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Kirov H, Caldonazo T, Mukharyamov M, Toshmatov S, Fischer J, Schneider U, Siemeni T, Doenst T. Cardiac Surgery 2023 Reviewed. Thorac Cardiovasc Surg 2024. [PMID: 38740368 DOI: 10.1055/s-0044-1786758] [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: 05/16/2024]
Abstract
We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term "cardiac surgery AND 2023." We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiac Surgery, Saarland University Medical Center, Homburg Saar, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
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Doenst T, Schneider U, Caldonazo T, Toshmatov S, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2022 Reviewed. Thorac Cardiovasc Surg 2023; 71:356-365. [PMID: 37196662 DOI: 10.1055/s-0043-57228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
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von Samson P, Sandhaus T, Faerber G, Kirov H, Siemeni T, Doenst T. Serial Assessment of Bronchial Anastomoses by Endobronchial Ultrasonography for Follow-Up in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1285] [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, 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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Doenst T, Schneider U, Can T, Caldonazo T, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2021 Reviewed. Thorac Cardiovasc Surg 2022; 70:278-288. [PMID: 35537447 DOI: 10.1055/s-0042-1744264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PubMed displayed more than 35,000 hits for the search term "cardiac surgery AND 2021." We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term "myocardial revascularization" is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tolga Can
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
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Knöfel AK, Siemeni T, Madrahimov N, Sommer W, Salman J, Avsar M, Kühn C, Tudorache I, Haverich A, Falk C, Warnecke G, Ius F. Primary Graft Dysfunction following Lung Transplantation Is Associated with Increased In Vivo T-Cell Alloreactivity. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742874] [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)
| | - T. Siemeni
- Klinik für Herz- und Thoraxchirurgie am Universitätsklinikum Jena, Jena, Deutschland
| | - N. Madrahimov
- Department of Thoracic and Cardiovascular Surgery, University Clinic Würzburg, Würzburg, Deutschland
| | - W. Sommer
- Heidelberg University, Heidelberg, Deutschland
| | - J. Salman
- Herz-, thorax-, transplantations-, gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M. Avsar
- Herz-, thorax-, transplantations-, gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C. Kühn
- Saldernstraße 14, Hannover, Deutschland
| | - I. Tudorache
- Heinrich-Heine-University, Department of Cardiac Surgery, Duesseldorf, Deutschland
| | - A. Haverich
- Carl-Neuberg-Straße 1, Hannover, Deutschland
| | - C. Falk
- Institute of transplant immunology, Hannover Medical School, Hannover, Deutschland
| | - G. Warnecke
- Heidelberg University, Heidelberg, Deutschland
| | - F. Ius
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Göttingen, Deutschland
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Hitz AM, Bläsing KA, Wiegmann B, Bellmàs-Sanz R, Chichelnitskiy E, Wandrer F, Horn LM, Neudörfl C, Keil J, Beushausen K, Ius F, Sommer W, Avsar M, Kühn C, Tudorache I, Salman J, Siemeni T, Haverich A, Warnecke G, Falk CS, Kühne JF. Donor NK and T Cells in the Periphery of Lung Transplant Recipients Contain High Frequencies of Killer Cell Immunoglobulin-Like Receptor-Positive Subsets. Front Immunol 2021; 12:778885. [PMID: 34966390 PMCID: PMC8710687 DOI: 10.3389/fimmu.2021.778885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/04/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction For end-stage lung diseases, double lung transplantation (DLTx) is the ultimate curative treatment option. However, acute and chronic rejection and chronic dysfunction are major limitations in thoracic transplantation medicine. Thus, a better understanding of the contribution of immune responses early after DLTx is urgently needed. Passenger cells, derived from donor lungs and migrating into the recipient periphery, are comprised primarily by NK and T cells. Here, we aimed at characterizing the expression of killer cell immunoglobulin-like receptors (KIR) on donor and recipient NK and T cells in recipient blood after DLTx. Furthermore, we investigated the functional status and capacity of donor vs. recipient NK cells. Methods Peripheral blood samples of 51 DLTx recipients were analyzed pre Tx and at T0, T24 and 3wk post Tx for the presence of HLA-mismatched donor NK and T cells, their KIR repertoire as well as activation status using flow cytometry. Results Within the first 3 weeks after DLTx, donor NK and T cells were detected in all patients with a peak at T0. An increase of the KIR2DL/S1-positive subset was found within the donor NK cell repertoire. Moreover, donor NK cells showed significantly higher frequencies of KIR2DL/S1-positive cells (p<0.01) 3wk post DLTx compared to recipient NK cells. This effect was also observed in donor KIR+ T cells 3wk after DLTx with higher proportions of KIR2DL/S1 (p<0.05) and KIR3DL/S1 (p<0.01) positive T cells. Higher activation levels of donor NK and T cells (p<0.001) were detected compared to recipient cells via CD25 expression as well as a higher degranulation capacity upon activation by K562 target cells. Conclusion Higher frequencies of donor NK and T cells expressing KIR compared to recipient NK and T cells argue for their origin in the lung as a part of a highly specialized immunocompetent compartment. Despite KIR expression, higher activation levels of donor NK and T cells in the periphery of recipients suggest their pre-activation during the ex situ phase. Taken together, donor NK and T cells are likely to have a regulatory effect in the balance between tolerance and rejection and, hence, graft survival after DLTx.
