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Assfalg V, Miller G, Stocker F, Hüser N, Hartmann D, Heemann U, Tieken I, Zanen W, Vogelaar S, Rosenkranz AR, Schneeberger S, Függer R, Berlakovich G, Ysebaert DR, Jacobs-Tulleneers-Thevissen D, Mikhalski D, van Laecke S, Kuypers D, Mühlfeld AS, Viebahn R, Pratschke J, Melchior S, Hauser IA, Jänigen B, Weimer R, Richter N, Foller S, Schulte K, Kurschat C, Harth A, Moench C, Rademacher S, Nitschke M, Krämer BK, Renders L, Koliogiannis D, Pascher A, Hoyer J, Weinmann-Menke J, Schiffer M, Banas B, Hakenberg O, Schwenger V, Nadalin S, Lopau K, Piros L, Nemes B, Szakaly P, Bouts A, Bemelman FJ, Sanders JS, de Vries APJ, Christiaans MHL, Hilbrands L, van Zuilen AD, Arnol M, Stippel D, Wahba R. Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis. Transplantation 2024; 108:1200-1211. [PMID: 38073036 DOI: 10.1097/tp.0000000000004878] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15 658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Wouter Zanen
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Függer
- Department of Surgery, Krankenhaus der Elisabethinen and Johannes Kepler University, Linz, Austria
| | | | - Dirk R Ysebaert
- Department of HPB and Transplantation Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | | | - Dimitri Mikhalski
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, ULB, Brussels, Belgium
| | | | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Anja S Mühlfeld
- Department of Nephrology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Richard Viebahn
- Chirurgische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Bochum, Germany
| | - Johann Pratschke
- Chirurgische Klinik CCM/CVK, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ingeborg A Hauser
- Department of Nephrology, University Clinic Frankfurt, Frankfurt am Main, Germany
| | - Bernd Jänigen
- Department of General and Digestive Surgery, Transplant Unit, Freiburg, Germany
| | - Rolf Weimer
- Department of Internal Medicine, Nephrology/Renal Transplantation, University of Giessen, Giessen, Germany
| | - Nicolas Richter
- Medizinische Hochschule Hannover, Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany
| | - Susan Foller
- Department of Urology, Jena University Hospital, Jena, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ana Harth
- Medizinische Klinik I Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Christian Moench
- General-, Visceral- and Transplantation Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Nitschke
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Dionysios Koliogiannis
- Department of General, Visceral, and Transplant Surgery, LMU University of Munich, Munich, Germany
| | - Andreas Pascher
- Department of General, Visceral, and Transplant Surgery, UKM Muenster, Münster, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, University Medical Center, Philipps University Marburg, Marburg, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, Division of Nephrology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mario Schiffer
- Nephrology and Hypertension, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Bernhard Banas
- Abteilung für Nephrologie, Universitäres Transplantationszentrum, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, Rostock University Medical Centre, Rostock, Germany
| | - Vedat Schwenger
- Department of Nephrology and Transplant Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Kai Lopau
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg-Kidney Transplant Program, Wuerzburg, Germany
| | - Laszlo Piros
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Balazs Nemes
- Department of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Szakaly
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Antonia Bouts
- Pediatric Nephrology Department, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jan S Sanders
- Departement of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center and Transplant Center, Leiden, the Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, the Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dirk Stippel
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roger Wahba
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Körber N, Holzmann-Littig C, Wilkens G, Liao BH, Werz ML, Platen L, Cheng CC, Tellenbach M, Kappler V, Lehner V, Mijočević H, Christa C, Assfalg V, Heemann U, Schmaderer C, Protzer U, Braunisch MC, Bauer T, Renders L. Comparable cellular and humoral immunity upon homologous and heterologous COVID-19 vaccination regimens in kidney transplant recipients. Front Immunol 2023; 14:1172477. [PMID: 37063863 PMCID: PMC10102365 DOI: 10.3389/fimmu.2023.1172477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundKidney transplant recipients (KTRs) are at high risk for a severe course of coronavirus disease 2019 (COVID-19); thus, effective vaccination is critical. However, the achievement of protective immunogenicity is hampered by immunosuppressive therapies. We assessed cellular and humoral immunity and breakthrough infection rates in KTRs vaccinated with homologous and heterologous COVID-19 vaccination regimens.MethodWe performed a comparative in-depth analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific T-cell responses using multiplex Fluorospot assays and SARS-CoV-2-specific neutralizing antibodies (NAbs) between three-times homologously (n = 18) and heterologously (n = 8) vaccinated KTRs.ResultsWe detected SARS-CoV-2-reactive T cells in 100% of KTRs upon third vaccination, with comparable frequencies, T-cell expression profiles, and relative interferon γ and interleukin 2 production per single cell between homologously and heterologously vaccinated KTRs. SARS-CoV-2-specific NAb positivity rates were significantly higher in heterologously (87.5%) compared to homologously vaccinated (50.0%) KTRs (P < 0.0001), whereas the magnitudes of NAb titers were comparable between both subcohorts after third vaccination. SARS-CoV-2 breakthrough infections occurred in equal numbers in homologously (38.9%) and heterologously (37.5%) vaccinated KTRs with mild-to-moderate courses of COVID-19.ConclusionOur data support a more comprehensive assessment of not only humoral but also cellular SARS-CoV-2-specific immunity in KTRs to provide an in-depth understanding about the COVID-19 vaccine–induced immune response in a transplant setting.
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Affiliation(s)
- Nina Körber
- Institute of Virology, Helmholtz Zentrum München, Munich, Germany
- *Correspondence: Nina Körber,
| | - Christopher Holzmann-Littig
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
- Technical University of Munich (TUM) Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gesa Wilkens
- Institute of Virology, Helmholtz Zentrum München, Munich, Germany
| | - Bo-Hung Liao
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Maia L. Werz
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Louise Platen
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Cho-Chin Cheng
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Myriam Tellenbach
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Verena Kappler
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Viktor Lehner
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Hrvoje Mijočević
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Catharina Christa
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, Helmholtz Zentrum München, Munich, Germany
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Matthias C. Braunisch
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Tanja Bauer
- Institute of Virology, Helmholtz Zentrum München, Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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3
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Miller G, Ankerst DP, Kattan MW, Hüser N, Vogelaar S, Tieken I, Heemann U, Assfalg V. Kidney Transplantation Outcome Predictions (KTOP): A Risk Prediction Tool for Kidney Transplants from Brain-dead Deceased Donors Based on a Large European Cohort. Eur Urol 2023; 83:173-179. [PMID: 35000822 DOI: 10.1016/j.eururo.2021.12.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND European kidney donation shortages mandate efficient organ allocation by optimizing the prediction of success for individual recipients. OBJECTIVE To develop the first European online risk tool for kidney transplant outcomes on the basis of recipient-only and recipient plus donor characteristics. DESIGN, SETTING, AND PARTICIPANTS We used individual recipient and donor risk factors and three outcomes (death, death with functioning graft [DWFG], and graft loss) for 32 958 transplants within the Eurotransplant kidney allocation system and the Eurotransplant senior program between January 2006 and May 2018 in eight European countries to develop and validate a risk tool. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox proportional-hazards models were used to analyze the association of risk factors with overall patient mortality, and proportional subdistribution hazard regression models for their association with graft loss and DWFG. Prediction models were developed with recipient-only and recipient-donor risk factors. Sensitivity analyses based on time-specific area under the receiver operating characteristic curve (AUC) with leave-one-country-out validation were performed and calibration plots were generated. RESULTS AND LIMITATIONS The 10-yr cumulative incidence rate was 37% for mortality, 12% for DWFG, and 41% for graft loss. In recipient-donor models the leading risk factors for mortality were recipient diabetes (hazard ratio [HR] 10.73), retransplantation (HR 3.08 per transplant), and recipient age (HR 1.08). Effects were similar for DWFG. For graft loss, diabetes (subdistributional HR [SHR] 1.32), increased donor age (SHR 1.02), and prolonged cold ischemia time (SHR 1.02) had increased SHRs. All p values were <0.001. CONCLUSIONS Previously identified risk factors for outcomes following kidney transplants allow for outcome prediction with 10-yr AUC values of up to 0.81. PATIENT SUMMARY Using European data, we estimated individual risks to predict the success of kidney transplants and support physicians in decision-making. An online tool is now available (https://riskcalc.org/ktop/) for predicting kidney transplant outcomes both before and after a donor has been identified.
