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Munker D, Arnold P, Leuschner G, Irlbeck M, Michel S, Kauke T, Meiser B, Behr J, Kneidinger N, Veit T. Impact of ILD-Specific Therapies on Perioperative Course in Patients with Progressive Interstitial Lung Disease Undergoing Lung Transplantation. J Clin Med 2023; 12:4996. [PMID: 37568398 PMCID: PMC10419359 DOI: 10.3390/jcm12154996] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Immunosuppressants and antifibrotics are currently used to treat patients with various interstitial lung diseases, which may undergo lung transplantation (LTx). The retrospective study aimed to evaluate the potential effects of therapeutic regimen on the perioperative course in patients with idiopathic pulmonary fibrosis (IPF) or progressive pulmonary fibrosis (PPF) undergoing LTx. All patients with IPF and PPF undergoing LTx between January 2014 and December 2021 were included. We retrospectively screened for previous use of immunosuppressants and antifibrotic therapy. We analyzed perioperative courses, short-term outcomes, and safety retrospectively. In total, 286 patients with diagnosis of IPF or PPF were analyzed. According to the treatment regimen before LTx, the study cohort was divided into four groups and compared. No differences between antifibrotic monotherapy, combined antifibrotic and immunosuppressive therapy with regard to postoperative complications were observed. Length of mechanical ventilation was shorter in patients with antifibrotics prior to LTx. Pretreatment with antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy, lower body mass index (BMI) and lower blood loss, were independently associated with primary graft dysfunction grades 0-3 72 hours after LTx (p < 0.001). Finally, patients with antifibrotic monotherapy developed significantly less de novo donor-specific antibodies (DSA) (p = 0.009). Higher intraoperative blood loss, etiology of interstitial lung disease (ILD) and older age were independently associated with shorter survival after LTx. Use of antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy in IPF/PPF patients undergoing LTx, proved to be safe and might lead to beneficial effects after LTx.
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Affiliation(s)
- Dieter Munker
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Paola Arnold
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Gabriela Leuschner
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich (LMU), 81377 Munich, Germany;
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich (LMU), 81377 Munich, Germany;
| | - Teresa Kauke
- Department of Thoracic Surgery, University of Munich (LMU), 81377 Munich, Germany;
| | - Bruno Meiser
- Transplant Center, University of Munich, 81377 Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Tobias Veit
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
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Veit T, Barnikel M, Kneidinger N, Munker D, Arnold P, Barton J, Crispin A, Milger K, Behr J, Neurohr C, Leuschner G. Clinical Impact of Physical Activity and Cough on Disease Progression in Fibrotic Interstitial Lung Disease. J Clin Med 2023; 12:jcm12113787. [PMID: 37297982 DOI: 10.3390/jcm12113787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Physical activity limitations and cough are common in patients with interstitial lung disease (ILD), potentially leading to reduced health-related quality of life. We aimed to compare physical activity and cough between patients with subjective, progressive idiopathic pulmonary fibrosis (IPF) and fibrotic non-IPF ILD. In this prospective observational study, wrist accelerometers were worn for seven consecutive days to track steps per day (SPD). Cough was evaluated using a visual analog scale (VAScough) at baseline and weekly for six months. We included 35 patients (IPF: n = 13; non-IPF: n = 22; mean ± SD age 61.8 ± 10.8 years; FVC 65.3 ± 21.7% predicted). Baseline mean ± SD SPD was 5008 ± 4234, with no differences between IPF and non-IPF ILD. At baseline, cough was reported by 94.3% patients (mean ± SD VAScough 3.3 ± 2.6). Compared to non-IPF ILD, patients with IPF had significantly higher burden of cough (p = 0.020), and experienced a greater increase in cough over six months (p = 0.009). Patients who died or underwent lung transplantation (n = 5), had significantly lower SPD (p = 0.007) and higher VAScough (p = 0.047). Long-term follow up identified VAScough (HR: 1.387; 95%-CI 1.081-1.781; p = 0.010) and SPD (per 1000 SPD: HR 0.606; 95%-CI: 0.412-0.892; p = 0.011) as significant predictors for transplant-free survival. In conclusion, although activity didn't differ between IPF and non-IPF ILD, cough burden was significantly greater in IPF. SPD and VAScough differed significantly in patients who subsequently experienced disease progression and were associated with long-term transplant-free survival, calling for better acknowledgement of both parameters in disease management.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Alexander Crispin
- IBE-Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University, 81377 Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Hospital Schillerhoehe, Academic Teaching Hospital of the University of Tuebingen, 70376 Gerlingen, Germany
| | - Gabriela Leuschner
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
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Walter J, Kovàcs J, Munker D, Sellmer L, Kauke T, Behr J, Barton J, Kneidinger N, Schneider C, Tufman A. EP04.01-015 Lung Cancer after Solid Organ Transplantation - A Claims Data Analysis. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.427] [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: 10/14/2022]
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Kahnert K, Trudzinski FC, Berger C, Munker D, Milger K, Irlbeck M, Tomasi R, Schneider C, Michel S, Ghiani A, Herth FJF, Behr J, Jörres RA, Kneidinger N. Oxygenated Hemoglobin Predicts Outcome in Patients with Chronic Lung Allograft Dysfunction. Respiration 2022; 101:638-645. [PMID: 35354156 DOI: 10.1159/000522517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/27/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long-term outcome of lung transplantation (LTx) recipients is limited by chronic lung allograft dysfunction (CLAD). In this setting of new onset respiratory failure, the amount of oxygenated hemoglobin (OxyHem; hemoglobin (Hb) concentration × fractional oxygen saturation) may provide valuable information. OBJECTIVE We hypothesized that OxyHem predicts survival of LTx recipients at the onset of CLAD. METHODS Data from 292 LTx recipients with CLAD were analyzed. After excluding patients with missing data or supplemental oxygen, the final population comprised 218 patients. The relationship between survival upon CLAD and OxyHem was analyzed by Cox regression analyses and ROC curves. RESULTS Among the 218 patients (102 males, 116 females), 128 (58.7%) died, median survival time after CLAD onset being 1,156 days. Survival was significantly associated with type of transplantation, time to CLAD, CLAD stage at onset, and OxyHem, which was superior to Hb or oxygen saturation. The risk for death after CLAD increased by 14% per reduction of OxyHem by 1 g/dL, and values below 11 g/dL corresponded to an 80% increase in mortality risk. CONCLUSION Thus, OxyHem was identified as an independent predictor of mortality after CLAD onset. Whether it is useful in supporting therapeutic decisions and potentially home monitoring in the surveillance of lung transplant recipients has to be studied further.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
| | - Franziska C Trudzinski
- Thoraxklinik-Heidelberg gGmbH, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Christiane Berger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
| | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich (LMU), Munich, Germany
| | - Roland Tomasi
- Department of Anaesthesiology, University of Munich (LMU), Munich, Germany
| | | | - Sebastian Michel
- Clinic of Cardiac Surgery, Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
| | - Alessandro Ghiani
- Department of Respiratory Medicine, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Felix J F Herth
- Thoraxklinik-Heidelberg gGmbH, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Juergen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), University of Munich (LMU), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany
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Ghiani A, Tsitouras K, Paderewska J, Munker D, Walcher S, Neurohr C, Kneidinger N. Tracheal stenosis in prolonged mechanically ventilated patients: prevalence, risk factors, and bronchoscopic management. BMC Pulm Med 2022; 22:24. [PMID: 34991555 PMCID: PMC8740413 DOI: 10.1186/s12890-022-01821-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/14/2021] [Accepted: 12/31/2021] [Indexed: 11/14/2022] Open
Abstract
Background Various complications may arise from prolonged mechanical ventilation, but the risk of tracheal stenosis occurring late after translaryngeal intubation or tracheostomy is less common. This study aimed to determine the prevalence, type, risk factors, and management of tracheal stenoses in mechanically ventilated tracheotomized patients deemed ready for decannulation following prolonged weaning. Methods A retrospective observational study on 357 prolonged mechanically ventilated, tracheotomized patients admitted to a specialized weaning center over seven years. Flexible bronchoscopy was used to discern the type, level, and severity of tracheal stenosis in each case. We described the management of these stenoses and used a binary logistic regression analysis to determine independent risk factors for stenosis development. Results On admission, 272 patients (76%) had percutaneous tracheostomies, and 114 patients (32%) presented mild to moderate tracheal stenosis following weaning completion, with a median tracheal cross-section reduction of 40% (IQR 25–50). The majority of stenoses (88%) were located in the upper tracheal region, most commonly resulting from localized granulation tissue formation at the site of the internal stoma (96%). The logistic regression analysis determined that obesity (OR 2.16 [95%CI 1.29–3.63], P < 0.01), presence of a percutaneous tracheostomy (2.02 [1.12–3.66], P = 0.020), and cricothyrotomy status (5.35 [1.96–14.6], P < 0.01) were independently related to stenoses. Interventional bronchoscopy with Nd:YAG photocoagulation was a highly effective first-line treatment, with only three patients (2.6%) ultimately referred to tracheal surgery. Conclusions Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01821-6.
