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Franz M, Tavil S, de Manna ND, Aburahma K, Boethig D, Bobylev D, Welte T, Greer M, Schwerk N, Ruhparwar A, Kuehn C, Salman J, Ius F. Oversizing lung allografts deteriorates outcomes in patients with pulmonary fibrosis. J Heart Lung Transplant 2024:S1053-2498(24)01516-X. [PMID: 38438087 DOI: 10.1016/j.healun.2024.02.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Lung transplantation is the only curative treatment for patients with end-stage pulmonary fibrosis. Due to the shortage of donor organs most lung allografts are either oversized or undersized. It is still under debate whether over- or undersizing is preferably performed regarding the postoperative outcome. We therefore analysed our data using predicted total lung capacity to compare size-mismatches. METHODS Patient records were retrospectively reviewed. Three groups were formed, one including patients with a donor-recipients pTLC-ratio (DRPR) of <1.0 (undersized group), the second with a DRPR of ≥1.0 and <1.1 (size matched group) and the third group with a DRPR of ≥1.1 (oversized group). Outcomes were evaluated using Chi-Square test and Kruskall-Wallis test as well as Kaplan-Meier analysis, competing risk analysis and multivariable analysis, respectively. RESULTS Between January 2010 and May 2023, among the 1501 patients transplanted at our institution, 422 (28%) patients were included, 26 (2%) patients forming the oversized group (median DRPR: 1.14), 101 (7%) patients forming the size matched group (median DRPR: 1.03) and 296 (20%) patients forming the undersized group (median DRPR: 0.92). Patients from the oversized group had a higher PGD grade 3 rate at 24 (p<0.001), 48 (p<0.001) and 72 (p=0.039) hours after transplantation as well as a higher in-hospital mortality compared to the undersized group (p=0.033). The long-term survival was also better in the undersized group compared to the oversized group (p=0.011) and to the size matched group (p=0.01). CONCLUSION Oversizing lung allografts more than 10% deteriorated early postoperative outcomes and long-term survival in patients with pulmonary fibrosis.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Saleh Tavil
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nunzio Davide de Manna
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Diseases (DZL/BREATH), Hannover, Germany
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2
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Benazzo A, Bagnera C, Ius F, Del Fante C, Gottlieb J, Hoetzenecker K, Meloni F, Jaksch P, Greer M. A European Multi-Center Analysis of Extracorporeal Photopheresis as Therapy for Chronic Lung Allograft Dysfunction. Transpl Int 2024; 36:11551. [PMID: 38282747 PMCID: PMC10811603 DOI: 10.3389/ti.2023.11551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/07/2023] [Indexed: 01/30/2024]
Abstract
Extracorporeal photopheresis (ECP) is used by few lung transplant centers to treat chronic lung allograft dysfunction (CLAD). Although reported results suggest a beneficial effect on CLAD progression, evidence is limited to single center experiences. The aim of this study is to analyze outcomes of ECP in a large multicenter European cohort. The primary endpoint was patient survival after initiation of ECP. This study included 631 patients, 87% suffered from bronchiolitis obliterans syndrome (BOS), and 13% had restrictive allograft syndrome (RAS). Long-term stabilization was achieved in 42%, improvement in 9%, and no response in 26%. Within the first 12 months of therapy, 23% of patients died. Patients' survival after initiation of ECP at 5 years was 56% in stable, 70% in responders, and 35% in non-responders (p = 0.001). In multivariable Cox regression, both stabilization (HR: 0.48, CI: 0.27-0.86, p = 0.013) and response (HR: 0.11, CI: 0.04-0.35, p < 0.001) to ECP were associated with survival. Absolute FEV1 at baseline was also protective (HR: 0.09, CI: 0.01-0.94, p = 0.046). RAS phenotype was the only risk factor for mortality (HR: 2.11, 1.16-3.83, p = 0.006). This study provides long-term outcomes of ECP use in CLAD patients in the largest published cohort to date. Two-thirds of the cohort had a sustained response to ECP with excellent long-term results.
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Affiliation(s)
- Alberto Benazzo
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Cecilia Bagnera
- Malattie dell’Apparato Respiratorio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabio Ius
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Claudia Del Fante
- Servizio Immunoematologia e Medicina Trasfusionale, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Federica Meloni
- Malattie dell’Apparato Respiratorio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, Hannover, Germany
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3
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Heise EL, Chichelnitskiy E, Greer M, Franz M, Aburahma K, Iablonskii P, de Manna ND, Christoph S, Verboom M, Hallensleben M, Boethig D, Avsar M, Welte T, Schwerk N, Sommer W, Haverich A, Warnecke G, Kuehn C, Falk C, Salman J, Ius F. Lung transplantation despite preformed donor-specific antihuman leukocyte antigen antibodies: a 9-year single-center experience. Am J Transplant 2023; 23:1740-1756. [PMID: 37225088 DOI: 10.1016/j.ajt.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
Pretransplant allosensitization to human leukocyte antigens (HLA) increases the recipient's waiting list time and mortality in lung transplantation. Rather than waiting for crossmatch-negative donors, since 2013, recipients with preformed donor-specific antiHLA antibodies (pfDSA) have been managed with repeated IgA- and IgM-enriched intravenous immunoglobulin (IgGAM) infusions, usually in combination with plasmapheresis before IgGAM and a single dose of antiCD20 antibody. This retrospective study presents our 9-year experience with patients transplanted with pfDSA. Records of patients transplanted between February 2013 and May 2022 were reviewed. Outcomes were compared between patients with pfDSA and those without any de novo donor-specific antiHLA antibodies. The median follow-up time was 50 months. Of the 1,043 patients who had undergone lung transplantation, 758 (72.7%) did not develop any early donor-specific antiHLA antibodies, and 62 (5.9%) patients exhibited pfDSA. Among the 52 (84%) patients who completed treatment, pfDSA was cleared in 38 (73%). In pfDSA vs control patients and at 8-year follow-up, respectively, graft survival (%) was 75 vs 65 (P = .493) and freedom from chronic lung allograft dysfunction (%) was 63 vs 65 (P = .525). In lung transplantation, crossing the preformed HLA-antibody barrier is safe using a treatment protocol based on IgGAM. Patients with pfDSA have a good 8-year graft survival rate and freedom from chronic lung allograft dysfunction, similar to control patients.
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Affiliation(s)
- Emma L Heise
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Evgeny Chichelnitskiy
- Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine,Hannover Medical School,Hannover,Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Iablonskii
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Nunzio D de Manna
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Stella Christoph
- Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany
| | - Murielle Verboom
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Michael Hallensleben
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine,Hannover Medical School,Hannover,Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Christine Falk
- Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany.
