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Vogl M, Scheed A, Seebacher G, Stubenberger E, Ghanim B. A novel mutation of the folliculin gene causing Birt-Hogg-Dubé syndrome as rare cause for secondary pneumothorax. Oxf Med Case Reports 2020; 2020:omaa016. [PMID: 32257251 PMCID: PMC7104189 DOI: 10.1093/omcr/omaa016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
The Birt–Hogg–Dubé syndrome is an orphan genetic disease characterized by the development of renal neoplasms, fibrofolliculomas, pulmonary cysts and spontaneous pneumothoraces. Here, we report on the case of a 21-year-old man presenting with a primary event of a persistent spontaneous pneumothorax. Computed tomography images and a positive family history for pneumothoraces led to the suspicion of Birt–Hogg–Dubé syndrome. Genetic testing then confirmed the suspected clinical diagnosis, however with a mutation that has not yet been reported.
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Affiliation(s)
- Melanie Vogl
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Axel Scheed
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Institute of Clinical Surgery, Karl Landsteiner Society, Krems an der Donau, Austria
| | - Gernot Seebacher
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Institute of Clinical Surgery, Karl Landsteiner Society, Krems an der Donau, Austria
| | - Elisabeth Stubenberger
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Bahil Ghanim
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Institute of Clinical Surgery, Karl Landsteiner Society, Krems an der Donau, Austria
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Ghanim B, Rosenmayr A, Stockhammer P, Vogl M, Celik A, Bas A, Kurul IC, Akyurek N, Varga A, Plönes T, Bankfalvi A, Hager T, Schuler M, Hackner K, Errhalt P, Scheed A, Seebacher G, Hegedus B, Stubenberger E, Aigner C. Tumour cell PD-L1 expression is prognostic in patients with malignant pleural effusion: the impact of C-reactive protein and immune-checkpoint inhibition. Sci Rep 2020; 10:5784. [PMID: 32238865 PMCID: PMC7113285 DOI: 10.1038/s41598-020-62813-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/19/2020] [Indexed: 12/23/2022] Open
Abstract
Malignant pleural effusion (MPE) confers dismal prognosis and has limited treatment options. While immune-checkpoint inhibition (ICI) proved clinical efficacy in a variety of malignancies, data on the prognostic role of PD-L1 in MPE is scarce. We retrospectively studied PD-L1 tumour proportion score and Ki-67 index in pleural biopsies or cytologies from 123 patients (69 lung cancer, 25 mesothelioma, and 29 extrathoracic primary malignancies). Additionally, the impact of C-reactive protein (CRP) and platelet count was also analysed. Median overall survival (OS) after MPE diagnosis was 9 months. Patients with PD-L1 positive tumours (≥1%) had significantly shorter OS than patients with negative PD-L1 status (p = 0.031). CRP and Ki-67 index were also prognostic and remained independent prognosticators after multivariate analysis. Interestingly, Ki-67 index and CRP influenced the prognostic power of PD-L1. Finally, patients receiving ICI tended to have a longer median OS and CRP - but not PD-L1 - was a significant prognosticator in this subgroup. In summary, histological and circulating biomarkers should also be taken into account as potential biomarkers in ICI therapy and they may have an impact on the prognostic power of PD-L1. Our findings might help personalizing immune-checkpoint inhibition for patients with MPE and warrant further prospective validation.