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Affiliation(s)
- Anna-Maria Hitz
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Kim-Alina Bläsing
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Bettina Wiegmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, DZL, BREATH Site, Hannover, Germany
| | - Ramon Bellmàs-Sanz
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | | | - Franziska Wandrer
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Horn
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Christine Neudörfl
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Jana Keil
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Kerstin Beushausen
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christine S Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, DZL, BREATH Site, Hannover, Germany.,German Center for Infection Research, DZIF, TTU-IICH, Hannover-Braunschweig, Germany
| | - Jenny F Kühne
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
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Siemeni T, Färber G, Doenst T. Treatment effects of coronary bypass surgery-the math and the myths of the ejection fraction. Eur J Cardiothorac Surg 2021; 60:697-698. [PMID: 33969414 DOI: 10.1093/ejcts/ezab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
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9
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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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Christoph S, Hitz A, Bellmas-Sanz R, Kühne J, Ruhl L, Wiegmann B, Sommer W, Salman J, Siemeni T, Kühn C, Haverich A, Warnecke G, Falk C. The Ratio between Naïve and Memory B Cells is Associated with Development of Early Donor-Specific Antibodies within the First Month after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.456] [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: 11/28/2022] Open
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11
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Knoefel A, Siemeni T, Ius F, Avsar M, Hacker K, Salman J, Haverich A, Falk C, Warnecke G. Regulatory T Cells and the Effect of Ex Vivo Preservation on the Development of Transplant Arteriosclerosis in a Humanized Mouse Model. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.970] [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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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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13
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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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14
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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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15
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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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16
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Knöfel AK, Siemeni T, Ius F, Madrahimov N, Sommer W, Avsar M, Salman J, Haverich A, Falk C, Warnecke G. The Effect of Ex Vivo Preservation and Regulatory T Cells on the Development of Transplant Arteriosclerosis in a Humanized Mouse Model. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725620] [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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17
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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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18
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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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19
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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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20
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Hacker KS, Jansson K, Pichler J, Salman J, Avsar M, Siemeni T, Knöfel AK, Höffler K, Gottlieb J, Frühauf J, Werner M, Poyanmehr R, Jonigk D, Balzer MS, Hewicker-Trautwein M, Haverich A, Sommer W, Warnecke G. Delayed non-myeloablative irradiation to induce long-term allograft acceptance in a large animal lung transplantation model. Transpl Immunol 2020; 65:101350. [PMID: 33127498 DOI: 10.1016/j.trim.2020.101350] [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: 04/17/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
We previously induced long-term allograft acceptance in an allogeneic lung transplantation (LTx) model in miniature swine using perioperative non-myeloablative irradiation (IRR) combined with infusion of donor specific alloantigen. In order to improve clinical applicability, we delayed induction with irradiation in this study. Left sided single LTx was performed in minipigs. Group 1 received non-myeloablative irradiation (7Gy thymus and 1.5Gy whole body IRR) before LTx and a perioperative donor specific splenocyte infusion (SpTx). Group 2 received perioperative SpTx but delayed IRR three days after LTx. Group 3 was exposed to delayed IRR without SpTx. Whereas 4 out of 7 animals from the non-delayed group never rejected their grafts and were electively sacrificed on postoperative day (POD) +500, all animals from group 2 rejected their grafts before POD 108. In group 3, 3 out of 8 animals developed long-term allograft acceptance. In all groups, donor leukocyte chimerism peaked up to 20% in peripheral blood one hour after reperfusion of the lung. Group 1 maintained prolonged chimerism beyond POD 7, whereas chimerism levels in groups 2 and 3 decreased continuously thereafter. Delayed irradiation has the potential to improve long-term graft survival, yet not as efficient as a perioperative conditioning protocol.