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Affiliation(s)
- Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany.
| | - Donna P Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany; Department of Life Science Systems, Munich Data Science Institute, Technical University of Munich, Freising, Germany
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Norbert Hüser
- TransplanTUM - Munich Transplant Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Uwe Heemann
- TransplanTUM - Munich Transplant Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- TransplanTUM - Munich Transplant Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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4
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Steffani M, Stöss C, Laschinger M, Assfalg V, Schulze S, Mogler C, Lohöfer F, Paprottka P, Hüser N, Friess H, Hartmann D, Novotny A. softALPPS - A novel, individual procedure for patients with advanced liver tumors. HPB (Oxford) 2022; 24:1362-1364. [PMID: 35289281 DOI: 10.1016/j.hpb.2022.02.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The first-line therapy for liver malignancies is a radical extended liver resection. This high-risk operation has a high incidence of post-hepatectomy liver failure (PHLF) due to a small future liver remnant (FLR). One of the procedures to increase the FLR is the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) which is still associated with high morbidity and mortality. Here, we present a new, less invasive ALPPS variant that may be associated with lower morbidity. METHODS SoftALPPS is characterized by reduced trauma to the liver tissue and individual adaptation to the patient's health constitution. In softALPPS, portal vein embolization (PVE) is performed instead of portal vein ligation (PVL) after complete recovery of liver function. In addition, a non-absorbable foil was avoided in order to be able to extend the interval to step two or skip step two when required. RESULTS Four patients successfully underwent softALPPS. Two of these patients have been followed-up for over a year (one patient with Klatskin tumor, one patient with extensive HCC). Both patients show no evidence of recurrence after 12 months and are in good medical condition. The other two patients who recently had surgery are also doing well. CONCLUSION SoftALPPS offers the chance to curatively resect patients with high tumor burden of the liver even when the FLR is inadequate. This individual therapy method can give patients the possibility of complete tumor resection and can help to reduce perioperative morbidity.
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Affiliation(s)
- Marcella Steffani
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Christian Stöss
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Volker Assfalg
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Sarah Schulze
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Carolin Mogler
- Institute of General and Surgical Pathology, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Fabian Lohöfer
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Philipp Paprottka
- Department of Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany.
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5
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Assfalg V, Miller G, Stocker F, van Meel M, Groenevelt T, Tieken I, Ankerst D, Renders L, Novotny A, Hartmann D, Jell A, Rahmel A, Wahba R, Mühlfeld A, Bouts A, Ysebaert D, Globke B, Jacobs-Tulleneers-Thevissen D, Piros L, Stippel D, Heller K, Eisenberger U, van Laecke S, Weimer R, Rosenkranz AR, Berger S, Fischer L, Kliem V, Vondran F, Sester U, Schneeberger S, Harth A, Kuypers D, Függer R, Arnol M, Christiaans M, Weinmann-Menke J, Krüger B, Hilbrands L, Banas B, Hakenberg O, Minnee R, Schwenger V, Heyne N, van Zuilen A, Reindl-Schwaighofer R, Lopau K, Hüser N, Heemann U. Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis. Transplantation 2022; 106:1215-1226. [PMID: 34608103 DOI: 10.1097/tp.0000000000003964] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND At Eurotransplant (ET), kidneys are transferred to "rescue allocation" (RA), whenever the standard allocation (SA) algorithms Eurotransplant Kidney Allocation System (ETKAS) and Eurotransplant Senior Program (ESP) fail. We analyzed the outcome of RA. METHODS Retrospective patient clinical and demographic characteristics association analyses were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 after SA from 71 centers across all ET countries from 2006 to 2018. RESULTS Numbers of DDRTs after RA increased over the time, especially in Germany. RA played a minor role in ESP versus ETKAS (2.7% versus 10.4%). RA recipients and donors were older compared with SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary nonfunction was comparable. Among ETKAS recipients, HLA matching was more favorable in SA (mean 3.7 versus 2.5). In multivariate modeling, the incidence of graft loss in ETKAS recipients was reduced in RA compared with SA (subdistribution hazard ratio, 0.80; 95% confidence interval [0.70-0.91], P < 0.001), whereas other outcomes (mortality, death with functioning graft (DwFG)) were not significantly different. None of the 3 outcomes were significantly different when comparing RA with SA within the ESP program. CONCLUSIONS Facing increased waiting times and mortality on dialysis due to donor shortage, this study reveals encouragingly positive DDRT outcomes following RA. This supports the extension of RA to more patients and as an alternative tool to enable transplantation in patients in countries with prohibitively long waiting times or at risk of deterioration.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Marieke van Meel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Tiny Groenevelt
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Donna Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Alexander Novotny
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Alissa Jell
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Axel Rahmel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Roger Wahba
- Department of General Visceral Cancer and Transplant Surgery, Transplant Center Cologne, University of Cologne Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anja Mühlfeld
- Department of Nephrology, Universitätsklinikum Aachen, Aachen, Germany
| | - Antonia Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital & University of Antwerp, Edegem, Antwerpen, Belgium
| | - Brigitta Globke
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - László Piros
- Department of Transplantation and Surgery, School of Medicine, Semmelweis University, Budapest, Hungary
| | - Dirk Stippel
- Department of General Visceral Cancer and Transplant Surgery, Transplant Center Cologne, University of Cologne Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Katharina Heller
- Medizinische Klinik 4, Universitätsklinikum Erlangen-Nürnberg, Transplantation szentrum Erlangen-Nürnberg, Erlangen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Rolf Weimer
- Department of Internal Medicine, Nephrology and Renal Transplantation, University Clinic of Giessen and Marburg (UKGM), Giessen, Germany
| | - Alexander R Rosenkranz
- Universitätsklinik für Innere Medizin, Nephrologie, Medizinische Universität Graz, Graz, Austria
| | - Stefan Berger
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Kliem
- Division of Nephrology, Department of Internal Medicine, Transplantationszentrum Hannoversch Münden, Münden, Germany
| | - Florian Vondran
- Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ana Harth
- Medizinische Klinik I, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Innere Medizin II, Nephrologie, Uniklinik Witten/Herdecke, Köln, Germany
| | - Dirk Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Reinhold Függer
- Department of Surgery, Ordensklinikum Elisabethinen Linz, Linz, Austria
| | - Miha Arnol
- Department of Nephrology and Renal Transplantation, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maarten Christiaans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julia Weinmann-Menke
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Nephrologie und Nierentransplantation, Mainz, Germany
| | - Bernd Krüger
- Department of Nephrology, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernhard Banas
- Department of Nephrology, Universitätsklinikum Regensburg, Universitäres Transplantationszentrum, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, University Hospital Rostock, Rostock, Germany
| | - Robert Minnee
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Vedat Schwenger
- Department of Nephrology, Klinikum der Landeshauptstadt Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, Tübingen University Hospital, Tübingen, Germany
| | - Arjan van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Kai Lopau
- Division of Nephrology, Department of Internal Medicine 1, University hospital Wuerzburg, Würzburg, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
