1
|
Hofmann J, Meszaros AT, Buch ML, Nardin F, Hackl V, Strolz CJ, Zelger B, Fodor M, Cardini B, Oberhuber R, Resch T, Weissenbacher A, Troppmair J, Schneeberger S, Hautz T. Bioenergetic and Cytokine Profiling May Help to Rescue More DCD Livers for Transplantation. Int J Mol Sci 2023; 24:ijms24119536. [PMID: 37298486 DOI: 10.3390/ijms24119536] [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: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
The majority of organs used for liver transplantation come from brain-dead donors (DBD). In order to overcome the organ shortage, increasingly donation after circulatory death (DCD) organs are also considered. Since normothermic machine perfusion (NMP) restores metabolic activity and allows for in-depth assessment of organ quality and function prior to transplantation, such organs may benefit from NMP. We herein compare the bioenergetic performance through a comprehensive evaluation of mitochondria by high-resolution respirometry in tissue biopsies and the inflammatory response in DBD and DCD livers during NMP. While livers were indistinguishable by perfusate biomarker assessment and histology, our findings revealed a greater impairment of mitochondrial function in DCD livers after static cold storage compared to DBD livers. During subsequent NMPs, DCD organs recovered and eventually showed a similar performance as DBD livers. Cytokine expression analysis showed no differences in the early phase of NMP, while towards the end of NMP, significantly elevated levels of IL-1β, IL-5 and IL-6 were found in the perfusate of DCD livers. Based on our results, we find it worthwhile to reconsider more DCD organs for transplantation to further extend the donor pool. Therefore, donor organ quality criteria must be developed, which may include an assessment of bioenergetic function and cytokine quantification.
Collapse
Affiliation(s)
- Julia Hofmann
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Andras T Meszaros
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Madita L Buch
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Florian Nardin
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Verena Hackl
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Carola J Strolz
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bettina Zelger
- Department of Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Margot Fodor
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Benno Cardini
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Rupert Oberhuber
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Thomas Resch
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Annemarie Weissenbacher
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Jakob Troppmair
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stefan Schneeberger
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Theresa Hautz
- organLife Organ Regeneration Center of Excellence and Daniel Swarovski Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
2
|
Bellotti R, Cardini B, Strolz CJ, Stättner S, Oberhuber R, Braunwarth E, Resch T, Scheidl S, Margreiter C, Schneeberger S, Öfner D, Maglione M. Single Center, Propensity Score Matching Analysis of Different Reconstruction Techniques following Pancreatoduodenectomy. J Clin Med 2023; 12:3318. [PMID: 37176758 PMCID: PMC10179219 DOI: 10.3390/jcm12093318] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Pancreatoduodenectomy is still hampered by significant morbidity. So far, there is no universally accepted technique aimed at minimizing postoperative complications. Herein, we compare three different reconstruction techniques. METHODS This is a retrospective study of a prospectively maintained database including 283 patients operated between January 2010 and December 2020. Three reconstruction techniques were compared: (1) the Neuhaus-style telescope pancreatojejunostomy, (2) the pancreatogastrostomy, and (3) the modified Blumgart-style, duct-to-mucosa pancreatojejunostomy. The primary endpoint consisted in determining the rates of clinically relevant postoperative pancreatic fistulas (CR-POPF); the secondary endpoints included 90 days morbidity and mortality rates. A propensity score matching analysis was used. RESULTS Rates of CR-POPF did not differ significantly between the groups (Neuhaus-style pancreatojejunostomy 16%, pancreatogastrostomy 17%, modified Blumgart-style pancreatojejunostomy 15%), neither in the unmatched nor in the matched analysis (p = 0.993 and p = 0.901, respectively). Similarly, no significant differences could be observed with regard to major morbidity (unmatched p = 0.596, matched p = 0.188) and mortality rates (unmatched p = 0.371, matched p = 0.209) within the first 90 days following surgery. Propensity-score matching analyses revealed, however, a higher occurrence of post-pancreatectomy hemorrhage after pancreatogastrostomy (p = 0.015). CONCLUSION Similar CR-POPF rates suggest no crucial role of the applied reconstruction technique. Increased incidence of intraluminal post-pancreatectomy hemorrhages following pancreatogastrostomy demands awareness for meticulous hemostasis.