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Affiliation(s)
- Alessandro Ghiani
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic (Affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Auerbachstrasse 110, 70376, Stuttgart, Germany.
| | - Konstantinos Tsitouras
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic (Affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Joanna Paderewska
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic (Affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Munich, Germany
| | - Swenja Walcher
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic (Affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Claus Neurohr
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic (Affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Auerbachstrasse 110, 70376, Stuttgart, Germany.,Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Bolt T, Tufman A, Sellmer L, Kahnert K, Mertsch P, Kovács J, Kauffmann-Guerrero D, Munker D, Manapov F, Schneider C, Behr J, Walter J. Changes in Behavior After Vaccination and Opinions Toward Mask Wearing: Thoracic Oncology Patient–Reported Experiences During the COVID-19 Pandemic. Clin Med Insights Oncol 2022; 16:11795549221123618. [PMID: 36176285 PMCID: PMC9515761 DOI: 10.1177/11795549221123618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The COVID-19 vaccines, face masks, and social distancing are effective interventions to prevent SARS-CoV-2 infections. In this study, we aimed to determine lung cancer patients’ attitudes toward vaccination, changes in behavior after vaccination, and willingness to continue mask wearing after the pandemic. Methods: We sent out questionnaires to 220 thoracic oncology patients treated at our lung cancer center in May 2021. The questionnaire focused on patients’ vaccination status, self-reported experiences surrounding vaccination, and assessed changes in behaviors before and after vaccination as well as opinions toward mask wearing after the pandemic. Results are presented as absolute and relative frequencies and means with standard deviation and compared using t test, paired t test, and analysis of variance test as well as chi2 test, and Fisher exact text. Results: About 91.0% of patients reported having received at least 1 vaccination. About 73.3% of patients reported having at least 1 reaction to the vaccination. The most common reactions were pain at the injection site, fatigue, and headache. After vaccination, patients increased contact with family and friends, use of public transport, and grocery shopping. Overall, the level of willingness to wear masks beyond the end of the pandemic differed according to vaccination status. Conclusions: Acceptance of the COVID-19 vaccination among thoracic oncology patients in Germany was high. Overall, patients with thoracic malignancies tolerated the COVID-19 vaccination well. Rate of adverse reaction was not higher compared with the general population. After the vaccination, patients increased social contacts and usage of public transport. These changes suggest positive psychological effects on quality of life. While reducing social distancing can increase the risk of infection, our results indicate that an extension of mask mandates after the pandemic would likely be accepted by a majority of thoracic oncology patients, suggesting that our cohort was still aware and in support of other measure of protection.
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Affiliation(s)
- Toki Bolt
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Laura Sellmer
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Kathrin Kahnert
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Julia Kovács
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Thoracic Surgery, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Dieter Munker
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
| | - Farkhad Manapov
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Radiation Oncology, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
| | - Christian Schneider
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Thoracic Surgery, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
| | - Juergen Behr
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Julia Walter
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Thoracic Surgery, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
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Munker D, Veit T, Schönermarck U, Arnold P, Leuschner G, Barton J, Mümmler C, Briegel I, Mumm JN, Zoller M, Kauke T, Sisic A, Ghiani A, Walter J, Milger K, Mueller S, Michel S, Munker S, Keppler O, Fischereder M, Meiser B, Behr J, Kneidinger N, Neurohr C. Polyomavirus exerts detrimental effects on renal function in patients after lung transplantation. J Clin Virol 2021; 145:105029. [PMID: 34798365 DOI: 10.1016/j.jcv.2021.105029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity and mortality after lung transplantation (LTX). Calcineurin inhibitor (CNI) nephrotoxicity is the leading cause of CKD. After kidney transplantation, polyomavirus-associated nephropathy (PyVAN) is a well-recognized problem. This study aims to evaluate the role of polyomavirus in patients after LTX. METHODS From January 2017 to January 2020, all lung transplant recipients who performed follow-up visits in our center were included in the study and retrospectively assessed. We measured renal function (creatinine levels before and after transplantation), JCPyV, and BKPyV load by polymerase chain reaction (PCR) in serum and urine samples after transplantation. RESULTS In total, 104 consecutive patients (59 males, 56.7%) with a mean age of 49.6 ± 11.1 years were identified. JCPyV was found in urine of 36 patients (34.6%) and serum of 3 patients (2.9%). BKPyV was found in urine of 40 patients (38.5%) and serum of 4 patients (3.8%), respectively. Urine evidence for JCPyV (p < 0.001, coefficient: +21.44) and BKPyV (p < 0.001, coefficient: +29.65) correlated highly with further kidney function decline. CONCLUSION Kidney function deterioration is associated with JCPyV and BKPyV viruria in patients after LTX. This might indicate a role of PyVAN in lung transplant recipients.
