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Zwirner S, Abu Rmilah AA, Klotz S, Pfaffenroth B, Kloevekorn P, Moschopoulou AA, Schuette S, Haag M, Selig R, Li K, Zhou W, Nelson E, Poso A, Chen H, Amiot B, Jia Y, Minshew A, Michalak G, Cui W, Rist E, Longerich T, Jung B, Felgendreff P, Trompak O, Premsrirut PK, Gries K, Muerdter TE, Heinkele G, Wuestefeld T, Shapiro D, Weissbach M, Koenigsrainer A, Sipos B, Ab E, Zacarias MO, Theisgen S, Gruenheit N, Biskup S, Schwab M, Albrecht W, Laufer S, Nyberg S, Zender L. First-in-class MKK4 inhibitors enhance liver regeneration and prevent liver failure. Cell 2024; 187:1666-1684.e26. [PMID: 38490194 PMCID: PMC11011246 DOI: 10.1016/j.cell.2024.02.023] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/20/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
Diminished hepatocyte regeneration is a key feature of acute and chronic liver diseases and after extended liver resections, resulting in the inability to maintain or restore a sufficient functional liver mass. Therapies to restore hepatocyte regeneration are lacking, making liver transplantation the only curative option for end-stage liver disease. Here, we report on the structure-based development and characterization (nuclear magnetic resonance [NMR] spectroscopy) of first-in-class small molecule inhibitors of the dual-specificity kinase MKK4 (MKK4i). MKK4i increased liver regeneration upon hepatectomy in murine and porcine models, allowed for survival of pigs in a lethal 85% hepatectomy model, and showed antisteatotic and antifibrotic effects in liver disease mouse models. A first-in-human phase I trial (European Union Drug Regulating Authorities Clinical Trials [EudraCT] 2021-000193-28) with the clinical candidate HRX215 was conducted and revealed excellent safety and pharmacokinetics. Clinical trials to probe HRX215 for prevention/treatment of liver failure after extensive oncological liver resections or after transplantation of small grafts are warranted.
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Affiliation(s)
- Stefan Zwirner
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany; HepaRegeniX GmbH, Tübingen 72072, Germany
| | - Anan A Abu Rmilah
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Sabrina Klotz
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Bent Pfaffenroth
- Department of Pharmaceutical Chemistry, University of Tübingen, Tübingen 72076, Germany
| | - Philip Kloevekorn
- Department of Pharmaceutical Chemistry, University of Tübingen, Tübingen 72076, Germany
| | - Athina A Moschopoulou
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Svenja Schuette
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Mathias Haag
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart 70376, Germany
| | - Roland Selig
- HepaRegeniX GmbH, Tübingen 72072, Germany; Department of Pharmaceutical Chemistry, University of Tübingen, Tübingen 72076, Germany
| | - Kewei Li
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Wei Zhou
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Erek Nelson
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Antti Poso
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany; School of Pharmacy, University of Eastern Finland, Kuopio 70211, Finland; iFIT Cluster of Excellence (EXC 2180) "Image-guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen 72076, Germany
| | - Harvey Chen
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Bruce Amiot
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Yao Jia
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Anna Minshew
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory Michalak
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Wei Cui
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Elke Rist
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | | | - Philipp Felgendreff
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA
| | - Omelyan Trompak
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | | | - Katharina Gries
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Thomas E Muerdter
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart 70376, Germany
| | - Georg Heinkele
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart 70376, Germany
| | - Torsten Wuestefeld
- Laboratory for In Vivo Genetics & Gene Therapy, Genome Institute of Singapore, Agency for Science, Technology and Research (A(∗)STAR), Singapore 138672, Singapore; School of Biological Sciences, Nanyang Technological University of Singapore, Singapore 637551, Singapore
| | | | | | - Alfred Koenigsrainer
- iFIT Cluster of Excellence (EXC 2180) "Image-guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen 72076, Germany; German Cancer Research Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany; Department of General-, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen 72076, Germany
| | - Bence Sipos
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany
| | - Eiso Ab
- ZoBio B.V., Leiden 2333 CH, the Netherlands
| | | | | | | | | | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart 70376, Germany; iFIT Cluster of Excellence (EXC 2180) "Image-guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen 72076, Germany; Department of Clinical Pharmacology, Pharmacy and Biochemistry, University of Tübingen, Tübingen 72076, Germany
| | | | - Stefan Laufer
- Department of Pharmaceutical Chemistry, University of Tübingen, Tübingen 72076, Germany; Tübingen Center for Academic Drug Discovery & Development (TüCAD(2)), Tübingen 72076, Germany.
| | - Scott Nyberg
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA.
| | - Lars Zender
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen 72076, Germany; iFIT Cluster of Excellence (EXC 2180) "Image-guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen 72076, Germany; German Cancer Research Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany; Tübingen Center for Academic Drug Discovery & Development (TüCAD(2)), Tübingen 72076, Germany.