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Affiliation(s)
- Bahil Ghanim
- Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria
- Karl Landsteiner Society - Institute for Clinical Surgery, Krems an der Donau, Austria
| | - Anna Rosenmayr
- Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria
| | - Paul Stockhammer
- University Duisburg-Essen, University Medicine Essen - Ruhrlandklinik, Department of Thoracic Surgery, Essen, Germany
- Medical University of Vienna, Department of Thoracic Surgery, Vienna, Austria
| | - Melanie Vogl
- Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria
- Karl Landsteiner Society - Institute for Clinical Surgery, Krems an der Donau, Austria
| | - Ali Celik
- Gazi University School of Medicine, Department of Thoracic Surgery, Ankara, Turkey
| | - Aynur Bas
- Gazi University School of Medicine, Department of Thoracic Surgery, Ankara, Turkey
| | - Ismail Cuneyt Kurul
- Gazi University School of Medicine, Department of Thoracic Surgery, Ankara, Turkey
| | - Nalan Akyurek
- Gazi University School of Medicine, Department of Pathology, Ankara, Turkey
| | - Alexander Varga
- Karl Landsteiner University of Health Sciences, Department of Pathology, University Hospital Krems, Krems an der Donau, Austria
| | - Till Plönes
- University Duisburg-Essen, University Medicine Essen - Ruhrlandklinik, Department of Thoracic Surgery, Essen, Germany
| | - Agnes Bankfalvi
- University Duisburg-Essen, University Medicine Essen, Department of Pathology, Essen, Germany
| | - Thomas Hager
- University Duisburg-Essen, University Medicine Essen, Department of Pathology, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Duisburg-Essen, & German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
| | - Klaus Hackner
- Karl Landsteiner University of Health Sciences, Department of Pneumology, University Hospital Krems, Krems an der Donau, Austria
| | - Peter Errhalt
- Karl Landsteiner University of Health Sciences, Department of Pneumology, University Hospital Krems, Krems an der Donau, Austria
| | - Axel Scheed
- Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria
- Karl Landsteiner Society - Institute for Clinical Surgery, Krems an der Donau, Austria
| | - Gernot Seebacher
- Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria
- Karl Landsteiner Society - Institute for Clinical Surgery, Krems an der Donau, Austria
| | - Balazs Hegedus
- University Duisburg-Essen, University Medicine Essen - Ruhrlandklinik, Department of Thoracic Surgery, Essen, Germany
| | - Elisabeth Stubenberger
- Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria.
- Karl Landsteiner Society - Institute for Clinical Surgery, Krems an der Donau, Austria.
| | - Clemens Aigner
- University Duisburg-Essen, University Medicine Essen - Ruhrlandklinik, Department of Thoracic Surgery, Essen, Germany.
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Slama A, Barta M, Schillab L, Mitterbauer A, Benedek A, Hoetzenecker K, Scheed A, Lang G, Matilla J, Taghavi S, Jaksch P, Klepetko W, Aigner C. F-129PHYSIOLOGICAL ASSESSMENT AND CLINICAL OUTCOMES OF EX-VIVO PERFUSED MARGINAL DONOR LUNGS. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Ghanim B, Scheed A, Simonitsch-Klupp I, Klepetko W, Ankersmit HJ. Chondroid hamartoma of the lung presenting as cavern. Clin Respir J 2015; 10:671-2. [PMID: 25619409 DOI: 10.1111/crj.12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Bahil Ghanim
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Axel Scheed
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. .,Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna.
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Jaksch P, Ankersmit J, Scheed A, Kocher A, Muraközy G, Klepetko W, Lang G. Alemtuzumab in lung transplantation: an open-label, randomized, prospective single center study. Am J Transplant 2014; 14:1839-45. [PMID: 25039364 DOI: 10.1111/ajt.12824] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/18/2014] [Accepted: 03/27/2014] [Indexed: 01/25/2023]
Abstract
Induction therapy with alemtuzumab followed by lower maintenance immunosuppression (IS) has been associated with reduced morbidity and mortality in abdominal and heart transplantation (TX). In the current study, alemtuzumab, in combination with reduced levels of maintenance IS, was compared to thymoglobulin in combination with standard IS. Sixty consecutive patients who underwent lung transplantation (LUTX) at a single center were prospectively randomized in two groups: group A received alemtuzumab in conjunction with reduced doses of tacrolimus, steroids and mycophenolate mofetil. Group B received thymoglobulin in association with standard dose IS. Patient and graft survival, freedom from acute cellular rejection (ACR), lymphocytic bronchiolitis, bronchiolitis obliterans syndrome, kidney function, infectious complications and posttransplant lymphoproliferative disorder were analyzed. Alemtuzumab induction therapy resulted in complete the absence of ACR episodes ≥ A2 within the first year post-TX. The difference to thymoglobulin was significant (alemtuzumab 0 vs. ATG 0.33; p = 0.019). All other factors studied did not show any differences between the two groups. Alemtuzumab induction therapy after LUTX in combination with reduced maintenance IS significantly reduces higher-grade rejection rates. This novel therapeutic agent had no impact on survival, infections rates, kidney function and incidence of malignancies.
