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Le Quang T, Gungor AC, Vasyukov D, Hoffmann J, Smajic J, Zeier M. Advanced calibration kit for scanning microwave microscope: Design, fabrication, and measurement. Rev Sci Instrum 2021; 92:023705. [PMID: 33648098 DOI: 10.1063/5.0032129] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
We present in this paper a new design of a capacitive calibration kit for scanning microwave microscopy (SMM). As demonstrated by finite element modelings, the produced devices are highly independent of material parameters due to their lateral configuration. The fabrication of these gold-based structures is realized by using well established clean-room techniques. SMM measurements are performed under different conditions, and all capacitive structures exhibit a strong contrast with respect to the non-capacitive background. The obtained experimental data are employed to calibrate the used SMM tips and to extract the capacitance of produced devices following a method based on the short-open-load calibration algorithm for one-port vector network analyzers. The comparison of experimental capacitance and nominal values provided by our models proves the applicability of the used calibration approach for a wide frequency range.
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Affiliation(s)
- T Le Quang
- RF and Microwave Laboratory of the Federal Institute of Metrology METAS of Switzerland, 3003 Bern-Wabern, Switzerland
| | - A C Gungor
- Institute of Electromagnetic Fields (IEF), ETH Zurich, 8092 Zurich, Switzerland
| | - D Vasyukov
- RF and Microwave Laboratory of the Federal Institute of Metrology METAS of Switzerland, 3003 Bern-Wabern, Switzerland
| | - J Hoffmann
- RF and Microwave Laboratory of the Federal Institute of Metrology METAS of Switzerland, 3003 Bern-Wabern, Switzerland
| | - J Smajic
- Institute of Electromagnetic Fields (IEF), ETH Zurich, 8092 Zurich, Switzerland
| | - M Zeier
- RF and Microwave Laboratory of the Federal Institute of Metrology METAS of Switzerland, 3003 Bern-Wabern, Switzerland
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Neuberger M, Sommerer C, Böhnisch S, Metzendorf N, Mehrabi A, Stremmel W, Gotthardt D, Zeier M, Weiss KH, Rupp C. Effect of mycophenolic acid on inosine monophosphate dehydrogenase (IMPDH) activity in liver transplant patients. Clin Res Hepatol Gastroenterol 2020; 44:543-550. [PMID: 31924555 DOI: 10.1016/j.clinre.2019.12.001] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Due to the development of immunosuppressants, the focus in transplanted patients has shifted from short-term to long-term survival as well as a better adjustment of these drugs in order to prevent over- and under-immunosuppression. Mycophenolic acid (MPA) is a noncompetitive inhibitor of inosine monophosphate dehydrogenase (IMPDH) and approved for prophylaxis of acute rejection after kidney, heart, and liver transplantation, where it has become a part of the standard therapy. Targeting inosine monophosphate IMPDH activity as a surrogate pharmacodynamic marker of MPA-induced immunosuppression may allow a more accurate assessment of efficacy and aid in limiting toxicity in liver transplanted patients. AIM Assess IMPDH-inhibition in liver transplant recipients and its impact on biliary/infectious complications, acute cellular rejection (ACR) and liver dependent survival. METHODS This observational cohort study comprises 117 liver transplanted patients that were treated with mycophenolate mofetil (MMF) for at least 3 months. Blood samples (BS) were collected and MPA serum level and IMPDH activity were measured before (t(0)), 30minutes (t(30)) and 2h after (t(120)) MMF morning dose administration. Regarding MPA, we assessed the area under the curve (AUC). Patients were prospectively followed up for one year and assessed for infectious and biliary complications, episodes of ACR and liver dependent survival. RESULTS The MPA levels showed a broad interindividual variability at t(0) (2.0±1.8ng/ml), t(30) (12.7±9.0ng/ml) and t(120) (7.5±4.3ng/ml). Corresponding IMPDH activity was at t(o) (23.2±9.5 nmol/h/mg), at t(30) (16.3±8.8 nmol/h/mg) and t(120) (18.2±8.7 nmol/h/mg). With regard to MPA level we found no correlation with infectious or biliary complications within the follow-up period. Patients with baseline IMPDH(a) below the median had significant more viral infections (6 (10.2%) vs. 17 (29.3%); P=0.009) with especially more cytomegalovirus (CMV) infections (1 (3.4%) vs. 6 (21.4%); P=0.03)). Furthermore, patients with baseline IMPDH(a) above the median developed more often non-anastomotic biliary strictures (8 (13.6%) vs. 1 (1.7%), P=0.03). We found the group reaching the combined clinical endpoint of death and re-transplantation showing significantly lower MPA baseline values (t(0) 0.9±0.7 vs. 2.1±1.8μg/ml Mann-Whitney-U: P=0.02). We calculated a simplified MPA(AUC) with the MPA level at baseline, 30 and 120minutes after MPA administration. Whereas we found no differences with regard to baseline characteristics at entry into the study patients with MPA (AUC) below the median experienced significantly more often the combined clinical endpoint (12.1% (7/58) vs. 0.0% (0/57); P=0.002) and had a reduced actuarial re-transplantation-free survival (1.0 year vs. 0.58 years; Log-rank: P=0.007) during the prospective one-year follow-up period. In univariate and multivariate analysis including gender, age, BMI, ACR, MPA (AUC) and IMPDH(a) only BMI, MPA (AUC) and IMPDH(a) were independently associated with reduced actuarial re-transplantation-free survival. CONCLUSION MPA-levels and IMPDH-activity in liver transplanted patients allows individual risk assessment. Patients with higher IMPDH inhibition acquire more often viral infections. Insufficient IMPDH inhibition is associated with development of non-anastomotic bile duct strictures and reduced re-transplantation-free survival.
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Affiliation(s)
- M Neuberger
- University Hospital Heidelberg, Internal Medicine IV, 69120 Heidelberg, Germany
| | - C Sommerer
- University Hospital Heidelberg, Division of Nephrology, 69120 Heidelberg, Germany
| | - S Böhnisch
- University Hospital Heidelberg, Division of Nephrology, 69120 Heidelberg, Germany
| | - N Metzendorf
- University Hospital Heidelberg, Division of Nephrology, 69120 Heidelberg, Germany
| | - A Mehrabi
- University of Heidelberg, Department of General, Visceral, and Transplantation Surgery, 69120 Heidelberg, Germany
| | - W Stremmel
- University Hospital Heidelberg, Internal Medicine IV, 69120 Heidelberg, Germany
| | - D Gotthardt
- University Hospital Heidelberg, Internal Medicine IV, 69120 Heidelberg, Germany
| | - M Zeier
- University Hospital Heidelberg, Division of Nephrology, 69120 Heidelberg, Germany
| | - K H Weiss
- University Hospital Heidelberg, Internal Medicine IV, 69120 Heidelberg, Germany
| | - C Rupp
- University Hospital Heidelberg, Internal Medicine IV, 69120 Heidelberg, Germany.
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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Affiliation(s)
| | | | | | - E. Ritz
- Department of Internal Medicine University of Heidelberg 6900 Heidelberg FRG
| | - J. Rau
- Department of Surgery St. Josefs-Krankenhaus Heidelberg FRG
| | - S. Pomer
- Department of Urology University of Heidelberg 6900 Heidelberg FRG
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Schaier M, Wolf RC, Kubera K, Nagel S, Bartsch A, Zeier M, Bendszus M, Herweh C. Vasogenic Brain Edema During Maintenance Hemodialysis : Preliminary Results from Tract-based Spatial Statistics and Voxel-based Morphometry. Clin Neuroradiol 2019; 31:217-224. [PMID: 31848644 DOI: 10.1007/s00062-019-00865-2] [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: 06/10/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hemodialysis (HD), especially when first initiated, can cause neurological deterioration. Presumably this is due to transient cerebral edema, which has been observed using diffusion weighted magnetic resonance imaging (MRI) in experimental and human studies; however, this has not been investigated under maintenance hemodialysis (mHD). Moreover, there are no studies to date investigating regional effects of mHD on grey and white matter volumes. METHODS In this study eight patients with end stage renal disease (ESRD) were examined immediately before and after mHD sessions with multimodal MRI, including diffusion tensor imaging (DTI) and high-resolution structural imaging. Additionally, eight healthy, age-matched and sex-matched controls were examined for comparison. Data were analyzed using tract-based spatial statistics and voxel-based morphometry. RESULTS At baseline, ESRD patients had significantly reduced values of fractional anisotropy (FA) and axial diffusivity as well as bilaterally reduced grey matter volume in the insula, compared with controls. After the mHD session, FA further decreased while axial, radial, and mean diffusivity significantly increased ubiquitously throughout the white matter. Voxel-based morphometry revealed a corresponding significant increase in white matter volume in the central right hemisphere and splenium, as well as in cortical grey matter in the anterior medial frontal and cingulate cortex. None of the patients showed neurological deterioration. CONCLUSION In this study ESRD patients showed white matter changes indicative of chronic microstructural damage when compared with healthy controls, as previously reported. In addition, patients showed signs of a transient extracellular cerebral edema, which has not yet been observed in the absence of neurological symptoms.