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Affiliation(s)
- Karolin S Hacker
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Katharina Jansson
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jeanette Pichler
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jawad Salman
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Murat Avsar
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Thierry Siemeni
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ann-Kathrin Knöfel
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Klaus Höffler
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jens Gottlieb
- German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jörg Frühauf
- Department of Radiation Therapy and Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Werner
- Department of Radiation Therapy and Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Reza Poyanmehr
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Danny Jonigk
- Institute for Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Michael S Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Marion Hewicker-Trautwein
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559 Hannover, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Wiebke Sommer
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Gregor Warnecke
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Salman J, Bernhard BA, Ius F, Poyanmehr R, Sommer W, Aburahma K, Alhadidi H, Siemeni T, Kuehn C, Avsar M, Haverich A, Warnecke G, Tudorache I. Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis. Ann Thorac Surg 2020; 111:1316-1324. [PMID: 32890486 DOI: 10.1016/j.athoracsur.2020.06.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/10/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Venous-arterial extracorporeal membrane oxygenation (ECMO) is an established technique for intraoperative cardiopulmonary support in patients undergoing lung transplantation. Patients with pulmonary fibrosis have a higher risk to require it. The aim of this study was to identify risk factors for the need of intraoperative ECMO use. METHODS Records of patients undergoing lung transplantation for pulmonary fibrosis at our institution between January 2010 and May 2018 were retrospectively reviewed. Univariate logistic regression analysis was used for statistical identification of risk factors. RESULTS There were 105 patients (34%) who required intraoperative ECMO support (ECMO+ group), and 203 (66%) did not (ECMO- group). Preoperative proof of pulmonary hypertension was identified as a risk factor for intraoperative ECMO support (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2-6.5; P < .01). Revealed mean pulmonary arterial pressure values exceeding 50 mm Hg and pulmonary vascular resistance values exceeding 9.4 Wood units were identified as risk factors for the need of intraoperative ECMO use with a prediction probability of 70%. Increased recipient body surface area (OR, 0.2; 95% CI, 0.1-0.5; P < .01) emerged as a protective factor against intraoperative ECMO (Hosmer-Lemeshow statistic, P = .71) as well as higher cardiac output (OR, 0.7; 95% CI, 0.6-0.9; P < .01). The postoperative course was more complicated in the ECMO+ group, whereas survival at 5 years did not differ among groups (70% vs 69%, P = .79). CONCLUSIONS Pulmonary hypertension with elevated pulmonary vascular resistance values predicts the need of intraoperative ECMO in patients receiving lung transplantation for pulmonary fibrosis. Although the postoperative course was more complicated in the ECMO+ group, long-term survival did not differ significantly.
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Affiliation(s)
- Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Beeke-Alina Bernhard
- 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
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research (DZL/BREATH), Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hani Alhadidi
- Division of Thoracic Surgery, King Hussein Medical Center, Amman, Jordan
| | - Thierry Siemeni
- 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
| | - Murat Avsar
- 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
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research (DZL/BREATH), Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research (DZL/BREATH), Hannover, Germany
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Ius F, Salman J, Knoefel A, Nakagiri T, Sommer W, Siemeni T, Kühn C, Avsar M, Falk C, Haverich A, Tudorache I, Warnecke G. Increased Frequency of Regulatory CD127low T Cells Early after Lung Transplant is Associated with Improved Graft Survival: 10-Year Single-Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1248] [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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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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24
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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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Siemeni T, Knoefel A, Ius F, Salman J, Sommer W, Avsar M, Kuehn C, Maus U, Falk C, Tudorache I, Haverich A, Warnecke G. Correlation of CLAD in Lung Transplant Recipients with Transplant Arteriosclerosis in Humanized Mice: A 5-years Follow Up Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.807] [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: 11/29/2022] Open
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Ius F, Sommer W, Salman J, Siemeni T, Kühn C, Avsar M, Schwerk N, Müller C, Falk C, Haverich A, Tudorache I, Warnecke G. Six-Year Results of an IgA- and IgM-Enriched Immunoglobulin-Based Therapy for Early Detectable Anti-HLA Donor Specific Antibodies in Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ius F, Salman J, Sommer W, Poyanmehr R, Avsar M, Siemeni T, Bobylev D, Schwerk N, Müller C, Haverich A, Kühn C, Warnecke G, Tudorache I. Extracorporeal Membrane Oxygenation during Lung Transplantation and Long-Term Graft Function: Results from a 9-Year Single-Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.961] [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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Salman J, Ius F, Sommer W, Siemeni T, Fleissner F, Alhadidi H, Kugler C, Avsar M, Haverich A, Warnecke G, Tudorache I, Kuhn C. Long-Term Results of Bilateral Lung Transplantation in Patients With End-Stage Pulmonary Lymphangioleiomyomatosis. Prog Transplant 2020; 29:115-121. [PMID: 31084354 DOI: 10.1177/1526924819835815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/17/2022]
Abstract
INTRODUCTION Lymphangioleiomyomatosis (LAM) is a rare disease in women, leading to progressive deterioration of lung function and respiratory failure. We describe the outcome of patients with end-stage LAM who underwent lung transplantation at our center. MATERIALS AND METHODS The records of patients with LAM transplanted at our institution between February 1997 and May 2015 were reviewed retrospectively. Morbidity and mortality were analyzed, and actuarial survival was calculated using Kaplan-Meier methods. The cumulative survival of transplant patients with LAM at our center was compared with survival after transplantation due to different diseases at our center and the results of the International Society for Heart and Lung Transplantation. Quality of life was assessed by a patient self-report at the end of the first postoperative year. RESULTS During the study period, 25 patients underwent lung transplantation for LAM. All patients were women with a mean age of 50 (9) years. Thirteen patients (52%) had undergone previous thoracotomy. All patients (100%) received bilateral lung transplantation. One (4%) case of in-hospital mortality occurred and 9 (36%) late deaths. Two (8%) cases of late death were due to chronic lung allograft dysfunction. The 1-, 3-, and 5-year survival rates were 92%, 84%, and 76%, respectively. Quality-of-life ratings were above the normal in all eight 36-Item Short Form Health Survey subscales 1 year after transplantation. CONCLUSIONS Lung transplantation offers a valuable therapy for patients with end-stage pulmonary LAM.