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Affiliation(s)
- P Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Wien, Austria
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Slama A, Ghanim B, Klikovits T, Scheed A, Hoda MA, Hoetzenecker K, Jaksch P, Matilla J, Taghavi S, Klepetko W, Aigner C. Lobar lung transplantation--is it comparable with standard lung transplantation? Transpl Int 2014; 27:909-16. [PMID: 24810771 DOI: 10.1111/tri.12348] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/17/2014] [Accepted: 05/05/2014] [Indexed: 01/05/2023]
Abstract
Lobar lung transplantation is used mainly for urgent small recipients who are less likely to obtain size matched lungs in due time. Only limited numbers have been published, and we herewith report the largest series of lobar-LuTX. We analyzed our LuTX database from 1/2001 to 12/2012 and compared the outcome of lobar-LuTX recipients with those receiving standard LuTX. Seven hundred and seventy-eighty LuTX (group 1) were performed either in standard technique by implanting the whole lungs (n = 539) or with downsizing by wedge resection of the right middle lobe and/or the left lingula (n = 239). One hundred and thirty-eight LuTX were performed in lobar technique (group 2) to overcome more pronounced size discrepancies. Patients in group 1 had a different spectrum of diagnoses and were less frequently bridged to LuTX (P < 0.001). Intubation time, ICU stay, and hospital stay were shorter in group 1 (P < 0.001). One-year survival was 84.8% vs. 65.1%, and 5-years survival 69.9% vs. 54.9% (P < 0.001). In multivariate analyzes, procedure, diagnosis, and pre-operative bridging were shown to be significant prognostic factors in survival. Early postoperative outcome in Lobar LuTX was significantly inferior to standard LuTX recipients. However, survival rates of successfully dismissed patients were comparable with standard LuTX (P = 0.168); thereby, Lobar-LuTX remains an important option in the management of urgent small recipients.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Weseslindtner L, Kerschner H, Steinacher D, Kundi M, Jaksch P, Simon B, Hatos-Agyi L, Scheed A, Klepetko W, Puchhammer-Stöckl E. Association of human cytomegalovirus DNAaemia and specific granzyme B responses in lung transplant recipients. Clin Exp Immunol 2013; 173:438-43. [PMID: 23607435 DOI: 10.1111/cei.12123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/18/2022] Open
Abstract
In lung transplant recipients (LTRs), human cytomegalovirus (HCMV) DNAaemia could be associated with HCMV disease and reduced allograft survival. In the present study we analysed whether or not HCMV-specific granzyme B (Grz-B) responses indicating CD8(+) T cell cytotoxicity exert an impact on HCMV DNAaemia and relate to specific interferon (IFN)-γ secretion. HCMV-specific Grz-B responses were quantitated by enzyme-linked immunosorbent assay (ELISA) in 70 samples from 39 HCMV seropositive LTRs who were prospectively investigated for HCMV DNA plasma levels and IFN-γ kinetics using a standardized CD8(+) T cell assay (QuantiFERON®-CMV assay). In all LTRs who were protected from HCMV DNAaemia by early and persistent IFN-γ responses, Grz-B responses were also detected. In LTRs who developed episodes of HCMV DNAaemia, the Grz-B responses which were detected prior to viral DNA detection differed significantly in patients who experienced episodes with high (exceeding 1000 copies/ml) and low plasma DNA levels (P = 0·0290, Fisher's exact test). Furthermore, the extent of Grz-B release prior to viral DNAaemia correlated statistically with the detected levels of IFN-γ (P < 0·0001, Spearman's rank test). Of note, simultaneous detection of Grz-B and IFN-γ secretion was associated significantly with protection from high HCMV DNA plasma levels during the subsequent follow-up (P = 0·0057, Fisher's exact test), and this association was stronger than for IFN-γ detection alone. We conclude that, in addition to IFN-γ responses, Grz-B secretion by CD8(+) T cells is essential to control HCMV replication and a simultaneous measurement of IFN-γ and Grz-B could contribute to the immune monitoring of LTRs.