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Aburahma K, de Manna ND, Boethig D, Franz M, Iablonskii P, Heise EL, Bobylev D, Avsar M, Greer M, Schwerk N, Sommer W, Welte T, Haverich A, Warnecke G, Kuehn C, Salman J, Ius F. Impact of Total Ischemic Time and Disease Severity Class on Graft Function after Bilateral Lung Transplantation. Eur J Cardiothorac Surg 2023:7160914. [PMID: 37171893 DOI: 10.1093/ejcts/ezad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/10/2023] [Accepted: 05/11/2023] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVES Total ischemic time is considered a limiting factor in lung transplantation. In this retrospective study we investigate effects of ischemic time and disease burden on outcomes after bilateral lung transplantation. METHODS 1,298 patients undergoing bilateral lung transplantation between January 2010 and May 2022 (Follow-up 100%, median 54 months) were included. Pre-transplant diseases 'severity (recipient body mass index, recipient age, previous lung transplantation, Tacrolimus immunosuppression, preoperative recipient extracorporeal membrane oxygenation support, lung volume reduction) for graft failure was individually calculated and- as ischemic time- categorised. Vice-versa adjusted Cox models were calculated. Considering competing risks, we assessed cumulative incidences of airway obstructive complications and chronic lung allograft dysfunction with death as competing risk factors for primary graft dysfunction were assessed by binary logistic regression. RESULTS Higher disease burden significantly accelerated chronic lung allograft dysfunction and death occurrence (p < 0.001); ischemic time did not. Ischemic time adjusted disease burden strata showed 50% graft survival differences at 11 years after transplantation (range 24-74%), disease burden adjusted ischemic time strata 18% for all and 6% (54-60%) among those above 7 hours. All significant primary graft dysfunction risk factors were diagnoses related, ischemic time was not significantly important, and odds ratios did not increase with ischemic time. CONCLUSION The eventual graft survival disadvantage that results from an ischemic time between 7 and at least 11 hours is negligible in contrast to frequent recipients' disease-based risk levels.
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Affiliation(s)
- Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nunzio D de Manna
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Emma L Heise
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Hannover and Heidelberg, Germany
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5
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Franz M, Aburahma K, Avsar M, Bobylev D, Sommer W, Greer M, Tudorache I, Welte T, Haverich A, Warnecke G, Kuehn C, Ius F, Salman J. Does Donor-Recipient Sex Mismatch Have an Influence on Long Term Outcomes after Lung Transplantation? An Experience of a High Volume Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1020] [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: 04/05/2023] Open
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Benazzo A, Auner S, Boehm P, Schwarz S, Bagnera C, Ius F, Hoetzenecker K, Meloni F, Jaksch P, Greer M. A Multicenter Experience with Extracorporeal Photopheresis as Treatment of Clad. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1603] [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: 04/05/2023] Open
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7
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Heise E, Chichelnitskiy E, Franz M, Aburahma K, Iablonski P, Bobylev D, Saipbaev A, Schwerk N, Sommer W, Greer M, Avsar M, Wiegmann B, Knöfel A, Kühne J, Warnecke G, Haverich A, Kühn C, Salman J, Falk C, Ius F. Perioperative Desensitization Changes the Plasma Cytokine Milieu in Lung Transplant Patients with Preformed Donor Specific Antibodies. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.425] [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: 04/05/2023] Open
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Floethmann K, Aburahma K, de Manna N, Franz M, Yablonski P, Saipbaev A, Greer M, Avsar M, Bobylev D, Schwerk N, Sommer W, Warnecke G, Welte T, Haverich A, Kuehn C, Salman J, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 12-Year Single-Center Experience Using the Eurotransplant Lung Donor Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1018] [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: 04/05/2023] Open
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Franz M, Aburahma K, Avsar M, Bobylev D, Sommer W, Greer M, Tudorache I, Welte T, Haverich A, Warnecke G, Kuehn C, Ius F, Salman J. 12-Year Experience with Postoperatively Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Arterial Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.417] [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: 04/05/2023] Open
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10
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Aburahma K, Franz M, Yablonski P, de Manna N, Saipbaev A, Avsar M, Schwerk N, Sommer W, Greer M, Falk C, Welte T, Haverich A, Kuehn C, Warnecke G, Salman J, Ius F. Nine-Year Results of an IgA-And IgM-Enriched Human Immunoglobulin-Based Therapy for Early Detectable Anti-HLA Donor Specific Antibodies after Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.895] [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: 04/05/2023] Open
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Obert AJ, Kern AL, Gutberlet M, Voskrebenzev A, Kaireit TF, Crisosto C, Greer M, Krause ET, Wacker F, Vogel-Claussen J. Volume-Controlled 19 F MR Ventilation Imaging of Fluorinated Gas. J Magn Reson Imaging 2023; 57:1114-1128. [PMID: 36129419 DOI: 10.1002/jmri.28385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND 19 F MRI of inhaled gas tracers has developed into a promising tool for pulmonary diagnostics. Prior to clinical use, the intersession repeatability of acquired ventilation parameters must be quantified and maximized. PURPOSE To evaluate repeatability of static and dynamic 19 F ventilation parameters and correlation with predicted forced expiratory volume in 1 second (FEV1 %pred) with and without inspiratory volume control. STUDY TYPE Prospective. POPULATION A total of 30 healthy subjects and 26 patients with chronic obstructive pulmonary disease (COPD). FIELD STRENGTH/SEQUENCE Three-dimensional (3D) gradient echo pulse sequence with golden-angle stack-of-stars k-space encoding at 1.5 T. ASSESSMENT All study participants underwent 19 F ventilation MRI over eight breaths with inspiratory volume control (w VC) and without inspiratory volume control (w/o VC), which was repeated within 1 week. Ventilated volume percentage (VVP), fractional ventilation (FV), and wash-in time (WI) were computed. Lung function testing was conducted on the first visit. STATISTICAL TESTS Correlation between imaging and FEV1 %pred was measured using Pearson correlation coefficient (r). Differences in imaging parameters between first and second visit were analyzed using paired t-test. Repeatability was quantified using intraclass correlation coefficient (ICC) and coefficient of variation (CoV). Minimum detectable effect size (MDES) was calculated with a power analysis for study size n = 30 and a power of 0.8. All hypotheses were tested with a significance level of 5% two sided. RESULTS Strong and moderate linear correlations with FEV1 %pred for COPD patients were found in almost all imaging parameters. The ICC w VC exceeds the ICC w/o VC for all imaging parameters. CoV was significantly lower w VC for initial VVP in COPD patients, FV, CoV FV, WI and standard deviation (SD) of WI. MDES of all imaging parameters were smaller w VC. DATA CONCLUSION 19 F gas wash-in MRI with inspiratory volume control increases the correlation and repeatability of imaging parameters with lung function testing. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Arnd J Obert
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Agilo L Kern
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Till F Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Cristian Crisosto
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Mark Greer
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - E Tobias Krause
- Institute of Animal Welfare and Animal Husbandry, Friedrich-Loeffler-Institute, Celle, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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12