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Felgendreff P, Hosseiniasl SM, Felgendreff L, Amiot BP, Minshew A, Ahmadzada B, Qu Z, Wilken S, Arribas Gomez I, Nyberg SL, Cook CN. Comprehensive analysis of brain injury parameters in a preclinical porcine model of acute liver failure. Front Med (Lausanne) 2024; 11:1363979. [PMID: 38606159 PMCID: PMC11007081 DOI: 10.3389/fmed.2024.1363979] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/21/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Acute liver failure (ALF) is defined as acute loss of liver function leading to hepatic encephalopathy associated with a high risk of patient death. Brain injury markers in serum and tissue can help detect and monitor ALF-associated brain injury. This study compares different brain injury parameters in plasma and tissue along with the progression of ALF. Method ALF was induced by performing an 85% liver resection. Following the resection, animals were recovered and monitored for up to 48 h or until reaching the predefined endpoint of receiving standard medical therapy (SMT). Blood and serum samples were taken at Tbaseline, T24, and upon reaching the endpoint (Tend). Control animals were euthanized by exsanguination following plasma sampling. Postmortem brain tissue samples were collected from the frontal cortex (FCTx) and cerebellum (Cb) of all animals. Glial fibrillary acidic protein (GFAP) and tau protein and mRNA levels were quantified using ELISA and qRT-PCR in all plasma and brain samples. Plasma neurofilament light (NFL) was also measured using ELISA. Results All ALF animals (n = 4) were euthanized upon showing signs of brain herniation. Evaluation of brain injury biomarkers revealed that GFAP was elevated in ALF animals at T24h and Tend, while Tau and NFL concentrations were unchanged. Moreover, plasma glial fibrillary acidic protein (GFAP) levels were negatively correlated with total protein and positively correlated with both aspartate transaminase (AST) and alkaline phosphatase (AP). Additionally, lower GFAP and tau RNA expressions were observed in the FCTx of the ALF group but not in the CB tissue. Conclusion The current large animal study has identified a strong correlation between GFAP concentration in the blood and markers of ALF. Additionally, the protein and gene expression analyses in the FCTx revealed that this area appears to be susceptible, while the CB is protected from the detrimental impacts of ALF-associated brain swelling. These results warrant further studies to investigate the mechanisms behind this process.
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Affiliation(s)
- Philipp Felgendreff
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | | | - Lisa Felgendreff
- Department of Journalism and Communication Research, Hannover University of Music, Drama, and Media, Hanover, Germany
| | - Bruce P. Amiot
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Anna Minshew
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Zhi Qu
- Transplant Center, Hannover Medical School, Hannover, Germany
| | - Silvana Wilken
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Ines Arribas Gomez
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Scott L. Nyberg
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, United States
| | - Casey N. Cook
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
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Felgendreff P, Lawrence JM, Hosseiniasl SM, Jacobs JF, Amiot BP, Felgendreff L, Minshew A, Sultan A, Ahmadzada B, Rahe MC, Nyberg SL. Clinical characterization of a hypersensitivity mixed bacterial and fungal dermatitis in a translational model of porcine NASH. Front Cell Infect Microbiol 2024; 13:1277045. [PMID: 38327680 PMCID: PMC10847572 DOI: 10.3389/fcimb.2023.1277045] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The development of animal models of chronic liver disease via diet modification is a promising avenue for translational research but can lead to unexpected side effects that impact model adoption. While these side effects are well characterized in rodent models of nonalcoholic steatohepatitis (NASH), limited knowledge of these effects exists for novel porcine models of NASH. To close this gap, the present study investigates the side effects of diet-based NASH induction in pigs, with a systematic analysis of the pathologic mechanisms underlying dermatitis development and evaluation of treatment approaches. Method Twelve pigs (10 large domestic pigs, 2 Goettingen minipigs) were fed a methionine- and choline-deficient, high-fat diet for 8 weeks to induce NASH. A retrospective review of each animal's clinical record was performed to identify the side effects of the diet. Following the identification of diet-associated dermatitis, severity was judged by using a novel gradation system that characterized the individual lesions and body regions resulting in a cumulative evaluation. In addition to this clinical assessment, the etiology of the dermatitis was investigated via histopathologic and microbiologic testing. Furthermore, the success of prophylactic and therapeutic treatment approaches was evaluated by considering dermatitis development and clinical course. Results All study animals demonstrated unexpected side effects of the methionine- and choline-deficient, high fat diet. In addition to marked dermatitis, study pigs showed impaired weight gain and developed steatorrhea and anemia. Based on the skin gradation system, five animals developed severe dermatitis, four animals moderate dermatitis, and three animals mild diet-associated dermatitis. Histological and microbiological evaluation of the affected skin showed signs of a hypersensitivity reaction with secondary infection by bacteria and fungi. The analysis showed that preemptive bathing extended the lesion-free duration by nearly 20 days. Furthermore, bathing in combination with a targeted antibiotic treatment represented a helpful treatment approach for diet-associated dermatitis. Conclusion The provision of a methionine- and choline-deficient, high fat diet represents an effective approach for inducing NASH liver disease in pigs but predisposes study animals to multiple side effects. These side effects are universal to animals on study but can be adequately managed and do not represent a significant limitation of this model.
