1
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Helleberg M, Niemann CU, Moestrup KS, Kirk O, Lebech AM, Lundgren J. Response to Aviv et al. J Infect Dis 2021; 224:559-561. [PMID: 33964164 PMCID: PMC8136013 DOI: 10.1093/infdis/jiab249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
- CHIP, Rigshospitalet, Copenhagen University Hospital, Denmark
- Corresponding author: Marie Helleberg, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ö, Denmark, Phone: +45 35458555 Fax: +45 35455758, E-mail:
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - K S Moestrup
- CHIP, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - O Kirk
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - A M Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
- CHIP, Rigshospitalet, Copenhagen University Hospital, Denmark
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2
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Pettengell R, Uddin R, Boumendil A, Johnson R, Metzner B, Martín A, Romejko-Jarosinska J, Bence-Bruckler I, Giri P, Niemann CU, Robinson SP, Kimby E, Schmitz N, Dreger P, Goldstone AH, Montoto S. Durable benefit of rituximab maintenance post-autograft in patients with relapsed follicular lymphoma: 12-year follow-up of the EBMT lymphoma working party Lym1 trial. Bone Marrow Transplant 2021; 56:1413-1421. [PMID: 33452448 DOI: 10.1038/s41409-020-01182-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 01/16/2023]
Abstract
We report the 12-year follow-up of the prospective randomized EBMT LYM1 trial to determine whether the benefit of brief duration rituximab maintenance (RM) on progression-free survival (PFS) in patients with relapsed follicular lymphoma (FL) receiving an autologous stem cell transplant (ASCT) is sustained. One hundred and thirty-eight patients received RM with or without purging. The median follow-up after random assignment is 12 years (range 10-13) for the whole series. The 10-year PFS after ASCT is 47% (95% CI 40-54) with only 4 patients relapsing after 7.5 years. RM continues to significantly improve 10-year PFS after ASCT in comparison with NM [P = 0.002; HR 0.548 (95% CI 0.38-0.80)]. Ten-year non-relapse mortality (NRM) was not significantly different between treatment groups (7% overall). 10-year overall survival (OS) after ASCT was 75% (69-81) for the whole series, with no significant differences according to treatment sub-groups. 10-year OS for patients who progressed within 24 months (POD24T) was 60%, in comparison with 85% for patients without progression. Thus the benefit of rituximab maintenance after ASCT on relapse prevention is sustained at 12 years, suggesting that RM adds to ASCT-mediated disease eradication and may enhance the curative potential of ASCT.
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Affiliation(s)
- R Pettengell
- Institute of Medical & Biomedical Education, St George's University of London, London, United Kingdom.
| | - R Uddin
- EBMT Clinical Trials Office, European Society for Blood and Marrow Transplantation, London, United Kingdom
| | - A Boumendil
- Statistics, European Society for Blood and Marrow Transplantation, Paris, France
| | - R Johnson
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - B Metzner
- University Clinic for Internal Medicine, Oncology and Haematology, Klinikum Oldenburg, Oldenburg, Germany
| | - A Martín
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - J Romejko-Jarosinska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw, Poland
| | | | - P Giri
- Haematology, Royal Adelaide Hospital, Adelaide, Southern Australia, Australia
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - S P Robinson
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - E Kimby
- Department of Hematology, Karolinska Institute, Stockholm, Sweden
| | - N Schmitz
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A H Goldstone
- University College London Hospital, London, United Kingdom
| | - S Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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3
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Eichhorst B, Robak T, Montserrat E, Ghia P, Niemann CU, Kater AP, Gregor M, Cymbalista F, Buske C, Hillmen P, Hallek M, Mey U. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2021; 32:23-33. [PMID: 33091559 DOI: 10.1016/j.annonc.2020.09.019] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- B Eichhorst
- Department I Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - T Robak
- Department of Hematology, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - E Montserrat
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - P Ghia
- Strategic Research Program on CLL, Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A P Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, LYMMCARE, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Gregor
- Hematology, Luzerner Kantonsspital, Luzern, Switzerland
| | - F Cymbalista
- Hematology Biology, Hôpital Avicenne, Assistance Publique Hopitaux de Paris, UMR U978 INSERM, Bobigny, France
| | - C Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center, University Hospital of Ulm, Ulm, Germany
| | - P Hillmen
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, Leeds, UK
