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![]() Prediction of partial liver function and volume after portal vein embolisation
Liver Resection is a standard procedure in patients suffering from liver metastasis or primary liver tumor. Up to 70-80% of the healthy liver volume can be removed without disadvantages to the patient. Due to regeneration processes liver volume and function reconstitute within 3 to 6 weeks after operation to preoperative values. However due to liver insufficiency, higher mortality rates occur in patients with low future liver remnant (<25%, FLR). Embolization of the right portal vein branch (PVE) is nowadays a commonly used procedure to pre-condition the liver before extended resection of the right lobe (liver segments IV-VIII). The volume of the left lateral liver lobe (FLR, segments II and III) increases due to PVE already before liver resection. Thus PVE leads to decreased postoperative morality and increased operability rates.
Project start: January 2012
Project status: clinical phase
Doctoral fellows: Thomas Keuchel / Clemens Wagner
Tutor: Dr. med. M. Malinowski
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![]() a ICT-enabled, cellular artificial liver system incorporating personalized patient management and support
Chronic liver disease continues to be a frequent situation in today's population. Progressive liver tissue destruction results in inability to perform normal organ function. In turn, decompensation in chronic liver insufficiency results in impairment of liver function and development of complications. Liver failure is life-threatening and due to chronic graft shortage patients have to wait a long time for a curative organ replacement.
d-LIVER aims to provide remote ICT-enabled health monitoring of chronic liver failure patients in the home environment resulting in a much more efficient treatment and reduction of complications. Moreover the development of a remote monitored and controlled bio-artificial liver support devicer might replaced liver function properly. By means of the d-LIVER solution the quality of provided medical care may improve and in turn patients' quality of life might increase. Moreover d-LIVER might reduce the incidence and duration of hospitalization and consequently reduce the health economic burden of chronic liver disease.
Project start: November 2011
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![]() Early diagnosis of liver failure in septic patients using LiMAx test. Comparison with conventional methods
Patients in a bacterial sepsis are on a high risk to develop a multi organ failure. Since the liver is highly vulnerable to a deficient perfusion, the occurence of sepsis will soon lead to a dysfunction of this crucial organ. During sepsis the mutual interaction between hepatocyts, kupffer cells and endothelial cells causes a very complex immune response. In this process the liver is not only a victim but it also keeps the inflammatory response syndrome a live.
Project start: July 2011
Project status: clinical phase
Doctoral fellows: Hannah Vetter / Navid Ahmadi
Tutor: Dr. med. M. Kaffarnik
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![]() Influence of intraoperative bile duct obstruction on the postoperative liver function
Project start: March 2011
Project status: clinical phase
Doctoral fellow: Amir Kotobi
Tutor: Dr. med. J. Lock
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![]() Clinical course of patients with Klatskin-tumour depending on
operational intervention
Radical surgery represents the only curative option in patients with Klatskin tumors. Surgical intervention in terms of extended liver resection with en-bloc-resection of the extrahepatic bile duct can be either performed as an extended right-side hemihepatectomy or as extended left-side hemihepatectomy. Both interventions bear risk of postoperative complications. After extended right-side hemihepatectomy increased postoperative liver function due to larger resectate volume whereas after extended left-sided hemihepatectomy rather surgical complications such as bilioms have to be expected.
As there are no common criteria for decision making between extended right-side versus extended left-side hemihepatectomy in certain cases the decision which procedure will promise better results remains difficult.
Project start: January 2011
Project status: clinical phase
Doctoral fellow: Lina Demirel
Tutor: Dr. med. M. Malinowski
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![]() www.cellsignal.com
Importance of expression patterns of several cytokines and growth factors after liver resection to estimate the potential of liver regeneration
Liver resection has become a standard therapy in modern surgery. Surgical procedures have been improved but the postoperative morbidity and mortality caused by liver dysfunction are still a major problem.
