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Pollmann NS, Vogel T, Pongs C, Katou S, Morgül H, Houben P, Görlich D, Kneifel F, Reuter S, Pollmann L, Pascher A, Becker F. Donor Proteinuria and Allograft Function in Kidney Transplantation: Short- and Long-Term Results From a Retrospective Cohort Study. Transpl Int 2023; 36:11953. [PMID: 38156296 PMCID: PMC10754218 DOI: 10.3389/ti.2023.11953] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023]
Abstract
Donor proteinuria (DP) is a common but rarely evaluated aspect of today's kidney transplant allocation process. While proteinuria after kidney transplantation is a risk factor for impaired graft function and survival, the long-term effects of DP in kidney transplantation have not yet been evaluated. Therefore, this study aims to investigate the impact of DP on the long-term outcome after kidney transplantation. A total of 587 patients were found to be eligible and were stratified into two groups: (1) those receiving a graft from a donor without proteinuria (DP-) and (2) those receiving a graft from a donor with proteinuria (DP+). At 36 months, there was no difference in the primary composite endpoint including graft loss and patient survival (log-rank test, p = 0.377). However, the analysis of DP+ subgroups showed a significant decrease in overall patient survival in the group with high DP (p = 0.017). DP did not adversely affect patient or graft survival over 36 months. Nevertheless, this work revealed a trend towards decreased overall survival of patients with severe proteinuria in the subgroup analysis. Therefore, the underlying results suggest caution in allocating kidneys from donors with high levels of proteinuria.
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Affiliation(s)
- Nicola Sariye Pollmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Thomas Vogel
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Caroline Pongs
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Haluk Morgül
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Muenster, Muenster, Germany
| | - Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Lukas Pollmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
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Kneifel F, Vogel T, Bormann E, Becker F, Houben P, Flammang I, Slepecka P, Eichelmann AK, Brockmann JG, Pascher A. Graft-versus-host disease following liver transplantation: A systematic review of literature. Hepatol Commun 2023; 7:e0260. [PMID: 37755878 PMCID: PMC10531273 DOI: 10.1097/hc9.0000000000000260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Graft-versus-host disease following liver transplantation is a serious and usually fatal complication. Data identifying the risk factors and specifying the diagnosis and treatment options of the disease are scarce and contentious. Moreover, recommendations for therapeutic approaches are similarly sparse. METHODS A systematic review of the literature from 1988 to 2020 on graft-versus-host disease following liver transplantation was performed using the PubMed and MEDLINE databases. Medical subject headings, such as graft-versus-host disease and GvHD were used in combination with solid organ transplant, transplantation, or liver transplant. Following duplicate removal, 9298 articles were screened for suitability. A total of 238 full-text articles were analyzed for eligibility, resulting in 130 eligible articles for meta-analysis. Two hundred twenty-five patients developing graft-versus-host disease following liver transplantation reported herein were mainly published in case reports and case series. RESULTS Graft-versus-host disease occurred with an incidence of 1.2%. 85% developed following deceased donor liver transplant and 15% following living-related donor liver transplantation. The median follow-up period following liver transplantation was 84 days (interquartile range, 45-180). The median time from liver transplantation to graft-versus-host disease onset was 30 days (interquartile range, 21-42). The main clinical features included skin rash (59%), fever (43%), diarrhea (36%), and pancytopenia (30%). The overall mortality rate was 71%. Neither univariate (HR = 0.999; 95% CI, 0.493-2.023; p = 1.0) nor multivariate Cox regression analysis revealed a significant correlation between adaptation of immunosuppression and survival probability (HR = 1.475; 95% CI, 0.659-3.303; p = 0.3). CONCLUSIONS This systematic review suggests that an increase in immunosuppressive regimen does not yield any survival benefit in patients suffering from graft-versus-host disease following liver transplantation.