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Affiliation(s)
- M Schaier
- Department of Medicine I (Nephrology), University Hospital Heidelberg, Heidelberg, Germany
| | - R C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - K Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - S Nagel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Bartsch
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - M Zeier
- Department of Medicine I (Nephrology), University Hospital Heidelberg, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - C Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Kulu Y, Fathi P, Golriz M, Khajeh E, Sabagh M, Ghamarnejad O, Mieth M, Ulrich A, Hackert T, Müller-Stich B, Strobel O, Michalski C, Morath C, Zeier M, Büchler M, Mehrabi A. Impact of Surgeon's Experience on Vascular and Haemorrhagic Complications After Kidney Transplantation. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2018.12.015] [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]
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Zeisbrich M, Becker N, Benner A, Radujkovic A, Schmitt K, Beimler J, Ho AD, Zeier M, Dreger P, Luft T. Transplant-associated thrombotic microangiopathy is an endothelial complication associated with refractoriness of acute GvHD. Bone Marrow Transplant 2017. [PMID: 28650448 DOI: 10.1038/bmt.2017.119] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is increasing evidence that endothelial dysfunction is involved in refractoriness of acute GvHD (aGvHD). Here we investigated the hypothesis that another endothelial complication, transplant-associated thrombotic microangiopathy (TMA), contributes to the pathogenesis of aGvHD refractoriness. TMA was retrospectively assessed in 771 patients after allogeneic stem cell transplantation (alloSCT). Incidences of TMA and refractory aGvHD were correlated with biomarkers of endothelial damage obtained before alloSCT for patients receiving or not receiving statin-based endothelial prophylaxis (SEP). Diagnostic criteria for TMA and refractory aGvHD were met by 41 (5.3%) and 76 (10%) patients, respectively. TMA was overrepresented in patients with refractory aGvHD (45.0 vs 2.3% in all other patients, P<0.001). TMA independently increased mortality. Elevated pretransplant suppressor of tumorigenicity-2 and nitrates along with high-risk variants of the thrombomodulin gene were associated with increased risk of TMA. In contrast, SEP abolished the unfavorable outcome predicted by pretransplant biomarkers on TMA risk. Patients on SEP had a significantly lower risk of TMA (P=0.001) and refractory aGvHD (P=0.055) in a multivariate multistate model. Our data provide evidence that TMA contributes to the pathogenesis of aGvHD refractoriness. Patients with an increased TMA risk can be identified pretransplant and may benefit from pharmacological endothelium protection.
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Affiliation(s)
- M Zeisbrich
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - N Becker
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - A Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - A Radujkovic
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - K Schmitt
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - J Beimler
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - A D Ho
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - M Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - P Dreger
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - T Luft
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
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Klein K, Rübenacker S, Schaefer SM, Kihm LP, Schwenger V, Macher-Goeppinger S, Schemmer P, Süsald C, Zeier M, Morath C, Becker LE. Tissue Expression of Aquaporin 2 Is Correlated to Urine Output and Allograft Function in Sensitized Kidney Transplant Patients. Transplant Proc 2017; 48:2629-2636. [PMID: 27788793 DOI: 10.1016/j.transproceed.2016.06.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 05/05/2016] [Accepted: 06/06/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Salt and water disturbances often occur during acute kidney allograft dysfunction that contribute to graft failure, but this condition has been poorly investigated in the alloreactivity setting. We evaluated the tissue expression of aquaporins (AQP1 and AQP2) and the epithelial sodium channel (ENAC) in kidney biopsy specimens from sensitized kidney transplant recipients. METHODS Eighty-six biopsy specimens from 33 sensitized patients were divided into 3 groups according to clinical context: time-zero (n = 9), protocol (n = 9), and indication (n = 68). The indication biopsy specimens were further divided into 3 subgroups according to the presence of acute tubular necrosis or rejection. Normal kidney tissue samples (n = 6) served as the control specimens. Immmunohistochemical expression of AQP1, AQP2, and ENAC was determined by using image analyzing software. RESULTS Significantly lower AQP1 expression was observed in the time-zero and indication biopsy specimens with rejection compared with control specimens (P = .03 and P = .04, respectively). AQP2 expression was significantly lower in patients with an indication biopsy specimen compared with control and protocol biopsy specimens (P = .05 and P = .005). For ENAC, a lower expression was noted in the indication biopsy specimens compared with the control specimens (P = .04). Both AQP1 and AQP2 tissue expressions were significantly correlated to urine output (r = 0.45 and r = 0.32; P = .001 and P = .02), and AQP2 was correlated with the glomerular filtration rate estimated by using the Modification of Diet in Renal Disease Study equation at biopsy (r = 0.23; P = .05). CONCLUSIONS These findings partially confirm previous experimental data showing downregulation of AQP1 expression after ischemia/reperfusion injury and during rejection. AQP2 downregulation seems to be rejection-independent, occurring during deteriorating or poor kidney graft function.
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Affiliation(s)
- K Klein
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - S Rübenacker
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - S M Schaefer
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - L P Kihm
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - V Schwenger
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - P Schemmer
- Department of Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - C Süsald
- Department of Transplant Immunology, University of Heidelberg, Heidelberg, Germany
| | - M Zeier
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - L E Becker
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany.
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Abstract
Atherosclerotic renal artery stenosis (ARAS) is one of the most relevant long-term complications of atherosclerotic disease. It is associated both with hypertension and increased renal and cardiovascular risk and overall mortality. Diagnostic modalities include non-invasive duplex ultrasound, dynamic magnetic resonance angiography (MRA) and computer tomography angiography (CTA) and are confirmed by using invasive renal angiography. Percutaneous revascularization of renal artery stenosis has been studied in various clinical trials. With regard to hypertension, several case series could show a clinical response to revascularization. However, the majority of randomized clinical trials could not confirm the correlation between intervention and the improvement of hypertension, kidney function, cardiovascular events, and mortality. Based on this predication the crucial tool in the treatment of ARAS is an optimal medical therapy, including statins, antihypertensive agents and platelet inhibition. Today the core point is to select subgroups and appropriate indications for better outcomes and avoiding unnecessary procedures very carefully. Therefore in patients with typical manifestations of ARAS including resistant or malignant hypertension, progressive decline of renal function, flash pulmonary edema or angina, renal artery intervention remains a sensible therapeutic option - after hemodynamic testing prior to revascularization. In the future further trials targeting patients who fulfill rational selection criteria need to be undertaken to confirm the efficacy of revascularization.