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Affiliation(s)
- Philipp Felgendreff
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | | | | | - Julie F. Jacobs
- Department of Comparative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Bruce P. Amiot
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Lisa Felgendreff
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Anna Minshew
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Ahmer Sultan
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Michael C. Rahe
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, United States
- Population Health and Pathobiology, North Carolina State University, Raleigh, NC, United States
| | - Scott L. Nyberg
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, United States
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Dondorf F, Graf M, Deeb AA, Rohland O, Felgendreff P, Ardelt M, Settmacher U, Rauchfuss F. Pathogen detection in patients with perihilar cholangiocarcinoma: Implications for targeted perioperative antibiotic therapy. Hepatobiliary Pancreat Dis Int 2023; 22:512-518. [PMID: 35153139 DOI: 10.1016/j.hbpd.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cholestasis should be relieved by biliary drainage prior to major liver resection. This condition is often associated with bacterial colonization of the otherwise sterile biliary system. Cholangitis reduces the regenerative capacity of the remaining liver. Therefore, targeted antibiotic therapy is a key feature in perioperative treatment in patients with perihilar cholangiocarcinoma (pCCC). METHODS Between December 1999 and December 2017, 251 pCCC patients were treated in our center. In total, 115 patients underwent a microbiological analysis. In addition to the characterization of the specific microorganisms and antibiotic resistance, we analyzed subgroups according to preoperative intervention. RESULTS Enterococci (87/254, 34%) and Enterobacteria (65/254, 26%) were the most frequently detected genera. In 43% (50/115) of patients, Enterococcus faecalis was found in the bile duct sample. Enterococcus faecium (29/115) and Escherichia coli (29/115) were detected in 25% of patients. In patients with percutaneous transhepatic biliary drainage (3/8, 38%) or stents (24/79, 30%), Enterococcus faecium was diagnosed most frequently (P < 0.05). Enterococcus faecium and Klebsiella oxytoca were significantly more frequently noted in the time period after 2012 (P < 0.05). With regard to fungal colonization, the focus was on various Candida strains, but these strains generally lacked resistance. CONCLUSIONS pCCC patients exhibit specific bacterial colonization features depending on the type of preoperative biliary intervention. Specifically, targeted antibiosis should be applied in this patient cohort to minimize the risk of biliary complications after major liver resection. In our cohort, the combination of meropenem and vancomycin represents an effective perioperative medical approach.
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Affiliation(s)
- Felix Dondorf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany.
| | - Maximilian Graf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Aladdin Ali Deeb
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Oliver Rohland
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Philipp Felgendreff
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany; Research Program "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena 07747, Germany
| | - Michael Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Falk Rauchfuss
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
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Hosseiniasl SM, Felgendreff P, Tharwat M, Amiot B, AbuRmilah A, Minshew AM, Bornschlegl AM, Jalan-Sakrikar N, Smart M, Dietz AB, Huebert RC, Nyberg SL. Biodegradable biliary stents coated with mesenchymal stromal cells in a porcine choledochojejunostomy model. Cytotherapy 2023; 25:483-489. [PMID: 36842850 PMCID: PMC10399303 DOI: 10.1016/j.jcyt.2023.01.014] [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: 08/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND AIMS Roux en y anastomosis is a preferred method of biliary reconstruction in liver transplantation that involves living donors or pediatric patients. However, biliary stricture is a frequent and serious complication, accounting for up to 40% of biliary complications in these patients. Previously, we demonstrated that extraluminal delivery of adipose-derived (AD) mesenchymal stromal cells (MSCs) decreased peri-biliary fibrosis and increased neo-angiogenesis in a porcine model of duct-to-duct biliary anastomosis. In this study, we used a porcine model of Roux en y anastomosis to evaluate the beneficial impact of a novel intraluminal MSC delivery system. METHODS Nine animals were divided into three groups: no stent (group 1), bare stent (group 2) and stent coated with AD-MSCs (group 3). All animals underwent cholecystectomy with roux en y choledochojejunostomy. Two animals per group were followed for 4 weeks and one animal per group was followed for 8 weeks. Cholangiograms and blood were sampled at baseline and the end of study. Biliary tissue was collected and examined by Masson trichrome staining and immunohistochemical staining for MSC markers (CD34 and CD44) and for neo-angiogenesis (CD31). RESULTS Two of three animals in group 1 developed an anastomotic site stricture. No strictures were observed in the animals of group 2 or group 3. CD34 and CD44 staining showed that AD-MSCs engrafted successfully at the anastomotic site by intraluminal delivery (group 3). Furthermore, biliary tissue from group 3 showed significantly less fibrosis and increased angiogenesis compared with the other groups. CONCLUSIONS Intraluminal delivery of AD-MSCs resulted in successful biliary engraftment of AD-MSCs as well as reduced peri-biliary fibrosis and increased neo-angiogenesis.
