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Otunla AA, Shanmugarajah K, Davies AH, Lucia Madariaga M, Shalhoub J. The Biological Parallels Between Atherosclerosis and Cardiac Allograft Vasculopathy: Implications for Solid Organ Chronic Rejection. Cardiol Rev 2024; 32:2-11. [PMID: 38051983 DOI: 10.1097/crd.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atherosclerosis and solid organ chronic rejection are pervasive chronic disease states that account for significant morbidity and mortality in developed countries. Recently, a series of shared molecular pathways have emerged, revealing biological parallels from early stages of development up to the advanced forms of pathology. These shared mechanistic processes are inflammatory in nature, reflecting the importance of inflammation in both disorders. Vascular inflammation triggers endothelial dysfunction and disease initiation through aberrant vasomotor control and shared patterns of endothelial activation. Endothelial dysfunction leads to the recruitment of immune cells and the perpetuation of the inflammatory response. This drives lesion formation through the release of key cytokines such as IFN-y, TNF-alpha, and IL-2. Continued interplay between the adaptive and innate immune response (represented by T lymphocytes and macrophages, respectively) promotes lesion instability and thrombotic complications; hallmarks of advanced disease in both atherosclerosis and solid organ chronic rejection. The aim of this study is to identify areas of overlap between atherosclerosis and chronic rejection. We then discuss new approaches to improve current understanding of the pathophysiology of both disorders, and eventually design novel therapeutics.
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Affiliation(s)
- Afolarin A Otunla
- From the Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Joseph Shalhoub
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
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Moneke I, Ogutur ED, Kalbhenn J, Hettich I, Passlick B, Jungraithmayr W, Senbaklavaci O. Independent risk factors for an increased incidence of thromboembolism after lung transplantation. J Thromb Thrombolysis 2023; 55:252-262. [PMID: 36495365 PMCID: PMC10011327 DOI: 10.1007/s11239-022-02748-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thromboembolism (TE) after lung transplantation (LTX) is associated with increased morbidity and mortality. The aim of this study is to analyze the incidence and outcome of venous and arterial thromboembolic complications and to identify independent risk factors. PATIENTS AND METHODS We retrospectively analyzed the medical records of 221 patients who underwent LTX at our institution between 2002 and 2021. Statistical analysis was performed using SPSS and GraphPad software. RESULTS 74 LTX recipients (33%) developed TE. The 30-days incidence and 12-months incidence were 12% and 23%, respectively. Nearly half of the patients (48%) developed pulmonary embolism, 10% ischemic stroke. Arterial hypertension (p = 0.006), a body mass index (BMI) > 30 (p = 0.006) and diabetes mellitus (p = 0.041) were independent predictors for TE. Moreover, a BMI of > 25 at the time of transplantation was associated with an increased risk for TE (43% vs. 32%, p = 0.035). At the time of LTX, 65% of the patients were older than 55 years. An age > 55 years also correlated with the incidence of TE (p = 0.037) and these patients had reduced overall post-transplant survival when the event occurred within the first postoperative year (59% vs. 72%, p = 0.028). CONCLUSIONS The incidence of TE after LTX is high, especially in lung transplant recipients with a BMI > 25 and an age > 55 years as well as cardiovascular risk factors closely associated with the metabolic syndrome. As these patients comprise a growing recipient fraction, intensified research should focus on the risks and benefits of regular screening or a prolonged TE prophylaxis in these patients. Trial registration number DKRS: 00021501.