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Bachmann Q, Haberfellner F, Büttner-Herold M, Torrez C, Haller B, Assfalg V, Renders L, Amann K, Heemann U, Schmaderer C, Kemmner S. The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome. Front Med (Lausanne) 2022; 9:875206. [PMID: 35573025 PMCID: PMC9100560 DOI: 10.3389/fmed.2022.875206] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The increasing organ shortage in kidney transplantation leads to the necessity to use kidneys previously considered unsuitable for transplantation. Numerous studies illustrate the need for a better decision guidance rather than only the classification into kidneys from standard or expanded criteria donors referred to as SCD/ECD-classification. The kidney donor profile index (KDPI) exhibits a score utilizing a much higher number of donor characteristics. Moreover, graft biopsies provide an opportunity to assess organ quality. Methods In a single center analysis 383 kidney transplantations (277 after deceased and 106 after living donation) performed between January 1st, 2006, and December 31st, 2016, retrospectively underwent SCD/ECD and KDPI scoring. Thereby, the quality of deceased donor kidneys was assessed by using the KDPI and the living donor kidneys by using the living KDPI, in the further analysis merged as (L)KDPI. Baseline biopsies taken 10 min after the onset of reperfusion were reviewed for chronic and acute lesions. Survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards analysis within a 5-year follow-up. Results The (L)KDPI correlated with glomerulosclerosis (r = 0.30, p < 0.001), arteriosclerosis (r = 0.33, p < 0.001), interstitial fibrosis, and tubular atrophy (r = 0.28, p < 0.001) as well as the extent of acute tubular injury (r = 0.20, p < 0.001). The C-statistic of the (L)KDPI concerning 5-year death censored graft survival was 0.692. Around 48% of ECD-kidneys were classified as (L)KDPI<85%. In a multivariate Cox proportional hazard analysis including (preformed) panel reactive antibodies, cold ischemia time, (L)KDPI, and SCD/ECD-classification, the (L)KDPI was significantly associated with risk of graft loss (hazard ratio per 10% increase in (L)KDPI: 1.185, 95% confidence interval: 1.033–1.360, p = 0.025). Survival analysis revealed decreased death censored (p < 0.001) and non-death censored (p < 0.001) graft survival in kidneys with an increasing (L)KDPI divided into groups of <35, 35–85, and >85%, respectively. Conclusion With a higher granularity compared to the SCD/ECD-classification the (L)KDPI is a promising tool to judge graft quality. The correlation with chronic and acute histological lesions in post-reperfusion kidney biopsies underlines the descriptive value of the (L)KDPI. However, its prognostic value is limited and underlines the urgent need for a more precise prognostic tool adopted to European kidney transplant conditions.
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Affiliation(s)
- Quirin Bachmann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Flora Haberfellner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Torrez
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- School of Medicine, Institute of AI and Informatics in Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Stephan Kemmner
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7
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Assfalg V, Misselwitz S, Renders L, Hüser N, Novotny A, Jäger C, Büttner-Herold M, Amann K, Schmaderer C, Heemann U, Wen M, Haberfellner F, Torrez C, Bachmann Q, Kemmner S. Kidney transplantation after rescue allocation-meticulous selection yields the chance for excellent outcome. Nephrol Dial Transplant 2021; 36:551-560. [PMID: 33367794 DOI: 10.1093/ndt/gfaa286] [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: 03/12/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5 h after procurement. Data on the outcomes and benefits of RA are scarce to date. METHODS We conducted a retrospective 8-year analysis of transplant outcomes of RA offers based on our in-house criteria catalogue for acceptance and decline of organs and potential recipients. RESULTS RA donors and recipients were both older compared with standard allocation (SA). RA donors more frequently had a history of hypertension, diabetes or fulfilled expanded criteria donor key parameters. RA recipients had poorer human leucocyte antigen (HLA) matches and longer cold ischaemia times (CITs). However, waiting time was shorter and delayed graft function, primary non-function and biopsy-proven rejections were comparable to SA. Five-year graft and patient survival after RA were similar to SA. In multivariate models accounting for confounding factors, graft survival and mortality after RA and SA were comparable as well. CONCLUSIONS Facing relevant comorbidities and rapid deterioration with the risk of being removed from the waiting list, kidney transplantation after RA was identified to allow for earlier transplantation with excellent outcome. Data from this survey propose not to reject categorically organs from multimorbid donors with older age and a history of hypertension or diabetes to aim for the best possible HLA matching and to carefully calculate overall expected CIT.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Svea Misselwitz
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Novotny
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carsten Jäger
- Department of Surgery, Study Site for Clinical Research, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Schmaderer
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ming Wen
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Flora Haberfellner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carlos Torrez
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Quirin Bachmann
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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8
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Nitsche U, Weber C, Kaufmann B, von Figura G, Assfalg V, Miller G, Friess H, Hüser N, Hartmann D. Survival data on timing of resection of liver metastases in colorectal cancer patients. Data Brief 2020; 31:105973. [PMID: 32671166 PMCID: PMC7341369 DOI: 10.1016/j.dib.2020.105973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
Between 2007 and 2016, 140 consecutive patients who underwent resection of colorectal cancer with simultaneous liver metastases at a single university hospital were retrospectively analysed. In order to gather information regarding potential survival differences for n = 68 simultaneous versus n = 72 staged resections of the colorectal primary tumor and the liver metastases, Clinical, histopathological, serological, and survival data were compared for those two patient groups. The rate of simultaneous tumor resections increased from approximately 25% in 2007 to >75% in 2016. There was no difference in tumor specific survival for patients with simultaneous vs. staged resection (p = 0.631). This effect continued after excluding patients with extrahepatic metastases (p = 0.440). Further, neoadjuvant treatment did not lead to differences in the tumor-specific survival (p = 0.123). Factors associated with an increased tumor-specific survival were low ASA score (p < 0.001), low number of tumor-affected lymph nodes (p < 0.001), histological grading G1/2 (p = 0.001), and a low number of liver metastases (p = 0.044). There was no significant survival difference for the primary tumor stage (pT), the Clavien-Dindo complication rate, the resection status (R0), and minor versus major hepatectomies.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Constance Weber
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Volker Assfalg
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
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9
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Nitsche U, Weber C, Kaufmann B, von Figura G, Assfalg V, Miller G, Friess H, Hüser N, Hartmann D. Simultaneous Versus Staged Resection of Colorectal Cancer Liver Metastasis: A Retrospective Single-Center Study. J Surg Res 2020; 255:346-354. [PMID: 32599454 DOI: 10.1016/j.jss.2020.05.076] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/08/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND For patients with colorectal cancer and synchronous liver metastasis, either a simultaneous, or a two-staged resection of the primary tumor and the liver metastases is possible. There are currently no guidelines preferring one approach to the other. MATERIAL AND METHODS Consecutive patients who underwent hepatic resection at our university hospital from 2007-2016 were included. Clinical, histopathologic, serologic, and survival data were analyzed. The primary end point was tumor-specific survival for patients with simultaneous versus staged resections. RESULTS Of all 140 patients, 68 underwent simultaneous resection and 72 underwent staged resection. The characteristics of both groups were comparable. Patients with simultaneous resections had a shorter duration of cumulative operation time (299 versus 460 min; P = 0.003) and a shorter cumulative length of hospital stay (23 versus 43 d; P = 0.002). Perioperative mortality (P = 0.257) did not differ significantly; however, patients with simultaneous resections had higher rates of grade 2 complications according to Clavien-Dindo (P < 0.001). Tumor-specific 1-y survival was 85 ± 5% for simultaneous and 83 ± 5% for staged resection (P = 0.631). On multivariable analysis, pT4 (P = 0.038), pN3 (P = 0.003), and G3/4 (P = 0.041) of the primary tumor and postoperative complications (Clavien-Dindo 3/4/5, P = 0.003) were poor prognostic factors regarding tumor-specific survival. CONCLUSIONS This is one of the largest and most thoroughly documented retrospective single-center studies of consecutive patients with synchronous hepatic metastases. Simultaneous resection of colorectal cancer together with hepatic metastases is a safe procedure in selected patients and does not have a significant influence on long-term survival.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Constance Weber