| | - M Hallek
- Department I Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany; Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - U Mey
- Department of Oncology and Haematology, Kantonsspital Graubuenden, Chur, Switzerland
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4
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Fischer K, Porro Lurà M, Al-Sawaf O, Bahlo J, Fink A, Tandon M, Dixon M, Robrecht S, Warburton S, Humphrey K, Samoylova O, Liberati A, Pinilla-Ibarz J, Opat S, Sivcheva L, Le Dû K, Fogliatto L, Utoft Niemann C, Weinkove R, Robinson S, Kipps T, Boettcher S, Tausch E, Schary W, Eichhorst B, Wendtner C, Langerak A, Kreuzer K, Goede V, Stilgenbauer S, Mobasher M, Ritgen M, Hallek M. FIXED-DURATION VENETOCLAX PLUS OBINUTUZUMAB IMPROVES PFS AND MINIMAL RESIDUAL DISEASE NEGATIVITY IN PATIENTS WITH PREVIOUSLY UNTREATED CLL AND COMORBIDITIES. Hematol Oncol 2019. [DOI: 10.1002/hon.52_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Porro Lurà
- Pharmaceuticals Division; PDGo, F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - M. Dixon
- Biostatistics; Roche Products Limited; Welwyn Garden City United Kingdom
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - S. Warburton
- Product Development - Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - O. Samoylova
- Hematology Department; Regional Clinical Hospital N.A. Semashko; Nizhny Novgorod Russian Federation
| | - A.M. Liberati
- Division of Onco-Hematology; Santa Maria Terni Hospital, University of Perugia; Perugia Italy
| | - J. Pinilla-Ibarz
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL United States
| | - S. Opat
- Haematology Department; School of Clinical Sciences at Monash Health; Monash University Victoria Australia
| | - L. Sivcheva
- First Internal Department; MHAT Hristo Botev; AD, Vratsa Bulgaria
| | - K. Le Dû
- Hematology Department; Clinique Victor Hugo; Le Mans France
| | - L.M. Fogliatto
- Department of Hematology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - C. Utoft Niemann
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - R. Weinkove
- Wellington Blood & Cancer Centre; Capital & Coast District Health Board, Wellington, New Zealand and Cancer Immunotherapy Programme, Malaghan Institute of Medical Research; Wellington New Zealand
| | - S. Robinson
- Department of Medicine; Division of Hematology, QEII Health Sciences Center; Halifax NS Canada
| | - T.J. Kipps
- Moores Cancer Center; UC San Diego Health; San Diego CA United States
| | - S. Boettcher
- Department III of Internal Medicine; University Hospital Rostock; Rostock Germany
| | - E. Tausch
- Department III of Internal Medicine; Ulm University; Ulm Germany
| | - W.L. Schary
- Clinical Development Oncology; AbbVie Inc.; North Chicago IL United States
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - C. Wendtner
- Department of Hematology; Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing Munich Germany
| | - A.W. Langerak
- Department of Immunology; Laboratory Medical Immunology, Erasmus MC; Rotterdam Netherlands
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - V. Goede
- Oncogeriatric Unit; Dept. of Geriatric Medicine, St. Marien Hospital; Cologne Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine, Ulm University, Ulm, Germany and Department for Hematology, Oncology and Rheumatology; Saarland University Medical School; Homburg/Saar Germany
| | - M. Mobasher
- Product Development Oncology; Genentech, Inc.; South San Francisco CA United States
| | - M. Ritgen
- Department II of Internal Medicine; Campus Kiel, University of Schleswig-Holstein; Kiel Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, CECAD (Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases); University of Cologne; Cologne Germany
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da Cunha-Bang C, Simonsen J, Rostgaard K, Geisler C, Hjalgrim H, Niemann CU. Improved survival for patients diagnosed with chronic lymphocytic leukemia in the era of chemo-immunotherapy: a Danish population-based study of 10455 patients. Blood Cancer J 2016; 6:e499. [PMID: 27834937 PMCID: PMC5148052 DOI: 10.1038/bcj.2016.105] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 09/08/2016] [Accepted: 09/16/2016] [Indexed: 12/12/2022] Open
Abstract
The treatment of chronic lymphocytic leukemia (CLL) is in rapid transition, and during recent decades both combination chemotherapy and immunotherapy have been introduced. To evaluate the effects of this development, we identified all CLL patients registered in the nation-wide Danish Cancer Register between 1978 and 2013. We identified 10 455 CLL patients and 508 995 CLL-free control persons from the general population. Compared with the latter, the relative mortality rate between CLL patients and their controls decreased from 3.4 (95% CI 3.2-3.6) to 1.9 (95% CI 1.7-2.1) for patients diagnosed in 1978-1984 and 2006-2013, respectively. The improved survival corresponded to a decreasing risk of death from malignant hematological diseases, whereas the risk of death from infections was stable during the study period. These population-based data substantiate the improved survival for patients treated with chemo-immunotherapy demonstrated in clinical studies.