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Affiliation(s)
- Dieter Munker
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Tobias Veit
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ulf Schönermarck
- Department of Medicine IV, University hospital, LMU Munich, Germany
| | - Paola Arnold
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gabriela Leuschner
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Carlo Mümmler
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ignaz Briegel
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jan-Niclas Mumm
- Department of Urology, University hospital, LMU Munich, Germany
| | - Michael Zoller
- Department of Anesthesiology, University hospital, LMU Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University hospital, LMU Munich, Germany
| | - Alma Sisic
- Transplant Center, University hospital, LMU Munich, Germany
| | - Alessandro Ghiani
- Department of Pneumology and Respiratory Medicine, Schillerhoehe Clinic (affiliated to Rober-Bosch-Hospital GmbG, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany
| | - Julia Walter
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Susanna Mueller
- Department of Pathology, University hospital, LMU Munich, Germany
| | - Sebastian Michel
- Department of Thoracic Surgery, University hospital, LMU Munich, Germany; Transplant Center, University hospital, LMU Munich, Germany
| | - Stefan Munker
- Department of Internal Medicine II, University hospital, LMU Munich, Germany
| | - Oliver Keppler
- Department of Internal Medicine II, University hospital, LMU Munich, Germany
| | | | - Bruno Meiser
- Transplant Center, University hospital, LMU Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus Neurohr
- Department of Virology, University hospital, LMU Munich, Germany; Department of Pneumology and Respiratory Medicine, Schillerhoehe Clinic (affiliated to Rober-Bosch-Hospital GmbG, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany
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Muenchhoff M, Graf A, Krebs S, Quartucci C, Hasmann S, Hellmuth JC, Scherer C, Osterman A, Boehm S, Mandel C, Becker-Pennrich AS, Zoller M, Stubbe HC, Munker S, Munker D, Milger K, Gapp M, Schneider S, Ruhle A, Jocham L, Nicolai L, Pekayvaz K, Weinberger T, Mairhofer H, Khatamzas E, Hofmann K, Spaeth PM, Bender S, Kääb S, Zwissler B, Mayerle J, Behr J, von Bergwelt-Baildon M, Reincke M, Grabein B, Hinske CL, Blum H, Keppler OT. Genomic epidemiology reveals multiple introductions of SARS-CoV-2 followed by community and nosocomial spread, Germany, February to May 2020. ACTA ACUST UNITED AC 2021; 26. [PMID: 34713795 PMCID: PMC8555370 DOI: 10.2807/1560-7917.es.2021.26.43.2002066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 11/24/2022]
Abstract
Background In the SARS-CoV-2 pandemic, viral genomes are available at unprecedented speed, but spatio-temporal bias in genome sequence sampling precludes phylogeographical inference without additional contextual data. Aim We applied genomic epidemiology to trace SARS-CoV-2 spread on an international, national and local level, to illustrate how transmission chains can be resolved to the level of a single event and single person using integrated sequence data and spatio-temporal metadata. Methods We investigated 289 COVID-19 cases at a university hospital in Munich, Germany, between 29 February and 27 May 2020. Using the ARTIC protocol, we obtained near full-length viral genomes from 174 SARS-CoV-2-positive respiratory samples. Phylogenetic analyses using the Auspice software were employed in combination with anamnestic reporting of travel history, interpersonal interactions and perceived high-risk exposures among patients and healthcare workers to characterise cluster outbreaks and establish likely scenarios and timelines of transmission. Results We identified multiple independent introductions in the Munich Metropolitan Region during the first weeks of the first pandemic wave, mainly by travellers returning from popular skiing areas in the Alps. In these early weeks, the rate of presumable hospital-acquired infections among patients and in particular healthcare workers was high (9.6% and 54%, respectively) and we illustrated how transmission chains can be dissected at high resolution combining virus sequences and spatio-temporal networks of human interactions. Conclusions Early spread of SARS-CoV-2 in Europe was catalysed by superspreading events and regional hotspots during the winter holiday season. Genomic epidemiology can be employed to trace viral spread and inform effective containment strategies.
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Affiliation(s)
- Maximilian Muenchhoff
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Graf
- Laboratory for Functional Genome Analysis, Gene Center, LMU Munich, Munich, Germany
| | - Stefan Krebs
- Laboratory for Functional Genome Analysis, Gene Center, LMU Munich, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sandra Hasmann
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Johannes C Hellmuth
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Stephan Boehm
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Christopher Mandel
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Andrea Sabine Becker-Pennrich
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.,Department of Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany
| | - Michael Zoller
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Hans Christian Stubbe
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Dieter Munker
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Madeleine Gapp
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Stephanie Schneider
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Adrian Ruhle
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Linda Jocham
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Leo Nicolai
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Kami Pekayvaz
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Tobias Weinberger
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Helga Mairhofer
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Elham Khatamzas
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany
| | - Katharina Hofmann
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Patricia M Spaeth
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Sabine Bender
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Zwissler
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Juergen Behr
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael von Bergwelt-Baildon
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany
| | - Martin Reincke
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany.,Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Beatrice Grabein
- Department of Clinical Microbiology and Hospital Hygiene, University Hospital, LMU Munich, Munich, Germany
| | - Christian Ludwig Hinske
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.,Department of Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Helmut Blum
- Laboratory for Functional Genome Analysis, Gene Center, LMU Munich, Munich, Germany
| | - Oliver T Keppler
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
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9
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Veit T, Munker D, Barton J, Milger K, Kauke T, Meiser B, Michel S, Zoller M, Nitschko H, Keppler OT, Behr J, Kneidinger N. Letermovir in lung transplant recipients with cytomegalovirus infection: A retrospective observational study. Am J Transplant 2021; 21:3449-3455. [PMID: 34118118 DOI: 10.1111/ajt.16718] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/08/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 01/25/2023]
Abstract
Letermovir is a new antiviral drug approved for the prophylaxis of CMV infection in allogeneic stem cell transplants. The aim of the study was to assess the therapeutic efficacy of letermovir in difficult to treat CMV infections in lung transplant recipients. All lung transplant recipients between March 2018 and August 2020, who have been treated with letermovir for ganciclovir-resistant or refractory CMV infection were included in the study and analysed retrospectively. In total, 28 patients were identified. CMV disease was present in 15 patients (53.6%). In 23 patients (82.1%), rapid response was noticed, and CMV-viral load could be significantly decreased (>1 log10 ) after a median of 17 [14-27] days and cleared subsequently in all of these patients. Five patients (17.9%) were classified as non-responder. Thereof, development of a mutation of the CMV UL56 terminase (UL-56-Gen: C325Y) conferring letermovir resistance could be observed in three patients (60%). Common side effects were mild and mostly of gastrointestinal nature. Mild adjustments of the immunosuppressive drugs were mandatory upon treatment initiation with letermovir. In addition to other interventions, letermovir was effective in difficult to treat CMV infections in lung transplant recipients. However, in patients with treatment failure mutation conferring letermovir, resistance should be taken into account.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Teresa Kauke
- Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany.,Department of Thoracic Surgery, University of Munich, LMU, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael Zoller
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Hans Nitschko
- Max von Pettenkofer Institute and Gene Center, Virology, German Center for Infection Research, Partner Site Munich, National Reference Center for Retroviruses, LMU, Munich, Germany
| | - Oliver T Keppler
- Max von Pettenkofer Institute and Gene Center, Virology, German Center for Infection Research, Partner Site Munich, National Reference Center for Retroviruses, LMU, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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10
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Kahnert K, Trudzinski FC, Bickert C, Munker D, Milger K, Irlbeck M, Tomasi R, Schneider C, Michel S, Herth F, Behr J, Jörres R, Kneidinger N. Oxygenated hemoglobin predicts outcome in patients with chronic lung allograft dysfunction. Transplantation 2021. [DOI: 10.1183/13993003.congress-2021.oa2915] [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: 11/05/2022]