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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10
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Assfalg V, Selig K, Tolksdorf J, Meel M, Vries E, Ramsoebhag A, Rahmel A, Renders L, Novotny A, Matevossian E, Schneeberger S, Rosenkranz AR, Berlakovich G, Ysebaert D, Knops N, Kuypers D, Weekers L, Muehlfeld A, Rump L, Hauser I, Pisarski P, Weimer R, Fornara P, Fischer L, Kliem V, Sester U, Stippel D, Arns W, Hau H, Nitschke M, Hoyer J, Thorban S, Weinmann‐Menke J, Heller K, Banas B, Schwenger V, Nadalin S, Lopau K, Hüser N, Heemann U. Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis. Transpl Int 2020; 33:617-631. [DOI: 10.1111/tri.13569] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/09/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022]
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11
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Kaufmann B, Wang B, Zhong S, Laschinger M, Patil P, Lu M, Assfalg V, Cheng Z, Friess H, Hüser N, von Figura G, Hartmann D. BRG1 promotes hepatocarcinogenesis by regulating proliferation and invasiveness. PLoS One 2017; 12:e0180225. [PMID: 28700662 PMCID: PMC5507512 DOI: 10.1371/journal.pone.0180225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/02/2017] [Accepted: 06/12/2017] [Indexed: 02/03/2023] Open
Abstract
The chromatin remodeler complex SWI/SNF plays an important role in physiological and pathological processes. Brahma related gene 1(BRG1), a catalytic subunit of the SWI/SNF complex, is known to be mutated in hepatocellular carcinoma (HCC). However, its role in HCC remains unclear. Here, we investigate the role of BRG1 on cell growth and invasiveness as well as its effect on the expression of putative target genes. Expression of BRG1 was examined in human liver tissue samples and in HCC cell lines. In addition, BRG1 was silenced in human HCC cell lines to analyse cell growth and invasiveness by growth curves, colony formation assay, invasion assay and the expression of putative target genes. BRG1 was found to be significantly increased in HCC samples compared to non-HCC samples. In addition, a declined proliferation rate of BRG1-silenced human HCC cell lines was associated with a decrease of expression of cyclin family members. In line with a decreased invasiveness of BRG1-siRNA-treated human HCC cell lines, down-regulation of MMP7 was detected. These results support the hypothesis that overexpression of BRG1 increases cell growth and invasiveness in HCC. Furthermore, the data highlight cyclin B, E and MMP7 to be associated with BRG1 during hepatocarcinogenesis.
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Affiliation(s)
- Benedikt Kaufmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Baocai Wang
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Suyang Zhong
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Pranali Patil
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Miao Lu
- Department of General Surgery, the Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Zhangjun Cheng
- Department of General Surgery, the Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Guido von Figura
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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12
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Jörger AK, Liu L, Fehlner K, Weisser T, Cheng Z, Lu M, Höchst B, Bolzer A, Wang B, Hartmann D, Assfalg V, Sunami Y, Schlitter AM, Friess H, Hüser N, Laschinger M. Impact of NKT Cells and LFA-1 on Liver Regeneration under Subseptic Conditions. PLoS One 2016; 11:e0168001. [PMID: 27977747 PMCID: PMC5158001 DOI: 10.1371/journal.pone.0168001] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/23/2016] [Indexed: 01/13/2023] Open
Abstract
Background Activation of the immune system in terms of subseptic conditions during liver regeneration is of paramount clinical importance. However, little is known about molecular mechanisms and their mediators that control hepatocyte proliferation. We sought to determine the functional role of immune cells, especially NKT cells, in response to partial hepatectomy (PH), and to uncover the impact of the integrin lymphocyte function-associated antigen-1 (LFA-1) on liver regeneration in a subseptic setting. Methods Wild-type (WT) and LFA-1-/- mice underwent a 2/3 PH and low-dose lipopolysaccharid (LPS) application. Hepatocyte proliferation, immune cell infiltration, and cytokine profile in the liver parenchyma were determined. Results Low-dose LPS application after PH results in a significant delay of liver regeneration between 48h and 72h, which is associated with a reduced number of CD3+ cells within the regenerating liver. In absence of LFA-1, an impaired regenerative capacity was observed under low-dose LPS application. Analysis of different leukocyte subpopulations showed less CD3+NK1.1+ NKT cells in the liver parenchyma of LFA-1-/- mice after PH and LPS application compared to WT controls, while CD3-NK1.1+ NK cells markedly increased. Concordantly with this observation, lower levels of NKT cell related cytokines IL-12 and IL-23 were expressed in the regenerating liver of LFA-1-/- mice, while the expression of NK cell-associated CCL5 and IL-10 was increased compared to WT mice. Conclusion A subseptic situation negatively alters hepatocyte proliferation. Within this scenario, we suggest an important impact of NKT cells and postulate a critical function for LFA-1 during processes of liver regeneration.
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Affiliation(s)
- Ann-Kathrin Jörger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lei Liu
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karin Fehlner
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tanja Weisser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Zhangjun Cheng
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Miao Lu
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bastian Höchst
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Baocai Wang
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Yoshiaki Sunami
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- * E-mail:
| | - Melanie Laschinger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Assfalg V, Hüser N. Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge. World J Transplant 2016; 6:165-173. [PMID: 27011914 PMCID: PMC4801792 DOI: 10.5500/wjt.v6.i1.165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/16/2015] [Accepted: 02/16/2016] [Indexed: 02/05/2023] Open
Abstract
Exposure to heparin is associated with a high incidence of immunization against platelet factor 4 (PF4)/heparin complexes. A subgroup of immunized patients is at risk of developing heparin-induced thrombocytopenia (HIT), an immune mediated prothrombotic adverse drug effect. Transplant recipients are frequently exposed to heparin either due to the underlying end-stage disease, which leads to listing and transplantation or during the transplant procedure and the perioperative period. To review the current scientific knowledge on anti-heparin/PF4 antibodies and HIT in transplant recipients a systematic PubMed literature search on articles in English language was performed. The definition of HIT is inconsistent amongst the publications. Overall, six studies and 15 case reports have been published on HIT before or after heart, liver, kidney, and lung transplantation, respectively. The frequency of seroconversion for anti-PF4/heparin antibodies ranged between 1.9% and 57.9%. However, different methods to detect anti-PF4/heparin antibodies were applied. In none of the studies HIT-associated thromboembolic events or fatalities were observed. More importantly, in patients with a history of HIT, reexposure to heparin during transplantation was not associated with thrombotic complications. Taken together, the overall incidence of HIT after solid organ transplantation seems to be very low. However, according to the current knowledge, cardiac transplant recipients may have the highest risk to develop HIT. Different alternative suggestions for heparin-free anticoagulation have been reported for recipients with suspected HIT albeit no official recommendations on management have been published for this special collective so far.
