with other conditions especially malignancy can have far reaching consequences for the patient health. Hence, Preoperative identification of XGC is essential for proper surgical management. Open cholecystectomy with complete resection of adjacent Xanthogranulomatous tissue is preferred in most patients due to dense fibrosis, Extensive local inflammation, and concerns of possible coexistent malignancy. A preoperative cholangiogram or FNAC and intraoperative immunohistochemistry on frozen sections examination should be considered to rule out coexisting malignancy. Florid XGC as diagnosis should be considered and reporting of such cases in medical literure will help in developing awareness and better understanding of this equivocal disease.

Research paper thumbnail of Ex Vivo Mesenchymal Stem Cell Therapy to Regenerate Machine Perfused Organs

International Journal of Molecular Sciences

Transplantation represents the treatment of choice for many end-stage diseases but is limited by ... more Transplantation represents the treatment of choice for many end-stage diseases but is limited by the shortage of healthy donor organs. Ex situ normothermic machine perfusion (NMP) has the potential to extend the donor pool by facilitating the use of marginal quality organs such as those from donors after cardiac death (DCD) and extended criteria donors (ECD). NMP provides a platform for organ quality assessment but also offers the opportunity to treat and eventually regenerate organs during the perfusion process prior to transplantation. Due to their anti-inflammatory, immunomodulatory and regenerative capacity, mesenchymal stem cells (MSCs) are considered as an interesting tool in this model system. Only a limited number of studies have reported on the use of MSCs during ex situ machine perfusion so far with a focus on feasibility and safety aspects. At this point, no clinical benefits have been conclusively demonstrated, and studies with controlled transplantation set-ups are urge...

Research paper thumbnail of Lessons Learned in 11 Years of Experience With Open Abdomen Treatment With Negative-Pressure Therapy for Various Abdominal Emergencies

Frontiers in Surgery, 2021

Introduction: Open abdomen (OA) treatment with negative-pressure therapy (NPT) was initiated for ... more Introduction: Open abdomen (OA) treatment with negative-pressure therapy (NPT) was initiated for perforated diverticulitis and subsequently extended to other abdominal emergencies. The aim of this retrospective study was to analyze the indications, procedures, duration of NPT, and the outcomes of all our patients.Methods: All consecutive patients treated with intra-abdominal NPT from January 1, 2008 to December 31, 2018 were retrospectively analyzed.Results: A total of 438 patients (44% females) with a median (range) age of 66 (12–94) years, BMI of 25 (14–48) kg/m2, and ASA class I, II, III, and IV scores of 36 (13%), 239 (55%), 95 (22%), and 3(1%), respectively, were treated with NPT. The indication for surgery was primary bowel perforation in 163 (37%), mesenteric ischemia in 53 (12%), anastomotic leakage in 53 (12%), ileus in 53 (12%), postoperative bowel perforation/leakage in 32 (7%), abdominal compartment in 15 (3%), pancreatic fistula in 13 (3%), gastric perforation in 13 (3%...

Research paper thumbnail of Myogenic Progenitor Cell Transplantation for Muscle Regeneration Following Hindlimb Ischemia and Reperfusion 

BackgroundMuscle is severely affected by ischemia/reperfusion injury (IRI). Quiescent satellite c... more BackgroundMuscle is severely affected by ischemia/reperfusion injury (IRI). Quiescent satellite cells differentiating into myogenic progenitor cells (MPC) possess a remarkable regenerative potential. We herein established a model of local application of MPC in murine hindlimb ischemia/reperfusion to study cell engraftment and differentiation required for muscle regeneration.MethodsA clamping model of murine (C57b/6J) hindlimb ischemia was established to induce IRI in skeletal muscle. After 2 hours (h) warm ischemic time (WIT) and reperfusion, reporter protein expressing MPC (TdTomato or Luci-GFP, 1x106 cells) obtained from isolated satellite cells were injected intramuscularly. Surface marker expression and differentiation potential of MPC were analyzed in vitro by flow cytometry and differentiation assay. In vivo bioluminescence imaging and histopathologic evaluation of biopsies were performed to quantify cell fate, engraftment and regeneration.Results 2h WIT induced severe IRI on ...

Research paper thumbnail of Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality

Frontiers in Surgery, 2021

Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of th... more Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival.Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels ≥10mg/dL or (iii) international normalized ratio (INR) ≥1.6 on postoperative day 7.Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly (P = 0.092; log rank-test = 2.87), graft survival was significantly higher in non-EAD patients (P = 0.008; log rank-test = 7.13). Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors (Bilirubin HR = 1.71 [1.34, 2.16]; INR HR = 2.69 [0.51, 14.31]), in contrast to AST (HR = 0.91 [0.75, 1.10]). S...