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11
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Munker D, Veit T, Barton J, Mertsch P, Mümmler C, Osterman A, Khatamzas E, Barnikel M, Hellmuth JC, Münchhoff M, Walter J, Ghiani A, Munker S, Dinkel J, Behr J, Kneidinger N, Milger K. Pulmonary function impairment of asymptomatic and persistently symptomatic patients 4 months after COVID-19 according to disease severity. Infection 2021; 50:157-168. [PMID: 34322859 PMCID: PMC8318328 DOI: 10.1007/s15010-021-01669-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 06/10/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
Objective Evaluation of pulmonary function impairment after COVID-19 in persistently symptomatic and asymptomatic patients of all disease severities and characterisation of risk factors. Methods Patients with confirmed SARS-CoV-2 infection underwent prospective follow-up with pulmonary function testing and blood gas analysis during steady-state cycle exercise 4 months after acute illness. Pulmonary function impairment (PFI) was defined as reduction below 80% predicted of DLCOcSB, TLC, FVC, or FEV1. Clinical data were analyzed to identify risk factors for impaired pulmonary function. Results 76 patients were included, hereof 35 outpatients with mild disease and 41 patients hospitalized due to COVID-19. Sixteen patients had critical disease requiring mechanical ventilation, 25 patients had moderate–severe disease. After 4 months, 44 patients reported persisting respiratory symptoms. Significant PFI was prevalent in 40 patients (52.6%) occurring among all disease severities. The most common cause for PFI was reduced DLCOcSB (n = 39, 51.3%), followed by reduced TLC and FVC. The severity of PFI was significantly associated with mechanical ventilation (p < 0.001). Further risk factors for DLCO impairment were COPD (p < 0.001), SARS-CoV-2 antibody-Titer (p = 0.014) and in hospitalized patients CT score. A decrease of paO2 > 3 mmHg during cycle exercise occurred in 1/5 of patients after mild disease course. Conclusion We characterized pulmonary function impairment in asymptomatic and persistently symptomatic patients of different severity groups of COVID-19 and identified further risk factors associated with persistently decreased pulmonary function. Remarkably, gas exchange abnormalities were revealed upon cycle exercise in some patients with mild disease courses and no preexisting pulmonary condition. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01669-8.
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Affiliation(s)
- Dieter Munker
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tobias Veit
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Carlo Mümmler
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig Maximilian University (LMU) of Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Elham Khatamzas
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Michaela Barnikel
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Johannes C Hellmuth
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Maximilian Münchhoff
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig Maximilian University (LMU) of Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Julia Walter
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Alessandro Ghiani
- Department of Pulmonology and Respiratory Medicine, Schillerhoehe Lung Clinic (affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestrasse 18, 70839, Gerlingen, Germany
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Center and LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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12
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Munker D, Osterman A, Stubbe H, Muenchhoff M, Veit T, Weinberger T, Barnikel M, Mumm JN, Milger K, Khatamzas E, Klauss S, Scherer C, Hellmuth JC, Giessen-Jung C, Zoller M, Herold T, Stecher S, de Toni EN, Schulz C, Kneidinger N, Keppler OT, Behr J, Mayerle J, Munker S. Dynamics of SARS-CoV-2 shedding in the respiratory tract depends on the severity of disease in COVID-19 patients. Eur Respir J 2021; 58:13993003.02724-2020. [PMID: 33602859 PMCID: PMC7898160 DOI: 10.1183/13993003.02724-2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023]
Abstract
A fraction of COVID-19 patients progress to a severe disease manifestation with respiratory failure and the necessity of mechanical ventilation. Identifying patients at risk is critical for optimised care and early therapeutic interventions. We investigated the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding relative to disease severity. We analysed nasopharyngeal and tracheal shedding of SARS-CoV-2 in 92 patients with diagnosed COVID-19. Upon admission, standardised nasopharyngeal swab or sputum samples were collected. If patients were mechanically ventilated, endotracheal aspirate samples were additionally obtained. Viral shedding was quantified by real-time PCR detection of SARS-CoV-2 RNA. 45% (41 out of 92) of COVID-19 patients had a severe disease course with the need for mechanical ventilation (severe group). At week 1, the initial viral shedding determined from nasopharyngeal swabs showed no significant difference between nonsevere and severe cases. At week 2, a difference could be observed as the viral shedding remained elevated in severely ill patients. A time-course of C-reactive protein, interleukin-6 and procalcitonin revealed an even more protracted inflammatory response following the delayed drop of virus shedding load in severely ill patients. A significant proportion (47.8%) of patients showed evidence of prolonged viral shedding (>17 days), which was associated with severe disease courses (73.2%). We report that viral shedding does not differ significantly between severe and nonsevere COVID-19 cases upon admission to the hospital. Elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between the second and third week, and prolonged viral shedding are associated with a more severe disease course. This work finds that elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between the second and third week, and prolonged viral shedding are associated with a more severe COVID-19 disease coursehttps://bit.ly/3p544zr
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Affiliation(s)
- Dieter Munker
- Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany.,These authors contributed equally to this work
| | - Andreas Osterman
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig Maximilian University, Munich, Germany.,German Center for Infection Research, Partner Site Munich and Associated Partner Site Munich, Munich, Germany.,These authors contributed equally to this work
| | - Hans Stubbe
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Maximilian Muenchhoff
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig Maximilian University, Munich, Germany.,German Center for Infection Research, Partner Site Munich and Associated Partner Site Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias Veit
- Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Tobias Weinberger
- Emergency Dept, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Dept of Medicine 1, Ludwig Maximilian University of Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michaela Barnikel
- Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Jan-Niclas Mumm
- Dept of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Katrin Milger
- Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Elham Khatamzas
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Dept of Medicine 3, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sarah Klauss
- Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Clemens Scherer
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Emergency Dept, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Dept of Medicine 1, Ludwig Maximilian University of Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Johannes C Hellmuth
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Dept of Medicine 3, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Clemens Giessen-Jung
- Dept of Medicine 3, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Michael Zoller
- Dept of Anaesthesiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias Herold
- Dept of Medicine 3, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stephanie Stecher
- Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Enrico N de Toni
- Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Schulz
- Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Oliver T Keppler
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig Maximilian University, Munich, Germany
| | - Jürgen Behr
- Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Julia Mayerle
- Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Munker
- Dept of Medicine 2, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Mümmler C, Dünzelmann K, Kneidinger N, Barnikel M, Munker D, Gröger M, Canis M, Behr J, Koch A, Haubner F, Milger K. Real-life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP. Clin Transl Allergy 2021; 11:e12049. [PMID: 34331521 PMCID: PMC8322752 DOI: 10.1002/clt2.12049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma. METHODS We performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti-IgE, anti-IL-5/R or anti-IL-4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy. RESULTS Fifty patients were included hereof treated with anti-IgE: 9, anti-IL-5/R: 26 and anti-IL-4R: 15 patients. At baseline median SNOT-20 was similar among groups (anti-IgE: 55, anti-IL-5/R: 52 and anti-IL-4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti-IL-4R group (4, 5 and 8, p = 0.002). After 6 months SNOT-20 improved significantly in all patient groups with median improvement of anti-IgE: -8 (p < 0.01), anti-IL-5/R: -13 (p < 0.001) and anti-IL-4R: -18 (p < 0.001), with larger improvement in the anti-IL-4R group than in anti-IgE (p < 0.001) and anti-IL-5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti-IgE: 0 (n.s.), anti-IL-5/R: -1 (p < 0.01) and anti-IL-4R: -3 (p < 0.001), VAS total symptoms by anti-IgE: -1 (n.s.), anti-IL-5/R: -2 (p < 0.001) and anti-IL-4R: -2 (p < 0.001). CONCLUSIONS Treatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti-IL-4R-treated patients.