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Assfalg V, Hüser N, van Meel M, Haller B, Rahmel A, de Boer J, Matevossian E, Novotny A, Knops N, Weekers L, Friess H, Pratschke J, Függer R, Janko O, Rasoul-Rockenschaub S, Bosmans JL, Broeders N, Peeters P, Mourad M, Kuypers D, Slaviček J, Muehlfeld A, Sommer F, Viebahn R, Pascher A, van der Giet M, Zantvoort F, Woitas RP, Putz J, Grabitz K, Kribben A, Hauser I, Pisarski P, Weimer R, Lorf T, Fornara P, Morath C, Nashan B, Lehner F, Kliem V, Sester U, Grimm MO, Feldkamp T, Kleinert R, Arns W, Mönch C, Schoenberg MB, Nitschke M, Krüger B, Thorban S, Arbogast HP, Wolters HH, Maier T, Lutz J, Heller K, Banas B, Hakenberg O, Kalus M, Nadalin S, Keller F, Lopau K, Bemelman FJ, Nurmohamed S, Sanders JS, de Fijter JW, Christiaans M, Hilbrands L, Betjes M, van Zuilen A, Heemann U. High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System: success or waste of organs? The Eurotransplant 15-year all-centre survey. Nephrol Dial Transplant 2016; 31:1515-22. [DOI: 10.1093/ndt/gfv446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/15/2015] [Indexed: 11/14/2022] Open
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Assfalg V, Wolf P, Reim D, Hüser N, Hellbrügge G, Matevossian E, Friess H, Holzmann B, Emmanuel KL, Novotny AR. Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI). Surg Today 2015. [PMID: 26212215 DOI: 10.1007/s00595-015-1226-z] [Citation(s) in RCA: 2] [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] [Indexed: 02/06/2023]
Abstract
PURPOSE Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus. METHODS In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation. RESULTS A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12-24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %. CONCLUSIONS The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.
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Affiliation(s)
- Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Petra Wolf
- Institute of Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Georg Hellbrügge
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Edouard Matevossian
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Bernhard Holzmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Klaus L Emmanuel
- Department of Surgery, Salzburger Landeskliniken, University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Department of Surgery, Krankenhaus der Barmherzigen Schwestern Linz, Seilerstätte 4, 4020, Linz, Austria
| | - Alexander R Novotny
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
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Kemter AM, Scheu S, Hüser N, Ruland C, Schumak B, Findeiß M, Cheng Z, Assfalg V, Arolt V, Zimmer A, Alferink J. The cannabinoid receptor 2 is involved in acute rejection of cardiac allografts. Life Sci 2015; 138:29-34. [PMID: 25744392 DOI: 10.1016/j.lfs.2015.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/30/2014] [Revised: 01/29/2015] [Accepted: 02/12/2015] [Indexed: 12/20/2022]
Abstract
AIMS Acute rejection of cardiac allografts is a major risk factor limiting survival of heart transplant recipients. Rejection is triggered by dendritic cell (DC) mediated activation of host T cells, amongst others CD4(+) T helper (TH)1- and TH17 cells. The cannabinoid receptor 2 (CB2) is an important modulator of cellular immune responses. However, its role in cardiac allograft rejection has not been studied so far. MAIN METHODS Here, we examined the effect of CB2 on cytokine release by mature DCs and its impact on CD4(+) T cell differentiation by utilizing in vitro generated bone marrow-derived DCs (BM-DCs) and CD4(+) T cells from CB2 knockout (Cnr2(-/-)) mice. We further assessed the functional role of CB2 in acute allograft rejection using Cnr2(-/-) mice in a fully major histocompatibility complex-mismatched mouse cardiac transplantation model. KEY FINDINGS Cardiac allograft rejection was accelerated in Cnr2(-/-) mice compared to wild type recipients. In vitro stimulation of BM-DCs showed enhanced secretion of the pro-inflammatory cytokines interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF) and the immunomodulatory cytokine TGF-β. Furthermore, secretion of the TH1/TH17 promoting cytokines IL-12 and IL-23 was increased in Cnr2(-/-) BM-DCs. In addition, Cnr2(-/-) CD4(+) T cells showed an enhanced capacity to differentiate into interferon (IFN)-γ- or IL-17-producing effector cells. SIGNIFICANCE These results demonstrate that CB2 modulates in vitro cytokine responses via DCs and directly via its influence on TH1/TH17 differentiation. These findings and the fact that allograft rejection is enhanced in Cnr2(-/-) mice suggest that CB2 may be a promising therapeutic target in organ transplantation.
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Affiliation(s)
- Andrea M Kemter
- Institute of Molecular Psychiatry, University of Bonn, Bonn, Germany
| | - Stefanie Scheu
- Institute of Medical Microbiology and Hospital Hygiene, University of Düsseldorf, Düsseldorf, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christina Ruland
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Beatrix Schumak
- Institute of Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany
| | - Matthias Findeiß
- Institute of Molecular Psychiatry, University of Bonn, Bonn, Germany
| | - Zhangjun Cheng
- Department of General Surgery, The Affiliated Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Andreas Zimmer
- Institute of Molecular Psychiatry, University of Bonn, Bonn, Germany
| | - Judith Alferink
- Institute of Molecular Psychiatry, University of Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany; Cells-in-Motion Cluster of Excellence EXC 1003, University of Münster, Münster , Germany.
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Bakchoul T, Assfalg V, Zöllner H, Evert M, Novotny A, Matevossian E, Friess H, Hartmann D, Hron G, Althaus K, Greinacher A, Hüser N. Anti-platelet factor 4/heparin antibodies in patients with impaired graft function after liver transplantation. J Thromb Haemost 2014; 12:871-8. [PMID: 24655935 DOI: 10.1111/jth.12569] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/25/2013] [Accepted: 03/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heparin, the standard perioperative anticoagulant for the prevention of graft vessel thrombosis in patients undergoing liver transplantation (LT), binds to the chemokine platelet factor 4 (PF4). Antibodies that are formed against the resulting PF4/heparin complexes can induce heparin-induced thrombocytopenia. LT is a clinical situation that allows the study of T-cell dependency of immune responses because T-cell function is largely suppressed pharmacologically in these patients to prevent graft rejection. OBJECTIVES To investigate the immune response against PF4/heparin complexes in patients undergoing LT. PATIENTS AND METHODS In this prospective cohort study, 38 consecutive patients undergoing LT were systematically screened for anti-PF4/heparin antibodies (enzyme immunoassay and heparin-induced platelet aggregation assay), platelet count, liver function, and engraftment. RESULTS At baseline, 5 (13%) of 38 patients tested positive for anti-PF4/heparin IgG (non-platelet-activating) antibodies. By day 20, an additional 5 (15%) of 33 patients seroconverted for immunoglobulin G (two platelet-activating) antibodies. No patient developed clinical heparin-induced thrombocytopenia. Two of six patients with graft function failure had anti-PF4/heparin IgG antibodies at the time of graft function failure. Graft liver biopsy samples from these patients showed thrombotic occlusions of the microcirculation. CONCLUSIONS Anti-PF4/heparin IgG antibodies are generated despite strong pharmacologic suppression of T cells, indicating that T cells likely have a limited role in the immune response to PF4/heparin complexes in humans.