Research paper thumbnail of Post-Transplant Malignancies following Pancreas Transplantation: Incidence and Implications on Long-Term Outcome from a Single-Center Perspective

Journal of Clinical Medicine, 2021

Chronic immunosuppression is associated with an increased risk of malignancy. The main objective ... more Chronic immunosuppression is associated with an increased risk of malignancy. The main objective of this study is to evaluate the incidence and effect of post-transplant malignancies (PTMs) following pancreas transplantation. The 348 first pancreas transplants performed between 1985 and 2015 were retrospectively analyzed in this study. Incidences of PTMs, as well as patient and graft survival, were evaluated. Out of 348 patients, 71 (20.4%) developed a PTM. Median time to diagnosis was 130 months. Thirty-six patients (50.7%) developed skin cancers (four patients with melanoma, 32 with NMSCs). Solid organ malignancy occurred in 25 (35.2%), hematologic malignancy in ten patients (14.1%). Affected patients were transplanted earlier [2000 (IQR 1993−2004) vs. 2003 (IQR 1999−2008); p < 0.001]. No differences in induction therapy were seen, both groups demonstrated comparable patient and graft survival. Pancreas transplant recipients with solid organ and hematologic malignancies had a t...

Research paper thumbnail of Influence of early biliary complications on survival rates after pediatric liver transplantation—A positive outlook

Pediatric Transplantation, 2021

BackgroundEarly biliary complications (EBC) constitute a burden after pediatric liver transplanta... more BackgroundEarly biliary complications (EBC) constitute a burden after pediatric liver transplantation frequently requiring immediate therapy. We aimed to assess the impact of EBC on short‐ and long‐term patient and graft survival as well as post‐transplant morbidity.MethodsWe analyzed 121 pediatric liver transplantations performed between 1984 and 2019 at the Medical University of Innsbruck for the occurrence of early (<90 days) biliary complications and investigated the influence of EBC on patient and graft survival.ResultsEarly biliary complications occurred in 30 (24.8%) out of the 121 pediatric liver transplant recipients. Patient survival at 15 years (89.2% vs. 84.2%, p = .65) and all‐cause (82.5% vs. 74.0%) and death‐censored graft survival (82.5% vs. 75.1%, p = .71) at 10 years were similar between the EBC and the non‐EBC group. The EBC group had a significantly longer ICU (25 vs. 16 days, p < .001) and initial hospital stay (64 vs. 42 days, p = .002). Livers of patient...

Research paper thumbnail of Delaying surgery for patients with a previous SARS-CoV-2 infection

British Journal of Surgery, 2020

Research paper thumbnail of A Retrospective Propensity Score Matched Analysis Reveals Superiority of Hypothermic Machine Perfusion over Static Cold Storage in Deceased Donor Kidney Transplantation

Journal of Clinical Medicine, 2020

Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage ... more Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage (SCS) in kidney transplantation, but its true benefit in the clinical routine remains incompletely understood. The aim of this study was to assess the effect of HMP vs. SCS in kidney transplantation. All kidney transplants performed between 08/2015 and 12/2019 (n = 347) were propensity score (PS) matched for cold ischemia time (CIT), extended criteria donor (ECD), gender mismatch, cytomegalovirus (CMV) mismatch, re-transplantation and Eurotransplant (ET) senior program. A total of 103 HMP and 103 SCS instances fitted the matching criteria. Prior to PS matching, the CIT was longer in the HMP group (17.5 h vs. 13.3 h; p < 0.001), while the delayed graft function (DGF) rates were 29.8% and 32.3% in HMP and SCS, respectively. In the PS matched groups, the DGF rate was 64.1% in SCS vs. 31.1% following HMP: equivalent to a 51.5% reduction of the DGF rate (OR 0.485, 95% CI 0.318–0.740). DGF ...

Research paper thumbnail of A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms: An International Multicenter Cohort Study

Cancers, 2020

Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) ... more Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients...