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Affiliation(s)
- M C Kihm
- Division of Nephrology, University of Heidelberg, Germany
| | - B Vogel
- Department of Cardiology, University of Heidelberg, Germany
| | - M Zeier
- Division of Nephrology, University of Heidelberg, Germany
| | - L P Kihm
- Department of Endocrinology and Clinical Chemistry, University of Heidelberg, Germany
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Schaefer SM, Süsal C, Opelz G, Döhler B, Becker LE, Klein K, Sickmüller S, Waldherr R, Macher-Goeppinger S, Schemmer P, Beimler J, Zeier M, Morath C. Pre-transplant soluble CD30 in combination with total DSA but not pre-transplant C1q-DSA predicts antibody-mediated graft loss in presensitized high-risk kidney transplant recipients. HLA 2016; 87:89-99. [DOI: 10.1111/tan.12735] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 12/11/2015] [Accepted: 01/04/2016] [Indexed: 02/01/2023]
Affiliation(s)
- S. M. Schaefer
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
| | - C. Süsal
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - G. Opelz
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - B. Döhler
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - L. E. Becker
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
| | - K. Klein
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
| | - S. Sickmüller
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
| | - R. Waldherr
- Department of Pathology; University of Heidelberg; Heidelberg Germany
| | | | - P. Schemmer
- Division of Transplantation Surgery; University of Heidelberg; Heidelberg Germany
| | - J. Beimler
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
| | - M. Zeier
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
| | - C. Morath
- Division of Nephrology; University Hospital of Heidelberg; Heidelberg Germany
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11
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Wagner MI, Jöst M, Spratte J, Schaier M, Mahnke K, Meuer S, Zeier M, Steinborn A. Differentiation of ICOS+ and ICOS- recent thymic emigrant regulatory T cells (RTE T regs) during normal pregnancy, pre-eclampsia and HELLP syndrome. Clin Exp Immunol 2015; 183:129-42. [PMID: 26285098 DOI: 10.1111/cei.12693] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/24/2022] Open
Abstract
Two different subsets of naturally occurring regulatory T cells (nTregs), defined by their expression of the inducible co-stimulatory (ICOS) molecule, are produced by the human thymus. To examine the differentiation of ICOS(+) and ICOS(-) CD45RA(+) CD31(+) recent thymic emigrant (RTE) T regs during normal pregnancy and in the presence of pre-eclampsia or haemolysis elevated liver enzymes low platelet (HELLP)-syndrome, we used six-colour flow cytometric analysis to determine the changes in the composition of the ICOS(+) and ICOS(-) T reg pools with CD45RA(+) CD31(+) RTE T regs, CD45RA(+) CD31(-) mature naive (MN) T regs, CD45RA(-) CD31(+) and CD45RA(-) CD31(-) memory Tregs. With the beginning of pregnancy until term, we observed a strong differentiation of both ICOS(+) and ICOS(-) CD45RA(+) CD31(+) RTE, but not CD45RA(+) CD31(-) MN T regs, into CD45RA(-) CD31(-) memory T regs. At the end of pregnancy, the onset of spontaneous term labour was associated with a significant breakdown of ICOS(+) CD45RA(-) CD31(-) memory T regs. However, in the presence of pre-eclampsia, there was a significantly increased differentiation of ICOS(+) and ICOS(-) CD45RA(+) CD31(+) RTE T regs into CD45RA(-) CD31(+) memory T regs, wherein the lacking differentiation into CD45RA(-) CD31(-) memory T regs was partially replaced by the increased differentiation of ICOS(+) and ICOS(-) CD45RA(+) CD31(-) MN Tregs into CD45RA(-) CD31(-) memory T regs. In patients with HELLP syndrome, this alternatively increased differentiation of CD45RA(-) CD31(-) MN T regs seemed to be exaggerated, and presumably restored the suppressive activity of magnetically isolated ICOS(+) and ICOS(-) T regs, which were shown to be significantly less suppressive in pre-eclampsia patients, but not in HELLP syndrome patients. Hence, our findings propose that the regular differentiation of both ICOS(+) and ICOS(-) CD45RA(+) CD31(+) RTE T regs ensures a healthy pregnancy course, while their disturbed differentiation is associated with the occurrence of pre-eclampsia and HELLP syndrome.
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Affiliation(s)
- M I Wagner
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - M Jöst
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - J Spratte
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - M Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - K Mahnke
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - S Meuer
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - M Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - A Steinborn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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Schwenger V, Hankel V, Seckinger J, Macher-Göppinger S, Morath C, Zeisbrich M, Zeier M, Kihm LP. Contrast-enhanced ultrasonography in the early period after kidney transplantation predicts long-term allograft function. Transplant Proc 2015; 46:3352-7. [PMID: 25498050 DOI: 10.1016/j.transproceed.2014.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Real-time contrast-enhanced sonography (CES) can assess microvascular tissue perfusion using gas-filled microbubbles. The purpose of the study was to evaluate the feasibility of early CES in predicting long-term kidney allograft function in comparison to color Doppler ultrasonography (CDUS). METHODS We prospectively studied 68 consecutive kidney transplant recipients using CES and conventional CDUS investigation 1 week after transplantation. Transplant tissue perfusion imaging was performed by low-power imaging during intravenous administration of the sonocontrast SonoVue. Renal tissue perfusion was assessed quantitatively using flash replenishment kinetics of microbubbles to estimate renal blood flow (RBF). The obtained sonography values were correlated with clinical data 1 week up to 1 year after transplantation. RESULTS In contrast with conventional CDUS resistive indices, RBF estimated by CES 1 week posttransplantation significantly correlated with kidney function after 1 year (r = 0.67; P < .001). Determination of RBF by CES revealed a significant correlation with donor age but not recipient age, whereas conventional CDUS resistive index was significantly correlated to recipient age (r = 0.54; P < .001) but not donor age. Furthermore RBF was associated with vascular fibrosis and intimal thickening of the engraftment biopsies. CONCLUSION This is the first prospective study demonstrating the prognostic value of CES early after kidney transplantation. In contrast with CDUS, CES reveals information about kidney allograft perfusion independent of recipient vascular compliance.
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Affiliation(s)
- V Schwenger
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - V Hankel
- Department of Radiation Oncology, University of Munich, Munich, Germany
| | - J Seckinger
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | | | - C Morath
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - M Zeisbrich
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - M Zeier
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - L P Kihm
- Department of Nephrology, University Hospital, Heidelberg, Germany; Department of Endocrinology, University Hospital, Heidelberg, Germany.
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Ritz E, Jones E, Waldherr R, Zeier M. The patient with ADPKD on maintenance hemodialysis. Contrib Nephrol 2015; 115:33-8. [PMID: 8585916 DOI: 10.1159/000424393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- E Ritz
- Department of Internal Medicine and Pathology, Ruperto Carola University, Heidelberg, Germany
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Bommer J, Barth HP, Zeier M, Mandelbaum A, Bommer G, Ritz E, Reichel H, Novack R. Efficacy comparison of intravenous and subcutaneous recombinant human erythropoietin administration in hemodialysis patients. Contrib Nephrol 2015; 88:136-43. [PMID: 2040175 DOI: 10.1159/000419523] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Bommer
- I. Medizinische Universitätsklinik Heidelberg, FRG
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15
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Jing J, Kielstein JT, Schultheiss UT, Sitter T, Titze SI, Schaeffner ES, McAdams-DeMarco M, Kronenberg F, Eckardt KU, Kottgen A, for the GCKD Study Investigators, Eckardt KU, Titze S, Prokosch HU, Barthlein B, Reis A, Ekici AB, Gefeller O, Hilgers KF, Hubner S, Avendano S, Becker-Grosspitsch D, Hauck N, Seuchter SA, Hausknecht B, Rittmeier M, Weigel A, Beck A, Ganslandt T, Knispel S, Dressel T, Malzer M, Floege J, Eitner F, Schlieper G, Findeisen K, Arweiler E, Ernst S, Unger M, Lipski S, Schaeffner E, Baid-Agrawal S, Petzold K, Schindler R, Kottgen A, Schultheiss U, Meder S, Mitsch E, Reinhard U, Walz G, Haller H, Lorenzen J, Kielstein JT, Otto P, Sommerer C, Follinger C, Zeier M, Wolf G, Busch M, Paul K, Dittrich L, Sitter T, Hilge R, Blank C, Wanner C, Krane V, Schmiedeke D, Toncar S, Cavitt D, Schonowsky K, Borner-Klein A, Kronenberg F, Raschenberger J, Kollerits B, Forer L, Schonherr S, Weissensteiner H, Oefner P, Gronwald W, Zacharias H, Schmid M. Prevalence and correlates of gout in a large cohort of patients with chronic kidney disease: the German Chronic Kidney Disease (GCKD) study. Nephrol Dial Transplant 2014; 30:613-21. [DOI: 10.1093/ndt/gfu352] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Abstract
The one common factor in solid organ transplantation is the need for lifelong maintenance immunosuppression. Drug regimens after organ transplantation typically comprise a combination of different immunosuppressive drugs. In most cases a triple drug regimen with different mechanisms of action is used. The aim is to improve both patient and graft survival while minimizing potential side effects of immunosuppressive medication. The basis of most immunosuppressive regimens is calcineurin inhibitors in combination with mycophenolic acid. There are various stages of immunosuppression after solid organ transplantation involving induction therapy, initial and long-term maintenance therapy. In each phase an individual combination of immunosuppressants is set up depending on the risk profile of the individual patient to prevent transplant rejection and organ loss. Based on these considerations, concepts of calcineurin inhibitor or steroid reduction have been established in transplant medicine in recent years. The key role in terms of development of new immunosuppressive strategies is taken by kidney transplantation, the most common solid organ transplantation performed.