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Franz M, Aburahma K, Avsar M, Boethig D, Greer M, Alhadidi H, Sommer W, Tudorache I, Warnecke G, Haverich A, Ius F, Salman J. Does donor-recipient age mismatch have an influence on outcome after lung transplantation? A single-centre experience. Eur J Cardiothorac Surg 2023; 63:7050935. [PMID: 36810928 DOI: 10.1093/ejcts/ezad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/14/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Lack of organ donors demands transplantation of older lung allografts for recipients between 0 and 50 years. So far, it has not yet been investigated whether donor-recipient age mismatch affects long-term outcome. METHODS Records of patients aged between 0 and 50 years were retrospectively reviewed. Donor-recipient age mismatch was calculated subtracting recipient age from donor age. Multivariable Cox regression analyses was performed to assess donor-recipient age mismatch regarding the end points' overall patient mortality, mortality conditioned to hospital discharge, biopsy-confirmed rejection and chronic lung allograft dysfunction. Furthermore, we performed competing risk analysis to analyse if age mismatch affects biopsy-confirmed rejection and CLAD while death being a competing risk. RESULTS Between January 2010 and September 2021, out of 1363 patients who underwent lung transplantation at our institution, 409 patients fulfilled the eligibility criteria and were included. Age mismatch ranged between 0 and 56 years. Multivariable analysis revealed that donor-recipient age mismatch does not affect overall patient mortality (P = 0.19), biopsy-confirmed rejection (P = 0.68) and chronic lung allograft dysfunction (P = 0.42). There was no difference seen in CLAD (P = 0.166) and biopsy-confirmed rejection (P = 0.944) with the competing risk death (P = 0.765 and P = 0.851; respectively). CONCLUSIONS Age mismatch between recipients and donors of lung allografts does not affect long-term outcomes after lung transplantation.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hani Alhadidi
- Division of Thoracic Surgery, King Hussein Medical Center, Amman, Jordan
| | - Wiebke Sommer
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL/BREATH), Hannover, Germany
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Ringshausen FC, Sauer-Heilborn A, Büttner T, Dittrich AM, Schwerk N, Ius F, Nährlich L, Welte T, Greer M. Lung transplantation for end-stage cystic fibrosis before and after the availability of elexacaftor-tezacaftor-ivacaftor, Germany, 2012-2021. Eur Respir J 2023; 61:13993003.01402-2022. [PMID: 36517178 DOI: 10.1183/13993003.01402-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Annette Sauer-Heilborn
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Tina Büttner
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Anna-Maria Dittrich
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Nicolaus Schwerk
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Fabio Ius
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School (MHH), Hannover, Germany
| | - Lutz Nährlich
- Department of Pediatrics, Justus-Liebig-University Giessen, and Universities of Giessen and Marburg Lung Center, German Center for Lung Research (DZL), Giessen, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
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14
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Sommer W, Franz M, Aburahma K, Saipbaev A, Flöthmann K, Yablonski P, Avsar M, Tudorache I, Greer M, Haverich A, Welte T, Kuehn C, Salman J, Warnecke G, Ius F. Lungs From Donors ≥70 Years of Age for Transplantation-Do Long-Term Outcomes Justify Their Use? Transpl Int 2023; 36:11071. [PMID: 37125386 PMCID: PMC10133456 DOI: 10.3389/ti.2023.11071] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023]
Abstract
Donor shortages have led transplant centers to extend their criteria for lung donors. Accepting lung donors ≥70 years of age has previously shown good short-term outcomes; however, no mid- and long-term outcome data on these extended criteria donors has been published to date. In this study, all patients who underwent lung transplantation between 06/2010 and 12/2019 were included in the analysis, and the outcomes were compared between patients receiving organs from donors <70 years of age and patients transplanted with lungs from donors ≥70 years of age. Among the 1,168 lung-transplanted patients, 62 patients received lungs from donors ≥70 years of age. The recipient age of those receiving older organs was significantly higher, and they were more likely to suffer from obstructive lung disease. Older donors were exposed to significantly shorter periods of mechanical ventilation prior to donation, had higher Horowitz indices, and were less likely to have smoked. The postoperative time on mechanical ventilation, time on ICU, and total hospital stay were comparable. The overall survival as well as CLAD-free survival showed no differences between both groups in the follow-up period. Utilization of lungs from donors ≥70 years of age leads to excellent mid- and long-term results that are similar to organs from younger donors when the organs from older donors are carefully preselected.
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Affiliation(s)
- Wiebke Sommer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Akylbek Saipbaev
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Flöthmann
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Yablonski
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University of Duesseldorf, Duesseldorf, Germany
| | - Mark Greer
- Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
- Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
| | - Fabio Ius
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
- *Correspondence: Fabio Ius,
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15
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Heise E, Franz M, Greer M, Aburahma K, Natanov R, Iablonskii P, Saipbaev A, Welte T, Haverich A, Salman J, Kühn C, Ius F. Lung Transplantation in Patients with Irreversible Lung Injury Due to SARS-CoV-2: A Single-Center Experience. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761753] [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: 03/22/2023]
Affiliation(s)
- E. Heise
- Hannover Medical School, Hannover, Deutschland
| | - M. Franz
- Hannover Medical School, Hannover, Deutschland
| | - M. Greer
- Hannover Medical School, Hannover, Deutschland
| | - K. Aburahma
- Hannover Medical School, Hannover, Deutschland
| | - R. Natanov
- Hannover Medical School, Hannover, Deutschland
| | | | - A. Saipbaev
- Hannover Medical School, Hannover, Deutschland
| | - T. Welte
- Hannover Medical School, Hannover, Deutschland
| | - A. Haverich
- Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Hannover Medical School, Hannover, Deutschland
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16
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Greer M, Liu B, Magnusson JM, Fuehner T, Schmidt BMW, Deluca D, Falk C, Ius F, Welte T. Assessing treatment outcomes in CLAD: The Hannover-extracorporeal photopheresis model. J Heart Lung Transplant 2022; 42:209-217. [PMID: 37071121 DOI: 10.1016/j.healun.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) is a leading cause of graft loss in lung transplantation. Despite this, convincing treatment data is lacking, and protocols vary widely between centers. CLAD phenotypes exist, but phenotype transitioning has increased the challenge of designing clinically relevant studies. Extracorporeal photopheresis (ECP) has long been a suggested salvage treatment, but efficacy appears unpredictable. This study describes our experiences with photopheresis, using novel temporal phenotyping to illustrate the clinical course. METHODS Retrospective analysis of patients completing ≥3 months of ECP for CLAD between 2007 and 2022 was performed. A latent class analysis employing a mixed-effects model was performed, deriving patient subgroups based on spirometry trajectory over the 12 months prior to photopheresis until graft loss or 4 years post photopheresis initiation. The resulting temporal phenotypes were compared in terms of treatment response and survival outcomes. Linear discriminatory analysis was used to assess phenotype predictability, relying solely on data available at photopheresis initiation. RESULTS Data from 5,169 outpatient attendances in 373 patients was used to construct the model. Five trajectories were identified, with uniform spirometry changes evident following 6 months of photopheresis. Outcomes were poorest in Fulminant patients (N = 25, 7%) with median survival of 1 year. In the remainder, poorer lung function at initiation led to poorer outcomes. The analysis revealed important confounders, affecting both decision-making and outcome interpretation. CONCLUSIONS Temporal phenotyping provided novel insights into ECP treatment response in CLAD, particularly the importance of timely intervention. Limitations in % Baseline values in guiding treatment decisions warrant further analysis. Photopheresis may have a more uniform effect than previously thought. Predicting survival at ECP initiation appears feasible.