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Affiliation(s)
- L Weseslindtner
- Department of Virology, Medical University of Vienna, Vienna, Austria
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Slama A, Hoda A, Klikovits T, Scheed A, Hötzenecker K, Matilla J, Lang G, Taghavi S, Klepetko W, Aigner C. Lobar Lung Transplantation – Is It Comparable to Standard Lung Transplantation? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Slama A, Scheed A, Hötzenecker K, Lang G, Urbanek B, Schmid W, Nierscher FJ, Klepetko W, Aigner C. The Importance of Repeated Measurements To Assess Transplant Suitability in Clinical Ex Vivo Lung Perfusion (EVLP). J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jaksch P, Scheed A, Keplinger M, Ernst MB, Dani T, Just U, Nahavandi H, Klepetko W, Knobler R. A prospective interventional study on the use of extracorporeal photopheresis in patients with bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant 2013; 31:950-7. [PMID: 22884382 DOI: 10.1016/j.healun.2012.05.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/23/2012] [Accepted: 05/15/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of this prospective study was to evaluate the efficacy and safety of extracorporeal photopheresis (ECP) in patients with bronchiolitis obliterans syndrome (BOS) after lung transplantation and to identify factors predicting treatment response. METHODS The study was performed at a single center and consisted of a cohort of 1,012 lung transplant recipients (November 1989-June 2010). A total of 194 patients developed BOS after a mean of 1,293 ± 1,008 days (range, 99-4,949 days) and received established treatment, and 51 patients received additional ECP. RESULTS Thirty-one (61%) of the ECP-treated patients responded to the therapy and showed sustained stabilization (forced expiratory volume in 1 second range, -5% to 5% vs baseline at start of ECP) of lung function over 6 months. Responders to ECP showed significantly greater survival and less need for retransplantation (p = 0.001) than non-responders. Factors associated with an inferior treatment response were cystic fibrosis as underlying lung disease and a longer time between transplantation and development of BOS. No side effects were observed after ECP. Compared with BOS patients not treated with ECP, the ECP responders showed an improved graft survival (p = 0.05). CONCLUSIONS These results confirm and suggest that early use of ECP could be an effective adjunct treatment for patients who develop BOS after lung transplantation.
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Affiliation(s)
- Peter Jaksch
- Department of Thoracic Surgery, University Hospital Vienna, Vienna, Austria.