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Affiliation(s)
- J Beimler
- Sektion Nephrologie, Nierenzentrum Heidelberg, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland,
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Breitkreutz I, Heiss C, Perne A, Beimler J, Jäger D, Egerer G, Ho AD, Neben K, Zeier M, Goldschmidt H, Raab MS. Bortezomib improves outcome after SCT in multiple myeloma patients with end-stage renal failure. Bone Marrow Transplant 2014; 49:1371-5. [DOI: 10.1038/bmt.2014.165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/17/2014] [Accepted: 06/13/2014] [Indexed: 01/03/2023]
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Affiliation(s)
- D H Krüger
- Institut für Med. Virologie, Helmut-Ruska-Haus, Charité - Universitätsmedizin Berlin, und Fachbereich Virologie, Labor Berlin Charité-Vivantes GmbH, 10117 Berlin
| | - J Hofmann
- Institut für Med. Virologie, Helmut-Ruska-Haus, Charité - Universitätsmedizin Berlin, und Fachbereich Virologie, Labor Berlin Charité-Vivantes GmbH, 10117 Berlin
| | | | - M Zeier
- Nephrologie, Universitätsklinikum Heidelberg
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Berthelot L, Robert T, Tabary T, Vuiblet V, Drame M, Toupance O, Rieu P, Monteiro RC, Toure F, Ferrario S, Cantaluppi V, De Lena M, Dellepiane S, Beltramo S, Rossetti M, Manzione AM, Messina M, Gai M, Dolla C, Biancone L, Camussi G, Pontrelli P, Oranger AR, Accetturo M, Rascio F, Gigante M, Castellano G, Schena A, Fiorentino M, Zito A, Zaza G, Stallone G, Gesualdo L, Grandaliano G, Pattonieri EF, Gregorini M, Corradetti V, Rocca C, Milanesi S, Peloso A, Ferrario J, Cannone M, Bosio F, Maggi N, Avanzini MA, Minutillo P, Paulli M, Maestri M, Rampino T, Dal Canton A, Wu KST, Coxall O, Luque Y, Candon S, Rabant M, Noel LH, Thervet E, Chatenoud L, Snanoudj R, Anglicheau D, Legendre C, Zuber J, Hruba P, Brabcova I, Krepsova E, Slatinska J, Sekerkova A, Striz I, Zachoval R, Viklicky O, Scholbach TM, Wang HK, Loong CC, Yang AH, Wu TH, Hruba P, Brabcova I, Krepsova E, Slatinska J, Sekerkova A, Striz I, Zachoval R, Viklicky O, Guberina H, Rebmann V, Dziallas P, Dolff S, Wohlschlaeger J, Heinemann FM, Witzke O, Zoet YM, Claas FHJ, Horn PA, Kribben A, Doxiadis IIN, Prasad N, Yadav B, Agarwal V, Jaiswal A, Rai M, Hope CM, Coates PT, Heeger PS, Carroll R, Zaza G, Masola V, Secchi MF, Onisto M, Gambaro G, Lupo A, Matsuyama M, Kobayashi T, Yoneda Y, Chargui J, Touraine JL, Yoshimura R, Vizza D, Perri A, Lupinacci S, Toteda G, Lofaro D, Leone F, Gigliotti P, La Russa A, Papalia T, Bonofilgio R, Sentis Fuster A, Kers J, Yapici U, Claessen N, Bemelman FJ, Ten Berge IJM, Florquin S, Glotz D, Rostaing L, Squifflet JP, Merville P, Belmokhtar C, Le Ny G, Lebranchu Y, Papazova DA, Friederich-Persson M, Koeners MP, Joles JA, Verhaar MC, Trivedi HL, Vanikar AV, Dave SD, Suarez Alvarez B, Garcia Melendreras S, Carvajal Palao R, Diaz Corte C, Ruiz Ortega M, Lopez-Larrea C, Yadav AK, Bansal D, Kumar V, Kumar V, Minz M, Jha V, Kaminska D, Koscielska-Kasprzak K, Chudoba P, Mazanowska O, Banasik M, Zabinska M, Boratynska M, Lepiesza A, Korta K, Klinger M, Csohany R, Prokai A, Pap D, Balicza-Himer N, Vannay A, Fekete A, Kis-Petik K, Peti-Peterdi J, Szabo A, Masajtis-Zagajewska A, Muras K, Niewodniczy M, Nowicki M, Pascual J, Srinivas TR, Chadban S, Citterio F, Henry M, Legendre C, Oppenheimer F, Lee PC, Tedesco-Silva H, Zeier M, Watarai Y, Dong G, Hexham M, Bernhardt P, Vincenti F, Rocchetti MT, Pontrelli P, Rascio F, Fiorentino M, Zito A, Stallone G, Gesualdo L, Grandaliano G, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Su owicz W, Dellepiane S, Cantaluppi V, Mitsuhashi M, Murakami T, Benso A, Biancone L, Camussi G, Scholbach TM, Wang HK, Loong CC, Wu TH, Leuning D, Reinders M, Lievers E, Duijs J, Van Zonneveld AJ, Van Kooten C, Engelse M, Rabelink T, Assounga A, Omarjee S, Ngema Z, Ersoy A, Gultepe A, Isiktas Sayilar E, Akalin H, Coskun F, Oner Torlak M, Ayar Y, Riegersperger M, Plischke M, Steinhauser C, Jallitsch-Halper A, Sengoelge G, Winkelmayer WC, Sunder-Plassmann G, Foedinger M, Kaziuk M, Kuz'Niewski M, Ignacak E, B Tkowska- Prokop A, Pa Ka K, Dumnicka P, Kolber W, Su Owicz W. TRANSPLANTATION BASIC SCIENCE, ALLOGENIC AND XENOGENIC TOLERANCE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu179] [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: 11/14/2022] Open
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Schlossberger V, Schober L, Rehnitz J, Schaier M, Zeier M, Meuer S, Schmitt E, Toth B, Strowitzki T, Steinborn A. The success of assisted reproduction technologies in relation to composition of the total regulatory T cell (Treg) pool and different Treg subsets. Hum Reprod 2013; 28:3062-73. [DOI: 10.1093/humrep/det316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Gombos P, Opelz G, Scherer S, Morath C, Zeier M, Schemmer P, Süsal C. Influence of test technique on sensitization status of patients on the kidney transplant waiting list. Am J Transplant 2013; 13:2075-82. [PMID: 23841891 DOI: 10.1111/ajt.12332] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 11/07/2012] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 01/25/2023]
Abstract
The exquisitely sensitive single antigen bead (SAB) technique was shown to detect human leukocyte antigen (HLA) antibodies in sera of healthy male blood donors. Such false reactions can have an impact on critical decisions, especially with respect to the determination of unacceptable HLA-antigen mismatches in patients awaiting a kidney transplant. We tested pretransplant sera of 534 patients on the kidney waiting list using complement-dependent cytotoxicity (CDC), enzyme-linked immunosorbent assay (ELISA) and SAB in parallel. Evidence of HLA antibodies was obtained in 5% of patients using CDC, 14% using ELISA, and 81% using SAB. Among patients without history of an immunizing event, 77% showed evidence of HLA antibodies in SAB. In contrast 98% of these patients were negative in ELISA and CDC. In patients without an immunizing event, SAB-detected antibodies reacted not always weakly but with mean fluorescence intensity (MFI) values as high as 14 440. High-MFI-value antibodies were found in some of these patients with HLA specificities that are rather common in general population, consideration of which would lead to unjustified exclusion of potential kidney donors. False SAB reactions can be unveiled by testing with additional antibody assays. Denial of donor kidneys to recipients based on HLA-antibody specificities detected exclusively in the SAB assay is not advisable.