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Affiliation(s)
- Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Thomas Vogel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Eike Bormann
- Institute of Biostatistics and Clinical Research, University Münster, Münster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Isabelle Flammang
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Patrycja Slepecka
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Jens G. Brockmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
- Department of Abdominal Transplant and Hepatobiliary Surgery, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
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Zurek-Leffers FM, Lehmann F, Brabenec L, Kintrup S, Hellenthal KEM, Mersjann K, Kneifel F, Hessler M, Arnemann PH, Kampmeier TG, Ertmer C, Kellner P, Wagner NM. A model of porcine polymicrobial septic shock. Intensive Care Med Exp 2023; 11:31. [PMID: 37264259 DOI: 10.1186/s40635-023-00513-7] [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: 12/14/2022] [Accepted: 04/21/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality of patients with sepsis is high and largely unchanged throughout the past decades. Animal models have been widely used for the study of sepsis and septic shock, but translation into effective treatment regimes in the clinic have mostly failed. Pigs are considered as suitable research models for human diseases due to their high comparability and similarity to human anatomy, genetics, and the immune system. We here evaluated the previously reported models of septic shock in pigs and established a novel model of polymicrobial sepsis that meets the clinical criteria of septic shock in pigs. MATERIALS AND METHODS The literature search was performed using the keywords "pig", "sepsis" and "septic shock". For the establishment of septic shock in n = 10 German landrace pigs, mechanical ventilation was initiated, central venous and arterial lines and invasive hemodynamic monitoring via pulse contour cardiac output measurement (PiCCO) established. Peritoneal polymicrobial faecal sepsis was induced by application of 3 g/kg body weight faeces into the abdominal cavity. Septic shock was defined according to the third international consensus definitions (Sepsis-3). Upon shock, pigs underwent the 1-h bundle for the treatment of human sepsis. Cytokine levels were measured by ELISA. RESULTS Published porcine sepsis models exhibited high methodological variability and did not meet the clinical criteria of septic shock. In our model, septic shock developed after an average of 4.8 ± 0.29 h and was associated with a reproducible drop in blood pressure (mean arterial pressure 54 ± 1 mmHg) and significant hyperlactatemia (3.76 ± 0.65 mmol/L). Septic shock was associated with elevated levels of interleukin-6 (IL6) and initial cardiac depression followed by a hyperdynamic phase with significant loss of systemic vascular resistance index after initial resuscitation. In addition, organ dysfunction (acute kidney injury) occurred. CONCLUSIONS We here established a model of septic shock in pigs that meets the clinical criteria of septic shock utilized in human patients. Our model may thus serve as a reference for clinically relevant sepsis research in pigs.
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Affiliation(s)
- Finnja Marie Zurek-Leffers
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Florian Lehmann
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Laura Brabenec
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Sebastian Kintrup
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Katharina E M Hellenthal
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kira Mersjann
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Michael Hessler
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Philip-Helge Arnemann
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Tim-Gerald Kampmeier
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Christian Ertmer
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Patrick Kellner
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Nana-Maria Wagner
- Department for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
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Kneifel F, Morgul H, Katou S, Hölzen JP, Strücker B, Juratli M, Pascher A, Becker F. Correction to: Struggle in the bubble - a prospective study on the effect of remote learning and distance education on confidence in practical surgical skills acquired during COVID-19. BMC Med Educ 2023; 23:206. [PMID: 37013540 PMCID: PMC10068710 DOI: 10.1186/s12909-023-04195-3] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany.