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Affiliation(s)
- C da Cunha-Bang
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Simonsen
- Department of Epidemiology Research, Statens Serum Institut - SSI, Copenhagen, Denmark
| | - K Rostgaard
- Department of Epidemiology Research, Statens Serum Institut - SSI, Copenhagen, Denmark
| | - C Geisler
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Hjalgrim
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut - SSI, Copenhagen, Denmark
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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6
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Patel MS, Niemann CU, Sally MB, De La Cruz S, Zatarain J, Ewing T, Crutchfield M, Enestvedt CK, Malinoski DJ. The Impact of Hydroxyethyl Starch Use in Deceased Organ Donors on the Development of Delayed Graft Function in Kidney Transplant Recipients: A Propensity-Adjusted Analysis. Am J Transplant 2015; 15:2152-8. [PMID: 25904248 DOI: 10.1111/ajt.13263] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/20/2015] [Accepted: 01/31/2015] [Indexed: 01/25/2023]
Abstract
Our objective was to evaluate the impact of hydroxyethyl starch (HES) use in organ donors after neurologic determination of death (DNDD) on recipient renal graft outcomes. The following data elements were prospectively collected for every DNDD managed by a single organ procurement organization from June 2011 to July 2013: demographics; critical care endpoints; treatments, including the use of HES; graft cold ischemia time (CIT); and the occurrence of recipient delayed graft function (DGF, dialysis in the first week after transplantation). Logistic regression was performed to identify independent predictors of DGF with a p-value <0.05. The results were then adjusted for each donor's calculated propensity to receive HES. Nine hundred eighty-six kidneys were transplanted from 529 donors. Forty-two percent received HES (1217 ± 528 mL) and 35% developed DGF. Kidneys from DNDDs who received HES had a higher crude rate of DGF (41% vs. 31%, p < 0.001). After accounting for the propensity to receive HES, independent predictors of DGF were age (OR 1.02 [1.01-1.04] per year), CIT (OR 1.04[1.02-1.06] per hour), creatinine (OR 1.5 [1.32-1.72] per mg/dL) and HES use (OR 1.41 [1.02-1.95]). HES use during donor management was independently associated with a 41% increase in the risk of DGF in kidney transplant recipients.
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Affiliation(s)
- M S Patel
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - C U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.,Department of Surgery, University of California San Francisco, San Francisco, CA
| | - M B Sally
- Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.,Department of Surgery, Oregon Health and Science University, Portland, OR
| | - S De La Cruz
- Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.,Department of Surgery, Oregon Health and Science University, Portland, OR
| | - J Zatarain
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - T Ewing
- School of Medicine, University of California, Davis, Sacramento, CA
| | - M Crutchfield
- Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR
| | - C K Enestvedt
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - D J Malinoski
- Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.,Department of Surgery, Oregon Health and Science University, Portland, OR
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7
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Herman SEM, Niemann CU, Farooqui M, Jones J, Mustafa RZ, Lipsky A, Saba N, Martyr S, Soto S, Valdez J, Gyamfi JA, Maric I, Calvo KR, Pedersen LB, Geisler CH, Liu D, Marti GE, Aue G, Wiestner A. Ibrutinib-induced lymphocytosis in patients with chronic lymphocytic leukemia: correlative analyses from a phase II study. Leukemia 2014; 28:2188-96. [PMID: 24699307 PMCID: PMC4185271 DOI: 10.1038/leu.2014.122] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [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: 01/06/2014] [Revised: 02/21/2014] [Accepted: 03/21/2014] [Indexed: 02/06/2023]
Abstract
Ibrutinib and other targeted inhibitors of B-cell receptor signaling achieve impressive clinical results for patients with chronic lymphocytic leukemia (CLL). A treatment-induced rise in absolute lymphocyte count (ALC) has emerged as a class effect of kinase inhibitors in CLL and warrants further investigation. We here report correlative studies in 64 patients with CLL treated with ibrutinib. We quantified tumor burden in blood, lymph nodes, spleen, and bone marrow, assessed phenotypic changes of circulating cells, and measured whole blood viscosity. With just one dose of ibrutinib the average increase in ALC was 66%, and in over 40% of patients the ALC peaked within 24 hours of initiating treatment. Circulating CLL cells on day 2 showed increased Ki67 and CD38 expression, indicating an efflux of tumor cells from the tissue compartments into the blood. The kinetics and degree of the treatment-induced lymphocytosis was highly variable; interestingly in patients with a high baseline ALC the relative increase was mild and resolution rapid. After two cycles of treatment the disease burden in lymph node, bone marrow, and spleen decreased irrespective of the relative change in ALC. Whole blood viscosity was dependent on both ALC and hemoglobin. No adverse events were attributed to the lymphocytosis.