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Affiliation(s)
- P Gombos
- Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany
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22
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Riediger C, Beimler J, Weitz J, Zeier M, Sauer P. Cytomegalovirus infection of the major duodenal papilla in a renal allograft recipient with severe biliary obstruction and acalculous cholecystitis. Transpl Infect Dis 2013; 15:E129-33. [PMID: 23790000 DOI: 10.1111/tid.12105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 09/03/2012] [Revised: 01/14/2013] [Accepted: 02/26/2013] [Indexed: 01/11/2023]
Abstract
Cytomegalovirus (CMV) can cause severe infections with serious consequences in renal transplant recipients. Disseminated CMV infections can affect almost every organ, but obstructive cholestasis and cholangitis, as a consequence of a CMV-induced papillitis, is extremely rare. We are reporting a rare case of obstructive cholestasis and cholecystitis due to CMV-related inflammation of the major duodenal papilla in a 60-year-old woman 3 months after renal transplantation. In addition, the patient suffered from a disseminated CMV infection with ulcerative esophagitis and gastritis. Because of the severe CMV infection, failure of the renal graft occurred. Obstructive cholestasis was resolved through internal stenting, and the progressive cholecystitis necessitated an emergency cholecystectomy. Following antiviral therapy with ganciclovir, the gastrointestinal ulcerations regressed and renal function was restored. Diagnosis of the CMV-related disease was established only in tissue samples, whereas standard serologic tests had failed.
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Affiliation(s)
- C Riediger
- Department of Hepatology, University of Heidelberg, Heidelberg, Germany.
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Abstract
Currently, there are two major options for the successful and timely transplantation of sensitized kidney transplant recipients: (1) avoidance of the sensitization barrier using special allocation programs, or (2) desensitization. In the case of broadly sensitized kidney patients, a combination of both options might be necessary. This review focuses on new advances in desensitization of crossmatch-positive kidney transplant recipients which include immunoadsorption and the administration of new substances such as the complement C5 inhibitor eculizumab. Finally, integrated algorithms that combine different measures are acknowledged.
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Affiliation(s)
- C Morath
- Department of Nephrology, University of Heidelberg, Germany
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Rheinheimer S, Schneider F, Stieltjes B, Morath C, Zeier M, Kauczor HU, Hallscheidt P. IVIM-DWI of transplanted kidneys: reduced diffusion and perfusion dependent on cold ischemia time. Eur J Radiol 2012; 81:e951-6. [PMID: 22785337 DOI: 10.1016/j.ejrad.2012.06.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/15/2012] [Accepted: 06/17/2012] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the effect of cold ischemia time (CIT) of renal allografts on diffusion and perfusion using intravoxel incoherent motion (IVIM) derived parameters. MATERIAL AND METHODS A total of 37 patients with renal allografts (CIT: 27 <15 h, 10 ≥15 h) and 30 individuals with healthy kidneys were examined at 1.5 T using a single-shot echo-planar diffusion-weighted pulse sequence with nine b-values ranging from 0 to 800 s/mm(2). ADC, perfusion fraction f, and the diffusion coefficient D were calculated using the IVIM model. Parameters of allografts stratified by CIT were compared with healthy kidney groups using the Mann-Whitney U test for unpaired data. We computed the Spearman correlation coefficient for correlation with creatinine values. RESULTS ADC, D, and f of transplanted kidneys were significantly lower than in the healthy controls. The long-CIT group showed significantly lower diffusion parameters compared with the short-CIT group [mean±SD]: ADC: 1.63±0.14 μm(2)/ms, f: 11.90±5.22%, D: 1.55±0.25 μm(2)/ms versus ADC: 1.79±0.13 μm(2)/ms, f: 16.12±3.43%, D: 1.73±0.14 μm(2)/ms, P(ADC), (f), (D)<0.05. CONCLUSION Our results suggest that diffusion parameters, especially the ADC, depend on the CIT of the kidney allograft. Potentially, this stands for functional changes in renal allografts. Diffusion-weighted imaging could be used for follow-up examinations. Thus, diffusion parameters may help guide therapy in patients with delayed graft function.
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Affiliation(s)
- S Rheinheimer
- Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
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Pirson Y, Chauveau D, Watson ML, Zeier M, Breuning M. La polykystose autosomique dominante : progrès cliniques et génétiques. ACTA ACUST UNITED AC 2012. [DOI: 10.4267/10608/298] [Citation(s) in RCA: 2] [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: 11/30/2022]
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Wagener N, Nyarangi-Dix J, Teber D, Zeier M, Hohenfellner M. Applicability of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Allograft Recipients. Transplant Proc 2012; 44:1287-92. [DOI: 10.1016/j.transproceed.2012.01.120] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
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Cerini C, Gondouin B, Dou L, Duval-Sabatier A, Brunet P, Dignat- George F, Burtey S, Okano K, Okano K, Iwasaki T, Jinnai H, Hibi A, Miwa N, Kimata N, Nitta K, Akiba T, Dolley-Hitze T, Verhoest G, Jouan F, Arlot-Bonnemains Y, Lavenu A, Belaud-Rotureau MA, Rioux-Leclercq N, Vigneau C, Cox SN, Sallustio F, Serino G, Loverre A, Pesce F, Gigante M, Zaza G, Stifanelli P, Ancona N, Schena FP, Marc P, Jacques T, Green JM, Mortensen RB, Verma R, Leu K, Schatz PJ, Wojchowski DM, Ihoriya C, Satoh M, Sasaki T, Kashihara N, Jung YJ, Kang KP, Lee AS, Lee JE, Lee S, Park SK, Kim W, Kang KP, Florian T, Tepel M, Ying L, Katharina K, Nora F, Antje W, Alexandra S, Chiu YT, Wu MJ, Liu ZH, Liang Y, Zheng CX, Chen ZH, Zeng CH, Ranzinger J, Rustom A, Kihm L, Heide D, Scheurich P, Zeier M, Schwenger V, Liu J, Liu J, Zhong F, Xu L, Zhou Q, Hao X, Wang W, Chen N, Zhong F, Zhong F, Liu X, Zhou Q, Hao X, Lu Y, Guo S, Wang W, Lin D, Chen N, Vilasi A, Deplano S, Deplano S, Cutillas P, Unwin R, Tam FWK, Medrano-Andres D, Lopez-Martinez V, Martinez-Miguel P, Cano JL, Arribas I, Rodiguez-Puyol M, Lopez-Ongil S, Kadoya H, Nagasu H, Satoh M, Sasaki T, Kashihara N, Lindeberg E, Grundstrom G, Alexandra S, Tepel M, Katharina K, Alexandra M, Ghosh CC, David S, Mukherjee A, John SG, Mcintyre CW, Haller H, Parikh SM, Troyano N, Del Nogal M, Olmos G, Mora I, DE Frutos S, Rodriguez-Puyol M, Ruiz MP, Rothe H, Rothe H, Shapiro W, Ketteler M, Ramakrishnan SK, Loupy A, Houillier P, Guilhermino Pereira L, Boim M, Aragao D, Casarini D, Jin Y, Jin Y, Chen N, Moon JY, Kim YG, Lee SH, Lee TW, Ihm CG, Kim EY, Lee HJ, Wi JG, Jeong KH, Ruan XZ, LI LC, Varghese Z, Chen JB, Lee CT, Moorhead J, Dou L, Gondouin B, Cerini C, Poitevin S, Brunet P, Dignat-George F, Stephane B, Bonanni A, Verzola D, Maggi D, Brunori G, Sofia A, Mannucci I, Maffioli S, Salani B, D'amato E, Saffioti S, Laudon A, Cordera R, Garibotto G, Maquigussa E, Boim M, Arnoni C, Guilhermino Pereira L. Cell signalling / Pathophysiology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs213] [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: 11/12/2022] Open