Research paper thumbnail of Early response evaluation during preoperative chemotherapy for colorectal liver metastases: Combined size and morphology‐based criteria predict pathological response and survival after resection

Journal of Surgical Oncology, 2019

BackgroundShort treatment‐duration with early restaging is crucial to avoid liver injury after pr... more BackgroundShort treatment‐duration with early restaging is crucial to avoid liver injury after preoperative chemotherapy (preopCTX) for colorectal liver metastases (CRLM). Response evaluation according to response evaluation criteria in solid tumors (RECIST) criteria implies several limitations. Early tumor shrinkage (ETS; ≥20% size reduction <6‐12 weeks) or morphological criteria (MC) may better predict oncological outcome.MethodsIn patients undergoing resection after preopCTX between 2003–2017 pathological and radiological response was reassessed according to Blazer classification, ETS, MC, and RECIST within 90 days and correlated with survival.ResultsSeventy‐two patients were included, with a median of two (1‐10) liver lesions, 53% bilobar involvement, and 7% extrahepatic disease. PreopCTX was applied for 3 months in median (1‐6). During restaging after a median of 62 days, presence of ETS was associated with improved median overall survival (OS; 57.1 vs 33.7 months; P = .010)...

Research paper thumbnail of Outcomes following pancreatic resections—results and challenges of an Austrian university hospital compared to nationwide data and international centres

European Surgery, 2019

Background Despite clear advances in decreasing postoperative mortality below 4% after pancreatic... more Background Despite clear advances in decreasing postoperative mortality below 4% after pancreatic resections in experienced centres, specific morbidity according to standardized definitions still remains high. While some recent multicentre studies have reported on complications after pancreatic surgery in Austria, detailed outcome data from single highvolume centres over longer time-periods are scarce. This study provides an in-depth picture of patient characteristics, indications, morbidity and mortality after pancreatic surgery in an Austrian tertiary referral centre. Methods All patients undergoing curative intent resection between 2010 and 2017 at the Medical University of Innsbruck were evaluated. Patient characteristics and procedural details, overall and specific complications including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and postpancreatectomy haemorrhage (PPH) rates according to accepted definitions are reported. Outcomes after pancreatic head resections, distal pancreatectomy and other types of resections are compared. Factors associated with severe and overall morbidity are evaluated by logistic regression modelling. Results A total of 343 patients underwent pancreatic resection, at a median of 64 years (53% males). Most

Research paper thumbnail of Intensified preoperative chemoradiation by adding oxaliplatin in locally advanced, primary operable (cT3NxM0) rectal cancer

Strahlentherapie und Onkologie, 2017

Purpose The major goals of preoperative treatment for locally advanced rectal cancers (LARCs) are... more Purpose The major goals of preoperative treatment for locally advanced rectal cancers (LARCs) are improvement of local tumor control, tumor downsizing, and downstaging. Modifications with respect to standardized chemoradiation protocol, e. g., integrating oxaliplatin, are realized with the aim of improving primary tumor response and patient outcome. Patients and methods In this phase II multicenter study, patients with LARC of the mid-or lower rectum, cT3cNxcM0 as staged by MRI, were included and treated preoperatively with a combination of capecitabine and oxaliplatin following a standardized protocol during radiation. The focus of this long-term analysis was overall (OS) and disease-free survival (DFS). ClinicalTrials.gov number, NCT00297141 The investigators participating in the Tyrolean Oncology Working Group Trial 05 (TAKO 05) and Austrian Breast and Colorectal Cancer Study Group Trial R-02 (ABCSG R-02) are listed in the appendix.

Research paper thumbnail of Interventional management after complicated pancreatic surgery

European Surgery, 2019

Background Despite technical advances in surgical resection and postoperative management of the p... more Background Despite technical advances in surgical resection and postoperative management of the pancreas, surgical procedures of the pancreas are associated with a high rate of complications, resulting in a relevant morbidity and mortality. Early diagnosis and management of complications associated with pancreas surgery is mandatory, favoring a multidisciplinary approach. Methods Interventional radiology offers minimal invasive techniques to manage post-surgical complications. These procedures are highlighted in this review, including percutaneous drainage of fluid collections, percutaneous transhepatic biliary interventions, arterial embolisation and fistula embolisation. Results Post-surgical complications of pancreatic surgery are effectively managed by radiological procedures, offering a feasible and safe treatment with low morbidity rates. Accurate patient selection is key to an effective management of clinical situations where these interventions represent the first line approach. Conclusions Radiologic procedures allow for minimal invasive treatment of postoperative complications af

Research paper thumbnail of Impact of bile leakage on perioperative and long-term oncological outcome