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Affiliation(s)
- S E M Herman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - C U Niemann
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Farooqui
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Jones
- 1] Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA [2] Medical Research Scholars Program, National Institutes of Health, Bethesda, MD, USA
| | - R Z Mustafa
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Lipsky
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - N Saba
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Martyr
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Soto
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Valdez
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J A Gyamfi
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - I Maric
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - K R Calvo
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - L B Pedersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C H Geisler
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - D Liu
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - G E Marti
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - G Aue
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Wray C, Scovotti JC, Tobis J, Niemann CU, Planinsic R, Walia A, Findlay J, Wagener G, Cywinski JB, Markovic D, Hughes C, Humar A, Olmos A, Sierra R, Busuttil R, Steadman RH. Liver transplantation outcome in patients with angiographically proven coronary artery disease: a multi-institutional study. Am J Transplant 2013; 13:184-91. [PMID: 23126562 DOI: 10.1111/j.1600-6143.2012.04293.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [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: 05/14/2012] [Revised: 08/01/2012] [Accepted: 08/22/2012] [Indexed: 01/25/2023]
Abstract
Over the last decade the age of liver transplant (LT) recipients and the likelihood of coronary artery disease (CAD) in this population have increased. There are no multicenter studies that have examined the impact of CAD on LT outcomes. In this historical cohort study, we identified adult LT recipients who underwent angiography prior to transplantation at seven institutions over a 12-year period. For each patient we recorded demographic data, recipient and donor risk factors, duration of follow-up, the presence of angiographically proven obstructive CAD (≥50% stenosis) and post-LT survival. Obstructive CAD was present in 151 of 630 patients, the CAD(+) group. Nonobstructive CAD was found in 479 patients, the CAD(-) group. Patient survival was similar for the CAD(+) group (adjusted HR 1.13, CI = [0.79, 1.62], p = 0.493) compared to the CAD(-) group. The CAD(+) patients were further stratified into severe (CADsev, >70% stenosis, n = 96), and moderate CAD (CADmod, 50-70% stenosis, n = 55) groups. Survival for the CADsev (adjusted HR = 1.26, CI = [0.83, 1.91], p = 0.277) and CADmod (adjusted HR = 0.93, CI = [0.52, 1.66], p = 0.797) groups were similar to the CAD(-) group. We conclude that when current CAD treatment strategies are employed prior to transplant, post-LT survival is not significantly different between patients with and without obstructive CAD.
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Affiliation(s)
- C Wray
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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9
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Biancofiore G, Niemann CU. Liver transplant perioperative pathways: which way towards high-quality care and better outcomes? Minerva Anestesiol 2010; 76:769-770. [PMID: 20935608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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10
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Eilers H, Liu KD, Gruber A, Niemann CU. Chronic kidney disease: implications for the perioperative period. Minerva Anestesiol 2010; 76:725-736. [PMID: 20820151] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
End-stage renal disease (ESRD) and chronic kidney disease (CKD) are increasing health problems worldwide. In the US alone, an estimated 26 million people suffer from some form of CKD. In countries such as India and Pakistan, the prevalence of CKD is also rapidly rising. The presence of CKD is associated with increased perioperative morbidity and mortality, even when adjusted for other variables such as hypertension or diabetes. Frequently, CKD is under diagnosed, so patients and physicians are often unaware of the impaired renal function. Renal dysfunction as a predictor of perioperative outcomes is discussed together with therapeutic interventions aimed at the protection of renal function. Better interventions and diagnostic tools, such as cystatin C, are needed to further improve perioperative morbidity and mortality in patients with CKD.
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Affiliation(s)
- H Eilers
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0648, USA.
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11
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Niemann CU, Eilers H. Abdominal organ transplantation. Minerva Anestesiol 2010; 76:266-275. [PMID: 20332740] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The improvement in the success of solid organ transplantation over the past decades is remarkable and well documented. It is now a well-accepted treatment modality for patients with end-stage organ disease. Within the field of transplantation, abdominal organ transplantation is significantly more common than thoracic transplantation. Abdominal organ transplantation includes kidney, liver, pancreas, and combinations of abdominal organs. The most frequently transplanted organs are kidney and liver, which account together for more than 70% of all transplanted organs. For this limited review, it is impossible to cover all organ systems in abdominal transplantation in a comprehensive fashion. Hence, the focus will be on the most commonly performed procedures, namely kidney and liver transplantation. Triggered by the lack of large definitive studies, we intentionally raise controversial points, and some readers may disagree with some of the conclusions. However, these disagreements are a reflection of the paucity of adequate data for some of the discussed topics.
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Affiliation(s)
- C U Niemann
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0648, USA.
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Niemann CU, Kjeldsen L, Ralfkiaer E, Jensen MK, Borregaard N. Serglycin proteoglycan in hematologic malignancies: a marker of acute myeloid leukemia. Leukemia 2007; 21:2406-10. [PMID: 17928883 DOI: 10.1038/sj.leu.2404975] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Serglycin is the major cell-associated proteoglycan of hematopoietic cells. Previous work has demonstrated that serglycin may be involved in targeting some proteins to granules of cytotoxic lymphocytes, mast cells and neutrophils. We characterized the expression of serglycin in various hematologic malignancies by immunohistochemistry and ELISA. Serglycin expression was found to distinguish acute myeloid leukemia (AML) from acute lymphoblastic leukemia. In contrast to myeloperoxidase, serglycin was found to be a selective marker for immature myeloid cells, distinguishing AML from Philadelphia chromosome-negative chronic myeloproliferative disorders.