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Affiliation(s)
- Jawad Salman
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,2 German Centre for Lung Research, Hannover, Germany
| | - Fabio Ius
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,2 German Centre for Lung Research, Hannover, Germany
| | - Thierry Siemeni
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hani Alhadidi
- 3 Department of Thoracic Surgery, King Hussein Medical Center, Amman, Jordan
| | - Christiane Kugler
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,2 German Centre for Lung Research, Hannover, Germany
| | - Igor Tudorache
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuhn
- 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,2 German Centre for Lung Research, Hannover, Germany
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Ius F, Müller C, Sommer W, Verboom M, Hallensleben M, Salman J, Siemeni T, Kühn C, Avsar M, Bobylev D, Poyanmehr R, Erdfelder C, Böthig D, Carlens J, Bayir L, Hansen G, Blasczyk R, Falk C, Tecklenburg A, Haverich A, Tudorache I, Schwerk N, Warnecke G. Six-year experience with treatment of early donor-specific anti-HLA antibodies in pediatric lung transplantation using a human immunoglobulin-based protocol. Pediatr Pulmonol 2020; 55:754-764. [PMID: 31909902 DOI: 10.1002/ppul.24639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/31/2019] [Accepted: 12/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Experience with the treatment of early donor-specific anti-HLA antibodies (eDSA) after lung transplantation in children is very limited. At our institution, we have treated patients with eDSA since 2013 with successive infusions of intravenous human immunoglobulins (IVIG), combined in some cases with a single dose of Rituximab and plasmapheresis (therapeutic plasma exchange [tPE]) or immunoabsorption. The aim of this study was to present the 6-year results of IVIG-based therapy in pediatric lung recipients. METHODS Records of pediatric (<18 years old) patients transplanted at our institution between 01/2013 and 03/2019 were reviewed. Outcomes were compared between patients with eDSA treated with IVIG (IVIG group) and without eDSA (control group). Median (interquartile range [IQR]) follow-up amounted to 28 (12-52) months. RESULTS During the study period, 66 lung-transplanted pediatric patients were included, of which 27 (41%) formed the IVIG group and 38 (57%) the control group. Among the IVIG patients, 14 (52%) patients showed concomitant graft dysfunction (possible clinical antibody-mediated rejection). The median time to eDSA detection was 24 (14-63) days after transplantation. eDSA were cleared in 25 (96%) of the 26 patients which completed treatment. At 3 years, graft survival (%) was 73 vs 85 (P = .65); freedom (%) from chronic lung allograft rejection (CLAD) was 89 vs 78 (P = .82); and from infection 47 vs 31 (P = .15), in IVIG vs control patients, respectively. CONCLUSIONS After lung transplantation, an IVIG-based treatment for eDSA yielded high eDSA clearance. IVIG and control patients showed similar CLAD-free and graft survival.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Murielle Verboom
- Institute of Transfusion Medicine, 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
| | - Christian Kühn
- 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
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Böthig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Lale Bayir
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- German Center for Lung Research (DZL/BREATH), Hannover, Germany.,Institute of Transplant Immunology, Hannover Medical School, 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
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Gregor Warnecke
- 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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Ius F, Salman J, Knoefel AK, Sommer W, Nakagiri T, Verboom M, Siemeni T, Poyanmehr R, Bobylev D, Kuehn C, Avsar M, Erdfelder C, Hallensleben M, Boethig D, Hecker H, Schwerk N, Mueller C, Welte T, Falk C, Preissler G, Haverich A, Tudorache I, Warnecke G. Increased frequency of CD4 + CD25 high CD127 low T cells early after lung transplant is associated with improved graft survival - a retrospective study. Transpl Int 2020; 33:503-516. [PMID: 31903646 DOI: 10.1111/tri.13568] [Citation(s) in RCA: 12] [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: 02/06/2019] [Revised: 05/04/2019] [Accepted: 12/20/2019] [Indexed: 12/30/2022]
Abstract
In this retrospective study, we analyzed the presence of any association of three CD4+ CD25high regulatory T-cell subpopulations at 3 weeks after lung transplantation with the later incidence of chronic lung allograft dysfunction and graft survival. Among lung-transplanted patients between January 2009 and April 2018, only patients with sufficient T-cell measurements at 3 weeks after transplantation were included into the study. Putative regulatory T cells were defined as CD4+ CD25high T cells, detected in peripheral blood and further analyzed for CD127low , FoxP3+ , and CD152+ using fluorescence-activated cell sorting (FACS) analysis. Associations of regulatory T cells with chronic lung allograft dysfunction (CLAD) and graft survival were evaluated using Cox analysis. During the study period, 724 (71%) patients were included into the study. Freedom from chronic lung allograft dysfunction (CLAD) and graft survival amounted to 66% and 68% at 5 years. At the multivariable analysis, increasing frequencies of CD127low were associated with better freedom from CLAD (hazard ratio for each 1% increase of %CD127low , HR = 0.989, 95% CI = 0.981-0.996, P = 0.003) and better graft survival (HR = 0.991, 95% CI = 0.984-0.999, P = 0.026). A higher frequency of CD127low regulatory T cells in peripheral blood early after lung transplantation estimated a protective effect against chronic lung allograft dysfunction, mortality, and re-transplantation.