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Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Ecem Deniz Ogutur
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Johannes Kalbhenn
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Ina Hettich
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Omer Senbaklavaci
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Tanaka S, Tymowski CD, Tran-Dinh A, Meilhac O, Lortat-Jacob B, Zappella N, Jean-Baptiste S, Robert T, Goletto T, Godet C, Castier Y, Mal H, Mordant P, Atchade E, Messika J, Montravers P. Low HDL-Cholesterol Concentrations in Lung Transplant Candidates are Strongly Associated With One-Year Mortality After Lung Transplantation. Transpl Int 2023; 36:10841. [PMID: 36726695 PMCID: PMC9884674 DOI: 10.3389/ti.2023.10841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
High-density lipoproteins (HDLs), whose main role is the reverse transport of cholesterol, also have pleiotropic anti-inflammatory, antioxidant, anti-apoptotic and anti-infectious properties. During sepsis, HDL cholesterol (HDL-C) concentration is low, HDL particle functionality is altered, and these modifications are correlated with poor outcomes. Based on the protective effects of HDL, we hypothesized that HDL-C levels could be associated with lung transplantation (LT) outcome. We thus looked for an association between basal HDL-C concentration and one-year mortality after LT. In this single-center prospective study including consecutive LTs from 2015 to 2020, 215 patients were included, essentially pulmonary fibrosis (47%) and chronic obstructive pulmonary disease (COPD) (38%) patients. Mortality rate at one-year was 23%. Basal HDL-C concentration stratified nonsurvivors to survivors at one-year (HDL-C = 1.26 [1.12-1.62] mmol/L vs. HDL-C = 1.55 [1.22-1.97] mmol/L, p = 0.006). Multivariate analysis confirmed that HDL-C concentration during the pretransplant assessment period was the only variable inversely associated with mortality. Moreover, mortality at one-year in patients with HDL-C concentrations ≤1.45 mmol/L was significantly higher (log-rank test, p = 0.00085). In conclusion, low basal HDL-C concentrations in candidates for LT are strongly associated with mortality after LT. To better understand this association, further studies in this field are essential and, in particular, a better characterization of HDL particles seems necessary.
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Affiliation(s)
- Sébastien Tanaka
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Réunion Island University, Saint-Denis de La Réunion, France,*Correspondence: Sébastien Tanaka,
| | - Christian De Tymowski
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,French Institute of Health and Medical Research (INSERM) U1149, Center for Research on Inflammation, Paris, France
| | - Alexy Tran-Dinh
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France
| | - Olivier Meilhac
- French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Réunion Island University, Saint-Denis de La Réunion, France,Reunion Island University-Affiliated Hospital, Saint-Denis, France
| | - Brice Lortat-Jacob
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Sylvain Jean-Baptiste
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Robert
- Department of Biochemistry, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Goletto
- Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Cendrine Godet
- Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Yves Castier
- UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France,Department of Vascular and Thoracic Surgery, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Hervé Mal
- UFR Paris Nord, Université Paris Cité, Paris, France,Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Pierre Mordant
- UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France,Department of Vascular and Thoracic Surgery, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Enora Atchade
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Jonathan Messika
- UFR Paris Nord, Université Paris Cité, Paris, France,Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France,Paris Transplant Group, Paris, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,UFR Paris Nord, Université Paris Cité, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
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Adegunsoye A, Strek ME, Garrity E, Guzy R, Bag R. Comprehensive Care of the Lung Transplant Patient. Chest 2016; 152:150-164. [PMID: 27729262 DOI: 10.1016/j.chest.2016.10.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 12/20/2022] Open
Abstract
Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other medical or surgical interventions. With improving survival rates, the number of lung transplant recipients with preexisting and posttransplant comorbidities that require attention continues to increase. A partnership between transplant and nontransplant care providers is necessary to deliver comprehensive and optimal care for transplant candidates and recipients. The goals of this partnership include timely referral and assistance with transplant evaluation, optimization of comorbidities and preparation for transplantation, management of common posttransplant medical comorbidities, immunization, screening for malignancy, and counseling for a healthy lifestyle to maximize the likelihood of a good outcome. We aim to provide an outline of the main aspects of the care of candidates for and recipients of lung transplants for nontransplant physicians and other care providers.
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Affiliation(s)
- Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Edward Garrity
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL
| | - Robert Guzy
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL
| | - Remzi Bag
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL.
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