HPB, 2018

Introduction: Hydatidosis is an endemic zoonosis, caused by the parasite Echinoccocus granulosus.... more Introduction: Hydatidosis is an endemic zoonosis, caused by the parasite Echinoccocus granulosus. The liver is the most commonly affected organ. The disease is slowly progressive and may remain asymptomatic for several years. When symptomatic, the clinical presentation may vary from abdominal pain, jaundice and even anaphylactic shock in extreme cases. One of the most common complications of disease is the fistulization of a hydatid cyst into the biliary tree. However, other intrahepatic structures may be rarely involved. The purpose of this study is to report a case of liver hydatid cyst with direct portal vein invasion, an unusual complication of this condition. Methods: case report. Results: A 62-year-old man comes to the outpatient clinic referring abdominal pain in the right hypocondrium for 3 months. He denies jaundice and weight loss. He claims to have been travelling in South America for several months. CT scan shows multiple confluent cysts in segments VII and VIII, with heterogeneous content and parietal calcifications, measuring about 13 x 6.5 cm. Two other cystic images with the same characteristics are present in segment V. There is thrombosis of the right portal branch. The thrombus has attenuation similar to the cystic lesions described above, corresponding to the portal extension of the hydatid cyst. The patient underwent an open right hepatectomy and gross examination of the surgical specimen confirmed the presence of hydatid material inside the right portal branch. Conclusion: Although rarely, hydatid cysts may directly involve the portal vein.

Research paper thumbnail of Major vascular resection and reconstruction combined with liver resection for primary and metastatic hepatic tumors

Research paper thumbnail of Impact of primary tumour location on long-term survival after hepatic resection for colorectal liver metastasis

HPB, 2018

The impact of primary tumour location (sidedness) in colorectal cancer has been thoroughly invest... more The impact of primary tumour location (sidedness) in colorectal cancer has been thoroughly investigated in first-lineand palliative chemotherapystudies. While in these patients, right-sided tumours were associated with worse outcome, data on impact of sidedness concerning postoperative long-term survival after resection for colorectal liver metastasis (CRLM) are scarce. Methods: All patients undergoing hepatic resection for newly diagnosed CRLM in two Austrian high-volume centres between 2003e2016 were analysed. Influence of patient, treatment and tumour characteristics on postoperative survival was evaluated. Results: A total of 252 patients (40% female; median 64a) underwent resection with a 90-day-mortality of 1.2% (31% major resections, 55% received preoperative chemotherapy). Primary tumour characteristics were: 25% rightsided, 57% nodal positive. Metastasis characteristics were: synchronous metastasis in 64%, 38% bilobar hepatic

Research paper thumbnail of Surgical techniques and strategies for the treatment of primary liver tumours: hepatocellular and cholangiocellular carcinoma

European Surgery, 2018

Background Owing to remarkable improvements of surgical techniques and associated specialities, l... more Background Owing to remarkable improvements of surgical techniques and associated specialities, liver surgery has become the standard of care for hepatocellular carcinoma and cholangiocarcinoma. Although applied with much greater safety, hepatic resections for primary liver tumours remain challenging and need to be integrated in a complex multidisciplinary treatment approach. Methods This literature review gives an update on the recent developments regarding basics of open and laparoscopic liver surgery and surgical strategies for primary liver tumours. Results Single-centre reports and multicentre registries mainly from Asia and Europe dominate the surgical literature on primary liver tumours, but the numbers of randomized trials are slowly increasing. Perioperative outcomes of open liver surgery for hepatocellular and cholangiocellular carcinoma have vastly improved over the last decades, accompanied by some progress in terms of oncological outcome. The laparoscopic approach is increasingly being applied in many centres, even for patients with underlying liver disease, and may result in decreased morbidity. Liver transplantation represents

Research paper thumbnail of Intraductal tubulopapillary neoplasm (ITPN) of the pancreas associated with an invasive component: a case report with review of the literature

World Journal of Surgical Oncology, 2017

Background: Intraductal tubulopapillary neoplasm (ITPN) depicts a distinct entity in the subgroup... more Background: Intraductal tubulopapillary neoplasm (ITPN) depicts a distinct entity in the subgroup of premalignant epithelial tumors of the pancreas. Although the histomorphological and immunophenotypical characterization of ITPN has been described by several authors in terms of report of case series in the past, the rarity of that tumor subtype and similarity to other entities still makes identification of ITPN a challenge for radiologists and pathologists. To date, little is known about tubulopapillary carcinoma that can evolve from ITPN. Case presentation: In the present work, we analyze one case of ITPN associated with an invasive component and discuss the results involving the current literature. Collected patient data included medical history, clinical symptoms, laboratory tests, radiological imaging, reports of interventions and operation, and histopathological and immunohistochemical examinations. The patient initially presented with acute pancreatitis. A solid tumor obstructing the main pancreatic duct and sticking out of the papilla of Vater was detected and caught via endoscopic intervention. Histopathological examination of the specimen revealed mainly tubular growth pattern with back to back tubular glands. Immunohistochemically, the tumor was strongly positive for keratin 7 (CK7) and pankeratin AE1/AE3, and alpha 1 antichymotrypsin; negative for synaptophysin and chromogranin A, CDx2, CK20, S100, carcinoembryonic antigen (CEA), MUC 2, MUC5AC, and somatostatin; and in part positive for CA19-9. Extended pancreatoduodenectomy was performed, the final diagnosis was tubulopapillary carcinoma grown in an ITPN. Conclusion: The identification of an ITPN of the pancreas can be a challenging task. Endoscopic retrograde cholangiopancreaticography is an excellent tool to directly see and indirectly visualize the intraductal solid tumor and to take a biopsy for histopathological evaluation at the same time. Together with a thorough immunohistochemical workup, differential diagnoses can be ruled out quickly. To date, reports of ITPN are rare and little is known about the potential for malignant transformation and the prognosis of tubulopapillary carcinoma grown from an ITPN. Radical surgical resection following oncologic criteria is recommended; however, more data will be needed to assess an adequate treatment and follow-up standard.