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Affiliation(s)
- 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
| | - Ann-Kathrin Knoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Tomoyuki Nakagiri
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murielle Verboom
- Department of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- 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
| | - Christian Kuehn
- 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
| | - Caroline Erdfelder
- 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
| | - Hartmut Hecker
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- 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
| | - Tobias Welte
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Gerhard Preissler
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Surgery, Munich Lung Transplant Group, Ludwig-Maximilian's University, Munich, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, 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.,German Center for Lung Research (DZL), Hannover, Germany
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Ius F, Sommer W, Salman J, Siemeni T, Kühn C, Avsar M, Schwerk N, Haverich A, Tudorache I, Warnecke G. Six-Year Clinical Results of an IgA-and IgM-Enriched Human Immunoglobulin-Based Therapy for Early Anti-HLA Donor Specific Antibodies after Lung Transplantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705377] [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: 10/24/2022]
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Madrahimov N, Natanov R, Khalikov A, Boyle EC, Jonigk D, Knoefel AK, Siemeni T, Haverich A. Warming and cooling device using thermoelectric Peltier elements tested on male mice. Lab Anim 2019; 54:23677219873687. [PMID: 31554461 DOI: 10.1177/0023677219873687] [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] [Indexed: 11/16/2022]
Abstract
Hypothermia is a treatment strategy for different clinical conditions and an essential part of cardiopulmonary bypass in complex cardiac procedures. Clinically, cooling patients is achieved via a mattress and heat exchanger integrated into a membrane oxygenator connected to a waterbed using a refrigerator system based on volatile and toxic liquids. Peltier elements are known as environmentally friendly thermoelectric generators that enable rapid warming and cooling. In this paper, we describe the construction of a novel device for rapid and precise control of mouse warming and cooling using thermoelectric Peltier elements. Six male BALB/c mice were subjected to deep hypothermia and were rewarmed under full physiological monitoring. After rewarming, all animals were observed for two hours, and pathology was evaluated in several organs. All animals tolerated the rapid cooling process well and remained active after rewarming. Temperature-relevant changes were seen via electrocardiography, with heart-rate patterns showing a strong linear correlation to body temperature. No myocardial ischaemia was seen. However, two animals experienced bradycardic atrial fibrillation which spontaneously converted to normal sinus rhythm during rewarming. No histological damage was seen in the heart, liver, kidney or lungs. Our device can effectively be used for heat shock and hypothermia studies in mice, and we foresee no obstacles for its application to other small rodents such as hamsters and young rats. In comparison to known experimental and clinical methods of hypothermia, our device is environmentally friendly, cost-effective and easy to handle, allowing precise control and maintenance of body temperatures ranging from 18℃ to 42℃.