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Affiliation(s)
- C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
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Niemann CU, Behrends M, Quan D, Eilers H, Gropper MA, Roberts JP, Hirose R. Recombinant factor VIIa reduces transfusion requirements in liver transplant patients with high MELD scores. Transfus Med 2006; 16:93-100. [PMID: 16623915 DOI: 10.1111/j.1365-3148.2006.00653.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 12/24/2022]
Abstract
Patients undergoing orthotopic liver transplantation (OLT) often experience significant coagulopathy and remain at risk for excessive blood loss and massive transfusion. The ability of recombinant factor VIIa (rFVIIa) to reduce transfusion requirements during OLT has not been well established. This retrospective study investigates whether rFVIIa reduces transfusion requirements in liver transplant patients with a significantly prolonged prothrombin time (PT) and a model of end-stage liver disease (MELD) score of > 20. Eleven patients received a single dose of rFVIIa (58 +/- 18 microg kg(-1)) at the time of incision. This group was matched with a selected control group that fulfilled all of the inclusion/exclusion criteria. Patient characteristics, pre-operative PT, HCT, PLT and MELD were identical between groups. Prophylactic application of rFVIIA reduced packed red blood cells (3.9 +/- 2.6 versus 6.9 +/- 2.3 U, P = 0.01) and fresh-frozen plasma (FFP) (12.6 +/- 6 versus 19.8 +/- 7 U, P = 0.018) transfusion requirements when compared with the control group. FFP administration in the first 24 h after surgery was also significantly less in the rVIIa group when compared with the control group (388 +/- 385 versus 1225 +/- 701 mL, P = 0.003). Hospital stay following transplantation tended to be shorter in the rFVIIa group, albeit statistical significance was not achieved (11 +/- 7.3 versus 7.9 +/- 2.7, P = 0.2). All but one patient in the control group survived for 30 days after transplantation. In a selected group of patients with prolonged PT and high MELD score, the prophylactic application of rFVIIa at the start of the OLT may reduce perioperative transfusion requirements.
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Affiliation(s)
- C U Niemann
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0648, USA.
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Abstract
UNLABELLED Ischemic preconditioning (IP) has been shown to ameliorate renal ischemia reperfusion injury. Using a rat kidney transplantation model we determined if IP improves graft function after prolonged cold storage. MATERIALS AND METHODS Syngeneic rat kidneys were divided into two groups. Prior to 42 hours of cold storage in UW and transplantation, one group (n = 10) received IP (15 minutes of warm ischemia/10 minutes of reperfusion), whereas another group (n = 10) received no treatment. Early graft function and 1-week recipient survival were assessed. RESULTS Recipient survival was not significantly different between groups [70% (IP) vs 40% (non-IP); P = .28]. IP treatment led to a quicker recovery of renal function. On PODs 3 and 6, serum creatinine levels in the IP group were significantly lower compared with the untreated group. In conclusion, one cycle of IP (15/10) accelerates recovery of renal graft function after severe ischemia reperfusion injury. This simple treatment modality may improve outcomes of renal transplants with prolonged cold storage.
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Affiliation(s)
- T F Fuller
- Department of Urology, Charité Hospital, Humboldt University, Berlin, Germany.
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Niemann CU, Hirose R, Stock P, Roberts JP, Mandell S, Spencer Yost C. Intraoperative fluid management of living donor versus cadaveric liver transplant recipients. Transplant Proc 2004; 36:1466-8. [PMID: 15251359 DOI: 10.1016/j.transproceed.2004.04.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/17/2022]
Abstract
Living donor liver transplantation has increasingly become an alternative to cadaveric donor liver transplants for select adult patients. Because these cases can be performed electively, living donor recipients may have better compensated liver disease at the time of surgery than cadaver donor recipients. However, it is unknown if this difference would have a significant effect on their intraoperative course. Therefore, we compared the intraoperative fluid management of patients receiving liver grafts from either living or cadaveric donors (n = 25, each group). Patient groups did not differ in demographics or baseline laboratory values. The duration of anesthesia and anhepatic phases were significantly longer in living donor cases (651 +/- 80 minutes vs 409 +/- 20 and 55 +/- 14 vs 45 +/- 6, P < .05). Adjusted for anesthesia time and patient weight, fluid administration (crystalloid and albumin) was not different between the two groups. Intraoperative transfusion requirements were also not significantly different in recipients from living donors versus cadaveric donors with regard to red blood cells, fresh frozen plasma, platelets, and cryoprecipitate. However, arterial oxygenation was better preserved in recipients from living donors. The PaO2/FiO2 (P/F) ratio at the end of the procedure was significantly better in patients receiving livers from living rather than from cadaveric donors (P/F ratio 335 +/- 114 mm Hg vs 271 +/- 174, P < .05). Our results indicate that while intraoperative fluid and transfusion requirements are similar, the impact of transplantation on pulmonary gas exchange is more pronounced in patients receiving organs from cadaveric donors. This difference may arise from longer cold ischemia times present in the cadaveric donor group.
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Affiliation(s)
- C U Niemann
- Anesthesia and Perioperative Care, University of California San Francisco, 94143, USA
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16
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Abstract
The extraocular muscles (EOM) are anatomically and physiologically distinct from other striated muscles in mammals. Among other differences, they can be driven to generate individual twitch contractions at an extremely high frequency and are resistant to [Ca(2+)]-induced myonecrosis. While EOM are preferentially targeted in some neuromuscular diseases such as myasthenia gravis and congenital fibrosis of the extraocular muscles, they are enigmatically spared in Duchenne's muscular dystrophy, despite the widespread damage seen in all other skeletal muscle groups during the course of this disease. To address the molecular mechanisms that specify the EOM-phenotype, we characterized the transcriptional profile of genes expressed in rat EOM versus limb muscle using a differential display strategy. Ninety-five putative differentially expressed cDNA tags were cloned, from which fourteen were confirmed as being differentially expressed by RNA slot blot and Northern blot analysis. Ten of these cDNAs were homologous to known human or murine genes and ESTs, while four genes that were upregulated in EOM were novel, and have been named expressed in ocular muscle (eom) 1-4. The identification of these differentially expressed genes may provide mechanistic clues toward understanding the unique patho-physiological phenotype of EOM.