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Adamczak M, Koleganova N, Nyengaard JR, Ritz E, Wiecek A, Slabiak Blaz N, Yi Chun DX, Alexandre H, Sandrine GS, Olivier T, Isabelle E, Christophe L, Guy T, Pierre Francois W, Jean-Philippe R, Yvon L, Eric R, Muller-Krebs S, Muller-Krebs S, Weber L, Tsobaneli J, Reiser J, Zeier M, Schwenger V, Tinel C, Samson M, Bonnotte B, Mousson C, Machcinska M, Machcinska M, Bocian K, Wyzgal M, Korczak-Kowalska G, Ju MK, Huh KH, Park KT, Kim SJ, Cho BH, Kim CD, So BJ, Leee S, Kang CM, Joo DJ, Kim YS, Bocian K, Zarzycki M, Sobich A, Korczak-Kowalska G, Matsuyama M, Hase T, Yoshimura R, Koshino K, Sakai K, Suzuki T, Nobori S, Ushigome H, Brikci-Nigassa L, Chargui J, Touraine JL, Yoshimura N, Cantaluppi V, Medica D, Figliolini F, Migliori M, Mannari C, Dellepiane S, Quercia AD, Randone O, Tamagnone M, Messina M, Manzione AM, Ranghino A, Biancone L, Segoloni GP, Camussi G, Turk TR, Zou X, Rauen U, De Groot H, Amann K, Kribben A, Eckardt KU, Bernhardt WM, Witzke O, Lidia G, Wouter C, Yvon L, Eric A, Yann LM, Guy T, Christian N, Marie E, Pierre M, Zineb A, Miriana D, Annick M, Marc A, Daniel A, Wornle M, Ribeiro A, Motamedi N, Grone HJ, Cohen CD, Schlondorff D, Schmid H, Teplan V, Banas M, Banas B, Steege A, Bergler T, Kruger B, Schnulle P, Yard B, Kramer BK, Hoger S, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Zaza G, Rascio F, Pontrelli P, Granata S, Rugiu C, Grandaliano G, Lupo A, Wohlfahrtova M, Wohlfahrtova M, Brabcova I, Balaz P, Janousek L, Lodererova A, Honsova E, Wohlfahrt P, Viklicky O, Grabner A, Grabner A, Kentrup D, Edemir B, Sirin Y, Pavenstadt H, Schober O, Schlatter E, Schafers M, Schnockel U, Reuter S, Rascio F, Pontrelli P, Accetturo M, Gigante M, Gigante M, Tataranni T, Zito A, Schena A, Schena FP, Stallone G, Gesualdo L, Grandaliano G, Maillard N, Masson I, Lena A, Manolie M, Eric A, Christophe M, Lassen CK, Keller AK, Moldrup U, Bibby BM, Jespersen B, Cvetkovic T, Velickovic Radovanovic R, Pavlovic R, Djordjevic V, Vlahovic P, Stefanovic N, Sladojevic N, Ignjatovic A, Rong S, Menne J, Haller H, Suszdak P, Tomczuk P, Gueler F, Nelli S, Sara D, Salma EK, Naoufal M, Tarik M, Mohamed Z, Guislaine M, Mohamed Gharbi B, Benyounes R, Lu X, Rong S, Shushakova N, Menne J, Kirsch T, Haller H, Gueler F, Bockmeyer CL, Bockmeyer CL, Ramackers W, Wittig J, Agustian PA, Klose J, Dammrich ME, Kreipe H, Brocker V, Winkler M, Becker JU, Agustian PA, Bockmeyer CL, Wittig J, Becker JU, Bockmeyer CL. Transplantation - basic. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs247] [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: 11/15/2022] Open
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Fleming T, Cuny J, Nawroth G, Djuric Z, Humpert PM, Zeier M, Bierhaus A, Nawroth PP. Is diabetes an acquired disorder of reactive glucose metabolites and their intermediates? Diabetologia 2012; 55:1151-5. [PMID: 22270223 DOI: 10.1007/s00125-012-2452-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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: 09/26/2011] [Accepted: 12/13/2011] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS We hypothesised that diabetic patients would differ from those without diabetes in regard to the handling of glucose-derived reactive metabolites, evidenced by triosephosphate intermediates (TP(INT)) and methylglyoxal (MG), irrespective of the type of diabetes, plasma glucose level or HbA(1c) value. METHODS To test this hypothesis, erythrocytes were isolated from patients with type 1 (n = 12) and type 2 (n = 12) diabetes with varying blood glucose and HbA(1c) levels. These were then compared with erythrocytes isolated from individuals without diabetes (n = 10), with respect to MG, as determined by HPLC, and TP(INT), as determined by endpoint enzymatic assays. RESULTS The concentrations of intracellular TP(INT) and MG were significantly elevated in erythrocytes from diabetic patients. Normalisation of either TP(INT) or MG to intracellular glucose concentration (nmol glucose/mgHb) confirmed that erythrocytes from diabetic patients accumulated more reactive metabolites than did those from healthy controls. CONCLUSIONS/INTERPRETATION Diabetic patients can be characterised by an increased formation of TP(INT) and MG. The 25-fold increase of MG in type 1 and the 15-fold increase in type 2 diabetes, together with a several-fold increase in TP(INT) and decreased glyceraldehyde-3-phosphate dehydrogenase activity even under normal glucose conditions, imply that normalising glucose level cannot completely prevent late diabetic complications until this acquired error of metabolism has been restored.
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Affiliation(s)
- T Fleming
- Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
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Steinborn A, Schmitt E, Kisielewicz A, Rechenberg S, Seissler N, Mahnke K, Schaier M, Zeier M, Sohn C. Pregnancy-associated diseases are characterized by the composition of the systemic regulatory T cell (Treg) pool with distinct subsets of Tregs. Clin Exp Immunol 2012; 167:84-98. [PMID: 22132888 DOI: 10.1111/j.1365-2249.2011.04493.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Dysregulations concerning the composition and function of regulatory T cells (T(regs)) are assumed to be involved in the pathophysiology of complicated pregnancies. We used six-colour flow cytometric analysis to demonstrate that the total CD4(+) CD127(low+/-) CD25(+) forkhead box protein 3 (FoxP3)(+) T(reg) cell pool contains four distinct T(reg) subsets: DR(high+) CD45RA(-), DR(low+) CD45RA(-), DR(-) CD45RA(-) T(regs) and naive DR(-) CD45RA(+) T(regs). During the normal course of pregnancy, the most prominent changes in the composition of the total T(reg) cell pool were observed between the 10th and 20th weeks of gestation, with a clear decrease in the percentage of DR(high+) CD45RA(-) and DR(low+) CD45RA(-) T(regs) and a clear increase in the percentage of naive DR(-) CD45RA(+) T(regs). After that time, the composition of the total T(reg) cell pool did not change significantly. Its suppressive activity remained stable during normally progressing pregnancy, but decreased significantly at term. Compared to healthy pregnancies the composition of the total T(reg) cell pool changed in the way that its percentage of naive DR(-) CD45RA(+) T(regs) was reduced significantly in the presence of pre-eclampsia and in the presence of preterm labour necessitating preterm delivery (PL). Interestingly, its percentage of DR(high+) CD45RA(-) and DR(low+) CD45RA(-) T(regs) was increased significantly in pregnancies affected by pre-eclampsia, while PL was accompanied by a significantly increased percentage of DR(-) CD45RA(-) and DR(low+) CD45RA(-) T(regs). The suppressive activity of the total T(reg) cell pool was diminished in both patient collectives. Hence, our findings propose that pre-eclampsia and PL are characterized by homeostatic changes in the composition of the total T(reg) pool with distinct T(reg) subsets that were accompanied by a significant decrease of its suppressive activity.
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Affiliation(s)
- A Steinborn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.