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Jaksch P, Wiedemann D, Augustin V, Muraközy G, Scheed A, Kocher AA, Klepetko W. Antithymocyte globulin induction therapy improves survival in lung transplantation for cystic fibrosis. Transpl Int 2012; 26:34-41. [DOI: 10.1111/j.1432-2277.2012.01570.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Savai R, Pullamsetti SS, Kolbe J, Bieniek E, Voswinckel R, Fink L, Scheed A, Ritter C, Dahal BK, Vater A, Klussmann S, Ghofrani HA, Weissmann N, Klepetko W, Banat GA, Seeger W, Grimminger F, Schermuly RT. Immune and inflammatory cell involvement in the pathology of idiopathic pulmonary arterial hypertension. Am J Respir Crit Care Med 2012; 186:897-908. [PMID: 22955318 DOI: 10.1164/rccm.201202-0335oc] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Pulmonary arterial hypertension (PAH) is characterized by vasoconstriction and vascular remodeling. Recent studies have revealed that immune and inflammatory responses play a crucial role in pathogenesis of idiopathic PAH. OBJECTIVES To systematically evaluate the number and cross-sectional distribution of inflammatory cells in different sizes of pulmonary arteries from explanted lungs of patients with idiopathic PAH versus healthy donor lungs and to demonstrate functional relevance by blocking stromal-derived factor-1 by the Spiegelmer NOX-A12 in monocrotaline-induced pulmonary hypertension in rats. METHODS Immunohistochemistry was performed on lung tissue sections from patients with idiopathic PAH and healthy donors. All positively stained cells in whole-lung tissue sections, surrounding the vessels, and in the different compartments of the vessels were counted. To study the effects of blocking SDF-1, rats with monocrotaline-induced pulmonary hypertension were treated with NOX-A12 from Day 21 to Day 35 after monocrotaline administration. MEASUREMENTS AND MAIN RESULTS We found a significant increase of the perivascular number of macrophages (CD68(+)), macrophages/monocytes (CD14(+)), mast cells (toluidine blue(+)), dendritic cells (CD209(+)), T cells (CD3(+)), cytotoxic T cells (CD8(+)), and helper T cells (CD4(+)) in vessels of idiopathic PAH lungs compared with control subjects. FoxP3(+) mononuclear cells were significantly decreased. In the monocrotaline model, the NOX-A12-induced reduction of mast cells, CD68(+) macrophages, and CD3(+) T cells was associated with improvement of hemodynamics and pulmonary vascular remodeling. CONCLUSIONS Our findings reveal altered perivascular inflammatory cell infiltration in pulmonary vascular lesions of patients with idiopathic pulmonary arterial hypertension. Targeting attraction of inflammatory cells by blocking stromal-derived factor-1 may be a novel approach for treatment of PAH.
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Affiliation(s)
- Rajkumar Savai
- Pulmonary Pharmacotherapy, Universities of Giessen and Marburg Lung Center, Aulweg 130, Giessen, Germany
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Weseslindtner L, Kerschner H, Steinacher D, Nachbagauer R, Kundi M, Jaksch P, Simon B, Hatos-Agyi L, Scheed A, Klepetko W, Puchhammer-Stöckl E. Prospective analysis of human cytomegalovirus DNAemia and specific CD8+ T cell responses in lung transplant recipients. Am J Transplant 2012; 12:2172-80. [PMID: 22548920 DOI: 10.1111/j.1600-6143.2012.04076.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In lung transplant recipients (LuTRs), human cytomegalovirus (HCMV) DNAemia may be associated with HCMV disease and reduced survival of the allograft. Because T cells are essential for controlling HCMV replication, we investigated in this prospective study whether the kinetics of plasma HCMV DNA loads in LuTRs are associated with HCMV-specific CD8+ T cell responses, which were longitudinally assessed using a standardized assay. Sixty-seven LuTRs were monitored during the first year posttransplantation, with a mean of 17 HCMV DNA PCR quantifications and 11.5 CD8+ T cell tests performed per patient. HCMV-specific CD8+ T cell responses displayed variable kinetics in different patients, differed significantly before the onset of HCMV DNAemia in LuTRs who subsequently experienced episodes of DNAemia with high (>1000 copies/mL) and low plasma DNA levels (p = 0.0046, Fisher's exact test), and were absent before HCMV disease. In HCMV-seropositive LuTRs, high-level DNAemia requiring preemptive therapy occurred more frequently when HCMV-specific CD8+ T cell responses fluctuated, were detected only after HCMV DNA detection, or remained undetectable (p = 0.0392, Fisher's exact test). Thus, our data indicate that HCMV-specific CD8+ T cells influence the magnitude of HCMV DNAemia episodes, and we propose that a standardized measurement of CD8+ T cell immunity might contribute to monitoring the immune status of LuTRs posttransplantation.