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Affiliation(s)
| | - Philipp Felgendreff
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department for General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Mohammad Tharwat
- General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Bruce Amiot
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Anan AbuRmilah
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna M Minshew
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander M Bornschlegl
- Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Nidhi Jalan-Sakrikar
- Gastroenterology Research Unit, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Michele Smart
- Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Robert C Huebert
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA; Gastroenterology Research Unit, Mayo Clinic and Foundation, Rochester, Minnesota, USA; Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Scott L Nyberg
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
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Li K, Tharwat M, Larson EL, Felgendreff P, Hosseiniasl SM, Rmilah AA, Safwat K, Ross JJ, Nyberg SL. Re-Endothelialization of Decellularized Liver Scaffolds: A Step for Bioengineered Liver Transplantation. Front Bioeng Biotechnol 2022; 10:833163. [PMID: 35360393 PMCID: PMC8960611 DOI: 10.3389/fbioe.2022.833163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Bioengineered livers (BELs) are an attractive therapeutic alternative to address the donor organ shortage for liver transplantation. The goal of BELs technology aims at replacement or regeneration of the native human liver. A variety of approaches have been proposed for tissue engineering of transplantable livers; the current review will highlight the decellularization-recellularization approach to BELs. For example, vascular patency and appropriate cell distribution and expansion are critical components in the production of successful BELs. Proper solutions to these components of BELs have challenged its development. Several strategies, such as heparin immobilization, heparin-gelatin, REDV peptide, and anti-CD31 aptamer have been developed to extend the vascular patency of revascularized bioengineered livers (rBELs). Other novel methods have been developed to enhance cell seeding of parenchymal cells and to increase graft functionality during both bench and in vivo perfusion. These enhanced methods have been associated with up to 15 days of survival in large animal (porcine) models of heterotopic transplantation but have not yet permitted extended survival after implantation of BELs in the orthotopic position. This review will highlight both the remaining challenges and the potential for clinical application of functional bioengineered grafts.
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Affiliation(s)
- Kewei Li
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Mohammad Tharwat
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ellen L. Larson
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Philipp Felgendreff
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Department for General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | | | - Anan Abu Rmilah
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Khaled Safwat
- General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Scott L. Nyberg
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Scott L. Nyberg,
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Dondorf F, Deeb AA, Bauschke A, Felgendreff P, Tautenhahn HM, Ardelt M, Settmacher U, Rauchfuss F. Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure. Langenbecks Arch Surg 2021; 406:1111-1118. [PMID: 33970336 PMCID: PMC8208903 DOI: 10.1007/s00423-021-02181-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy. METHODS In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses. RESULTS Volumetric analysis showed a significant volume increase, especially for patients with colorectal metastases. Pre-existing liver parenchyma damage (odds ratio = 0.717, p = 0.017) and preoperative chemotherapy were found to be significant predictors (odds ratio = 0.803, p = 0.045) of higher morbidity and mortality. In addition, a survival benefit for maintenance of middle hepatic vein was shown. CONCLUSION This technical modification of the ALPPS procedure can accentuate future liver remnant volume hypertrophy. The higher morbidity and mortality observed are most likely associated with pre-existing parenchymal damage within this group.