Therefore reliable und quick diagnostic tools in the field of liver function capacity are indispensable. The LiMAx test is a method to determine the maximum of liver function capacity. Aditionally there are surveys dealing with the temporal course of several cytocines and growth factors after liver resection. Most of these accomplished on animals show a correlation between cytocines/ growth factors and liver regeneration. Thereby there shoud be developed a better comprehension of the relationship between regeneration and function of the liver. In this process a better prediction of liver damage might be possible.
Project start: June 2010
Project status: clinical phase
Doctoral fellows: Juliane Aurich / Felix Wohlgemuth / Tim Reese
Tutor: Dr. med. A. Schulz
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![]() Influence of chemotherapy on liver function in patients with colorectal liver metastases
Liver metastases are found in approximately 50% of the patients with colorectal cancer. Resection of these metastases is the only curative treatment for these patients. However, only about 20% of them are deemed resectable at the time of diagnosis of their metastases. Neoadjuvant chemotherapy has been found to improve resection rates and is therefore increasingly administered preoperatively in order to achieve higher resection rates and a better overall survival. However, recently concerns have arisen about the influence of chemotherapy on liver function and a resulting higher morbidity and mortality.
The objective of this study is therefore to investigate the influence of chemotherapy on liver function (measured with the new LiMAx-test) and to find a possible connection between chemotherapy, liver function, morbidity and mortality.
Project start: May 2009
Project status: writing
Doctoral fellow: Tilman Westphal
Tutor: Dr. med. J. Lock
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![]() Transcriptional pathways of hepatic steatosis
Hepatic regulation of glucose and lipid homeostasis is influenced by various hormones, signalling pathways and transcriptional factors. Regarding animal-experimental research there is little doubt, that hepatic steatosis influences liver function and regeneration. An evidence for casual relationship between fatty liver and low grade of postoperative regeneration in human being is lacking. In our prospective clinical trial we will analyze human liver and fat tissue to provide datas concerning the molecular hepatic pathways in correlation to clinical liver function tests (LiMAx, ICG), blood parameters and a standardized clinical reporting form.
Project start: February 2009
Project status: writing
Doctoral fellow: Steffi Hoppe
Tutor: Dr. med. J. Lock
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![]() Prognostic potential of different tests for liver function in patients with cirrhosis
Despite an increasing demand of liver grafts for transplantation within recent years, the actual number of available donors has remained stable and insufficient. As a consequence, the patients' mortality on waiting lists remains a reasonable problem in medicine.
Therefore the allocation of grafts is a valuable tool to limit the problems arising from donor shortage. Effective transplant waiting lists allocate the available grafts firstly to those patients, who would have had a poor prognosis without transplantation. Nevertheless, it is a challenging issue to identify these patients, because a certain number of tests and classification systems are available to assess end-stage liver disease.
Liver allocation is currently based on the model for end-stage liver disease score (MELD). The MELD score includes 3 laboratory parameters: International Normalized Ratio (INR), serum creatinine and serum bilirubin. Clinical studies revealed its potential to predict short-term prognosis (6-month mortality). Nevertheless more and more authors criticize the problems and limitations of the MELD-Score.
Therefore additional parameters for the classification of graft function need to be explored for further optimization of the organ allocation system.
Project start: February 2009
Project status: clinical phase
Doctoral fellows: Susanne Biele / Dimitry Shelkov / Katja Lüttgert
Tutor: Dr. med. M. Malinowski / Dr. med. univ. M. Jara
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![]() Enhancing the safety of oncological liver resection by virtual preoperative planning of the residual liver-volume and function (FUSION Study)
In the current treatment of liver tumors, the curative approach of partial resection plays the most important role. Although this procedure is considered to be relatively safe, postoperative liver failure by inappropriate residual liver volume remains a life-threatening complication, which surgeons strive to avoid. Hence, a tool for the effective planning of postoperative liver volume and functional capacity is necessary to improve patients' outcome. We evaluate a novel system consisting of virtual resection by 3D-computer tomography and the LiMAx-Test for maximal enzymatic liver function capacity for enhanced planning of residual volume and function in a prospective clinical trial.
Project start: October 2008
Project status: clinical phase
Doctoral fellows: Rhea Röhl / Antje Kirchstein
Tutor: Dr. med. M. Malinowski
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