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Busch M, Stahl K, Fuge J, Schrimpf C, RIttgerodt N, Greer M, Mederacke YS, Haverich A, Wedemeyer H, Heidrich B, Schneider A, Lenzen H, Mederacke I. Out of sight for the endoscopist? Gastrointestinal bleeding after aortic repair. Scand J Gastroenterol 2022; 57:1112-1119. [PMID: 35527697 DOI: 10.1080/00365521.2022.2062258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIM Secondary Aortoenteric Fistulas (sAEF) are difficult to diagnose and usually result in fatal gastrointestinal (GI) bleeding following aortic repair. Outcomes are largely dependent on a timely diagnosis, but AEFs remain challenging to identify endoscopically and are usually diagnosed on computed tomography (CT) scans. The aim of our study was optimize diagnosis of AEF by identifying patients developing GI bleeding after aortic repair, investigate their clinical course and identify factors specific to different bleeding sources. METHODS A retrospective, single-center study capturing all patients developing upper or lower GI bleeding after aortic surgery between January 2009 and March 2020 was performed. Electronic health records were screened for diagnostic codes of the relevant procedures. Bleeding was classified into three groups: AEF with demonstrable fistula, ischemic - macroscopic ulceration plus histological confirmation or imaging and "other" due to other recognized conventional cause, such as peptic ulcer disease. RESULTS 47 GI bleeding episodes in 39 patients were identified. Of these, 10 episodes (21%) were caused by AEF, 16 (34%) by ischemic ulceration and 21 (45%) due to other causes. Patients with AEF exhibited more frequent hemodynamic instability requiring vasopressors and had higher mortality, while ischemic ulcerations were associated with more recent operation or hypotensive episode. CONCLUSIONS GI bleeding complications are uncommon following aortic surgery. AEF and ischemic ulceration are however frequent bleeding causes in this cohort. In patients presenting with fulminant bleeding, primary CT-scanning should be considered.
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Affiliation(s)
- Markus Busch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Claudia Schrimpf
- Department for Heart-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nina RIttgerodt
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Young-Seon Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Heart-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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18
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Franz M, Siemeni T, Aburahma K, Yablonski P, Poyanmehr R, Avsar M, Bobylev D, Sommer W, Boethig D, Greer M, Gottlieb J, Tudorache I, Hoeper MM, Warnecke G, Haverich A, Kuehn C, Ius F, Salman J. Lung transplantation and severe coronary artery disease: results from a single-centre experience. Eur J Cardiothorac Surg 2022; 62:6608696. [PMID: 35703921 DOI: 10.1093/ejcts/ezac348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The management of severe coronary artery disease at the time of lung transplantation remains a challenge. We analyzed the short- and long-term-outcomes of lung transplant recipients with severe coronary artery disease. METHODS Records of adult patients transplanted at our institution between April 2010 and February 2021 were retrospectively reviewed. Severe coronary artery disease was defined by coronary stenosis ≥70% (main stem ≥50%) at the coronary angiography performed before or at the time of listing. Patient characteristics, perioperative- and long-term-outcomes were compared between patients with and without severe coronary artery disease. RESULTS Among 896 lung-transplanted patients who had undergone a coronary angiography before transplantation, 77 (8.5%) showed severe coronary artery disease, the remaining 819 (91.5%) did not. Patients with severe coronary artery disease were older (p < 0.0001), more often male (p < 0.0001) and were transplanted more often for pulmonary fibrosis (p = 0.0007). The median (interquartile range) follow-up was 46 (20-76) months. At the Cox multivariable analysis severe coronary artery disease was not associated with mortality. Patients with pretransplant percutaneous transluminal coronary angioplasty and patients with coronary artery bypass graft surgery concomitant to transplantation had equivalent survival compared to patients without severe coronary artery disease (p = 0.513, p = 0.556). CONCLUSIONS Severe coronary artery disease was not associated with decreased survival after lung transplantation. Concomitant coronary artery bypass graft surgery and pretransplant percutaneous transluminal coronary angioplasty can be used for revascularization.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Yablonski
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Medical Faculty of St-Petersburg State University, St-Petersburg, Russia
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac surgery, Heidelberg Medical School, Heidelberg, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac surgery, Heidelberg Medical School, Heidelberg, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
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Salman J, Franz M, Yablonski P, Saipbaev A, Avsar M, Schwerk N, Sommer W, Greer M, Falk C, Welte T, Haverich A, Kuehn C, Warnecke G, Ius F. Eight-Year Results of an IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Early Detectable Anti-HLA Donor Specific Antibodies After Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.632] [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: 12/01/2022] Open
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20
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Franz M, Aburahma K, Yablonski P, Flöthmann K, Bobylev D, Schwerk N, Sommer W, Greer M, Avsar M, Welte T, Falk C, Haverich A, Kühn C, Warnecke G, Salman J, Ius F. Perioperative Desensitization with IgA- and IgM-Enriched Human Immunoglobulins Allows Safe Lung Transplantation in Patients with Preformed Donor Specific Antibodies. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.633] [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: 11/17/2022] Open
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21
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Sanz RB, Hitz A, Chichelnitskiy E, Wiegmann B, Blaesing K, Sommer W, Ius F, Kuehne J, Knoefel A, Horn L, Tudorache I, Haverich A, Jonigk D, Greer M, Kapellos T, Bassler K, Schultze J, Warnecke G, Falk C. Donor T and NK Cells with a Special Tissue-Resident Memory Phenotype Migrate into the Periphery of Lung Transplant Recipients - A Potential Feature for Tolerance Development. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Greer M, Ius F, Salman J, Welte T, Fuehner T. Extracorporeal Photopheresis in CLAD: A 15-Year Single Centre Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.266] [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] Open
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23
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Sommer W, Aburahma K, Franz M, Floethmann K, Yablonski P, Avsar M, Tudorache I, Greer M, Haverich A, Welte T, Kuehn C, Salman J, Warnecke G, Ius F. Using Donor Lungs ≥70 Years of Age for Transplantation - Do Long-Term Outcomes Justify the Use? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1622] [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: 11/16/2022] Open
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Greer M, Mueller C, Vagi R, Wolf-Maras R, Klintschar M, Jaeger B, Schwerk N, Fuehner T, Salman J, Hoeper M, Haverich A, Ius F. Out of the Frying-Pan and into the Fire: Transplant Candidate Selection in Acute Lung Failure Due to SARS-CoV-2 Infection. J Heart Lung Transplant 2022. [PMCID: PMC8988482 DOI: 10.1016/j.healun.2022.01.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The COVID-19 pandemic led to unprecedented rates of acute lung failure (ALF), and a rise in lung transplantation (LTx) referrals. Data on LTx in ALF is limited to LTx outcomes, and the unpredictable course of SARS-CoV-2 makes candidate selection challenging. This study summarizes our experiences, in both patients transplanted and those we declined. Methods LTx referrals for ALF due to SARS-CoV-2 between 01Apr20-01Oct21 were reviewed. Set parameters were collected prospectively. Acceptance criteria reflected previous guidance. Cases were discussed at our multi-disciplinary meeting and suitable candidates evaluated at source before transfer for consent and listing. Internal follow-up and external data from declined patients were retrospectively analysed, with survival to discharge and length of hospital stay as end-points. Results 45 patients were referred (78% male). Median age was 55.8 [IQR 47.6-59.8] years. 36 (80%) required both mechanical ventilation and vvECMO, of median duration 46 [31-82] and 34 [24-72] days respectively. Consolidation was the commonest CT finding (47%). Bacterial colonisation (23/45, 51%), coagulopathy (21/45, 47%) and hepatic dysfunction (11/45, 24%) were common. Twenty-two patients were conscious, of whom 21 were evaluated. Five patients died during evaluation, from either sepsis or bleeding. One failed evaluation, and one withdrew consent. Six patients improved, making urgent LTx unnecessary, with 5 attending our review clinic. Of the 8 patients successfully evaluated, one died unexpectantly awaiting transfer, one improved at listing and a further patient died of sepsis after listing. Three patients underwent LTx, all being discharged home at 3 months post-LTx. Conclusion LTx candidate selection in critically ill SARS-CoV2 patients is challenging. Late recovery, particularly in non-fibrotic ALF is not unusual. Decision-making needs to include “acceptable morbidity” as a prelude to delayed evaluation and perhaps listing. More data is needed about declined candidates, particularly unweanable sedated patients with single-organ failure. Even successful awake recipients may experience significant psychological injury, underlining previous arguments in sedated patients. Equity to all candidates needs consideration, given the extraordinary demands on organ availability and care resources.