| | - Haluk Morgul
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Jens P Hölzen
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Benjamin Strücker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Mazen Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
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Kneifel F, Morgul H, Katou S, Hölzen JP, Strücker B, Juratli M, Pascher A, Becker F. Struggle in the bubble - a prospective study on the effect of remote learning and distance education on confidence in practical surgical skills acquired during COVID-19. BMC Med Educ 2023; 23:115. [PMID: 36793029 PMCID: PMC9931444 DOI: 10.1186/s12909-023-04092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) has significantly changed healthcare systems and medical education. Universities were required to develop innovative curricula based on remote and distance education to continue medical education. This prospective questionnaire-based study aimed to investigate the impact of COVID-19-associated remote learning on the surgical training of medical students. METHODS A 16-item questionnaire-based survey was distributed to medical students at the University Hospital of Münster before and after a surgical skills laboratory (SSL). Two cohorts were included: summer semester 2021 (COV-19), with rigorous social-distancing restrictions requiered SSL to be remotely, and winter semester 2021 (postCOV-19), in which the SSL was provided as a face-to-face, hands-on course. RESULTS Both, cohorts showed a significant improvement in self-assessment of pre- and post-course confidence. While no significant difference in the average gain in self-confidence for sterile working was observed between the two cohorts, improvement in self-confidence was significantly higher in the COV-19 cohort regarding skin suturing and knot tying (p < 0.0001). However the average improvement regarding history and physical was significantly higher in the postCOV-19 cohort (p < 0.0001). In subgroup analysis, gender-associated differences varied in the two cohorts and were not related to specific subtasks, while age-stratified analysis revealed superior results for younger students. CONCLUSION The results of our study underline the usability, feasibility, and adequacy of remote learning for the surgical training of medical students. The on-site distance education version, presented in the study, allows the continuing of hands-on experience in a safe environment in compliance with governmental social-distancing restrictions.
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Affiliation(s)
- Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany.
| | - Haluk Morgul
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Jens P Hölzen
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Benjamin Strücker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Mazen Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
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Houben P, Bormann E, Kneifel F, Katou S, Morgül MH, Vogel T, Bahde R, Radünz S, Pascher A, Schmidt H, Brockmann JG, Becker F. How Old Is Old? An Age-Stratified Analysis of Elderly Liver Donors above 65. J Clin Med 2022; 11:jcm11133899. [PMID: 35807185 PMCID: PMC9267186 DOI: 10.3390/jcm11133899] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023] Open
Abstract
In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donors remains elusive. In this study, liver transplantations between January 2006 and May 2018 were analyzed retrospectively. Ninety-two recipients of grafts from donors ≥65 years were identified and divided into two groups: (1) ≥65–69 and (2) ≥ 70 years. One-year patient survival was comparable between recipients of grafts from donors ≥65–69 and ≥70 years (78.9% and 70.0%). One-year graft survival was 73.1% (donor ≥65–69) and 62.5% (donor ≥ 70), while multivariate analysis revealed superior one-year graft survival to be associated with a donor age of ≥65–69. No statistically significant differences were found for rates of primary non-function. The influence of donor age on graft and patient survival appears not to have a distinct impact on dismal outcomes in the range of 65–70 years. The impact of old donor age needs to be balanced with other risk factors, as these donors provide grafts that offer a lifesaving graft function.
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Affiliation(s)
- Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
- Correspondence: ; Tel.: +49-251-835-6301; Fax: +49-251-835-6311
| | - Eike Bormann
- Institute of Biostatistics and Clinical Research, University Hospital Münster, 48149 Münster, Germany;
| | - Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Mehmet Haluk Morgül
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Thomas Vogel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Ralf Bahde
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Sonia Radünz
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Hartmut Schmidt
- Department of Internal Medicine B, Gastroenterology and Hepatology, University Hospital Münster, 48149 Münster, Germany;
| | - Jens Gunther Brockmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany; (F.K.); (S.K.); (M.H.M.); (T.V.); (R.B.); (S.R.); (A.P.); (J.G.B.); (F.B.)