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Affiliation(s)
- Carlo Mümmler
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
- Comprehensive Pneumology Center (CPC‐M)LMU and Helmholtz Center MunichMunichGermany
| | - Kristin Dünzelmann
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
- Comprehensive Pneumology Center (CPC‐M)LMU and Helmholtz Center MunichMunichGermany
| | - Nikolaus Kneidinger
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
- Comprehensive Pneumology Center (CPC‐M)LMU and Helmholtz Center MunichMunichGermany
| | - Michaela Barnikel
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
- Comprehensive Pneumology Center (CPC‐M)LMU and Helmholtz Center MunichMunichGermany
| | - Dieter Munker
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
- Comprehensive Pneumology Center (CPC‐M)LMU and Helmholtz Center MunichMunichGermany
| | - Moritz Gröger
- Department of OtorhinolaryngologyUniversity HospitalLMU MunichMunichGermany
| | - Martin Canis
- Department of OtorhinolaryngologyUniversity HospitalLMU MunichMunichGermany
| | - Jürgen Behr
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
- Comprehensive Pneumology Center (CPC‐M)LMU and Helmholtz Center MunichMunichGermany
| | - Andrea Koch
- Abteilung für LungenheilkundePyhrn‐Eisenwurzen Klinikum SteyrMunichAustria
| | - Frank Haubner
- Department of OtorhinolaryngologyUniversity HospitalLMU MunichMunichGermany
| | - Katrin Milger
- Department of Medicine VUniversity HospitalLMU MunichMunichGermany
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14
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Veit T, Pan M, Munker D, Arnold P, Dick A, Kunze S, Meiser B, Schneider C, Michel S, Zoller M, Böhm S, Walter J, Behr J, Kneidinger N, Kauke T. Association of CMV-specific T-cell immunity and risk of CMV infection in lung transplant recipients. Clin Transplant 2021; 35:e14294. [PMID: 33749938 DOI: 10.1111/ctr.14294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/30/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Protecting against CMV infection and maintaining CMV in latent state are largely provided by CMV-specific T-cells in lung transplant recipients. The aim of the study was to assess whether a specific T-cell response is associated with the risk for CMV infection in seronegative patients who are at high risk for delayed CMV infection. METHODS All CMV-seronegative recipients (R-) from CMV-seropositive donors (D+) between January 2018 and April 2019 were included and retrospectively screened for CMV infection before and after assessment of CMV-specific cell-mediated immunity. RESULTS Thirty-one of the 50 patients (62%) developed early-onset CMV infection. Lower absolute neutrophil counts were significantly associated with early-onset CMV infection. Antiviral prophylaxis was ceased after 137.2 ± 42.8 days. CMV-CMI were measured at a median of 5.5 months after LTx. 19 patients experienced early and late-onset CMV infection after prophylaxis withdrawal within 15 months post transplantation. Positive CMV-CMI was significantly associated with lower risk of late-onset CMV infection after transplantation in logistic and cox-regression analysis (OR=0.05, p = .01; OR=2,369, p = .026). CONCLUSION D+/R- lung transplant recipients are at high risk of developing early and late-onset CMV infection. Measurement of CMV-CMI soon after transplantation might further define the CMV infection prediction risk in LTx recipients being at high risk for CMV viremia.
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Affiliation(s)
- Tobias Veit
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Ming Pan
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany
| | - Dieter Munker
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Paola Arnold
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Andrea Dick
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany
| | - Susanne Kunze
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany
| | - Bruno Meiser
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Transplant Center, University of Munich, LMU, Munich, Germany
| | - Christian Schneider
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Department of Thoracic Surgery, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | - Michael Zoller
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Stephan Böhm
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Faculty of Medicine, Virology, Max von Pettenkofer Institute, University of Munich, LMU, Munich, Germany
| | - Julia Walter
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Department of Thoracic Surgery, University of Munich, LMU, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Teresa Kauke
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.,Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany.,Department of Thoracic Surgery, University of Munich, LMU, Munich, Germany
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15
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Veit T, Barnikel M, Crispin A, Kneidinger N, Ceelen F, Arnold P, Munker D, Schmitzer M, Barton J, Schiopu S, Schiller HB, Frankenberger M, Milger K, Behr J, Neurohr C, Leuschner G. Variability of forced vital capacity in progressive interstitial lung disease: a prospective observational study. Respir Res 2020; 21:270. [PMID: 33076914 PMCID: PMC7574190 DOI: 10.1186/s12931-020-01524-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/26/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background Fibrotic interstitial lung disease (ILD) is often associated with poor outcomes, but has few predictors of progression. Daily home spirometry has been proposed to provide important information about the clinical course of idiopathic pulmonary disease (IPF). However, experience is limited, and home spirometry is not a routine component of patient care in ILD. Using home spirometry, we aimed to investigate the predictive potential of daily measurements of forced vital capacity (FVC) in fibrotic ILD. Methods In this prospective observational study, patients with fibrotic ILD and clinical progression were provided with home spirometers for daily measurements over 6 months. Hospital based spirometry was performed after three and 6 months. Disease progression, defined as death, lung transplantation, acute exacerbation or FVC decline > 10% relative was assessed in the cohort. Results From May 2017 until August 2018, we included 47 patients (IPF n = 20; non-IPF n = 27). Sufficient daily measurements were performed by 85.1% of the study cohort. Among these 40 patients (IPF n = 17; non-IPF n = 23), who had a mean ± SD age of 60.7 ± 11.3 years and FVC 64.7 ± 21.7% predicted (2.4 ± 0.8 L), 12 patients experienced disease progression (death: n = 2; lung transplantation: n = 3; acute exacerbation: n = 1; FVC decline > 10%: n = 6). Within the first 28 days, a group of patients had high daily variability in FVC, with 60.0% having a variation ≥5%. Patients with disease progression had significantly higher FVC variability than those in the stable group (median variability 8.6% vs. 4.8%; p = 0.002). Cox regression identified FVC variability as independently associated with disease progression when controlling for multiple confounding variables (hazard ratio: 1.203; 95% CI:1.050–1.378; p = 0.0076). Conclusions Daily home spirometry is feasible in IPF and non-IPF ILD and facilitates the identification of FVC variability, which was associated with disease progression.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Alexander Crispin
- IBE - Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Magdalena Schmitzer
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sanziana Schiopu
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Herbert B Schiller
- Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Department of Pneumology, Asklepios Fachkliniken Muenchen-Gauting, Academic Teaching Hospital of the University of Munich, Gauting, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Hospital Schillerhoehe, Academic Teaching Hospital of the University of Tuebingen, Gerlingen, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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16
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Mümmler C, Munker D, Barnikel M, Veit T, Kayser MZ, Welte T, Behr J, Kneidinger N, Suhling H, Milger K. Dupilumab Improves Asthma Control and Lung Function in Patients with Insufficient Outcome During Previous Antibody Therapy. J Allergy Clin Immunol Pract 2020; 9:1177-1185.e4. [PMID: 32980583 DOI: 10.1016/j.jaip.2020.09.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biological treatments directed against IgE and IL-5 have largely improved outcomes for patients with severe type 2-high asthma. However, a fraction of patients with severe asthma show insufficient treatment outcome under anti-IgE and anti-IL-5/IL-5 receptor α antibodies. OBJECTIVE To evaluate whether switching to dupilumab was of benefit in patients with insufficient outcome under previous anti-IgE or anti-IL-5/IL-5 receptor α therapy. METHODS We retrospectively analyzed 38 patients who were switched to dupilumab from a previous anti-IgE or anti-IL-5/IL-5 receptor α medication because of insufficient outcome. We defined response criteria after 3 to 6 months as an improvement in at least 1 of the following criteria without deterioration in the other criteria, comparing values under dupilumab with values under previous antibody therapy: (1) increase of 3 or more in Asthma Control Test score, (2) 50% or more reduction in oral corticosteroid dose, and (3) FEV1 improvement greater than or equal to 150 mL, and classified patients as responders and nonresponders. RESULTS Switch to dupilumab led to a response in 76% of patients. In the total cohort, Asthma Control Test score increased by a mean of 2.9 (P < .0001), whereas exacerbations decreased significantly (P < .0001) and number of oral corticosteroid-dependent patients decreased from 15 to 12. Mean FEV1 improved by 305 mL (P < .0001). Median fractional exhaled nitric oxide decreased by -30 ppb (P < .0001), whereas eosinophil counts increased by 0.17 G/L (P < .01). There were no significant differences in clinical characteristics between responders and nonresponders to dupilumab. However, patients with increased fractional exhaled nitric oxide (≥25 ppb) during previous antibody therapy were more often responders than patients with low fractional exhaled nitric oxide (<25 ppb) (P < .05). CONCLUSIONS Altogether, we show that a switch to dupilumab in patients with insufficient outcome under previous biological therapy was effective in most patients.