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Salman J, Aburahma K, Franz M, Schwerk N, Greer M, Falk C, Welte T, Haverich A, Kühn C, Warnecke G, Ius F. Risk Factors for the Development of Early Anti-HLA Donor Specific Antibodies After Lung Transplantation: The Role of Primary Graft Dysfunction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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26
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Seeliger B, Kayser MZ, Drick N, Fuge J, Valtin C, Greer M, Gottlieb J. Graphic narrative based informed consent for bronchoscopy improves satisfaction in patients after lung-transplantation: A randomized controlled trial. Patient Educ Couns 2022; 105:949-955. [PMID: 34417064 DOI: 10.1016/j.pec.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study investigated the effects of supplementing standard informed consent (IC) with a graphic narrative on patient satisfaction, periprocedural anxiety and experience. METHODS Patients due to undergo first conscious surveillance bronchoscopy following lung transplantation were randomized to receive IC with (intervention group) or without (control group) a graphic narrative illustrating the procedure. The primary endpoint was overall patient satisfaction with the IC. Key secondary endpoints were change in state anxiety level, as measured by State Trait Anxiety Inventory, and a questionnaire assessing satisfaction with IC and adverse experience during bronchoscopy (judged by patient and examiners). RESULTS Sixty patients were randomized, and 59 patients were included in the analysis (30 intervention-group; 29 control-group). Overall patient satisfaction was higher in the intervention group 9.5 (25Q-75Q: 8.6-9.8) vs. 8.6 (25Q-75Q: 8.1-9.2), p = 0.028). Change in state anxiety level (before vs after informed consent) was similar between the groups. There were no significant differences in adverse experience during bronchoscopy. CONCLUSION Addition of a graphic narrative illustrating bronchoscopy improved patient satisfaction with IC but did not influence anxiety before and adverse experience during the procedure. PRACTICE IMPLICATIONS Supplementing the IC process with a procedure-specific graphic narrative may be a simple tool to improve patient satisfaction.
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Affiliation(s)
- Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Lung Research Center (DZL), Hannover, Germany.
| | - Moritz Z Kayser
- Department of Respiratory Medicine, Hannover Medical School, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jan Fuge
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Lung Research Center (DZL), Hannover, Germany
| | - Christina Valtin
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Lung Research Center (DZL), Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Lung Research Center (DZL), Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Lung Research Center (DZL), Hannover, Germany
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Flöthmann K, Aburahma K, Franz M, Poyanmehr R, Iablonskii P, Saipbaev A, Greer M, Avsar M, Bobylev D, Schwerk N, Niehaus A, Sommer W, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 11-Year Single-Center Experience Using the Eurotransplant Lung Donor Score. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- K. Flöthmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - K. Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - R. Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - A. Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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Aburahma K, Iablonskii P, Saipbaev A, Niehaus A, Avsar M, Bobylev D, Schwerk N, Sommer W, Greer M, Tudorache I, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Eight-Year Results of an IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Possible Subclinical and Clinical Antibody-Mediated Rejection after Lung Transplantation. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- K. Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - I. Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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Franz M, Iablonskii P, Flöthmann K, Bobylev D, Saipbaev A, Schwerk N, Sommer W, Greer M, Avsar M, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Preformed Donor-Specific Antibodies in Lung Transplantation: Eight-Year Experience with Perioperative Desensitization Using IgA- and IgM-Enriched Human Immunoglobulins. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - K. Flöthmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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Iablonskii P, Carlens J, Mueller C, Aburahma K, Niehaus A, Boethig D, Franz M, Floethmann K, Sommer W, Optenhoefel J, Tudorache I, Greer M, Koeditz H, Jack T, Hansmann G, Kuehn C, Horke A, Hansen G, Haverich A, Warnecke G, Avsar M, Salman J, Bobylev D, Ius F, Schwerk N. Indications and outcome after lung transplantation in children under 12 years of age: A 16-year single center experience. J Heart Lung Transplant 2021; 41:226-236. [PMID: 34836753 DOI: 10.1016/j.healun.2021.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Paediatric lung transplantation poses unique management challenges. Experience regarding indications and outcome is scarce, especially in younger children. The primary aim of this study was to investigate outcome after first lung transplantation in children <12 years of age in comparison to adolescents (12-17 years old). METHODS Records of patients <18 years who underwent first lung transplantation between 01/2005 and 01/2021 were retrospectively reviewed, and compared between children <12 years old and adolescents. Median (IQR) follow-up was 51 (23-91) months. RESULTS Of the 117 patients underwent first lung transplantation at our institution, of whom 42 (35.8%) patients were <12 years and 75 (64.2%) ≥12 years old. Compared to adolescents, children were more often transplanted for interstitial lung disease (33.3% vs 12%, p = 0.005) and precapillary pulmonary hypertension (28.6% vs 12%, p = 0.025), and required more often intraoperative cardiopulmonary bypass (31% vs 14.7%, p = 0.036) and postoperative ECMO support (47.6% vs 13.3%, p < 0.001). Postoperatively, children required longer ventilation times (78 vs 18 hours, p = 0.009) and longer ICU stay (9.5 vs 3 days, p < 0.001) compared to their older counterparts. Primary graft dysfunction grade 3 at 72 hours (9.5% vs 9.3%, p = 0.999), in-hospital mortality (2.4% vs 6.7%, p = 0.418), graft survival (80% vs 62%, p = 0.479) and freedom from chronic lung allograft dysfunction (76% vs 59%, p = 0.41) at 8-year follow-up did not differ between groups. CONCLUSIONS Lung transplantation in children under 12 years is challenging due to underlying medical conditions and operative complexity. Nevertheless, outcomes are comparable to those in older children.