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Affiliation(s)
- F Dondorf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - A Ali Deeb
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Bauschke
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - P Felgendreff
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Research Program "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena, Germany
| | - H M Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Research Program "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena, Germany
| | - M Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - F Rauchfuss
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Felgendreff P, Schindler C, Mussbach F, Xie C, Gremse F, Settmacher U, Dahmen U. Identification of tissue sections from decellularized liver scaffolds for repopulation experiments. Heliyon 2021; 7:e06129. [PMID: 33644446 PMCID: PMC7895725 DOI: 10.1016/j.heliyon.2021.e06129] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Biological organ engineering is a novel experimental approach to generate functional liver grafts by decellularization and repopulation. Currently, healthy organs of small or large animals and human organs with preexisting liver diseases are used to optimize decellularization and repopulation.However, the effects of morphological changes on allo- and xenogeneic cell-scaffold interactions during repopulation procedure, e.g., using scaffold-sections, are unknown. We present a sequential morphological workflow to identify murine liver scaffold-sections with well-preserved microarchitecture. METHODS Native livers (CONT, n = 9) and livers with experimentally induced pathologies (hepatics steatosis: STEA, n = 7; hepatic fibrosis induced by bile duct ligation: BDL, n = 9; nodular regenerative hyperplasia induced by 90% partial hepatectomy: PH, n = 8) were decellularized using SDS and Triton X-100 to generate cell-free scaffolds. Scaffold-sections were assessed using a sequential morphological workflow consisting of macroscopic, microscopic and morphological evaluation: (1) The scaffold was evaluated by a macroscopic decellularization score. (2) Regions without visible tissue remnants were localized for sampling and histological processing. Subsequent microscopical examination served to identify tissue samples without cell remnants. (3) Only cell-free tissue sections were subjected to detailed liver-specific morphological assessment using a histological and immunohistochemical decellularization score. RESULTS Decellularization was feasible in 33 livers, which were subjected to the sequential morphological workflow. In 11 of 33 scaffolds we achieved a good macroscopic decellularization result (CONT: 3 scaffolds; STEA: 3 scaffolds; BDL: 3 scaffolds; PH: 2 scaffolds). The microscopic assessment resulted in the selection of 88 cell-free tissue sections (CONT: 15 sections; STEA: 38 sections; BDL: 30 sections; PH: 5 sections). In 27 of those sections we obtained a good histological decellularization result (CONT: 3 sections; STEA: 6 sections; BDL: 17 sections; PH: 1 section). All experimental groups contained sections with a good immunohistochemical decellularization result (CONT: 6 sections; STEA: 5 sections; BDL: 4 sections; PH: 1 section). DISCUSSION Decellularization was possible in all experimental groups, irrespectively of the underlying morphological alteration. Furthermore, our proposed sequential morphological workflow was suitable to detect tissue sections with well-preserved hepatic microarchitecture, as needed for further repopulation experiments.
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Affiliation(s)
- Philipp Felgendreff
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
- Research Program “Else Kröner-Forschungskolleg AntiAge”, Jena University Hospital, Jena, Germany
| | - Claudia Schindler
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Franziska Mussbach
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Chichi Xie
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Felix Gremse
- Institute for Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
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9
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Dondorf F, Croner RS, Tautenhahn HM, Felgendreff P, Ardelt M, Settmacher U, Rauchfuss F. Liver Transplant Due to Flupirtine-Induced Acute Liver Failure. EXP CLIN TRANSPLANT 2020; 18:481-484. [PMID: 32635884 DOI: 10.6002/ect.2019.0297] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Acute drug-induced liver failure is a rare indication for liver transplant. There is only one case of flupirtine-induced liver failure requiring transplant in the literature. In February 2018, the European Medicines Agency issued a withdrawal of approval for flupirtine medication in European countries as a result of the risk of acute liver failure. MATERIALS AND METHODS The aim of this study was a German-wide collection of data regarding patients with liver transplant as a result of flupirtine-associated liver failure. RESULTS A total of 9 patients received transplants. All patients were women with a mean age of 43 years. Indication for flupirtine medication was musculoskeletal symptoms and migraine headache. The medication was taken over a period of approximately 3 months. All patients developed progressive acute liver failure, and no patient had previous chronic liver disease or cirrhosis. The mean laboratory Model for End Stage Liver Disease score for the patients was 31 ± 7 at time of transplant. Eight of the 9 patients were listed as "high urgency" for transplant. After transplant, they had an uneventful course with a prolonged mean intensive care unit stay of 13 ± 8.7 days. The whole hospitalization time was 43 ± 21 days. CONCLUSIONS This is the largest published series of patients who received liver transplant after a drug-induced acute liver failure from flupirtine medication.