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Affiliation(s)
- C U Niemann
- Department of Clinical Biochemistry, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
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Abstract
BACKGROUND Earlier studies have demonstrated that physiologic marker blood concentrations in the first minutes after administration, when intravenous anesthetics exert their maximum effect, are determined by both cardiac output and its distribution. Given the reported vasodilating properties of isoflurane, we studied the effects of isoflurane anesthesia on marker disposition as another paradigm of altered cardiac output and regional blood flow distribution. METHODS The dispositions of markers of intravascular space and blood flow (indocyanine green), extracellular space and free water diffusion (inulin), and total body water and tissue perfusion (antipyrine) were determined in four purpose-bred coonhounds. The dogs were studied while awake and while anesthetized with 1.7%, 2.6%, and 3.5% isoflurane (1.15, 1.7, and 2.3 minimum alveolar concentration, respectively) in a randomized order determined by a Latin square experimental design. Marker dispositions were described by recirculatory pharmacokinetic models based on very frequent early, and less frequent later, arterial blood samples. These models characterize the role of cardiac output and regional blood flow distribution on drug disposition. RESULTS Isoflurane caused a significant and dose-dependent decrease in cardiac output. Antipyrine disposition was profoundly affected by isoflurane anesthesia, during which nondistributive blood flow was maintained despite decreases in cardiac output, and the balance between fast and slow tissue volumes and blood flows was altered. CONCLUSIONS The isoflurane-induced changes in marker disposition were different than those the authors reported previously for halothane anesthesia, volume loading, or hypovolemia. These data provide further evidence that not only cardiac output but also its peripheral distribution affect early drug concentration history after rapid intravenous administration.
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Affiliation(s)
- M J Avram
- Department of Anesthesiology, Northwestern University Medical School, Chicago, Illinois 60611-3008, USA.
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Niemann CU, Henthorn TK, Krejcie TC, Shanks CA, Enders-Klein C, Avram MJ. Indocyanine green kinetics characterize blood volume and flow distribution and their alteration by propranolol. Clin Pharmacol Ther 2000; 67:342-50. [PMID: 10801242 DOI: 10.1067/mcp.2000.104945] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Although indocyanine green can be used to estimate cardiac output and blood volume independently, a recirculatory multicompartmental indocyanine green model enables description of these and additional intravascular events. Our model was used to describe the effect of propranolol on blood volume and flow distribution in humans. METHODS Indocyanine green disposition was determined twice in four healthy adult men, once during a propranolol infusion that decreased cardiac output. After injection of indocyanine green, arterial blood was collected frequently for 2 minutes and less frequently thereafter. Plasma indocyanine green concentrations were measured by HPLC. The recirculatory pharmacokinetic model incorporates data from both the initial transient oscillations and the later post-mixing portions of the blood indocyanine green concentration versus time curves to characterize not only blood volume and cardiac output but also their distribution among a central blood volume and fast and slow peripheral volumes in lumped parallel circuits. Flow through the central circulation (cardiac output) is described by two parallel Erlang distribution functions generated by two linear chains of compartments in parallel. RESULTS Propranolol reduced cardiac output from 10.6 to 4.1 L/min. Most of the decrease in cardiac output was at the expense of blood flow to the fast peripheral circuit, which represented nonsplanchnic circulation. Propranolol also reduced the blood volume of the fast peripheral circuit by more than half. CONCLUSION Our indocyanine green model is able to derive estimates of blood volume and cardiac output, as well as their systemic distribution during different physiologic conditions.