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Affiliation(s)
- Carlo Mümmler
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Moritz Z Kayser
- Department of Pneumology, Hanover Medical School, Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Tobias Welte
- Department of Pneumology, Hanover Medical School, Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Hendrik Suhling
- Department of Pneumology, Hanover Medical School, Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany; Comprehensive Pneumology Center (CPC-M), Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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17
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Leuschner G, Lauseker M, Howanietz AS, Milger K, Veit T, Munker D, Schneider C, Weig T, Michel S, Barton J, Meiser B, Dinkel J, Neurohr C, Behr J, Kneidinger N. Longitudinal lung function measurements in single lung transplant recipients with chronic lung allograft dysfunction. J Heart Lung Transplant 2020; 39:1270-1278. [PMID: 32917480 DOI: 10.1016/j.healun.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/06/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Phenotyping chronic lung allograft dysfunction (CLAD) in single lung transplant (SLTX) recipients is challenging. The aim of this study was to assess the diagnostic and prognostic value of longitudinal lung function tests in SLTX recipients with CLAD. METHODS A total of 295 SLTX recipients were analyzed and stratified according to native lung physiology. In addition to spirometry, measurements of static lung volumes and lung capacities were used to phenotype patients and to assess their prognostic value. Outcome was survival after CLAD onset. Patients with insufficient clinical information were excluded (n = 71). RESULTS Of 224 lung transplant recipients, 105 (46.9%) developed CLAD. Time to CLAD onset (hazard ratio [HR]: 0.82, 95% CI: 0.74-0.90; p < 0.001), severity of CLAD at onset (HR: 0.97, 95% CI: 0.94-0.99; p = 0.009), and progression after onset of CLAD (HR: 1.03, 95% CI: 1.00-1.05; p = 0.023) were associated with outcome. Phenotypes at onset were bronchiolitis obliterans syndrome (BOS) (59.1%), restrictive allograft syndrome (RAS) (12.4%), mixed phenotype (6.7%), and undefined phenotype (21.9%). Survival estimates differed significantly between phenotypes (p = 0.004), with RAS and mixed phenotype being associated with the worst survival, followed by BOS and undefined phenotype. Finally, a higher hazard for mortality was noticed for RAS (HR: 2.34, 95% CI: 0.99-5.52; p = 0.054) and mixed phenotype (HR: 3.30, 95% CI: 1.20-9.11; p = 0.021) while controlling for time to CLAD onset and severity of CLAD at onset. CONCLUSIONS Phenotyping CLAD in SLTX remains challenging with a high number of patients with an undefined phenotype despite comprehensive lung function testing. However, phenotyping is of prognostic value. Furthermore, early, severe, and progressive CLADs are associated with worse survival.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology
| | - Anne-Sophie Howanietz
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | | | | | | | - Jürgen Barton
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | | | - Julien Dinkel
- Institute for Clinical Radiology, University of Munich (LMU), Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL).
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18
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Veit T, Munker D, Leuschner G, Mümmler C, Sisic A, Kauke T, Schneider C, Irlbeck M, Michel S, Eser-Valerie D, Huber M, Barton J, Milger K, Meiser B, Behr J, Kneidinger N. High prevalence of falsely declaring nicotine abstinence in lung transplant candidates. PLoS One 2020; 15:e0234808. [PMID: 32555678 PMCID: PMC7302701 DOI: 10.1371/journal.pone.0234808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Tobacco use after lung transplantation is associated with adverse outcome. Therefore, active smoking is regarded as a contraindication for lung transplantation and should be excluded prior to placement on the waiting list. The aim of the study was to compare self-reporting with a systematic cotinine based screening approach to identify patients with active nicotine abuse. Nicotine use was systematically assessed by interviews and cotinine test in all lung transplant candidates at every visit in our center. Patients were classified according to the stage prior to transplantation and cotinine test results were compared to self-reports and retrospectively analyzed until June 2019. Of 620 lung transplant candidates, 92 patients (14.8%) had at least one positive cotinine test. COPD as underlying disease (OR 2.102, CI 1.110–3.981; p = 0.023), number of pack years (OR 1.014, CI 1.000–1.028; p = 0.047) and a time of cessation less than one year (OR 2.413, CI 1.410–4.128; p = 0.001) were associated with a positive cotinine test in multivariable regression analysis. The majority of non-COPD patients (n = 13, 72.2%) with a positive test had a cessation time of less than one year. 78 patients (84.7%) falsely declared not consuming any nicotine-based products prior to the test. Finally, all never smokers were test negative. In conclusion, our data demonstrate that active nicotine use is prevalent in transplant candidates with a high prevalence of falsely declaring nicotine abstinence. COPD was the main diagnosis in affected patients. Short cessation time and a high number of pack years are risk factors for continued nicotine abuse.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Carlo Mümmler
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Alma Sisic
- Transplant Center, University of Munich, Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University of Munich, Munich, Germany
| | | | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | - Daniela Eser-Valerie
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Maximilian Huber
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University of Munich, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
- * E-mail:
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Schiopu SRI, Zacherl M, Todica A, Bartenstein P, Milger K, Leuschner G, Munker D, Bauer M, Massberg S, Behr J, Neurohr C, Huber BC, Kneidinger N. Feasibility and accuracy of SPECT myocardial perfusion imaging in end-stage lung disease. J Nucl Cardiol 2020; 27:903-911. [PMID: 31428982 DOI: 10.1007/s12350-019-01851-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 07/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is associated with increased mortality in patients with chronic lung disease. However, non-invasive diagnostic of CAD is difficult, especially in patients with more advanced disease. Therefore, we aimed to assess the feasibility and accuracy of SPECT-myocardial perfusion imaging (MPI) stress testing with regadenoson in patients with end-stage lung disease (ELD) undergoing assessment of stable CAD. METHODS Between January 2012 and May 2018, 102 patients with ELD, who were referred to our institution for lung transplant evaluation, were assessed retrospectively. All patients underwent both stress SPECT-MPI as well as coronary angiography. RESULTS The mean age in our population was 57±6 years. All patients had severe pulmonary function impairment. During stress SPECT-MPI 14 patients (14%) reported regadenoson-related symptoms, but only 2 patients (2%) required medical treatment. Coronary angiography revealed obstructive CAD in 20 patients (20%). Among those, 5 patients had abnormal SPECT-MPI and PCI was performed in 3 patients accordingly. In 14 patients with obstructive CAD, revascularization was deferred based on normal SPECT-MPI findings. CONCLUSIONS SPECT-MPI using regadenoson is well tolerated in patients with ELD and can help to make decisions about coronary revascularization before lung transplant.
