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Ng C, Maier HT, Augustin F. Benefits of a multidisciplinary team approach on a challenging case of bilateral tension pneumothorax. J Thorac Dis 2018; 10:S3246-S3247. [PMID: 30370127 DOI: 10.21037/jtd.2018.08.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Caecilia Ng
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Thomas Maier
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Affiliation(s)
- Herbert Thomas Maier
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Margreiter C, Gummerer M, Gallotta V, Scheidl S, Öfner D, Kienzl-Wagner K, Maier HT, Oberhuber R, Margreiter R, Schneeberger S. Open Management of the Renal Vein Is a Safe Modification in Right-Sided Laparoscopic Living Donor Nephrectomy to Maximize Graft Vein Length. Transplant Proc 2018; 50:3199-3203. [PMID: 30577185 DOI: 10.1016/j.transproceed.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The primary objective in living donor kidney transplantation is donor safety. In laparoscopic living donor nephrectomy, most centers prefer the left kidney for donation given the shorter renal vein, higher rate of thromboses, and more difficult surgical procedure for right kidney retrieval. The goal of this study was to demonstrate the feasibility of a hybrid technique using a Satinsky clamp in right-sided living donor nephrectomy to obtain maximal renal vein and to compare the outcome with standard left-sided laparoscopic donor nephrectomies. MATERIAL AND METHODS Between 2005 and 2013, 77 patients underwent a left (group L) and 54 a right (group R) living donor nephrectomy. In group R, after laparoscopic dissection and mobilization of the right kidney, two 12-mm trocar incisions in the right upper quadrant were connected in a 5-7 cm subcostal incision. The caval vein was partially clamped under direct vision prior to dissection of the renal vein. The venotomy was then closed with a running 4-0 Prolene suture. The two groups were compared with regard to surgical complications, graft function, and graft survival. RESULTS Using this technique, no significant difference with regard to complications or graft function was observed. Serum creatinine at discharge in donor group L was 1.23 (±0.43) mg/dL and in donor group R 1.21 (±0.37) mg/dL (P = .71). Graft survival at one year was 100% in both groups. CONCLUSION Open management of the renal vein is a safe alternative in laparoscopic right-sided donor nephrectomy and ensures maximal length of the vein.
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Affiliation(s)
- C Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - M Gummerer
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of Vascular Surgery, Medical University of Innsbruck, Austria
| | - V Gallotta
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - S Scheidl
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - K Kienzl-Wagner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - H T Maier
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Lucciarini P, Augustin F, Maier HT, Zaraca F, Schmid T. Intraoperative complications during VATS lobectomies from conversion to minimally-invasive "trouble-shooting". J Vis Surg 2018; 4:28. [PMID: 29552510 DOI: 10.21037/jovs.2018.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 12/28/2017] [Indexed: 11/06/2022]
Abstract
The aim of this study was to explore intraoperative complications during video-assisted thoracoscopic surgery (VATS) lobectomy. Vascular and bronchial injuries, after a robust learning curve, can be sometimes successfully managed by VATS. During a VATS lobectomy, it is necessary: to be prepared in potentially dangerous situations; to think about strategies to handle intraoperative complications and to share these strategies with your own staff. Herein we present some videos showing cases where vascular injuries led to conversion and others where a minimally-invasive trouble shooting of intraoperative complications was achieved.
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Affiliation(s)
- Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery (VTT-Chirurgie), Medical University Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery (VTT-Chirurgie), Medical University Innsbruck, Austria
| | - Herbert Thomas Maier
- Department of Visceral, Transplant and Thoracic Surgery (VTT-Chirurgie), Medical University Innsbruck, Austria
| | - Francesco Zaraca
- Department of Vascular and Thoracic Surgery, Regional Hospital Bolzano, Italy
| | - Thomas Schmid
- Department of Visceral, Transplant and Thoracic Surgery (VTT-Chirurgie), Medical University Innsbruck, Austria
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Maier HT, Ashraf MI, Denecke C, Weiss S, Augustin F, Messner F, Vallant N, Böcklein M, Margreiter C, Göbel G, Pratschke J, Öfner-Velano D, Aigner F. Prediction of delayed graft function and long-term graft survival by serum and urinary neutrophil gelatinase-associated lipocalin during the early postoperative phase after kidney transplantation. PLoS One 2018; 13:e0189932. [PMID: 29304176 PMCID: PMC5755755 DOI: 10.1371/journal.pone.0189932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/03/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as an early marker protein for kidney dysfunction in various clinical settings. In this prospective study we evaluated serial changes of serum and urinary NGAL within the first 7 days after kidney transplantation in 170 consecutive recipients. The main focus of this study was to assess the performance of serum and urinary NGAL in the prediction of delayed graft function (DGF) and two-year graft and patient survival. Serum and urine samples of 170 patients undergoing primary kidney transplantation from October 2010 to December 2012 were prospectively collected from day 0 to 7. NGAL was analyzed by ELISA. Multivariate regression models, receiver-operating characteristics (ROC), and areas under ROC curves (AUC) were used to identify predictors of DGF. DGF occurred in 52 patients (30.6%). Serum (AUC = 0.869) and urinary NGAL (AUC = 0.872) on postoperative day (POD) 2 could accurately predict DGF compared to serum creatinine (AUC = 0.619). Multivariate analyses revealed donor age, serum and urinary NGAL significantly associated with DGF (p<0.001). Recipient age was the only significant factor in a cox regression model influencing two-year graft and patient survival. In conclusion, serum and urinary NGAL are early predictors of DGF after kidney transplantation.