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Affiliation(s)
- T Bakchoul
- Institute for Immunology and Transfusion Medicine, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
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Kornberg A, Witt U, Matevossian E, Küpper B, Assfalg V, Drzezga A, Hüser N, Wildgruber M, Friess H. Extended postinterventional tumor necrosis-implication for outcome in liver transplant patients with advanced HCC. PLoS One 2013; 8:e53960. [PMID: 23349774 PMCID: PMC3551930 DOI: 10.1371/journal.pone.0053960] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/04/2012] [Indexed: 12/12/2022] Open
Abstract
Background Locoregional interventional bridging therapy (IBT) is an accepted neoadjuvant approach in liver transplant candidates with hepatocellular carcinoma (HCC). However, the prognostic value of IBT in patients with advanced HCC is still undefined. Aim The aim of this trial was to evaluate the impact of postinterventional tumor necrosis on recurrence-free long-term survival after liver transplantation (LT) in patients with HCC, especially focusing on those exceeding the Milan criteria on pretransplant radiographic imaging. Patients and Methods A total of 93 consecutive liver transplant candidates with HCC were included in this trial. In 36 patients, tumors were clinically staged beyond Milan criteria prior LT. Fifty-nine patients underwent IBT by transarterial chemoembolization or radiofrequency ablation pretransplantation. Postinterventional tumor necrosis rate as assessed at liver explant pathology was correlated with outcome post-LT. Results There was no significant difference in 5-year tumor-free survival rate between the IBT- and the non-IBT subpopulation (78% versus 68%, P = 0.25). However, tumor response following IBT (≥50% tumor necrosis rate at explant pathology) resulted in a significantly better outcome 5 years post-LT (96%) than tumor non-response to IBT (<50% tumor necrosis rate at explant pathology; 21%; P<0.001). Five-year recurrence-free survival rate was 80% in Milan Out patients with extended post-IBT tumor necrosis versus 0% in Milan Out patients without tumor response to IBT (P<0.001). None of macromorphological HCC features, but only the absence of increased 18F-fluoro-deoxy-glucose (18FDG) uptake on pretransplant positron emission tomography (PET) was identified as independent predictor of postinterventional tumor response (P<0.001). Conclusion Our results implicate that extended postinterventional tumor necrosis promotes recurrence-free long-term survival in patients with HCC beyond standard criteria. Pretransplant PET assessment may identify those patients with advanced HCC that will benefit from post-IBT tumor response and may, thereby, achieve excellent posttransplant outcome.
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Affiliation(s)
- Arno Kornberg
- Department of Surgery, Klinikum rechts der Isar, Technical University, Munich, Germany.
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Kern H, Bald C, Hueser N, Assfalg V, von Weihern CH, Friess H, Matevossian E. Introduction of a new method of rat liver transplantation using retrograde reperfusion. Eur Surg 2012. [DOI: 10.1007/s10353-011-0061-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Novotny AR, Reim D, Assfalg V, Altmayr F, Friess HM, Emmanuel K, Holzmann B. Mixed antagonist response and sepsis severity-dependent dysbalance of pro- and anti-inflammatory responses at the onset of postoperative sepsis. Immunobiology 2011; 217:616-21. [PMID: 22204813 DOI: 10.1016/j.imbio.2011.10.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 10/25/2011] [Indexed: 12/24/2022]
Abstract
It has been postulated that an early systemic inflammatory response syndrome (SIRS) and a subsequent compensatory anti-inflammatory response syndrome (CARS) occur sequentially in sepsis. Co-existence of both is referred to as mixed antagonist response syndrome (MARS). Pro- and anti-inflammatory cytokine production was investigated in patients with postoperative sepsis, a murine peritonitis model and in vitro to further delineate the interaction of hyper- and hypo-inflammation in sepsis. IL-6 and IL-10 were measured in serum samples from 80 patients on d1 and d2 of postoperative sepsis and were similarly determined at various time points after induction of septic peritonitis in mice. Cytokine production of RAW264 macrophages was stimulated in vitro using TLR agonists. IL-6 and IL-10 were measured in supernatants. All cytokine measurements were performed by ELISA. In patients, the initial phase of the immune response to sepsis was characterized by a concomitant elevation of serum IL-6 and IL-10 levels. IL-10 levels were correlated with IL-6 levels in an exponential manner (p<0.001), which could be confirmed in a mouse model of septic peritonitis. In vitro experiments revealed that the observed exponential correlation may occur as function of TLR signaling intensity. Early postoperative sepsis seems to be characterized by a primary MARS. Sepsis severity was positively correlated with a disproportionate elevation of the anti-inflammatory response relative to the pro-inflammatory response, a pattern reminiscent of TLR-driven responses. Detailed characterization of immune responses in sepsis may help to direct standard therapies and to develop effective immunomodulatory strategies.
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Affiliation(s)
- Alexander R Novotny
- Department of Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
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Assfalg V, Hüser N, Michalski C, Gillen S, Kleeff J, Friess H. Palliative interventional and surgical therapy for unresectable pancreatic cancer. Cancers (Basel) 2011. [PMID: 24212634 DOI: 0.3390/cancers3010652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.
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Affiliation(s)
- Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich, Germany.
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Hüser N, Assfalg V, Hartmann D, Reim D, Novotny A, Friess H. [Diagnosis and surgical treatment of pancreatic cancer]. Eksp Klin Gastroenterol 2011:102-111. [PMID: 22364008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Despite sustained efforts, intensive research has not been proven successful to reveal risk factors, which relevantly influence early diagnostics or effective treatment of pancreatic carcinoma. Principally, it must be noted, that currently no ideal tumor marker exists for the (early) detection of pancreatic carcinoma. The most important imaging modalities are high-resolution computed tomography, abdominal ultrasound, and endosonography. Surgical procedures in therapy have become more and more standardised and lead to a decrease in morbidity and mortality on the one hand and to an increase in resectability on the other hand. Pylorus-preserving partial pancreaticoduodenectomy is the treatment of choice for a tumor of the pancreatic head, whereas resection of the left pancreas (including splenectomy) is the standard therapy for carcinomas of the pancreatic tail. In all cases, a local systematic lymphadenectomy is mandatory; hence the prognostic gain of an extended lymphadenectomy remains indeterminate. An infiltration of mesenteric and portal veins does not prevent respectability, as long as by venous resection an R0 status can be achieved. However arterial involvement in general excludes resection. Patients with marginally resectable or locally non-resectable tumors should be recruited into neoadjuvant radiochemotherapy trials since one third of these patients could be considered for potentially curative resection. However the majority of pancreatic cancer patients show locally unresectable or metastasized disease and therefore palliative treatment concepts are needed. Both, endoscopic or percutaneous stenting procedures and operative bypass surgery, are safe and reach high success rates.
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Hüser N, Assfalg V, Michalski CW, Gillen S, Kleeff J, Friess H. [Unresectable pancreatic cancer--palliative interventional and surgical treatment]. Zentralbl Chir 2010; 135:502-7. [PMID: 21154206 DOI: 10.1055/s-0030-1262549] [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: 10/18/2022]
Abstract
In most cases pancreatic cancer appears in a non-curatively resectable stage at time the diagnosis is made. Thus, palliative treatment concepts come to the fore in these patients. Patients without metastases, but presenting with marginally resectable or locally non-resectable tumours should not be treated in a palliative therapeutic scheme. These patients should be enrolled in neoadjuvant radiochemotherapy trials. After finishing treatment and restaging, a potentially curative resection can be achieved in approximately one-third of these patients. Within the scope of the best possible palliative care, excision of metastases together with resection of the primary cancer represents a therapeutic option to be contemplated in selected cases. For distinct locally unresectable or metastasised advanced pancreatic cancer, treatment of bile duct or duodenal obstruction is an essential part of the comprehensive palliative therapy. However, both endoscopic / percutaneous stenting procedures and surgical bypass makeshifts constitute safe and highly effective therapeutic alternatives in this context. In the case of operative drainage of the biliary tract the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision on a surgical versus an endoscopic procedure for palliation depends considerably on the tumour stage and the estimated prognosis and has to be determined interdisciplinary and individually in each case.