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Wagner T, Katou S, Wahl P, Vogt F, Kneifel F, Morgul H, Vogel T, Houben P, Becker F, Struecker B, Pascher A, Radunz S. Hyperspectral imaging for quantitative assessment of hepatic steatosis in human liver allografts. Clin Transplant 2022; 36:e14736. [PMID: 35622345 DOI: 10.1111/ctr.14736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In liver transplantation (LT), steatosis is commonly judged to be a risk factor for graft dysfunction, and quantitative assessment of hepatic steatosis remains crucial. Liver biopsy as the gold standard for evaluation of hepatic steatosis has certain drawbacks, i.e. invasiveness, and intra- and inter-observer variability. A non-invasive, quantitative modality could replace liver biopsy and eliminate these disadvantages, but has not yet been evaluated in human LT. METHODS We performed a pilot study to evaluate the feasibility and accuracy of hyperspectral imaging (HSI) in the assessment of hepatic steatosis of human liver allografts for transplantation. Thirteen deceased donor liver allografts were included in the study. The degree of steatosis was assessed by means of conventional liver biopsy as well as HSI, performed at the end of backtable preparation, during normothermic machine perfusion (NMP), and after reperfusion in the recipient. RESULTS Organ donors were 51 [30-83] years old, and 61.5% were male. Donor body mass index was 24.2 [16.5-38.0] kg/m2. The tissue lipid index (TLI) generated by HSI at the end of back-table preparation correlated significantly with the histopathologically assessed degree of overall hepatic steatosis (R2 = 0.9085, p<0.0001); this was based on a correlation of TLI and microvesicular steatosis (R2 = 0.8120; p<0.0001). There is also a linear relationship between the histopathologically assessed degree of overall steatosis and TLI during NMP (R2 = 0.5646; p = 0.0031) as well as TLI after reperfusion (R2 = 0.6562; p = 0.0008). CONCLUSION HSI may safely be applied for accurate assessment of hepatic steatosis in human liver grafts. Certainly, TLI needs further assessment and validation in larger sample sizes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tristan Wagner
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Philip Wahl
- Diaspective Vision GmbH, Am Salzhaff, Germany
| | - Franziska Vogt
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Haluk Morgul
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Thomas Vogel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Benjamin Struecker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Sonia Radunz
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
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BUßMEYER F, Kneifel F, Eichelmann AK, Palmes D, Hummel R, Lindner K. Effects of therapy modifications during the last decade on the outcome of patients undergoing esophagectomy for esophageal cancer. Minerva Surg 2021; 76:235-244. [PMID: 33855371 DOI: 10.23736/s2724-5691.21.08393-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND During the last decade, numerous therapeutic regimes were assessed to improve the outcome of patients with esophageal carcinoma. We analyzed the impact of therapy alterations, including the establishment of a standardized clinical pathway and the introduction of an interdisciplinary tumor conference on the outcome of patients undergoing esophagectomy because of esophageal cancer. METHODS Three hundred one patients were included (204 adenocarcinoma and 97 squamous cell carcinoma) who underwent an esophagectomy between 2006 and 2015. Patients were divided into 3 groups: interval A (2006-2008), interval B (2009-2011) and interval C (2012-2015) and evaluated separately focusing on therapy management and patients' outcome. RESULTS Over the time periods, the incidence of tumor entity of adenocarcinoma increased from 61% to 76.2% (P=0.059). Patients with an initial tumor stage uT1 increased significantly from 4% to 15.9% over the intervals (P=0.002), while positive nodal involvement remained comparable (P=0.237). Patients in the later interval suffered from greater physical impairments preoperatively, represented by a significantly increased American Society Anesthesiologists (ASA) score (P=0.023) and a reduced Karnofsky Index (P<0.001). The tumor conference was accompanied by an increasing implementation of neoadjuvant therapy (27.1% vs. 42.2%, P=0.097). After establishing the clinical pathway 30-day mortality decreased (P=0.67). Grad III anastomotic leakage decreased significantly from 6.5% to 2% (P=0.01). However, gastrointestinal (P=0.007), pulmonary complications (P<0.001) including pneumonia (P<0.001) increased. Over the past ten years both overall survival and relapse-free survival prolonged (P=0.056 and P=0.063, respectively). CONCLUSIONS Patients' collective suffering from esophageal cancer has changed over the last decade. Continuous further developments of the therapy regimes are needed to meet the requirements of reducing perioperative mortality and extending survival time.
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Affiliation(s)
- Florian BUßMEYER
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Felicia Kneifel
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Daniel Palmes
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Richard Hummel
- Department of Surgery, Campus Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Kirsten Lindner
- Department of Surgery, Campus Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany -
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