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Affiliation(s)
- Sanziana R I Schiopu
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Mathias Zacherl
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Matthäus Bauer
- Medical Controlling Unit, Department for Patient Management, Munich University Hospital (TM), 81366, Munich, Germany
| | - Steffen Massberg
- Medical Department I, Campus Grosshadern and Campus Innenstadt, Ludwig-Maximilians-University, Munich, Marchioninistrasse 15, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Asklepios Clinic München, Gauting, Germany
| | - Claus Neurohr
- Department for Pneumology and Respiratory Medicine, Robert-Bosch-Hospital, Schillerhöhe Clinic, Solitudestr. 18, 70839, Gerlingen, Germany
| | - Bruno C Huber
- Medical Department I, Campus Grosshadern and Campus Innenstadt, Ludwig-Maximilians-University, Munich, Marchioninistrasse 15, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Mumm JN, Osterman A, Ruzicka M, Stihl C, Vilsmaier T, Munker D, Khatamzas E, Giessen-Jung C, Stief C, Staehler M, Rodler S. Urinary Frequency as a Possibly Overlooked Symptom in COVID-19 Patients: Does SARS-CoV-2 Cause Viral Cystitis? Eur Urol 2020; 78:624-628. [PMID: 32475747 PMCID: PMC7236674 DOI: 10.1016/j.eururo.2020.05.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/12/2020] [Indexed: 01/21/2023]
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic is a challenge for physicians in triaging patients in emergency rooms. We found a potentially dangerous overlap of classical urinary symptoms and the as yet not fully described symptoms of COVID-19. After a patient was primarily triaged as a urosepsis case and then subsequently diagnosed with COVID-19, we focused on an increase in urinary frequency as a symptom of COVID-19 and identified this in seven males out of 57 patients currently being treated in our COVID-19 wards. In the absence of any other causes, urinary frequency may be secondary to viral cystitis due to underlying COVID-19 disease. We propose consideration of urinary frequency as an anamnestic tool in patients with infective symptoms to increase awareness among urologists during the current COVID-19 pandemic to prevent fatal implications of misinterpreting urological symptoms.
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Affiliation(s)
- Jan-Niclas Mumm
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.
| | - Andreas Osterman
- National Reference Center for Retroviruses, Max von Pettenkofer Institute and Gene Center, Faculty of Medicine, LMU München, Munich, Germany; German Center for Infection Research, Munich Partner Site, Munich, Germany
| | - Michael Ruzicka
- Medizinische Klinik III, Klinikum der Universität München, Munich, Germany
| | - Clemens Stihl
- Klink für Hals-Nasen-Ohren-Heilkunde, Klinikum der Universität München, Munich, Germany
| | - Theresa Vilsmaier
- Klink für Frauenheilkunde, Klinikum der Universität München, Munich, Germany
| | - Dieter Munker
- Medizinische Klinik V, Klinikum der Universität München, Munich, Germany
| | - Elham Khatamzas
- Medizinische Klinik III, Klinikum der Universität München, Munich, Germany
| | | | - Christian Stief
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Michael Staehler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Severin Rodler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
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Veit T, Leuschner G, Sisic A, Ceelen F, Munker D, Schmitzer M, Weig T, Michel S, Schneider C, Meiser B, Crispin A, Neurohr C, Behr J, Milger K, Kneidinger N. Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation. Am J Transplant 2019; 19:2358-2365. [PMID: 30942945 DOI: 10.1111/ajt.15378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/08/2019] [Revised: 03/17/2019] [Accepted: 03/24/2019] [Indexed: 01/25/2023]
Abstract
Pirfenidone demonstrated pleiotropic antiinflammatory effects in various experimental and clinical settings. The aim of this study was to assess the impact of previous treatment with pirfenidone on short-term outcomes after single lung transplantation (SLTx). Therefore, patients with idiopathic pulmonary fibrosis (IPF) who were undergoing SLTx were screened retrospectively for previous use of pirfenidone and compared to respective controls. Baseline parameters and short-term outcomes were recorded and analyzed. In total, 17 patients with pirfenidone were compared with 26 patients without antifibrotic treatment. Baseline characteristics and severity of disease did not differ between groups. Use of pirfenidone did not increase blood loss, wound-healing, or anastomotic complications. Severity of primary graft dysfunction at 72 hours was less (0.3 ± 0.6 vs 1.4 ± 1.3, P = .002), and length of mechanical ventilation (37.5 ± 34.8 vs 118.5 ± 151.0 hours, P = .016) and intensive care unit (ICU) stay (6.6 ± 7.1 vs 15.6 ± 20.3, P = .089) were shorter in patients with pirfenidone treatment. An independent beneficial effect of pirfenidone was confirmed by regression analysis while controlling for confounding variables (P = .016). Finally, incidence of acute cellular rejections within the first 30 days after SLTx was lower in patients with previous pirfenidone treatment (0.0% vs 19.2%; P = .040). Our data suggest a beneficial role of previous use of pirfenidone in patients with IPF who were undergoing SLTx.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Alma Sisic
- Transplant Center, University of Munich, Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Magdalena Schmitzer
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Thomas Weig
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | | | - Bruno Meiser
- Transplant Center, University of Munich, Munich, Germany
| | - Alexander Crispin
- IBE - Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
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22
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Matthes S, Stadler J, Barton J, Leuschner G, Munker D, Arnold P, Villena-Hermoza H, Frankenberger M, Probst P, Koch A, Kneidinger N, Milger K, Behr J, Neurohr C. Asthma features in severe COPD: Identifying treatable traits. Respir Med 2018; 145:89-94. [PMID: 30509722 DOI: 10.1016/j.rmed.2018.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/13/2023]
Abstract
AIM Biological therapies developed for severe asthma may have a role in COPD patients with asthma features. METHOD We carried out a prospective, consecutive, cross-sectional analysis of 80 patients with severe COPD GOLD IV/D. RESULTS We studied 80 patients (48.8% female), aged 57.6 ± 5.1 years, ex-smokers with 35.7 ± 21.2 pack years, BMI 22.3 ± 3.5 kg/m2, FEV1 of 0.61 ± 0.2 L (21.1 ± 5.6% pred), pO2 52.4 ± 8.4 mmHg, and BODE 6.9 ± 1.7. 68% had >2 moderate or severe exacerbations annually. 16.1% (5/31) patients showed FEV1 reversibility of >12% and >200 ml despite maximal therapy, 33% (15/45) had FENO ≥22.5 ppb, 33% (24/73) had serum IgE ≥100 I.E./ml and there was positive allergen sensitization in 51.5% (35/68). Blood eosinophilia of ≥150 cells/μl was seen in 47% (35/74). Induced sputum showed eosinophilia of ≥2% in 56% (14/24) with respiratory pathogens in 63.8% (30/47). We identified 12 (15%) patients with asthma-COPD overlap. Of these, 10 (83.3%) had frequent exacerbations and these patients had significantly more severe exacerbations requiring NIV or ICU than those without asthma features (p < 0.005). CONCLUSION We detected asthma features in a substantial subset of stable patients with severe COPD. Asthma features were associated with more severe exacerbation despite optimal COPD therapy, representing potential candidates for targeted therapy with anti- IgE or anti-IL5.