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Affiliation(s)
- C U Niemann
- Department of Anesthesiology, Northwestern University Medical School, Chicago, IL 60611-3008, USA
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Henthorn TK, Krejcie TC, Niemann CU, Enders-Klein C, Shanks CA, Avram MJ. Ketamine distribution described by a recirculatory pharmacokinetic model is not stereoselective. Anesthesiology 1999; 91:1733-43. [PMID: 10598617 DOI: 10.1097/00000542-199912000-00027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differences in the pharmacokinetics of the enantiomers of ketamine have been reported. The authors sought to determine whether these differences extend to pulmonary uptake and peripheral tissue distribution and to test the hypothesis that tissue distribution of the stereoisomers differs because of carrier-mediated drug transport. METHODS The dispositions of markers of intravascular space and blood flow (indocyanine green, ICG) and total body water and tissue perfusion (antipyrine) were determined along with S-(+)- and R-(-)-ketamine in five mongrel dogs. The dogs were studied while anesthetized with 2.0% halothane. Marker and drug dispositions were described by recirculatory pharmacokinetic models based on frequent early and less-frequent later arterial blood samples. These models characterize pulmonary uptake and the distribution of cardiac output into parallel peripheral circuits. RESULTS Plasma elimination clearance of the S-(+)-ketamine enantiomer, 29.9 ml x min(-1) x kg(-1), was higher than that of the R-(-)-enantiomer, 22.2 ml x min(-1) x kg(-1). The apparent pulmonary tissue volumes of the ketamine S-(+) and R-(-)-enantiomers (0.31 l) did not differ and was approximately twice that of antipyrine (0.16 l). The peripheral tissue distribution volumes and clearances and the total volume of distribution (2.1 l/kg) were the same for both stereoisomers when elimination clearances were modeled from the rapidly equilibrating peripheral compartment. CONCLUSIONS Although the elimination clearance of S-(+)-ketamine is 35% greater than that of the R-(-)-enantiomer, there is no difference in the apparent pulmonary tissue volume or peripheral tissue distribution between the stereoisomers, suggesting that physicochemical properties of ketamine other than stereoisomerism determine its perfusion-limited tissue distribution.
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Affiliation(s)
- T K Henthorn
- Department of Anesthesiology, Northwestern University Medical School, Chicago, Illinois, USA.
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Krejcie TC, Henthorn TK, Gentry WB, Niemann CU, Enders-Klein C, Shanks CA, Avram MJ. Modifications of blood volume alter the disposition of markers of blood volume, extracellular fluid, and total body water. J Pharmacol Exp Ther 1999; 291:1308-16. [PMID: 10565856] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Recirculatory pharmacokinetic models for indocyanine green (ICG), inulin, and antipyrine describe intravascular mixing and tissue distribution after i.v. administration. These models characterized physiologic marker disposition in four awake, splenectomized dogs while they were normovolemic, volume loaded (15% of estimated blood volume added as a starch solution), and mildly and moderately hypovolemic (15 and 30% of estimated blood volume removed). ICG-determined blood volumes increased 20% during volume loading and decreased 9 and 22% during mild and moderate hypovolemia. Dye (ICG) dilution cardiac output (CO) increased 31% during volume loading and decreased 27 and 38% during mild and moderate hypovolemia. ICG-defined central and fast peripheral intravascular circuits accommodated blood volume alterations and the fast peripheral circuit accommodated blood flow changes. Inulin-defined extracellular fluid volume contracted 14 and 21% during hypovolemia. Early inulin disposition changes reflected those of ICG. The ICG and inulin elimination clearances were unaffected by altered blood volume. Neither antipyrine-defined total body water volume nor antipyrine elimination clearance changed with altered blood volume. The fraction of CO not involved in drug distribution had a significant effect on the area under the antipyrine concentration-versus-time relationships (AUC) in the first minutes after drug administration. Hypovolemia increased the fraction of CO represented by nondistributive blood flow and increased the antipyrine AUC up to 60% because nondistributive blood flow did not change, despite decreased CO. Volume loading resulted in a smaller (less than 20%) antipyrine AUC decrease despite increased fast tissue distributive flow because nondistributive flow also increased with increased CO.
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Affiliation(s)
- T C Krejcie
- Northwestern University Medical School, Department of Anesthesiology, Chicago, Illinois 60611-3008, USA
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Avram MJ, Krejcie TC, Niemann CU, Klein C, Gentry WB, Shanks CA, Henthorn TK. The effect of halothane on the recirculatory pharmacokinetics of physiologic markers. Anesthesiology 1997; 87:1381-93. [PMID: 9416724 DOI: 10.1097/00000542-199712000-00018] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The cardiovascular effects of halothane are well recognized, but little is known of how this affects drug distribution. The effect of halothane anesthesia on physiologic factors that affect drug disposition from the moment of injection was investigated. METHODS The dispositions of markers of intravascular space and blood flow (indocyanine green), extracellular space and free water diffusion (inulin), and total body water and tissue perfusion (antipyrine) were determined in four purpose-bred coonhounds. The dogs were studied while awake and while anesthetized with 1%, 1.5%, and 2% halothane in a randomized order determined by a repeated measures Latin square experimental design. Marker dispositions were described by recirculatory pharmacokinetic models based on frequent early and less frequent later arterial blood samples. These models characterize the role of cardiac output and its distribution on drug disposition. RESULTS Halothane caused a significant and dose-dependent decrease in cardiac output. The disposition of antipyrine was most profoundly affected by halothane anesthesia, which increased both nondistributive intercompartmental clearance and volume while decreasing fast and slow tissue clearances and elimination clearance in a halothane dose-dependent manner. CONCLUSIONS Halothane-induced changes in blood flow to the compartments of the antipyrine recirculatory model were not proportional to changes in cardiac output. Halothane anesthesia significantly increased (to more than double) the area under the drug concentration versus time curve due to an increase in the apparent peripheral blood flow not involved in drug distribution, despite a dose-dependent cardiac output decrease. Recirculatory pharmacokinetic models include the best aspects of traditional compartmental and physiologic pharmacokinetic models while offering advantages over both.