Research paper thumbnail of Good Results with Individually Adapted Long-Term Immunosuppression Following Alemtuzumab Versus ATG Induction Therapy in Combined Kidney-Pancreas Transplantation: A Single-Center Report

Annals of Transplantation, 2019

Departmental sources Retrospective analysis of the long-term results of a randomized controlled t... more Departmental sources Retrospective analysis of the long-term results of a randomized controlled trial comparing alemtuzumab (ALEM) and antithymocyte globulin (ATG) as induction therapy in simultaneous pancreas-kidney transplantation (SPK) to address individualized long-term immunosuppression. Between 2006 and 2010 a total of 30 SPKs were randomized to treatment with ALEM plus tacrolimus (TAC) monotherapy (Group A, n=14) versus ATG induction plus TAC, mycophenolate mofetil (MMF) and steroids (Group B, n=16), followed by individualized long-term immunosuppression. We here present the long-term results for graft survival, graft function, and major complications. The 9-year patient survival rates in Groups A and Group B were 92.9% and 86.7% respectively; pancreas graft survival was 75.0% and 65.0% respectively; renal graft survival was 83.1% and 93.8% respectively. Long-term graft function was excellent with a creatinine of 1.5 mg/dL and 1.4 mg/dL, fasting glycemia of 104 mg/dL and 102 mg/dL, hemoglobin (Hb) A1c of 5.4 g% and 5.6 g% in Group A and Group B, respectively. Major complications were comparable in both groups. Good long-term results for patient, pancreas graft and kidney graft survival were achieved in both groups with individually adapted maintenance immunosuppression. ALEM is a valid induction therapy.

Research paper thumbnail of Sex differences in disease presentation, surgical and oncological outcome of hepatic resection for primary and metastatic liver tumours

52. Jahrestagung & 30. Fortbildungskurs der Österreichischen Gesellschaft für Gastroenterologie & Hepatologie (ÖGGH), 2019

patients who underwent laparoscopic or open cholecystectomies for acute or chronic cholecystitis ... more patients who underwent laparoscopic or open cholecystectomies for acute or chronic cholecystitis and suspicious gall bladder neoplasia. Methods: A retrospective chart review was conducted for patients who underwent laparoscopic or open cholecystectomies for acute or chronic cholecystitis and suspicious gall bladder neoplasia between September 2009 to November 2018. The study outcomes included the prevalence of Florid XCG, Clinical, Radiological, Intraoperative Characteristics, and Clinical Outcomes. Results: A total of 1963 patients were included in final data analysis, of whom 5 (0.25%) cases were diagnosed as florid XGC. The florid XGC mean age was (54.2; range: 33-63), and the majority 4 cases (80%) were males. Abdominal pain, Nausea, and Vomiting were the most frequent presenting clinical symptoms. Intraoperative findings included invasion to the liver, Adjacent pylorus, First part of the duodenum, and Colon. Postoperative complications occurred in (60%) with no mortality being observed in the patients. Conclusion: Florid XCG is a rare condition affecting the gall bladder however misdiagnosis with other conditions especially malignancy can have far reaching consequences for the patient health. Hence, Preoperative identification of XGC is essential for proper surgical management. Open cholecystectomy with complete resection of adjacent Xanthogranulomatous tissue is preferred in most patients due to dense fibrosis, Extensive local inflammation, and concerns of possible coexistent malignancy. A preoperative cholangiogram or FNAC and intraoperative immunohistochemistry on frozen sections examination should be considered to rule out coexisting malignancy. Florid XGC as diagnosis should be considered and reporting of such cases in medical literure will help in developing awareness and better understanding of this equivocal disease.