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Affiliation(s)
- L Weseslindtner
- Department of Virology, Medical University of Vienna, Vienna, Austria
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Aigner C, Slama A, Hötzenecker K, Scheed A, Urbanek B, Schmid W, Nierscher FJ, Lang G, Klepetko W. Clinical ex vivo lung perfusion--pushing the limits. Am J Transplant 2012; 12:1839-47. [PMID: 22458511 DOI: 10.1111/j.1600-6143.2012.04027.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 2-4 h. From March 2010-June 2011, 13 lungs were evaluated ex vivo. Median donor PaO(2) at FiO(2) 1.0/PEEP5 was 216 mmHg (range 133-271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO(2) higher than 350 mmHg. Median PvO(2) at final assessment in these lungs was 466 mmHg (range 434-525). These lungs were transplanted with a median total ischemic time of 577 min (range 486-678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirty-day mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.
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Affiliation(s)
- C Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
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Smeritschnig B, Jaksch P, Scheed A, Klepetko W. 520 Qualityof Life after Lung Transplantation in Patients with Cystic Fibrosis: A Cross-Sectional Study. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Aigner C, Slama A, Hötzenecker K, Urbanek B, Schmid W, Scheed A, Lang G, Keshavjee S, Klepetko W. 88 Clinical Ex Vivo Lung Perfusion – Pushing the Limits. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Weseslindtner L, Nachbagauer R, Kundi M, Jaksch P, Kerschner H, Simon B, Hatos-Agyi L, Scheed A, Aberle JH, Klepetko W, Puchhammer-Stöckl E. Human cytomegalovirus infection in lung transplant recipients triggers a CXCL-10 response. Am J Transplant 2011; 11:542-52. [PMID: 21219583 DOI: 10.1111/j.1600-6143.2010.03404.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human cytomegalovirus (HCMV) causes significant morbidity in lung transplant recipients (LTRs). The clinical effects of HCMV replication are determined partly by a type 1 T-helper cell (Th1) response. Because the chemokine interferon-inducible protein of 10 kilodaltons (IP-10, CXCL-10) induces a Th1 response, we investigated whether HCMV triggers IP-10 in LTRs. The IP-10 concentration and HCMV DNA load were determined in 107 plasma and 46 bronchoalveolar lavage fluid (BALF) samples from 36 LTRs. Initial HCMV detection posttransplantation was significantly associated with increased plasma IP-10, regardless of whether the patients showed HCMV DNAemia (p = 0.001) or HCMV replication only in the allograft (p < 0.0001). In subsequent episodes of HCMV detection, plasma IP-10 increased regardless of whether HCMV was detected in blood (p = 0.0078) or only in BALF (p < 0.0001) and decreased after successful antiviral therapy (p = 0.0005). Furthermore, levels of HCMV DNA and IP-10 correlated statistically (p = 0.0033). Increased IP-10 levels in HCMV-positive BALF samples were significantly associated with severe airflow obstruction, as indicated by a decrease in forced expiratory volume in one second (FEV1). Our data indicate that HCMV replication in LTRs evokes a plasma IP-10 response and that, when an IP-10 response is observed in BALF, it is associated with inflammatory airway obstruction in the allograft.
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Affiliation(s)
- L Weseslindtner
- Department of Virology Institute of Environmental Health Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
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Hoetzenecker K, Ankersmit HJ, Lang G, Scheed A, Marta G, Jaksch P, Klepetko W. Considerations on infectious complications using a drowned lung for transplantation. Transpl Int 2010; 23:e32-4. [DOI: 10.1111/j.1432-2277.2010.01099.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hatos-Agyi L, Scheed A, Keplinger M, Jaksch P, Klepetko W. 364: Posterior Reversible Encephalopathy Syndrome after Lung Transplantation. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hoda M, Ghanim B, Winter M, Jaksch P, Scheed A, Aigner C, Taghavi S, Lang G, Walter K. 230: Size Reduced Lung Transplantation –9 Years of Experience by a Single Centre. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jaksch P, Mueller-mang C, Zweytick B, Hoda A, Keplinger M, Scheed A, Lang G, Klepetko W. 111: Pulmonary Fibrosis and Functional Restriction: A Different Type of BO(S). J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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