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Affiliation(s)
- N Hüser
- Klinikum rechts der Isar der Technischen Universität München, Chirurgische Klinik und Poliklinik, München, Deutschland
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Matevossian E, Assfalg V, Novotny A, Reim D, Schmaderer C, Kern HD, Nährig J, Doll D, Hüser N. Adenoviral transfer in the liver: a novel in vivo simulation model in the rat. Eur Surg 2010. [DOI: 10.1007/s10353-010-0554-x] [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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Reim D, Hüser N, Humberg D, Novotny A, Assfalg V, Matevossian E, Friess H, Schuhmacher C. Preoperative clinically inapparent leucopenia in patients undergoing neoadjuvant chemotherapy for locally advanced gastric cancer is not a risk factor for surgical or general postoperative complications. J Surg Oncol 2010; 102:321-4. [DOI: 10.1002/jso.21622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Assfalg V, Hüser N, Reim D, Kaiser-Moore S, Rossmann-Bloeck T, Weighardt H, Novotny AR, Stangl MJ, Holzmann B, Emmanuel KL. Combined immunosuppressive and antibiotic therapy improves bacterial clearance and survival of polymicrobial septic peritonitis. Shock 2010; 33:155-61. [PMID: 19487979 DOI: 10.1097/shk.0b013e3181ab9014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 11/26/2022]
Abstract
Effective immunosuppressive therapy is essential to prevent transplant rejection but renders patients vulnerable to opportunistic infections. The present study investigates the effects of common immunosuppressive drugs on the course of septic peritonitis in an experimental mouse model. We show that treatment with a combination of tacrolimus, mycophenolate mofetil, and methylprednisolone resulted in highly elevated lethality of septic peritonitis. When immunosuppressive drugs were combined with antibiotic therapy, however, mice were almost completely protected. The combination of mycophenolate mofetil and methylprednisolone was shown to be required and sufficient to improve outcome of septic peritonitis in the presence of antibiotic therapy. Combined immunosuppressive and antibiotic therapy, but not antibiotic therapy alone, resulted in enhanced bacterial clearance. These beneficial effects were linked to an elevated expression of activation markers and an increased production of reactive oxygen metabolites by peritoneal neutrophils and correlated with a reduced messenger RNA expression of the inhibitory cytokine IL-22. In contrast, systemic or peritoneal levels of IL-10, IL-12, TNF-alpha, keratinocyte chemoattractant, and monocyte chemoattractant protein 1, and splenic messenger RNA levels of IFN-gamma were not influenced by the immunosuppressive therapy. These results therefore suggest that combined immunosuppressive and antibiotic therapy may improve bacterial clearance and survival of septic peritonitis by a mechanism that involves enhanced activation and antimicrobial activity of neutrophils and reduced production of IL-22.
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Affiliation(s)
- Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Matevossian E, Doll D, Hüser N, Brauer R, Sinicina I, Nährig J, Friess H, Stangl M, Assfalg V. Liver transplantation in the rat: single-center experience with technique, long-term survival, and functional and histologic findings. Transplant Proc 2010; 41:2631-6. [PMID: 19715990 DOI: 10.1016/j.transproceed.2009.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Orthotopic liver transplantation (OLT) in rats is frequently used as an experimental model. Numerous surgical techniques have been developed that enable the investigator to conduct clinically relevant studies. The objective of this study was to develop a rat model of acute and chronic rejection, to explicitly study technical modifications of vascular anastomoses with precision, and to examine histopathologic and functional changes in the graft. MATERIALS AND METHODS With DA-(RT1av1) rats as donors and Lewis-(RT1) rats as recipients, arterialized OLT was performed using a combined suture, cuff, and splint method. Recipients were divided into 5 groups: syngeneic control rats (group 1), allogeneic control rats (group 2), allogeneic OLT rats with low-dose tacrolimus (FK506) immunosuppression (group 3), allogeneic OLT rats with high-dose tacrolimus immunosuppression (group 4), and allogeneic OLT rats with high-dose tacrolimus immunosuppression and retrograde reperfusion via the infrahepatic caval vein (group 5). After OLT, serum parameters were determined and hepatic biopsy specimens were sampled. We examined the effects of acute rejection with or without immunosuppression therapy at histopathologic evaluation. RESULTS Liver grafts in syngeneic and allogeneic rats (groups 1, 2, 4, and 5) demonstrated normal serum parameters and histopathologic findings at 10 days after OLT, and 93% survival at 3 months. The simplified technique using 1 suture and 2 cuff anastomoses provided the best short- and long-term survival after OLT in all groups. Retrograde perfusion via the infrahepatic caval vein resulted in lower postoperative liver enzyme values. CONCLUSION The present model is feasible, enabling comprehensive preclinical experimental research on liver transplantation. Furthermore, we provide helpful instructions for learning this surgical technique.
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Affiliation(s)
- E Matevossian
- Department of Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
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Müller MW, Assfalg V, Michalski CW, Büchler P, Kleeff J, Friess H. [Middle segmental pancreatic resection: an organ-preserving option for benign lesions]. Chirurg 2009; 80:14-21. [PMID: 19011818 DOI: 10.1007/s00104-008-1576-9] [Citation(s) in RCA: 5] [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: 12/11/2022]
Abstract
Benign and low malignant tumors of the middle pancreatic segment can be resected by extended pancreaticoduodenectomy or distal pancreatic resection. Both procedures involve unavoidably extensive loss of normal pancreatic parenchyma, leading to deteriorated endocrine and exocrine pancreatic function. Segmental pancreatic resection represents an organ-preserving surgical procedure. Normal pancreatic tissue can be preserved as only the tumor with a pancreatic segment is resected. Several reports confirm lower mortality and minimal risk of postoperative endocrine or exocrine insufficiency than with standard pancreatic resections. The indication should be limited exclusively to benign or low malignant pancreatic tumors, metastases from other tumors, and focal chronic pancreatitis, as this type of resection cannot be deemed oncologic. Segmental pancreatic resections are technically more demanding and therefore should be performed in experienced centers.
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Affiliation(s)
- M W Müller
- Chirurgische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, München, Deutschland
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Hüser N, Matevossian E, Schmidbauer P, Assfalg V, Scherberich JE, Stangl M, Holzmann B, Friess H, Laschinger M. Calculated withdrawal of low-dose immunosuppression based on a detailed immunological monitoring after kidney transplantation between monocygotic twins. Transpl Immunol 2009; 22:38-43. [PMID: 19766188 DOI: 10.1016/j.trim.2009.09.002] [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] [Received: 05/13/2009] [Revised: 08/29/2009] [Accepted: 09/01/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pretransplant screening in living donor kidney transplantation includes human leukocyte antigen matching, and panel reactive antibody analysis, whereas T cell mediated anti-donor reactivity is not assessed routinely. We investigated T cell reactivity after living related kidney transplantation between two monocygotic twins and in consequence correlated the withdrawal of individual immunosuppressive medication with immunological findings. METHODS Immunosuppression consisted of mycophenolate mofetil, glucocorticoid single shot, and induction therapy with antithymocyte immunoglobulin. RESULTS FACS analysis of recipient peripheral blood cells revealed a normal haemogram after transplantation, showing non-activated CD4 and CD8 cells. Mixed lymphocyte reaction did not reveal donor-specific T cell activity. IFN-gamma and IL-10 ELISA of supernatants of recipient cells cocultivated with donor cells support the lack of Th1 and Th2 cell differentiation. CONCLUSION Based on immunological findings on days 5 and 20 MMF-therapy was reduced and stopped. Immunological monitoring on day 90 confirmed the absence of immune reactions directed against donor tissue.