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Affiliation(s)
- Sandhya Matthes
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany.
| | - Jakob Stadler
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Jürgen Barton
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Dieter Munker
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Paola Arnold
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Heidrun Villena-Hermoza
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Helmholtz Center Munich, Ludwig-Maximilians University Munich and Asklepios Klinik Gauting, Germany
| | - Philipp Probst
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany
| | - Andrea Koch
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Katrin Milger
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Claus Neurohr
- Department of Respiratory and Ventilatory Medicine, Klinik Schillerhöhe, Robert-Koch Hospital, Academic Hospital of the University of Tübingen, Germany
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23
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Leuschner G, Stocker F, Veit T, Kneidinger N, Winter H, Schramm R, Weig T, Matthes S, Ceelen F, Arnold P, Munker D, Klenner F, Hatz R, Frankenberger M, Behr J, Neurohr C. Outcome of lung transplantation in idiopathic pulmonary fibrosis with previous anti-fibrotic therapy. J Heart Lung Transplant 2017; 37:S1053-2498(17)31886-7. [PMID: 28734935 DOI: 10.1016/j.healun.2017.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 03/01/2017] [Revised: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-fibrotic drugs may interfere with wound-healing after major surgery, theoretically preventing sufficient bronchial anastomosis formation after lung transplantation (LTx). The aim of this study was to assess the impact of previous treatment with pirfenidone and nintedanib on outcomes after LTx in patients with idiopathic pulmonary fibrosis (IPF). METHODS All patients with IPF undergoing LTx at the University of Munich between January 2012 and November 2016 were retrospectively screened for previous use of anti-fibrotics. Post-transplant outcome and survival of patients with and without anti-fibrotic treatment were analyzed. RESULTS A total of 62 patients with IPF were transplanted (lung allocation score [mean ± SD] 53.1 ± 16.1). Of these, 23 (37.1%) received pirfenidone and 7 (11.3%) received nintedanib before LTx; the remaining 32 (51.6%) did not receive any anti-fibrotic drug (control group). Patients receiving anti-fibrotics were significantly older (p = 0.004) and their carbon monoxide diffusion capacity was significantly higher (p = 0.008) than in controls. Previous anti-fibrotic treatment did not increase blood product utilization, wound-healing or anastomotic complications after LTx. Post-transplant surgical revisions due to bleeding and/or impaired wound-healing were necessary in 18 (29.0%) patients (pirfenidone 30.4%, nintedanib 14.3%, control 31.3%; p = 0.66). Anastomosis insufficiency occurred in 2 (3.2%) patients, both in the control group. No patient died within the first 30 days post-LTx, and no significant differences regarding survival were seen during the follow-up (12-month survival: pirfenidone 77.0%, nintedanib 100%, control 90.6%; p = 0.29). CONCLUSION Our data show that previous use of anti-fibrotic therapy does not increase surgical complications or post-operative mortality after LTx.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany.
| | - Florian Stocker
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany
| | - Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Hauke Winter
- Munich Lung Transplant Group, Munich, Germany; Department of Thoracic Surgery, University of Munich, Munich, Germany
| | - René Schramm
- Munich Lung Transplant Group, Munich, Germany; Clinic of Cardiac Surgery, University of Munich, Munich, Germany
| | - Thomas Weig
- Munich Lung Transplant Group, Munich, Germany; Department of Anesthesiology, University of Munich, Munich, Germany
| | - Sandhya Matthes
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Friederike Klenner
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Rudolf Hatz
- Munich Lung Transplant Group, Munich, Germany; Department of Thoracic Surgery, University of Munich, Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, Member of the German Center for Lung Research, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
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24
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Munker D, Arnold P, Ceelen F, Kneidinger N, Leuschner G, Prechtl C, Matthes S, Veit T, Behr J, Neurohr C. Kortisonstoßtherapie bei Verschlechterung der Lungenfunktion nach Lungentransplantation und Ausschluss einer akuten zellulären Abstoßungsreaktion. Pneumologie 2017. [DOI: 10.1055/s-0037-1598292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Prechtl
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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25
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Leuschner G, Stocker F, Veit T, Kneidinger N, Ceelen F, Arnold P, Munker D, Matthes S, Behr J, Neurohr C. Lungentransplantation bei Patienten mit bestehender Pirfenidontherapie: eine Fallstudie. Pneumologie 2017. [DOI: 10.1055/s-0037-1598291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Stocker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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Ceelen F, Burger C, Kneidinger N, Matthes S, Leuschner G, Arnold P, Munker D, Veit T, Dinkel J, Behr J, Neurohr C. Stellenwert der Surveillance-Computertomografie nach Lungentransplantation. Pneumologie 2017. [DOI: 10.1055/s-0037-1598562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Burger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Dinkel
- Institut für Klinische Radiologie, Klinikum der Universität München
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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Matthes S, Barton J, Stadler J, Kneidinger N, Ceelen F, Leuschner G, Arnold P, Munker D, Veit T, Villena-Hermoza H, Frankenberger M, Behr J, Neurohr C. Phänotypische Charakterisierung von Patienten mit schwerer chronisch obstruktiver Lungenerkrankung (COPD). Pneumologie 2017. [DOI: 10.1055/s-0037-1598546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Barton
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Stadler
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - H Villena-Hermoza
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - M Frankenberger
- Cpc Comprehensive Pneumology Center, Forschungsambulanz Helmholtz Zentrum München; Ludwig-Maximilians Universität und Asklepios Klinik Gauting
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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28
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Arnold P, Munker D, Kneidinger N, Ceelen F, Leuschner G, Matthes S, Veit T, Prechtl C, Behr J, Neurohr C. Volumenbelastung bei Patienten mit fortgeschrittener Lungenerkrankung. Pneumologie 2017. [DOI: 10.1055/s-0037-1598569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Prechtl
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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