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Affiliation(s)
- Nodir Madrahimov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Abdurasul Khalikov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Erin C Boyle
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Institute of Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Ann-Katrin Knoefel
- 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
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Uribarri A, Rojas SV, Hanke JS, Dogan G, Siemeni T, Kaufeld T, Ius F, Goecke T, Rojas-Hernandez S, Warnecke G, Bara C, Avsar M, Haverich A. Valor pronóstico del índice de riesgo nutricional para los candidatos a implante de un dispositivo de asistencia ventricular izquierda de flujo continuo. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Ius F, Natanov R, Salman J, Kuehn C, Sommer W, Avsar M, Siemeni T, Bobylev D, Poyanmehr R, Boethig D, Optenhoefel J, Schwerk N, Haverich A, Warnecke G, Tudorache I. Extracorporeal membrane oxygenation as a bridge to lung transplantation may not impact overall mortality risk after transplantation: results from a 7-year single-centre experience. Eur J Cardiothorac Surg 2019; 54:334-340. [PMID: 29444222 DOI: 10.1093/ejcts/ezy036] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Extracorporeal membrane oxygenation (ECMO) has an important role in bridging patients to lung transplantation. In this study, we present our experience with pretransplant ECMO during the last 7 years and investigate its impact on graft outcomes. METHODS Records of all lung-transplanted patients at our institution between January 2010 and April 2017 were retrospectively reviewed. Graft survival was compared between patients who required pretransplant ECMO (pre-Tx ECMO+) and patients who did not (pre-Tx ECMO-). Risk factors for in-hospital mortality and graft survival were identified using a binary logistic regression and the Cox regression analyses, respectively. RESULTS Among the 917 patients transplanted during the study period, 68 (7%) required ECMO as a bridge to transplantation [awake strategy, n = 57 (84%) patients]. Median bridging time was 9 days. Among pre-Tx ECMO+ patients, the need for haemodialysis at any point during bridging emerged as an independent risk factor for in-hospital mortality (odds ratio 7.79, 95% confidence interval 1.21-50.24; P = 0.031). Although in-hospital mortality was significantly higher in pre-Tx ECMO+ versus pre-Tx ECMO- patients (15% vs 5%, P = 0.003), overall graft survival did not differ between groups (79% vs 90% and 61% vs 68% at 1 and 5 years, respectively, P = 0.13). Pretransplant ECMO did not emerge as a risk factor for graft survival in the multivariable analysis. CONCLUSIONS If applied in selected patients in a high-volume centre, pretransplant ECMO as a bridge to transplantation results in impaired, but still high in-hospital, survival and does not impact graft survival.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ruslan Natanov
- 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
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Giessen, Hannover, Germany
| | - Murat Avsar
- 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
| | - Reza Poyanmehr
- 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
| | - Joerg Optenhoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Giessen, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Giessen, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Sommer W, Ius F, Müller C, Bobylev D, Kuehn C, Avsar M, Salman J, Siemeni T, Miha O J, Horke A, Haverich A, Tudorache I, Schwerk N, Warnecke G. Extended criteria donor lungs do not impact recipient outcomes in pediatric transplantation. J Heart Lung Transplant 2019; 38:560-569. [DOI: 10.1016/j.healun.2019.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/11/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
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Siemeni T, Knöfel A, Ius F, Salman J, Sommer W, Avsar M, Poyanmehr R, Kühn C, Falk C, Tudorache I, Haverich A, Warnecke G. Linking CLAD in Lung Transplant Recipients after 3 Years Follow Up with Transplant Arteriosclerosis in Humanized Mice. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.327] [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: 11/28/2022] Open
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37
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Ius F, Salman J, Knöfel A, Nakagiri T, Sommer W, Siemeni T, Kühn C, Welte T, Falk C, Haverich A, Tudorache I, Warnecke G. Increased Frequency Of regulatory CD127low T Cells and of IL2+ T Cells Early after Lung Transplant is Associated with Improved Graft Survival. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.054] [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: 10/27/2022] Open
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38
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Rojas S, Ius F, Schibilsky D, Kaufeld T, Sommer W, Benk C, Goecke T, Siemeni T, Poyanmehr R, Rümke S, Mogaldea A, Bobylev D, Salman J, Avsar M, Tudorache I, Bara C, Beyersdorf F, Haverich A, Siepe M, Warnecke G. Cardiac Transplantation in Higher Risk Patients: Is Ex Vivo Heart Perfusion a Safe Preservation Technique? A Two Center Experience. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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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Nakagiri T, Knöfel A, Sommer W, Salman J, Siemeni T, Avsar M, Ius F, Zardo P, Tudorache I, Haverich A, Warnecke G. Cytotoxic T Cells Early after Lung Transplantation Precede the Restrictive Allograft Syndrome. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1035] [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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40
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Salman J, Ius F, Siemeni T, Sommer W, Kuehn C, Avsar M, Bobylev D, Gottlieb J, Welte T, Haverich A, Warnecke G, Tudorache I. Need for and Outcomes of Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.820] [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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41
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Ius F, Verboom M, Sommer W, Müller C, Hallensleben M, Salman J, Siemeni T, Kühn C, Avsar M, Bobylev D, Schwerk N, Haverich A, Tudorache I, Warnecke G. Five-Year Results of an IgA and IgM-Enriched Human Immunoglobulin G-Based Therapy for Early Anti-HLA Donor Specific Antibodies in 158 Lung-Transplanted Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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42
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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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Kaufeld T, Beckmann E, Ius F, Koigeldiev N, Sommer W, Mashaqi B, Fleissner FN, Siemeni T, Puntigam JO, Kaufeld J, Haverich A, Kuehn C. Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach? Perfusion 2019; 34:453-459. [PMID: 30736721 PMCID: PMC6732820 DOI: 10.1177/0267659119827231] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. METHODS Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. RESULTS The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). CONCLUSION We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.