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Affiliation(s)
- Norbert Hüser
- Department of Surgery, Technische Universität München, D-81675 Munich, Germany.
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Matevossian E, Hüser N, Kern H, Assfalg V, Preissel A, Sinicina I, Stangl M, Thorban S. Nitric oxide inhibition and consecutive Aspisol application show a prolonged survival of orthotopic transplanted livers in a rat model. Transplant Proc 2008; 40:971-3. [PMID: 18555092 DOI: 10.1016/j.transproceed.2008.03.041] [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: 11/16/2022]
Abstract
BACKGROUND It is generally accepted that nitric oxide (NO) plays a crucial role in acute rejection caused by inflammatory responses. Therefore, the purpose of this study was to investigate the effect on survival following arterialized orthotopic rat liver transplantations (o-RLTx) of NO inhibition and consequent blockade of platelet aggregation by application of Aspisol. MATERIALS AND METHODS Inbred LEWIS-(RT(1)) rats underwent arterialized o-RLTx under ether anesthesia with DA-(RT1av1) rats as organ donors. After liver transplantation, serum parameters were determined and hepatic biopsy specimens were sampled on postoperative days 5, 8, 10, 30, and 90. Sixty-one rats were divided into 5 groups: syngenic controls (group I, n = 12); allogenic controls (group II, n = 11); allogenic with FK506 immunosuppression (group III, n = 12); allogenic with AGH-treatment (group IV, n = 13); and allogenic with AGH/low- dose Aspisol treatment for 5 days after liver transplantation (group V, n = 13) (Bayer, Leverkusen, Germany). RESULTS Rats of group V with AGH/low-dose Aspisol treatment showed significantly longer graft survival (18.2 days +/- 1.8 days) compared with group II rats with untreated grafts (11.3 days +/- 1.7 days) the allogenic group IV with AGH treatment (11.2 days +/- 1.8 days; P < .05). Histological examination revealed moderate graft rejection among the AGH-treated group IV; however, marked platelet aggregation in sinusoids was present, which was not observed in the AGH/low-dose Aspisol-treated animals (group V). CONCLUSION Our data suggested that simultaneous treatment with AGH/low-dose Aspisol leads to a significant increase in survival and inhibition of platelet aggregation in the graft after orthotopic liver transplantation.
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Affiliation(s)
- E Matevossian
- Department of Surgery, Technical University of Munich, Munich, Germany.
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Thorban S, Hüser N, Novotny A, Raggi MC, Matevossian E, Schwarznau A, Assfalg V, Kriner M, Stangl M. High-risk constellation in living renal transplantation. Transplant Proc 2007; 39:505-8. [PMID: 17362768 DOI: 10.1016/j.transproceed.2007.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is only limited information about recipient risk factors for graft survival in living- donor kidney transplantation. This study aimed to investigate prognostic factors and their impact on living-related and unrelated renal transplant recipients. From October 2000 until October 2004, 81 adult living-related renal transplantations were performed at our institution. Using multivariate analysis, the association of the following variables with kidney graft outcome was studied: ages of donors and recipients, gender and body mass index, cold and warm ischemia, HLA mismatches, identity and compatibility of blood group, duration of dialysis, cytomegalovirus (CMV) status, recipient original disease, surgical and general complications, and status of retransplantation. Multivariate analysis revealed significant reduction of graft function and graft survival in recipients with retransplantation, more than 4 mismatches, and a high body mass index. Thus, living-donor kidney transplantation can be regarded as a safe and standardized operation relating to surgical technique, but further consideration of the recipient body mass index and the number of mismatches are recommended during the preparation for transplantation.
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Affiliation(s)
- S Thorban
- Division of Transplantation, Technical University, Munich, Department of Surgery, Munich, Germany.
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Hüser N, Geraurer KE, Novotny AR, Assfalg V, Stangl MJ. Successful living donor transplantation of a kidney with horseshoe malformation: extending the donor pool. Transpl Int 2005; 18:761-2. [PMID: 15910309 DOI: 10.1111/j.1432-2277.2005.00103.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hüser N, Tertilt C, Gerauer K, Maier S, Traeger T, Assfalg V, Reiter R, Heidecke CD, Pfeffer K. CCR4-deficient mice show prolonged graft survival in a chronic cardiac transplant rejection model. Eur J Immunol 2005; 35:128-38. [PMID: 15593118 DOI: 10.1002/eji.200324745] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 11/08/2022]
Abstract
Chronic graft rejection mediated by cellular immune responses still poses a serious clinical problem in transplant surgery. Chemokines coordinate the recruitment of leukocytes in inflammatory and immune responses. Their precise functions in the rejection of allografts are still ill defined. This study investigates the role of chemokine receptor 4 (CCR4) in acute and chronic cardiac allograft rejection in mice. Allogeneic hearts were transplanted into CCR4 deficient (CCR4(-/-)) and control recipients. Reverse transcription-PCR showed transcription of macrophage-derived chemokine and thymus and activation-regulated chemokine, the cognate chemokine ligands of CCR4, within the graft. Compared to wild-type controls, acute allograft rejection in CCR4(-/-) recipients was only slightly prolonged. In contrast, in a gallium nitrate chronic cardiac allograft rejection model, cardiac graft survival was significantly prolonged in CCR4(-/-) recipients. A relative increase in the percentage of graft infiltrating CD8(+) T cells in CCR4(-/-) recipients was observed 30 days after transplantation and was accompanied by a decrease in CD4(+) T cells. Moreover, the percentage of NK1.1(+)CD3(+) graft-infiltrating cells was significantly reduced on day 5 and day 30 post transplantation. These findings indicate that CCR4 is involved in the recruitment of NK1.1(+)CD3(+) cells into cardiac allografts and clearly establish an important and novel role for CCR4 in chronic graft rejection.
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MESH Headings
- Animals
- Antigens/metabolism
- Antigens, Ly
- Antigens, Surface
- Base Sequence
- CD8-Positive T-Lymphocytes/immunology
- Chemokine CCL17
- Chemokine CCL22
- Chemokines, CC/genetics
- Chronic Disease
- DNA/genetics
- Female
- Gene Expression
- Graft Rejection/immunology
- Graft Rejection/pathology
- Graft Survival/immunology
- Heart Transplantation/immunology
- Heart Transplantation/pathology
- Killer Cells, Natural/immunology
- Lectins, C-Type
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Knockout
- NK Cell Lectin-Like Receptor Subfamily B
- Proteins/metabolism
- Receptors, Antigen, T-Cell/metabolism
- Receptors, CCR4
- Receptors, Chemokine/deficiency
- Receptors, Chemokine/genetics
- T-Lymphocyte Subsets/immunology
- Time Factors
- Transplantation, Homologous
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Affiliation(s)
- Norbert Hüser
- Department of Surgery, Technische Universität München, Munich, Germany
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