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Boeglin WU, Coman L, Ambrozewicz P, Aniol K, Arrington J, Batigne G, Bosted P, Camsonne A, Chang G, Chen JP, Choi S, Deur A, Epstein M, Finn JM, Frullani S, Furget C, Garibaldi F, Gayou O, Gilman R, Hansen O, Hayes D, Higinbotham DW, Hinton W, Hyde C, Ibrahim H, de Jager CW, Jiang X, Jones MK, Kaufman LJ, Klein A, Kox S, Kramer L, Kumbartzki G, Laget JM, LeRose J, Lindgren R, Margaziotis DJ, Markowitz P, McCormick K, Meziani Z, Michaels R, Milbrath B, Mitchell J, Monaghan P, Moteabbed M, Moussiegt P, Nasseripour R, Paschke K, Perdrisat C, Piasetzky E, Punjabi V, Qattan IA, Quéméner G, Ransome RD, Raue B, Réal JS, Reinhold J, Reitz B, Roché R, Roedelbronn M, Saha A, Slifer K, Solvignon P, Sulkosky V, Ulmer PE, Voutier E, Weinstein LB, Wojtsekhowski B, Zeier M. Probing the high momentum component of the deuteron at high Q2. Phys Rev Lett 2011; 107:262501. [PMID: 22243152 DOI: 10.1103/physrevlett.107.262501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Indexed: 05/31/2023]
Abstract
The (2)H(e,e'p)n cross section at a momentum transfer of 3.5 (GeV/c)(2) was measured over a kinematical range that made it possible to study this reaction for a set of fixed missing momenta as a function of the neutron recoil angle θ(nq) and to extract missing momentum distributions for fixed values of θ(nq) up to 0.55 GeV/c. In the region of 35°≤θ(nq)≤45° recent calculations, which predict that final-state interactions are small, agree reasonably well with the experimental data. Therefore, these experimental reduced cross sections provide direct access to the high momentum component of the deuteron momentum distribution in exclusive deuteron electrodisintegration.
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Affiliation(s)
- W U Boeglin
- Florida International University, University Park, Florida 33199, USA
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Kunze R, Witt S, Vienken J, Rie K, Masayoshi N, Aritoshi K, Yoshinaga O, Yukiko H, Takahiro K, Hiroshi N, Takeshi N, Aoki S, Makino J, Noguchi M, Yamasaki F, Toda S, Santiago J, Caparros G, Vozmediano C, Molina F, Javier L, Sara A, Minerva A, Romera A, Kihm L, Diekmann C, Seckinger J, Sommerer C, Morath C, Zeier M, Schwenger V, Teixeira L, Rodrigues A, Carvalho MJ, Cabrita A, Mendonca D. Peritoneal dialysis. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.25] [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: 11/13/2022] Open
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33
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Wornle M, Ribeiro A, Motamedi N, Nitschko H, Cohen CD, Grone HJ, Schlondorff D, Schmid H, Kislat C, Schmidt T, Janssen M, Wolf M, Dirks J, Ahlenstiel T, Pape L, Fliser D, Sester M, Sester U, Urbanova M, Brabcova I, Girmanova E, Ondrej V, Gregorini M, Rampino T, Rocca C, Valsania T, Corradetti V, Bosio F, Bedino G, Carrara C, Pattonieri EF, Soccio G, Esposito P, Dal Canton A, Becker LE, Morath C, Schaier M, Gross ML, Bierhaus A, Waldherr R, Nawroth P, Zeier M, Tataranni T, Biondi G, Cariello M, Mangino M, Colucci G, Rutigliano M, Ditonno P, Schena FP, Pertosa G, Gesualdo L, Grandaliano G. Transplantation / Basic research. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.4] [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: 11/12/2022] Open
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34
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Kihm LP, Zeier M, Morath C. Immunosuppression after kidney transplantation. MINERVA UROL NEFROL 2011; 63:45-57. [PMID: 21336245] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Today kidney transplantation features excellent short-term outcomes with decreasing acute rejection episodes. In contrast, improvement of long-term allograft survival is much less impressive over the last decades. Thus, the goal of current immunosuppressive therapies is keeping the balance between the reduction of acute rejection episodes and organ specific and systemic side effects. With the development of a broad armamentarium of new immunosuppressive agents with different mechanisms of action, the minimization or avoidance of corticosteroids and calcineurin inhibitors became feasible.
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Affiliation(s)
- L P Kihm
- Department of Nephrology, University Hospital, Heidelberg, Germany.
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35
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Goldwasser R, Tönshoff B, Zeier M. Epidemiologie und Prävalenz von Hantavirus-Infektionen bei pädiatrischen Patienten in Deutschland 2001-2010. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Seckinger J, Tönshoff B, Stremmel W, Zeier M, Schmidt J. Die kombinierte und sequentielle Leber-Nieren-Transplantation. Dtsch Med Wochenschr 2010. [DOI: 10.1055/s-0030-1248660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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Seckinger J, Tönshoff B, Stremmel W, Zeier M, Schmidt J. Die kombinierte und sequentielle Leber-Nieren-Transplantation. Dtsch Med Wochenschr 2010; 135:1973-8. [DOI: 10.1055/s-0030-1263345] [Citation(s) in RCA: 3] [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: 10/19/2022]
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38
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Slifer K, Rondón OA, Aghalaryan A, Ahmidouch A, Asaturyan R, Bloch F, Boeglin W, Bosted P, Carasco C, Carlini R, Cha J, Chen JP, Christy ME, Cole L, Coman L, Crabb D, Danagoulian S, Day D, Dunne J, Elaasar M, Ent R, Fenker H, Frlez E, Gaskell D, Gan L, Gomez J, Hu B, Jourdan J, Jones MK, Keith C, Keppel CE, Khandaker M, Klein A, Kramer L, Liang Y, Lichtenstadt J, Lindgren R, Mack D, McKee P, McNulty D, Meekins D, Mkrtchyan H, Nasseripour R, Niculescu I, Normand K, Norum B, Pocanic D, Prok Y, Raue B, Reinhold J, Roche J, Kiselev D, Savvinov N, Sawatzky B, Seely M, Sick I, Smith C, Smith G, Stepanyan S, Tang L, Tajima S, Testa G, Vulcan W, Wang K, Warren G, Wesselmann FR, Wood S, Yan C, Yuan L, Yun J, Zeier M, Zhu H. Probing quark-gluon interactions with transverse polarized scattering. Phys Rev Lett 2010; 105:101601. [PMID: 20867509 DOI: 10.1103/physrevlett.105.101601] [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] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 08/24/2010] [Indexed: 05/29/2023]
Abstract
We have extracted QCD matrix elements from our data on doubly polarized inelastic scattering of electrons on nuclei. We find the higher twist matrix element d˜2, which arises strictly from quark-gluon interactions, to be unambiguously nonzero. The data also reveal an isospin dependence of higher twist effects if we assume that the Burkhardt-Cottingham sum rule is valid. The fundamental Bjorken sum rule obtained from the a0 matrix element is satisfied at our low momentum transfer.
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Affiliation(s)
- K Slifer
- University of Virginia, Charlottesville, Virginia 22903, USA
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Fonouni H, Golriz M, Mehrabi A, Oweira H, Schmied BM, Müller SA, Jarahian P, Tahmasbi Rad M, Esmaeilzadeh M, Tönshoff B, Weitz J, Büchler MW, Zeier M, Schmidt J. The role of an interdisciplinary transplant team on living donation kidney transplantation program. Transplant Proc 2010; 42:137-40. [PMID: 20172299 DOI: 10.1016/j.transproceed.2009.12.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
During the last decades, the disparity between the organ supply and the demand for kidney transplantation in Europe has led to consider living donors as a more acceptable option. In the last 7 years, we have established an interdisciplinary supporting transplant team to increase the rate of living donation. After 2001, the new interdisciplinary transplant team consisted of a transplant surgeon, a nephrologist, a pediatrician, a radiologist, a psychologist, a transplant coordinator, and a transplant nurse. We performed a prospective analysis to examine the effect of implementing this team on our living donation program. Demographic data, the annual number of procedures, the duration of waiting, and the cold ischemia time were evaluated among brain-dead and living donors. From January 2002 until December 2008, the number of patients who were annually on the waiting list increased 42% (from 377 to 536 patients). Consequently, the number of the total kidney transplants increased from 81 to 120 with an annual median of 98 cases. By implementing the interdisciplinary transplant team, a significant increase of living kidney donors was observed: from 18 to 42 cases; median = 27). In the last 7 years, a total number of 796 kidney transplants have been performed: 567 from brain-dead and 229 from living donors. In 2001, the waiting list times for recipients who received grafts from brain-dead versus living donors were 1356 versus 615 days respectively. Compared with 2008, the duration on the waiting list decreased significantly for patients receiving a living donor graft, whereas there was a slight increase for the patients in the brain-dead group: brain death versus living donors: 1407 versus 305 days. The interdisciplinary approach has also reduced the cold ischemia time for the living donor recipients: 3 hours and 42 minutes in 2001 versus 2 hours and 50 minutes in 2008. During the last years, by implementing an interdisciplinary transplant team, supporting living donor procedures has produce a gradual increase in the number of kidney transplants from living donors with a remarkable decrease in waiting and cold ischemia times, the latter presumably influencing graft quality.