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Affiliation(s)
- Pavel Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Julia Carlens
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Mueller
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Adelheid Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Floethmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Joerg Optenhoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Harald Koeditz
- Department of Pediatric Cardiology and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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Aburahma K, Salman J, Engel B, Vondran FWR, Greer M, Boethig D, Siemeni T, Avsar M, Schwerk N, Müller C, Taubert R, Hoeper MM, Welte T, Wedemeyer HH, Richter N, Warnecke G, Tudorache I, Haverich A, Kuehn C, Grannas G, Ius F. Liver-first strategy for a combined lung and liver transplant in patients with cystic fibrosis. Eur J Cardiothorac Surg 2021; 60:822-830. [PMID: 33956976 DOI: 10.1093/ejcts/ezab164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES A combined lung and liver transplant in patients with cystic fibrosis (CF) is an uncommon procedure. The goal of this study was to compare long-term outcomes between patients with CF who underwent either a combined lung-liver or a lung-only transplant. METHODS This is a retrospective single-centre study of patients with CF who underwent a lung transplant between January 2005 and May 2020. Since 2006, our preference for a combined lung-liver transplant was to transplant the liver first and then the lung. Outcomes were compared using the Kaplan-Meier analysis and the log-rank test. Median follow-up was 53 (23-97) months. RESULTS During the study period, among 357 patients with CF who underwent a lung transplant, 14 (4%) required a lung-liver transplant whereas 343 (96%) had a lung-only transplant. Lung cold ischaemic time was longer in the lung-liver transplant group, but no patient in this group showed primary graft dysfunction at 72 h after the transplant. Prevalence of anti-human leucocyte antigen donor-specific antibodies was 7.1% vs 13.7% in the lung-liver versus the lung-only transplant group (P = 0.42). At 5 years, lung graft survival (78% vs 69%) and freedom from chronic lung allograft dysfunction (79% vs 62%) did not differ between the lung-liver versus the lung-only groups (P = 0.45 and P = 0.55, respectively). Freedom from lung biopsy-confirmed rejection was significantly higher in patients undergoing a lung-liver transplant (91% vs 50%; P = 0.027). CONCLUSIONS A lung-liver transplant did not impair lung graft function. The lower prevalence of donor-specific antibodies and the better freedom from lung biopsy-confirmed rejection suggest tolerogenic effects of the liver graft.
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Affiliation(s)
- Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bastian Engel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Florian W R Vondran
- Department of General, Visceral, and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Hans H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Nicolas Richter
- Department of General, Visceral, and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gerrit Grannas
- Department of General, Visceral, and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Ius F, Salman J, Müller C, Carlens J, Aburahma K, Franz M, Niehaus A, Tudorache I, Sommer W, Greer M, Horke A, Kühn C, Haverich A, Avsar M, Bobylev D, Warnecke G, Schwerk N. Fifteen-Year Single Center Experience with Lung Transplantation in Pediatric Patients Younger Than 12 Years Old. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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33
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Flöthmann K, Salman J, Aburahma K, Siemeni T, Franz M, Greer M, Avsar M, Bobylev D, Müller C, Carlens J, Schwerk N, Niehaus A, Sommer W, Tudorache I, Warnecke G, Kühn C, Haverich A, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 10-year Single-Center Experience Using the Eurotransplant Lung Donor Score. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1903] [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: 11/24/2022] Open
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34
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Salman J, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Sommer W, Greer M, Tudorache I, Falk C, Kühn C, Haverich A, Warnecke G, Ius F. Seven-Year Clinical Results of an IgA-and IgM-Enriched Human Immunoglobulin-Based Therapy for Antibody-Mediated Rejection after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1077] [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: 11/24/2022] Open
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35
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Franz M, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Mueller C, Sommer W, Boethig D, Greer M, Tudorache I, Warnecke G, Hoeper M, Haverich A, Kuehn C, Salman J, Ius F. Influence of Donor-Recipient Age Mismatch in Young Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.927] [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: 11/16/2022] Open
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36
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Draeger H, Salman J, Aburahma K, Becker LS, Siemeni T, Boethig D, Sommer W, Avsar M, Bobylev D, Schwerk N, Müller C, Greer M, Gottlieb J, Welte T, Hoeper MM, Hinrichs JB, Tudorache I, Kühn C, Haverich A, Warnecke G, Ius F. Impact of unilateral diaphragm elevation on postoperative outcomes in bilateral lung transplantation - a retrospective single-center study. Transpl Int 2021; 34:474-487. [PMID: 33393142 DOI: 10.1111/tri.13812] [Citation(s) in RCA: 7] [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: 10/25/2020] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
This study evaluated the impact of unilateral diaphragm elevation following bilateral lung transplantation on postoperative course. Patient data for all lung transplantations performed at our institution between 01/2010 and 12/2019 were reviewed. Presence of right or left diaphragm elevation was retrospectively evaluated using serial chest X-rays performed while patients were standing and breathing spontaneously. Right elevation was defined by a > 40 mm difference between right and left diaphragmatic height. Left elevation was present if the left diaphragm was at the same height or higher than the right diaphragm. In total, 1093/1213 (90%) lung transplant recipients were included. Of these, 255 (23%) patients exhibited radiologic evidence of diaphragm elevation (right, 55%; left 45%; permanent, 62%). Postoperative course did not differ between groups. Forced expiratory volume in 1 second, forced vital capacity and total lung capacity were lower at 1-year follow-up in patients with permanent than in patients with transient or absent diaphragmatic elevation (P = 0.038, P < 0.001, P = 0.002, respectively). Graft survival did not differ between these groups (P = 0.597). Radiologic evidence of diaphragm elevation was found in 23% of our lung transplant recipients. While lung function tests were worse in patients with permanent elevation, diaphragm elevation did not have any relevant impact on outcomes.