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Affiliation(s)
- Felix Dondorf
- From the Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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10
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Morgul MH, Felgendreff P, Kienlein A, Gauger U, Semmling K, Hau HM, Tautenhahn HM, Bartels M. Milan criteria in the MELD era-is it justifiable to extend the limits for orthotopic liver transplantation? World J Surg Oncol 2020; 18:158. [PMID: 32635931 PMCID: PMC7339581 DOI: 10.1186/s12957-020-01932-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background The Milan criteria (MC) are widely used for the indication of liver transplantation (LTx) in hepatocellular carcinoma (HCC). Good long-term results have also been reported following LTx for patients exceeding the MC. In this article, we compare the overall and recurrence-free survival of our patients fulfilling and exceeding the MC according to the post-transplant histopathological results. Patients and methods Data from 120 patients with HCC (22 females and 98 males) were analyzed. The median patient age was 61 years (Q1, Q3 54.7, 65.4), and the median MELD score was 11 (Q1, Q3 8, 15). The median follow-up period was 53 months (Q1, Q3 16.6, 78). Patients were categorized into established criteria (MC, up-to-seven (UTS), Asan criteria, AFP score), and the outcome of the individual groups was compared. Results Seventy-four of 120 patients fulfilled the MC, 86 patients met the UTS criteria, 85 patients fulfilled the Asan criteria, and 79 patients had an AFP score less than or equal to 2. The 1- and 5-year survival rates of all patients were 76.7% and 55.6%, respectively. In total, 14.2% of all patients (5.4% of patients who met the MC, 7% of patients who met the UTS criteria, 5.9% of patients who met the Asan criteria, and 6.3% of patients who had an AFP score less than 2) experienced recurrence. Conclusions The outcomes of the patients were comparable to those reported in the current literature. In our population, similar recurrence and survival rates of the patients were noted for patients fulfilling the UTS criteria irrespective of fulfilling or exceeding the MC. Consequently, we consider using UTS criteria as the extended criterion for LTx indication.
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Affiliation(s)
- Mehmet Haluk Morgul
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.,Department of General, Visceral and Transplantation Surgery, University of Münster, Münster, Germany
| | - Philipp Felgendreff
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany. .,Department of General, Visceral, and Vascular Surgery, University of Jena, Am Klinikum 1, 07749, Jena, Germany. .,Research Programme "Else Kröner-Forschungskolleg AntiAge", University of Jena, Jena, Germany.
| | - Andreas Kienlein
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.,Department of Urology and Pediatric Urology, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | | | - Katrin Semmling
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.,Department of Gastr., Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.,Department of General, Visceral, and Vascular Surgery, University of Jena, Am Klinikum 1, 07749, Jena, Germany.,Research Programme "Else Kröner-Forschungskolleg AntiAge", University of Jena, Jena, Germany
| | - Michael Bartels
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University of Leipzig, Leipzig, Germany.,Department for General Visceral, Thoracic and Vascular Surgery, Helios Park-Klinikum Leipzig, Leipzig, Germany
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11
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Schindler C, Felgendreff P, Settmacher U, Dahmen U. [Video-based Analysis of Practical Skills - a Suitable Tool to Develop Surgical Training?]. Zentralbl Chir 2019; 144:606-613. [PMID: 31826295 DOI: 10.1055/a-1030-4676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Video-based analysis concepts are being is increasingly applied in medical education. These tools are mainly used to obtain information about the individual performance of a candidate and to provide feedback. The present study explores whether video-based analysis of practical skills can also be used for the development of surgical training. METHODS First, the performance of students in semester 10 (n = 38) in a surgical suture exercise (duration: 3 min) was video-documented. The video material was then analysed using 10 specific criteria. The analysis then served as a basis for the development of error prevention exercises. In the following, the effects of the additional teaching units on the performance in the suture exercise were examined in a pilot study using a two-group comparison. RESULTS The video sequences were reviewed independently by 2 experts. Typical errors could be observed in the handling of the surgical instruments, the handling of the suture material as well as in the motion sequence. Then, additional teaching units dealing with the identified error areas (handling of the instruments and the suture material) were developed. The results of the two-group comparison (before and after implementation of the new exercises) showed that completing the additional teaching units had a medium effect on the result quality of the suture exercise (Cohen's d = 0.73). CONCLUSION Video analysis of practical skills seems to be a suitable basis for the development of surgical training. Typical errors can be identified in terms of type and frequency, and preventive exercises can be developed, which have a positive effect on the quality of the results of a practical task.