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Affiliation(s)
- M J Avram
- Northwestern University Medical School Department of Anesthesiology, Chicago, Illinois 60611-3008, USA.
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Krejcie TC, Avram MJ, Gentry WB, Niemann CU, Janowski MP, Henthorn TK. A recirculatory model of the pulmonary uptake and pharmacokinetics of lidocaine based on analysis of arterial and mixed venous data from dogs. J Pharmacokinet Biopharm 1997; 25:169-90. [PMID: 9408858 DOI: 10.1023/a:1025780012960] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary uptake of basic amine xenobiotics such as lidocaine may influence the onset of drug effect and ameliorate toxicity. To date, pharmacokinetic analysis of pulmonary drug uptake has been only semiquantitative and ill-suited for relating pharmacodynamics to pharmacokinetics or for estimating the time course of the fraction of drug dose residing in the lung during a single pass. We have developed recirculatory models in an experiment in which lidocaine was injected into the right atrium simultaneously with markers of intravascular space (indocyanine green) and total body water (antipyrine); this was followed by rapid arterial and mixed venous blood sampling. Such models are interpretable physiologically and are capable of characterizing the kinetics of the pulmonary uptake of lidocaine in addition to peripheral tissue distribution and elimination. The apparent pulmonary tissue volume of lidocaine (39 ml/kg) was nearly ninefold greater than that of antipyrine (4.5 ml/kg). The recirculatory model characterized both arterial and mixed venous data, but the latter data were not essential for estimating lidocaine's pulmonary disposition either before or after recirculation of drug was evident.
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Affiliation(s)
- T C Krejcie
- Northwestern University Medical School, Department of Anesthesiology, Chicago, Illinois 60611-3008, USA
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Krejcie TC, Jacquez JA, Avram MJ, Niemann CU, Shanks CA, Henthorn TK. Use of parallel Erlang density functions to analyze first-pass pulmonary uptake of multiple indicators in dogs. J Pharmacokinet Biopharm 1996; 24:569-88. [PMID: 9300351 DOI: 10.1007/bf02353481] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The gamma and Erlang density functions describe a large class of lagged, right-skewed distributions. The Erlang distribution has been shown to be the analytic solution for a chain of compartments with identical rate constants. This relationship makes it useful for the analysis of first-pass pulmonary drug uptake data following intravenous bolus administration and the incorporation of this analysis into an overall systemic drug disposition model. However, others have shown that one Erlang density function characterizes the residence time distribution of solutes in single tissues with significant systematic error. We propose a model of two Erlang density functions in parallel that does characterize well the arterial appearance of indocyanine green, antipyrine, and alfentanil administered simultaneously by right atrial bolus injection. We derive the equations that permit calculation of the higher order moments of a system consisting of two parallel Erlang density functions and use the results of these calculations from the data for all three indicators to estimate pulmonary capillary blood volume and mean transit time in the dog.
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Affiliation(s)
- T C Krejcie
- Department of Anesthesiology, Northwestern University Medical School, Chicago, Illinois 60611-3008, USA
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Krejcie TC, Henthorn TK, Niemann CU, Klein C, Gupta DK, Gentry WB, Shanks CA, Avram MJ. Recirculatory pharmacokinetic models of markers of blood, extracellular fluid and total body water administered concomitantly. J Pharmacol Exp Ther 1996; 278:1050-7. [PMID: 8819485] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pharmacokinetic models were developed to describe the disposition of markers of extracellular fluid (inulin) and total body water (antipyrine) from the moment of injection to incorporate the intravascular mixing component, determined by a marker of intravascular space (indocyanine green, ICG). The simultaneous dispositions of these markers were characterized in four halothane-anesthetized dogs. After injection of ICG, [14C]-inulin, and antipyrine into the right atrium, femoral arterial blood samples were collected every 3 sec for 1 min and less frequently to 20 min for ICG and to 360 min for inulin and antipyrine. ICG and antipyrine concentrations were measured by high-performance liquid chromatography and [14C]-inulin concentrations were measured by liquid scintillation counting. The marker concentration histories were characterized completely by fully identifiable recirculatory compartmental models. Because neither ICG nor inulin distribute beyond intravascular space before recirculation, their first-pass data were modelled simultaneously to improve confidence in central circulation model parameters. This central circulation model included an estimate of cardiac output that was retained in the recirculatory models of all markers. Three tissue compartments were identified for antipyrine, a lipid soluble marker that equilibrates with tissue (including the lung) and estimates total body water and tissue blood flow. The hydrophilic marker, inulin, diffuses into interstitial fluid so slowly that only two extravascular compartments were identified. These models may be used to determine how cardiac output and its distribution, pulmonary drug uptake, and nondistributive blood flow contribute to variability in patient response to drugs with a rapid onset of effect.
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Affiliation(s)
- T C Krejcie
- Northwestern University Medical School, Department of Anesthesiology, Chicago, Illinois, USA
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