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Affiliation(s)
- Helge Draeger
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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37
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Franz M, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Müller C, Sommer W, Boethig D, Greer M, Tudorache I, Warnecke G, Hoeper M, Haverich A, Salman J, Ius F. Influence of Donor-Recipient Age Mismatch in Young Lung Transplant Recipients. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Salman J, Aburahma K, Siemeni T, Kühn C, Avsar M, Bobylev D, Franz M, Schwerk N, Niehaus A, Sommer W, Greer M, Tudorache I, Warnecke G, Haverich A, Ius F. Seven-Year Clinical Results of AN IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Antibody-Mediated Rejection in Lung Transplantation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Franz M, Aburahma K, Siemeni T, Avsar M, Bobylev D, Schwerk N, Müller C, Sommer W, Greer M, Tudorache I, Warnecke G, Hoeper M, Haverich A, Ius F, Salman J. 10-Year Experience with Postoperatively Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Hypertension. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Kayser MZ, Valtin C, Greer M, Karow B, Fuge J, Gottlieb J. Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients. Telemed J E Health 2020; 27:807-815. [PMID: 33054671 DOI: 10.1089/tmj.2020.0170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. This is due to both to the reallocation of resources toward COVID-19 patients as well as concern for the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant (LTx) recipients. Introduction: New methods such as telemedicine are needed to bridge the gap in follow-up care caused by the pandemic. Materials and Methods: A retrospective analysis of video consultations (VCs) in comparison with on-site visits (OSVs) was performed during a 6-week period in an LTx center in Germany. VC included a structured work-up questionnaire and vital sign documentation. Results: During the 6-week study period, 75 VCs were performed for 53 patients and 75 OSVs by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred through VC. Physician-patient consultations were reduced by 47% compared with the equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. Discussion: Implementation of VC helped to reduce the need for OSV and thus the risk of SARS-CoV-2 exposure in our patient cohort. This technology can be adopted to provide care for a wide range of chronic illnesses. Conclusions: VC can preserve access to specialist care while reducing SARS-CoV-2 exposure for patients with chronic illnesses during the pandemic.
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Affiliation(s)
- Moritz Z Kayser
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Bernd Karow
- Department for Hospital Innovation and Quality Management, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
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41
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Meyer BC, Hinrichs JB, Ivanyi P, Ehrlich S, Greer M, Hoeper MM, Busch M. Extracorporeal portosystemic shunt in secondary Budd-Chiari syndrome. J Hepatol 2020; 73:974-976. [PMID: 32684366 DOI: 10.1016/j.jhep.2020.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Philipp Ivanyi
- Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Steve Ehrlich
- Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover and German Centre of Lung Research (DZL), Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover and German Centre of Lung Research (DZL), Germany
| | - Markus Busch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
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42
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Greer M, Welte T. Chronic Obstructive Pulmonary Disease and Lung Transplantation. Semin Respir Crit Care Med 2020; 41:862-873. [PMID: 32726838 DOI: 10.1055/s-0040-1714250] [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: 10/23/2022]
Abstract
Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection-currently referred to as chronic lung allograft dysfunction-represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.
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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
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43
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Hitz A, BellmàsSanz R, Ius F, Kühne J, Wiegmann B, Sommer W, Salman J, Siemeni T, Greer M, Kühn C, Avsar M, Haverich A, Warnecke G, Falk C. Lung Transplant Recipients Developing Early DSA within the First Month are Characterized by a Higher Frequency of Naïve and a Lower Frequency of Memory B Cells. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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44
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Ius F, Draeger H, Sommer W, Siemeni T, Kühn C, Avsar M, Bobylev D, Schwerk N, Greer M, Haverich A, Tudorache I, Warnecke G. Impact of Diaphragmatic Dysfunction on Postoperative Course after Bilateral Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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45
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Abstract
Acute cellular rejection (ACR) is a common complication following lung transplantation (LTx), affecting almost a third of recipients in the first year. Established, comprehensive diagnostic criteria exist but they necessitate allograft biopsies which in turn increases clinical risk and can pose certain logistical and economic problems in service delivery. Undermining these challenges further, are known problems with inter-observer interpretation of biopsies and uncertainty as to the long-term implications of milder or indeed asymptomatic episodes. Increased risk of chronic lung allograft dysfunction (CLAD) has long been considered the most significant consequence of ACR. Consensus is lacking as to whether this applies to mild ACR, with contradictory evidence available. Given these issues, research into alternative, minimal or non-invasive biomarkers represents the main focus of research in ACR. A number of potential markers have been proposed, but none to date have demonstrated adequate sensitivity and specificity to allow translation from bench to bedside.
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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | | | - Danny Jonigk
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany.,Institute for Pathology, Hannover Medical School, Hannover, Germany
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46
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Kellar A, Carmen N, Greer M, Walters T, Griffiths A, Church P. A228 EVOLUTION OF MRE FINDINGS IN PAEDIATRIC PATIENTS WITH SMALL BOWEL CROHN’S DISEASE ON MAINTENANCE METHOTREXATE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.227] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Observational data in children and RCT data in adults indicate that methotrexate (MTX) is associated with induction and maintenance of clinical remission in luminal Crohn’s disease, but efficacy in achieving intestinal healing has not been examined.
Aims
To examine the evolution of MRE signs of inflammation in children treated with MTX.
Methods
In this retrospective cohort study, we reviewed paediatric CD patients on maintenance MTX monotherapy for >4 months who underwent serial MREs between July 2010 and October 2015. MREs were reviewed by a radiologist blind to clinical data. Overall inflammatory activity on each MRE was scored as minimal, mild, moderate or severe, informed by the presence of bowel wall thickness, wall enhancement, T2 hyperintensity, comb sign, mesenteric edema, penetrating disease, stricturing, diffusion restriction and motility. The radiologist’s global assessment of change from MRE 1 to MRE 2 was scored as improved, unchanged or worsened. Clinical findings, disease activity (assessed by weighted paediatric CD activity index [wPCDAI]) and surgical history were also extracted from medical records by a clinician blind to MRE results.
Results
Thirty-five patients were included (median age at diagnosis 12 [IQR 11–14] years; 77% male; 60% inflammatory (B1), 17% stricturing (B2), 23% penetrating (B3) disease). Between baseline and follow-up MRE, wPCDAI (median 15 [IQR 7–43] decreased to 8 [IQR 0–18]; p=0.006) and CRP (median 9 [IQR 2–36] decreased to 5 [IQR 5–9]; p=0.013) and 74% (N=26) were in clinical remission (wPCDAI < 12.5) at MRE 2. MRE features that significantly improved from MRE 1 to 2 were comb sign from 63% (N=37) to 38% (N=14) (p=0.02) and penetrating disease from 14% (N=8) to 0 (p=0.03). After a median of 17 months (IQR 13–23), 51% (N=18) of patients improved, 29% (N=10) worsened and 20% (N=7) had no change based on the radiologist’s global assessment. Of the 21 patients with moderate/severe disease at MRE 1, 33% (N=7) had minimal/mild disease by MRE 2. 66% (N=14/21) continued to have moderate/severe disease at MRE 2. Additionally, a further 14% (N=2/14) of those with minimal/mild disease at baseline MRE progressed to moderate/severe disease at MRE 2. Complete details of change between MRE 1 and MRE 2 are displayed in Figure 1.
Conclusions
Despite signs of clinical improvement, many paediatric CD patients on maintenance MTX therapy for >4 months have unchanged or worsened MRE findings. This underscores the need for follow-up imaging in these cases.