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Affiliation(s)
- Tim Kaufeld
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
- Tim Kaufeld, Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg
Strasse 1, 30625 Hannover, Germany.
| | - Eric Beckmann
- 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
| | - Nurbol Koigeldiev
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Wiebke Sommer
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Bakr Mashaqi
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Felix N Fleissner
- 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
| | - Jacob Ono Puntigam
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Jessica Kaufeld
- Department of Nephrology and
Hypertension, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Christian Kuehn
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
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Knofel AK, Siemeni T, Madrahimov N, Sommer W, Avsar M, Ius F, Jansson K, Ahrens L, Salman J, Kühn C, Tudorache I, Haverich A, Falk C, Warnecke G. Lung Transplant Recipients with Severe Primary Graft Dysfunction Developed Decreased Transplant Arteriosclerosis in Humanized Mice Models. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678982] [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: 10/27/2022]
Affiliation(s)
- A.-K. Knofel
- Medical School Hannover, HTTG, Hannover, Germany
| | - T. Siemeni
- Medical School Hannover, HTTG, Hannover, Germany
| | | | - W. Sommer
- Medical School Hannover, HTTG, Hannover, Germany
| | - M. Avsar
- Medical School Hannover, HTTG, Hannover, Germany
| | - F. Ius
- Medical School Hannover, HTTG, Hannover, Germany
| | - K. Jansson
- Medical School Hannover, HTTG, Hannover, Germany
| | - L. Ahrens
- Medical School Hannover, HTTG, Hannover, Germany
| | - J. Salman
- Medical School Hannover, HTTG, Hannover, Germany
| | - C. Kühn
- Medical School Hannover, HTTG, Hannover, Germany
| | - I. Tudorache
- Medical School Hannover, HTTG, Hannover, Germany
| | - A. Haverich
- Medical School Hannover, HTTG, Hannover, Germany
| | - C. Falk
- Medical School Hannover, Institut für Transplantationsimmunologie, Hannover, Germany
| | - G. Warnecke
- Medical School Hannover, HTTG, Hannover, Germany
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45
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Ius F, Sommer W, Verboom M, Salman J, Siemeni T, Kühn C, Avsar M, Bobylev D, Hallensleben M, Schwerk N, Müller C, Haverich A, Tudorache I, Warnecke G. Five-Year Results of an IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Early anti-HLA Donor-Specific Antibodies after Lung Transplantation. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678919] [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: 10/27/2022]
Affiliation(s)
- F. Ius
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - W. Sommer
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - M. Verboom
- Medizinische Hochschule Hannover, Transfusionsmedizin, Hannover, Germany
| | - J. Salman
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - T. Siemeni
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - C. Kühn
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - M. Avsar
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - D. Bobylev
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - M. Hallensleben
- Medizinische Hochschule Hannover, Transfusionsmedizin, Hannover, Germany
| | - N. Schwerk
- Medizinische Hochschule Hannover, Pädiatrische Pneumologie, Hannover, Germany
| | - C. Müller
- Medizinische Hochschule Hannover, Pädiatrische Pneumologie, Hannover, Germany
| | - A. Haverich
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - I. Tudorache
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - G. Warnecke
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
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46
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Siemeni T, Knofel AK, Ius F, Salman J, Sommer W, Avsar M, Kühn C, Falk C, Tudorache I, Haverich A, Warnecke G. Transplant Arteriosclerosis in Humanized Mice Reflects the Presence of Early Donor-Specific Antibodies in Lung Transplant Recipients and Is Controlled by Autologous Regulatory T Cells. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678897] [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: 10/27/2022]
Affiliation(s)
- T. Siemeni
- Hannover Medical School, HTTG, Hannover, Germany
| | - A.-K. Knofel
- Hannover Medical School, HTTG, Hannover, Germany
| | - F. Ius
- Hannover Medical School, HTTG, Hannover, Germany
| | - J. Salman
- Hannover Medical School, HTTG, Hannover, Germany
| | - W. Sommer
- Hannover Medical School, HTTG, Hannover, Germany
| | - M. Avsar
- Hannover Medical School, HTTG, Hannover, Germany
| | - C. Kühn
- Hannover Medical School, HTTG, Hannover, Germany
| | - C. Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - I. Tudorache
- Hannover Medical School, HTTG, Hannover, Germany
| | - A. Haverich
- Hannover Medical School, HTTG, Hannover, Germany
| | - G. Warnecke
- Hannover Medical School, HTTG, Hannover, Germany
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47
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Ius F, Salman J, Knofel AK, Nakagiri T, Sommer W, Siemeni T, Kuehn C, Avsar M, Welte T, Haverich A, Tudorache I, Warnecke G. Increased Frequency of Regulatory CD127low T Cells Early after Lung Transplant Is Associated with Improved Graft Survival. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678917] [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: 10/27/2022]
Affiliation(s)
- F. Ius
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - J. Salman
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - A.-K. Knofel
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - T. Nakagiri
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - W. Sommer
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - T. Siemeni
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - C. Kuehn
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - M. Avsar
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - T. Welte
- Medizinische Hochschule Hannover, Pneumologie, Hannover, Germany