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Affiliation(s)
- Claudia Schindler
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland
| | - Philipp Felgendreff
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland.,Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland
| | - Uta Dahmen
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland
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12
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Felgendreff P, Raschzok N, Kunze K, Leder A, Lippert S, Klunk S, Tautenhahn HM, Hau HM, Schmuck RB, Reutzel-Selke A, Sauer IM, Bartels M, Morgül MH. Tissue-based miRNA mapping in alcoholic liver cirrhosis: different profiles in cirrhosis with or without hepatocellular carcinoma. Biomarkers 2019; 25:62-68. [DOI: 10.1080/1354750x.2019.1691267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Philipp Felgendreff
- Department of General, Visceral, and Vascular Surgery, University of Jena, Jena, Germany
- Department of Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
- “Else Kröner-Forschungskolleg AntiAge”, Jena University Hospital, Jena, Germany
| | - Nathanael Raschzok
- Department of Surgery, Charité Mitte
- Campus Virchow-Klinikum, Berlin, Germany
- Experimental Surgery and Regenerative Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Kerstin Kunze
- Department of Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Annekatrin Leder
- Department of Surgery, Charité Mitte
- Campus Virchow-Klinikum, Berlin, Germany
| | - Steffen Lippert
- Department of Surgery, Charité Mitte
- Campus Virchow-Klinikum, Berlin, Germany
- Experimental Surgery and Regenerative Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sergej Klunk
- Department of Traumatology, Hand and Orthopedic Surgery, Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinberg, Germany
| | - Hans-Michael Tautenhahn
- Department of General, Visceral, and Vascular Surgery, University of Jena, Jena, Germany
- Department of Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Rosa Bianca Schmuck
- Department of Surgery, Charité Mitte
- Campus Virchow-Klinikum, Berlin, Germany
- Experimental Surgery and Regenerative Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Reutzel-Selke
- Department of Surgery, Charité Mitte
- Campus Virchow-Klinikum, Berlin, Germany
- Experimental Surgery and Regenerative Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Igor Maximilian Sauer
- Department of Surgery, Charité Mitte
- Campus Virchow-Klinikum, Berlin, Germany
- Experimental Surgery and Regenerative Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Bartels
- Department of Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
- Department of General Visceral, Thoracic, and Vascular Surgery, Helios Park-Klinikum Leipzig, Leipzig, Germany
| | - Mehmet Haluk Morgül
- Department of Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
- Department of General, Visceral- and Transplantation Surgery, University of Münster, Münster, Germany
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13
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Lederer AK, Haffa D, Felgendreff P, Makowiec F, Fichtner-Feigl S, Huber R, Kousoulas L. The impact of immunosuppression on postoperative graft function after graft-unrelated surgery: a retrospective controlled cohort study. BMC Nephrol 2019; 20:170. [PMID: 31096947 PMCID: PMC6521488 DOI: 10.1186/s12882-019-1358-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/04/2019] [Accepted: 04/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background Physicians are faced with a growing number of patients after renal transplantation undergoing graft-unrelated surgery. So far, little is known about the postoperative restitution of graft function and the risk factors for a poor outcome. Methods One hundred one kidney transplant recipients undergoing graft-unrelated surgery between 2005 and 2015 were reviewed retrospectively. A risk analysis was performed and differences in creatinine, GFR and immunosuppressive treatment were evaluated. Additional, a comparison with a case-matched non-transplanted control group were performed. Results Preoperative creatinine averaged 1.88 mg / dl [0.62–5.22 mg / dl] and increased to 2.49 mg / dl [0.69–8.30 mg / dl] postoperatively. Acute kidney failure occurred in 18 patients and 14 patients had a permanent renal failure. Significant risk factors for the development of postoperative renal dysfunction were female gender, a preoperative creatinine above 2.0 mg / dl as well as a GFR below 40 ml / min and emergency surgery. Patients with tacrolimus and mycophenolate mofetil treatment showed a significant lower risk of renal dysfunction than patients with other immunosuppressants postoperatively. Contrary to that, the risk of patients with cyclosporine treatment was significantly increased. Transplanted patients showed a significantly increased rate of postoperative renal dysfunction. Conclusions The choice of immunosuppressant might have an impact on graft function and survival of kidney transplant recipients after graft-unrelated surgery. Further investigations are needed. Electronic supplementary material The online version of this article (10.1186/s12882-019-1358-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann-Kathrin Lederer
- Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 115b, 79106, Freiburg im Breisgau, Germany.