Funding Agencies
None
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Affiliation(s)
- A Kellar
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - N Carmen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - M Greer
- Department of Diagnostic Imaging, SickKids Hospital; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - T Walters
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, SickKids Inflammatory Bowel Disease Centre, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - A Griffiths
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, SickKids Inflammatory Bowel Disease Centre, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - P Church
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, SickKids Inflammatory Bowel Disease Centre, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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47
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Moher Alsady T, Voskrebenzev A, Greer M, Becker L, Kaireit TF, Welte T, Wacker F, Gottlieb J, Vogel-Claussen J. MRI-derived regional flow-volume loop parameters detect early-stage chronic lung allograft dysfunction. J Magn Reson Imaging 2019; 50:1873-1882. [PMID: 31134705 DOI: 10.1002/jmri.26799] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 02/20/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) is a major cause for the low long-term survival rates after lung transplantation (LTx). Early detection of CLAD may enable providing medical treatment before a nonreversible graft dysfunction has occurred. MRI is advantageous to pulmonary function testing (PFT) in the ability to assess regional function changes, and thus have the potential in detecting very early stages of CLAD before changes in global forced expiratory volume during the first second (FEV1%) occur. PURPOSE To examine whether early stages of CLAD (diagnosed based on PFT values) could also be detected using MRI-derived parameters of regional flow-volume dynamics. STUDY TYPE Retrospective. POPULATION 62 lung transplantation recipients were included in the study, 29 of which had been diagnosed with CLAD at various stages. FIELD STRENGTH/SEQUENCE MRI datasets were acquired with a 1.5T Siemens scanner using a spoiled gradient echo sequence. ASSESSMENT MRI datasets were retrospectively preprocessed and analyzed by a blinded radiologist according to the phase resolved functional lung MRI (PREFUL-MRI) approach, resulting in fractional ventilation (FV) maps and regional flow-volume loops (rFVL). FV- and rFVL-based parameters of regional lung ventilation were estimated. STATISTICAL TESTS Differences between groups were compared by Mann-Whitney U-test with a Bonferroni correction for multiple comparisons (n = 2). RESULTS rFVL-CC-based parameters discriminated significantly between the presence or absence of CLAD (P < 0.003). DATA CONCLUSION Using the contrast media-free PREFUL-MRI technique, parameters of ventilation dynamics and its regional heterogeneity were shown to be sensitive for the detection of early CLAD stages. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2019;50:1873-1882.
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Affiliation(s)
- Tawfik Moher Alsady
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany
| | - Mark Greer
- German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany.,Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Lena Becker
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany
| | - Till F Kaireit
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany
| | - Tobias Welte
- German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany.,Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany
| | - Jens Gottlieb
- German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany.,Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hanover, Germany
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48
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Yang J, Al-Hashmi G, Walsh CM, Putra J, Siddiqui I, Castro D, Greer M. A82 CORRELATION OF MRE INTERPRETATION USING CONSENSUS RECOMMENDATIONS WITH VIDEO CAPSULE ENDOSCOPY IN PEDIATRIC IBD. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.081] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Yang
- SickKids Hospital, Toronto, ON, Canada
| | | | - C M Walsh
- SickKids Hospital, Toronto, ON, Canada
| | - J Putra
- SickKids Hospital, Toronto, ON, Canada
| | | | - D Castro
- SickKids Hospital, Toronto, ON, Canada
| | - M Greer
- SickKids Hospital, Toronto, ON, Canada
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49
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Sommer W, Kirschner H, Ius F, Salman J, Siemeni T, Bobylev D, Avsar M, Kuehn C, Greer M, Gottlieb J, Rahmel A, Welte T, Haverich A, Tudorache I, Warnecke G. Transplantation of donor lungs with pulmonary embolism - a retrospective study. Transpl Int 2019; 32:658-667. [PMID: 30712278 DOI: 10.1111/tri.13407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/29/2018] [Accepted: 01/29/2019] [Indexed: 12/01/2022]
Abstract
Lung transplantation from donors with fulminant pulmonary arterial embolism as a cause of death remains controversial. An analysis was performed comparing preoperative characteristics and outcomes of 25 donors with a primary diagnosis of pulmonary arterial embolism to 1085 recipients of donor lungs without pulmonary arterial embolism. No early functional impairment of donor lungs with pulmonary embolism was detectable as depicted by the incidence of primary graft dysfunction immediately after surgery (P = 0.66), 24 (P = 0.79), 48 (P = 0.99) and 72 h (P = 0.99) after transplantation. Pulmonary function testing at 1 year (P = 0.003) and at last outpatient control (P < 0.05) showed superior results in the cohort receiving lungs from donors with pulmonary embolism. Incidence of chronic lung allograft dysfunction (CLAD) showed no difference within the first year after lung transplantation, however, 5 year-CLAD free survival was superior in recipients (70.4% vs. 55.1%, P = 0.006) of donor lungs with pulmonary embolism. Overall survival was similar in both groups. Lungs from donors with fulminant pulmonary embolism prior to brain death can safely be used for lung transplantation without impairing postoperative outcomes. Lung function testing shows favorable midterm results in recipients of donor lungs with pulmonary embolism.
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Affiliation(s)
- Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, BREATH, Gießen, Germany
| | - Helmut Kirschner
- Deutsche Stiftung Organtransplantation (DSO), Frankfurt am Main, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Member of the German Centre for Lung Research, BREATH, Gießen, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Rahmel
- Deutsche Stiftung Organtransplantation (DSO), Frankfurt am Main, Germany
| | - Tobias Welte
- Member of the German Centre for Lung Research, BREATH, Gießen, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, BREATH, Gießen, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, BREATH, Gießen, Germany
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Seeliger B, Drick N, Avsar M, Tudorache I, Welte T, Gottlieb J, Greer M. Risk factors and outcomes of vocal cord paralysis after lung transplantation - a retrospective cohort study. Transpl Int 2019; 32:626-634. [PMID: 30663812 DOI: 10.1111/tri.13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/18/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022]
Abstract
Vocal cord paralysis (VCP) may complicate thoracic surgery and is associated with increased morbidity and mortality. Among lung transplant (LTx) recipients, chronic pulmonary aspiration can contribute to chronic allograft dysfunction (CLAD). We herein assessed the unknown incidence and clinical impact of VCP in a large LTx cohort. All first-time bilateral LTx recipients, transplanted between January 2010 and June 2015 were included in a single-centre retrospective analysis. Bronchoscopy reports were assessed for VCP. Patients exhibiting VCP were compared to propensity score-matched negative controls regarding CLAD onset and graft survival and secondary end-points, including inpatient duration and complications; lower respiratory tract infections (LRTI) within 24 months. In total, 583/713 (82%) patients were included in the analysis. A total of 52 (8.9%) exhibited VCP, which was transient in 34/52 patients (65%), recovering after median 6 months (IQR 2-12). Compared to 268 controls, 3-year graft survival and CLAD-free survival were non-inferior in VCP [HR 0.74 (95% CI 0.35-1.57), and HR 0.74 (95% CI 0.39-1.41)] respectively. Duration of hospitalization was similar and no differences in LRTI rates or airway complications were observed. Lower pre-Tx BMI increased risk for VCP [HR 0.88 (95% CI 0.79-0.99)]. Overall, VCP did not adversely affect graft and CLAD-free survival and secondary outcomes including LRTIs and hospitalizations.
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Affiliation(s)
- Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Igor Tudorache
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
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