| | - A. Haverich
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - I. Tudorache
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
| | - G. Warnecke
- Medizinische Hochschule Hannover, Herz- Thorax- Transplantations- Gefäßchirurgie, Hannover, Germany
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48
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Rojas S, Ius F, Schibilsky D, Kaufeld T, Benk C, Goecke T, Avsar M, Poyanmehr R, Rümke S, Mogaldea A, Bobylev D, Salman J, Siemeni T, Bara C, Beyersdorf F, Haverich A, Siepe M, Warnecke G. Ex Vivo Heart Perfusion for Higher Risk Cardiac Transplantations: A Retrospective Analysis from Two German Centers. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678914] [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: 10/27/2022]
Affiliation(s)
- S. Rojas
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - F. Ius
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - D. Schibilsky
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - T. Kaufeld
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - C. Benk
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - T. Goecke
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - M. Avsar
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - R. Poyanmehr
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - S. Rümke
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - A. Mogaldea
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - D. Bobylev
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - J. Salman
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - T. Siemeni
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - C. Bara
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - F. Beyersdorf
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - A. Haverich
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - M. Siepe
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - G. Warnecke
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
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49
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Madrahimov N, Khalikov A, Boyle EC, Natanov R, Knoefel AK, Siemeni T, Hoeffler K, Haverich A, Maus U, Kuehn C. Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse. J Vis Exp 2018. [PMID: 30417887 DOI: 10.3791/58146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) has increased substantially in recent years. ECMO has become a reliable and effective therapy for acute as well as end-stage lung diseases. With the increase in clinical demand and prolonged use of ECMO, procedural optimization and prevention of multi-organ damage are of critical importance. The aim of this protocol is to present a detailed technique of veno-venous ECMO in a non-intubated, spontaneously breathing mouse. This protocol demonstrates the technical design of the ECMO and surgical steps. This murine ECMO model will facilitate the study of pathophysiology related to ECMO (e.g., inflammation,bleeding and thromboembolic events). Due to the abundance of genetically modified mice, the molecular mechanisms involved in ECMO-related complications can also be dissected.
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Affiliation(s)
- Nodir Madrahimov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School;
| | - Abdurasul Khalikov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Erin C Boyle
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ann-Kathrin Knoefel
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Klaus Hoeffler
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ulrich Maus
- Department of Pneumology, Hannover Medical School
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
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50
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Natanov R, Gueler F, Falk CS, Kühn C, Maus U, Boyle EC, Siemeni T, Knoefel AK, Cebotari S, Haverich A, Madrahimov N. Blood cytokine expression correlates with early multi-organ damage in a mouse model of moderate hypothermia with circulatory arrest using cardiopulmonary bypass. PLoS One 2018; 13:e0205437. [PMID: 30308065 PMCID: PMC6181365 DOI: 10.1371/journal.pone.0205437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/25/2018] [Indexed: 12/12/2022] Open
Abstract
Cardiopulmonary bypass (CPB) with moderate hypothermic cardiac arrest (MHCA) is essential for prolonged complex procedures in cardiac surgery and is associated with postoperative complications. Although cytokine release provoked through MHCA under CPB plays a pivotal role in postoperative organ damage, the pathomechanisms are unclear. Here, we investigated the cytokine release pattern and histological organ damage after MHCA using a recently described mouse CPB model. Eight BALB/c mice underwent 60 minutes of circulatory arrest under CPB, were successively rewarmed and reperfused. Blood cytokine concentrations and liver and kidney function parameters were measured and histological changes to these organs were compared to control animals. Our results showed a marked increase in proinflammatory cytokines and histological changes in the kidney, lung, and liver after CPB. Furthermore, clinical chemistry showed signs of hemolysis and acute kidney injury. These results suggest early onset of solid organ injury which correlates with increased leukocyte infiltration. A better understanding of the interplay between pro-inflammatory cytokine activation and solid organ injury in this model of CBP with MHCA will inform strategies to reduce organ damage during cardiac surgeries in the clinic.
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Affiliation(s)
- Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Christine S. Falk
- Institute of Transplant Immunology, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Ulrich Maus
- Department of Pneumology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Erin C. Boyle
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Ann-Katrin Knoefel
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Nodir Madrahimov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
- * E-mail:
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