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Affiliation(s)
- Herbert Thomas Maier
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Muhammad Imtiaz Ashraf
- Daniel-Swarovski-Research Laboratory, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Christian Denecke
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Sascha Weiss
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Franka Messner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Natalie Vallant
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Matthias Böcklein
- Daniel-Swarovski-Research Laboratory, Innsbruck Medical University, Innsbruck, Austria
| | - Christian Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Dietmar Öfner-Velano
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Felix Aigner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
- * E-mail:
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Maier HT, Aigner F, Trenkwalder B, Zitt M, Vallant N, Perathoner A, Margreiter C, Moser P, Pratschke J, Amberger A. Up-regulation of Neutrophil Gelatinase-Associated Lipocalin in Colorectal Cancer Predicts Poor Patient Survival. World J Surg 2014; 38:2160-7. [DOI: 10.1007/s00268-014-2499-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Margreiter C, Mark W, Wiedemann D, Sucher R, Öllinger R, Bösmüller C, Freund M, Maier HT, Greiner A, Fritsch H, Pratschke J, Margreiter R, Aigner F. Pancreatic graft survival despite partial vascular graft thrombosis due to splenocephalic anastomoses. Am J Transplant 2010; 10:846-851. [PMID: 20420640 DOI: 10.1111/j.1600-6143.2010.03060.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thrombotic complications following pancreas transplantation are still the most common cause of nonimmunologic graft loss. The aim of this study was to analyze pancreatic graft function after partial arterial graft thrombosis and the investigation of the pancreatic arterial anatomy with regard to intraparenchymal anastomoses. We retrospectively analyzed the data for 175 consecutive pancreas transplants performed between January 2002 and October 2007. Selective Y-graft angiography was performed in 10 and rubber-milk injection in 5 fresh pancreas specimens. Thrombosis of one leg of the Y-graft was diagnosed in 18 (10.3%) patients. Only one of these patients with thrombosis of the splenic artery required exogenous insulin. Sufficient graft perfusion was demonstrated in all of the remaining grafts. One graft was lost due to acute rejection. In all specimens angiography showed an excellent perfusion of the pancreaticoduodenal arcade, even after selective cannulation of the splenic artery. Arterial collaterals between the gastroduodenal, splenic artery and the superior mesenteric artery were demonstrated. Our results demonstrate that global perfusion of the pancreatic graft and sufficient graft function is sustained after the thrombotic occlusion of one branch of the Y-graft by a complex system of intraparenchymal anastomoses. These anatomical findings may have consequences for resection strategies in pancreas surgery.
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Affiliation(s)
- C Margreiter
- Department of Visceral, Transplant and Thoracic Surgery
| | - W Mark
- Department of Visceral, Transplant and Thoracic Surgery
| | | | - R Sucher
- Department of Visceral, Transplant and Thoracic Surgery
| | - R Öllinger
- Department of Visceral, Transplant and Thoracic Surgery
| | - C Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery
| | - M Freund
- Department of Diagnostic Radiology
| | - H T Maier
- Department of Visceral, Transplant and Thoracic Surgery
| | | | - H Fritsch
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria
| | - J Pratschke
- Department of Visceral, Transplant and Thoracic Surgery
| | - R Margreiter
- Department of Visceral, Transplant and Thoracic Surgery
| | - F Aigner
- Department of Visceral, Transplant and Thoracic Surgery
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Aigner F, Maier HT, Schwelberger HG, Wallnöfer EA, Amberger A, Obrist P, Berger T, Mak TW, Maglione M, Margreiter R, Schneeberger S, Troppmair J. Lipocalin-2 regulates the inflammatory response during ischemia and reperfusion of the transplanted heart. Am J Transplant 2007; 7:779-88. [PMID: 17391123 DOI: 10.1111/j.1600-6143.2006.01723.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ischemia and reperfusion (IR) are known to negatively affect early allograft function following solid organ transplantation. Lipocalin-2 (Lcn-2) has been described as a marker and potential positive modulator of acute inflammation during these processes. Using a heterotopic murine heart transplant model we previously found that IR resulted in a pronounced upregulation of Lcn-2 mRNA in the heart at 12 (22.7-fold increase) and 24 h (9.8-fold increase) of reperfusion. We now confirm this increase at the protein level and provide evidence for infiltrating polymorphonuclear cells as the primary source of Lcn-2 protein. Lcn-2 levels are increased 6.6-fold at 12 h, 11.4-fold at 24 h and 6.4 fold at 48 h after reperfusion. In Lcn-2(-/-) grafts the number of infiltrating granulocytes is reduced by 54% (p < 0.05) at 2 h, 79% (p < 0.01) at 12 h, 72% (p < 0.01) at 24 h and 52% (p < 0.01) at 48 h after reperfusion compared to Lcn-2(+/+) grafts, without any differences in cardiomyocyte apoptosis. These data suggest a function of Lcn-2 in the initiation of the inflammatory response. Moreover, an increase in Lcn-2 is not only restricted to the transplanted heart, but is also observed in the kidney, hinting at a possible involvement of Lcn-2 in the systemic response to IR.
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Affiliation(s)
- F Aigner
- Department of General and Transplant Surgery and Daniel-Swarovski-Research Laboratory, Innsbruck Medical University, Austria.
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