Collapse
Affiliation(s)
- Ruben Bellotti
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Carola J. Strolz
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Hospital, 4840 Vöcklabruck, Austria
| | - Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Thomas Resch
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Stefan Scheidl
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Christian Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (R.B.)
| |
Collapse
|
3
|
Luger AK, Sonnweber T, Gruber L, Schwabl C, Cima K, Tymoszuk P, Gerstner AK, Pizzini A, Sahanic S, Boehm A, Coen M, Strolz CJ, Wöll E, Weiss G, Kirchmair R, Feuchtner GM, Prosch H, Tancevski I, Löffler-Ragg J, Widmann G. Chest CT of Lung Injury 1 Year after COVID-19 Pneumonia: The CovILD Study. Radiology 2022; 304:462-470. [PMID: 35348379 PMCID: PMC8988857 DOI: 10.1148/radiol.211670] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The long-term pulmonary sequelae of COVID-19 is not well known. Purpose To characterize patterns and rates of improvement of chest CT
abnormalities 1 year after COVID-19 pneumonia. Materials and Methods This was a secondary analysis of a prospective, multicenter observational
cohort study conducted from April 29 to August 12, 2020, to assess
pulmonary abnormalities at chest CT approximately 2, 3, and 6 months and
1 year after onset of COVID-19 symptoms. Pulmonary findings were graded
for each lung lobe using a qualitative CT severity score (CTSS) ranging
from 0 (normal) to 25 (all lobes involved). The association of
demographic and clinical factors with CT abnormalities after 1 year was
assessed with logistic regression. The rate of change of the CTSS at
follow-up CT was investigated by using the Friedmann test. Results Of 142 enrolled participants, 91 underwent a 1-year follow-up CT
examination and were included in the analysis (mean age, 59 years
± 13 [SD]; 35 women [38%]). In 49 of 91 (54%) participants, CT
abnormalities were observed: 31 of 91 (34%) participants showed subtle
subpleural reticulation, ground-glass opacities, or both, and 18 of 91
(20%) participants had extensive ground-glass opacities, reticulations,
bronchial dilation, microcystic changes, or a combination thereof. At
multivariable analysis, age of more than 60 years (odds ratio [OR], 5.8;
95% CI: 1.7, 24; P = .009), critical COVID-19 severity
(OR, 29; 95% CI: 4.8, 280; P < .001), and male
sex (OR, 8.9; 95% CI: 2.6, 36; P < .001) were
associated with persistent CT abnormalities at 1-year follow-up.
Reduction of CTSS was observed in participants at subsequent follow-up
CT (P < .001); during the study period, 49% (69
of 142) of participants had complete resolution of CT abnormalities.
Thirty-one of 49 (63%) participants with CT abnormalities showed no
further improvement after 6 months. Conclusion Long-term CT abnormalities were common 1 year after COVID-19
pneumonia. © RSNA, 2022 Online supplemental material is available for this
article. See also the editorial by Leung in this issue.
Collapse
Affiliation(s)
- Anna K Luger
- Department for Radiology, Medical University of Innsbruck, Austria
| | - Thomas Sonnweber
- Department for Radiology, Medical University of Innsbruck, Austria
| | - Leonhard Gruber
- Department for Radiology, Medical University of Innsbruck, Austria
| | | | - Katharina Cima
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Piotr Tymoszuk
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Anna K Gerstner
- Department for Radiology, Medical University of Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Sabina Sahanic
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Anna Boehm
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Maximilian Coen
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Carola J Strolz
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ewald Wöll
- Deptartment of Internal Medicine, St Vinzenz Hospital, Zams, Austria
| | - Günter Weiss
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ivan Tancevski
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Gerlig Widmann
- Department for Radiology, Medical University of Innsbruck, Austria
| |
Collapse
|