| | - Dominic Haffa
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Felgendreff
- Department for General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.,Research Program "Else-Kröner-Forschungskolleg AntiAge", University Hospital Jena, Jena, Germany
| | - Frank Makowiec
- Quality Management, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 115b, 79106, Freiburg im Breisgau, Germany
| | - Lampros Kousoulas
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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14
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Felgendreff P, Rauchfuß F, Settmacher U. Biomarker für thromboembolische Ereignisse bei Patienten mit Adenokarzinom des Pankreas. Chirurg 2019; 90:61. [DOI: 10.1007/s00104-019-0905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Dondorf F, Uteβ F, Fahrner R, Felgendreff P, Ardelt M, Tautenhahn HM, Settmacher U, Rauchfuβ F. Liver Transplant for Perihilar Cholangiocarcinoma (Klatskin Tumor): The Essential Role of Patient Selection. EXP CLIN TRANSPLANT 2018; 17:363-369. [PMID: 29911960 DOI: 10.6002/ect.2018.0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Perihilar cholangiocarcinoma (Klatskin tumor) is a rare tumor entity, which is diagnosed late due to uncharacteristic symptoms. The therapeutic strategy for cure is still liver resection. Liver transplant in cases of locally irresectable tumors represents an alternative potential curative therapy for a select group of patients. MATERIALS AND METHODS We present our data of 22 patients with irresectable Klatskin tumors who received transplants between 1996 and 2015. We analyzed relevant prognostic factors for the selection of patients to be transplanted to ensure an acceptable overall survival and reviewed known and established selection criteria. RESULTS Four factors (age, tumor size, serum level of carbohydrate antigen 19-9, percutaneous transhepatic cholangiodrainage) could be detected for possible patient selection. Positive lymph node status and advanced tumor stage according to the Union for International Cancer Control were confirmed as negative prognostic factors for survival after transplant. CONCLUSIONS Liver transplant is a curative therapy for selected patients with irresectable Klatskin tumors, but further prospective studies are urgently needed.
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Affiliation(s)
- Felix Dondorf
- From the Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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16
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Lederer AK, Felgendreff P, Tautenhahn HM, Goos M, Fichtner-Feigl S, Settmacher U, Best M. [Generation Y: the Uncertain Future of Surgery]. Zentralbl Chir 2017; 142:581-582. [PMID: 28743154 DOI: 10.1055/s-0043-109237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Philipp Felgendreff
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena
| | | | - Matthias Goos
- Allgemein- und Viszeralchirurgie, HELIOS Klinik Müllheim
| | | | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena
| | - Manuel Best
- Department für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg
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17
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Morgul MH, Splith K, Leonhardt C, Raschzok N, Reutzel-Selke A, Schmuck RB, Andreou A, Atanasov G, Benzing C, Krenzien F, Hau HM, Felgendreff P, Klunk S, Pratschke J, Sauer IM, Schmelzle M. The value of microparticles in detecting acute rejection episodes after liver transplantation. Biomarkers 2017; 23:25-32. [PMID: 28303731 DOI: 10.1080/1354750x.2017.1306754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Non-invasive markers for diagnosis of acute rejection (AR) following liver transplantation have not been developed, yet. OBJECTIVE We analyzed the correlation of plasma microparticle levels (MP) with AR. MATERIALS AND METHODS MP (CD4, CD8, CD25, CD31, MHC) of 11 AR patients and 11 controls were analyzed within the first week after transplantation. RESULTS CD4, CD8 and CD31 positive MP were higher in the AR, whereas overall MP count, CD25 and MHCI positive MP proportions did not differ between both groups. DISCUSSION AND CONCLUSION MP dynamics within the first period of transplantation could help to clarify on-going mechanisms of immunomodulation.
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Affiliation(s)
- Mehmet Haluk Morgul
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Katrin Splith
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Christoph Leonhardt
- b Department of Medicine I Cardiology, Angiology and Intensive Care , General Hospital Chemnitz gGmbH , Chemnitz , Germany
| | - Nathanael Raschzok
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Anja Reutzel-Selke
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Rosa Bianca Schmuck
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Andreas Andreou
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Georgi Atanasov
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Christian Benzing
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Felix Krenzien
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Hans-Michael Hau
- c Department of Visceral , Transplant, Thoracic, and Vascular Surgery, University Hospital Leipzig , Leipzig , Germany
| | - Philipp Felgendreff
- d Department of General , Visceral, and Vascular Surgery, University Hospital Jena , Jena , Germany
| | - Sergej Klunk
- e Department of Traumatology, Hand and Orthopedic Surgery , Harzklinikum Dorothea Christiane Erxleben GmbH , Quedlinburg , Germany
| | - Johann Pratschke
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Igor Maximillian Sauer
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Moritz Schmelzle
- a Department of Surgery , Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin , Berlin , Germany
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18
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Morgul MH, Raschzok N, Felgendreff P, Dietel C, Schmuck R, Hau HM, Thelen A, Benckert C, Reutzel-Selke A, Neuhaus P, Sauer IM, Jonas S. MicroRNA as Biomarker for Diagnosis and Prediction of Recurrence of Human Hepatocellular Carcinoma after Liver Transplantation - Preliminary Results from a Multicenter Database. Transplantation 2012. [DOI: 10.1097/00007890-201211271-00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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