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- Ahlman, Håkan, 1947, et al.
(författare)
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Interventional treatment of gastrointestinal neuroendocrine tumours.
- 2000
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Ingår i: Digestion. - 0012-2823. ; 62 Suppl 1, s. 59-68
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Tidskriftsartikel (refereegranskat)abstract
- Neuroendocrine (NE) tumours of the gastrointestinal tract (carcinoids and endocrine pancreatic tumours) are rare diseases. In the presence of liver metastases these patients may suffer from disabling symptoms due to hormone overproduction. Patients with localized disease can be resected for cure and also patients with liver metastases can undergo potentially curative tumour resection. However, long-term follow-up of the latter cases indicates frequent recurrence of tumour. Using close biochemical monitoring of tumour markers combined with newer techniques for tumour visualization, these recurrences can often be diagnosed at an early stage so that repeat surgical procedures can be performed. During the last years very active surgery has been recommended for NE tumours, many of which have a relatively slow growth. Even in patients not amenable to curative liver surgery, debulking can be considered if the main tumour burden can be safely excised. The primary aim of this type of treatment is palliation of hormonal symptoms. An important question is whether the aggressive treatment actually prolongs survival. No prospective studies have been performed. Such studies are hampered by the lack of strict surgical programs running over long periods and the relative rarity of NE tumours. Liver transplantation may be another treatment modality in selected cases.
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| 2. |
- Ahlman, Håkan, 1947, et al.
(författare)
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Liver transplantation for treatment of metastatic neuroendocrine tumors
- 2004
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Ingår i: Annals of the New York Academy of Sciences. - 0077-8923. ; 1014, s. 265-9
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Tidskriftsartikel (refereegranskat)abstract
- Liver transplantation can be considered a therapeutic option for patients with neuroendocrine tumors only metastatic to the liver. Important selection criteria are well-differentiated tumors and a low proliferation rate (Ki67 <10%). In this series, orthopic liver transplantation offered good relief of symptoms and long disease-free intervals with initial survival of grafts and patients as in benign disease. The experience with multivisceral transplantation is still limited.
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| 3. |
- Olausson, Michael, 1956, et al.
(författare)
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Indications and results of liver transplantation in patients with neuroendocrine tumors.
- 2002
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Ingår i: World journal of surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 26:8, s. 998-1004
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Tidskriftsartikel (refereegranskat)abstract
- Metastases from neuroendocrine (NE) tumors of the gastrointestinal tract, carcinoids, and endocrine pancreatic tumors (EPTs) can be confined to the liver for long periods and may exhibit slow growth. When considering liver transplantation (LTx) for patients with NE tumors, the expected results with conventional treatment must be weighed against the risk of LTx and immunosuppression. The following indications for LTx may be considered for patients with metastatic NE tumors limited to the liver: (1) tumors not accessible to curative surgery or major tumor reduction; (2) tumors not responding to medical or interventional treatment; and (3) tumors causing life-threatening hormonal symptoms. We excluded patients with poorly differentiated NE carcinoma or well differentiated NE carcinoma with a high proliferation index (Ki 67 > 10%). Over 4 years (1997-2001) we have performed transplants in nine patients (five with EPTs, four with carcinoids) with a mean +/- SEM follow-up of 22 +/- 5 months (range 4-45 months). Seven patients underwent orthotopic LTx and two multivisceral LTx. Eight patients are alive, six without clinical evidence of disease. Four patients developed recurrent tumors 9 to 36 months after LTx; two were detected at an early stage and underwent resection with curative intent. One patient with multivisceral Tx died after 4 months of posttransplant lymphoproliferative disease without tumor recurrence. In selected series LTx can offer good control of hormonal symptoms, a relatively long disease-free interval, and in individual cases potential cure.
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| 4. |
- Brandsaeter, B., et al.
(författare)
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Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy
- 2004
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Ingår i: Journal of hepatology. - : Elsevier BV. - 0168-8278. ; 40:5, s. 815-22
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Hepatobiliary malignancies are frequently seen in primary sclerosing cholangitis (PSC) and they complicate the evaluation of patients and timing of liver transplantation. METHODS: Data from all Nordic PSC patients listed for liver transplantation during 1990-2001 were recorded prospectively. Predictors of hepatobiliary malignancy and patient survival rates have been analysed. RESULTS: Hepatobiliary malignancy was found in 52/255 (20%) patients accepted to the waiting list. Recent diagnosis of PSC, no ursodeoxycholic acid (UDCA) treatment, clinical suspicion and previous colorectal-cancer were predictors of malignancy. Among 89 patients with a strong suspicion of malignancy prior to acceptance, 35 (39%) had confirmed malignancy. A clinical suspicion had been raised in 35/52 (67%) patients with malignancy. Malignancy was found in 31/223 patients who received a liver allograft. The 1-, 3- and 5-year patient survival rates following transplantation for patients with PSC and cholangiocarcinoma were 65, 35 and 35%, respectively. CONCLUSIONS: Hepatobiliary malignancy is suspected in 1/3 of the PSC patients and found in 1/5. Although cholangiocarcinoma is regarded as a contraindication to liver transplantation (LTX), PSC patients with cholangiocarcinoma had a 35% 5-year survival following transplantation.
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| 5. |
- Madsen, M., et al.
(författare)
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Application of human leukocyte antigen matching in the allocation of kidneys from cadaveric organ donors in the Nordic countries
- 2004
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Ingår i: Transplantation. - 0041-1337. ; 77:4, s. 621-3
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Tidskriftsartikel (refereegranskat)abstract
- The Nordic organ exchange organization Scandiatransplant was founded in 1969. It covers a population of 24.41 million inhabitants in five countries: Denmark (5.45 million), Finland (5.19 million), Iceland (0.29 million), Norway (4.54 million), and Sweden (8.94 million). Initially, the purpose of Scandiatransplant was to establish and maintain a common waiting list for all Nordic patients with end-stage renal failure waiting for a cadaveric kidney transplant. The basis of maintaining a common Nordic waiting list was the recognition of the wide polymorphism of the human leukocyte antigen system, which demands a substantial pool of waiting patients to provide optimal histocompatibility matching between organ donor and recipient. Thus, one of the major tasks of the organization was and still is to specify rules for the exchange of kidneys between the participating transplant centers. Scandiatransplant includes the cooperation of all 10 Nordic kidney transplant centers in addition to eight immunology laboratories. Denmark has four transplant centers located in Copenhagen, Herlev, Odense, and Aarhus. Finland has one center in Helsinki. Norway has one center located in Oslo. Sweden has four kidney transplantation centers located in each of the university hospitals in Goteborg, Malmo, Stockholm, and Uppsala. The fifth Nordic country, Iceland, is participating fully in organ donation but has no individual transplant center. Organ transplantation in Icelandic patients is performed in other Nordic countries.
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