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Affiliation(s)
- H Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Mehrabi A, Fonouni H, Ayoub E, Rahbari NN, Müller SA, Morath C, Seckinger J, Sadeghi M, Golriz M, Esmaeilzadeh M, Hillebrand N, Weitz J, Zeier M, Büchler MW, Schmidt J, Schmied BM. A single center experience of combined liver kidney transplantation. Clin Transplant 2010; 23 Suppl 21:102-14. [PMID: 19930323 DOI: 10.1111/j.1399-0012.2009.01146.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With advancements in the operative techniques, patient survival following liver transplantation (LTx) has increased substantially. This has led to the acceleration of pre-existing kidney disease because of immunosuppressive nephrotoxicity making additional kidney transplantation (KTx) inevitable. On the other hand, in a growing number of patients on the waiting list to receive liver, long waiting time has resulted in adverse effect of decompensated liver on the kidney function. During the last two decades, the transplant community has considered combined liver kidney transplantation (CLKTx) to overcome this problem. The aim of our study is to present an overview of our experience as well as a review of the literature in CLKTx and to discuss the controversy in this regard. All performed CLKTx (n = 22) at our institution as well as all available reported case series focusing on CLKTx are extracted. The references of the manuscripts were cross-checked to implement further articles into the review. The analyzed parameters include demographic data, indication for LTx and KTx, duration on the waiting list, Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, immunosuppressive regimen, post-transplant complications, graft and patient survival, and cause of death. From 1988 to 2009, a total of 22 CLKTx were performed at our institution. The median age of the patients at the time of CLKTx was 44.8 (range: 4.5-58.3 yr). The indications for LTx were liver cirrhosis, hyperoxaluria type 1, polycystic liver disease, primary or secondary sclerosing cholangitis, malignant hepatic epithelioid hemangioendothelioma, cystinosis, and congenital biliary fibrosis. The KTx indications were end-stage renal disease of various causes, hyperoxaluria type 1, polycystic kidney disease, and cystinosis. The mean follow-up duration for CLKTx patients were 4.6 +/- 3.5 yr (range: 0.5-12 yr). Overall, the most important encountered complications were sepsis (n = 8), liver failure leading to retransplantation (n = 4), liver rejection (n = 3), and kidney rejection (n = 1). The overall patient survival rate was 80%. Review of the literature showed that from 1984 to 2008, 3536 CLKTx cases were reported. The main indications for CLKTx were oxalosis of both organs, liver cirrhosis and chronic renal failure, polycystic liver and kidney disease, and liver cirrhosis along with hepatorenal syndrome (HRS). The most common encountered complications following CLKTx were infection, bleeding, biliary complications, retransplantation of the liver, acute hepatic artery thrombosis, and retransplantation of the kidney. From the available data regarding the need for post-operative dialysis (n = 673), a total of 175 recipients (26%) required hemodialysis. During the follow-up period, 154 episodes of liver rejection (4.3%) and 113 episodes of kidney rejection (3.2%) occurred. The cumulative 1, 2, 3, and 5 yr survival of both organs were 78.2%, 74.4%, 62.4%, and 60.9%, respectively. Additionally, the cumulative 1, 2, 3, and 5 yr patient survival were 84.9%, 52.8%, 45.4%, and 42.6%, respectively. The total number of reported deaths was 181 of 2808 cases (6.4%), from them the cause of death in 99 (55%) cases was sepsis. It can be concluded that there is still no definitive evidence of better graft and patient survival in CLKTx recipients when compared with LTx alone because of the complexity of the exact definition of irreversible kidney function in LTx candidates. Additionally, CLKTx is better to be performed earlier than isolated LTx and KTx leading to the avoidance of deterioration of clinical status, high rate of graft loss, and mortality. Shorter graft ischemia time and more effective immunosuppressive regimens can reduce the incidence of graft malfunctioning in CLKTx patients. Providing a model to reliably determine the need for CLKTx seems necessary. Such a model can be shaped based upon new and precise markers of renal function, and modification of MELD system.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Abstract
According to the Banff classification of renal allograft pathology, the category borderline changes defines changes insufficient for a diagnosis of acute rejection. The relationship between borderline changes and acute renal allograft rejection still remains unclear. The appropriate clinical management for patients showing such changes is controversial. One possible interpretation of the high incidence of subacute tubulitis is that these changes in the absence of graft dysfunction are of no consequence and that treatment with intensified immunosuppression is unnecessary and perhaps harmful. Another view, consistent with the high incidence of CAN in late protocol biopsy studies, is that immunosuppression has become so powerful, that rejection may not even be manifested by a rising serum creatinine. Borderline changes should be used as part of an algorithm, but not as the only criterion, for therapeutic decision making. Based on the weak evidence of existing studies, in our patients with clinical borderline rejection, we have to weigh the individual immunological risk against the potential side effects of increased immunosuppression. Even in the knowledge that a majority of patients with borderline infiltrates will not progress into rejection, in many transplant centers, borderline rejection is treated with additional steroids or augmentation of maintenance immunosuppression.
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Affiliation(s)
- J Beimler
- Department of Medicine, Division of Nephrology, University of Heidelberg, 69120 Heidelberg, Germany.
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Büchler MW, Fonouni H, Mehrabi A, Schmidt J, Zeier M. Innovations in transplantation Medicine. Introduction. Clin Transplant 2009; 23 Suppl 21:1. [PMID: 19930308 DOI: 10.1111/j.1399-0012.2009.01101.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morath C, Schmied B, Mehrabi A, Weitz J, Schmidt J, Werner J, Buchler M, Morcos M, Nawroth P, Schwenger V, Doehler B, Opelz G, Zeier M. Angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers after renal transplantation. Clin Transplant 2009; 23 Suppl 21:33-6. [DOI: 10.1111/j.1399-0012.2009.01107.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Brost S, Wenzel JJ, Ganten TM, Filser M, Flechtenmacher C, Boehm S, Astani A, Jilg W, Zeier M, Schnitzler P. Sporadic cases of acute autochthonous hepatitis E virus infection in Southwest Germany. J Clin Virol 2009; 47:89-92. [PMID: 19910247 DOI: 10.1016/j.jcv.2009.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 10/05/2009] [Accepted: 10/07/2009] [Indexed: 02/03/2023]
Abstract
Hepatitis E infection is usually a self-limiting disease and an important cause of acute hepatitis in tropical and subtropical regions where the virus is endemic. In industrialized countries, sporadic cases of acute hepatitis E virus (HEV) infections have been described and the number of documented autochthonous infections seems to be increasing. We report three sporadic cases of autochthonous hepatitis E infections in Southwestern Germany which presented at our university hospital within two years. All cases were men who presented with acute hepatitis, icterus and elevated liver. In case 1 and case 2, liver biopsy revealed acute hepatitis, both patients were positive for anti-HEV antibodies, case 1 was also positive for HEV RNA with a viral load of 3.0 x 10(3)copies/ml in serum. In case 3, anti-HEV antibodies were detectable and HEV RNA was detected in serum (4.3 x 10(3)copies/ml) and stool (1.4 x 10(6)copies/ml). None of the patients had a recent travel history outside Germany and close contact to animals has been denied. HEV sequence analysis of two patients revealed genotype 3 with homologies to other European isolates and isolates from swine. Thus the source of infection remains unclear. Hepatitis E should be considered in differential diagnosis in patients with unexplained hepatitis and patients with acute hepatitis, whatever their age or travel history might be, should be tested for HEV.
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Affiliation(s)
- S Brost
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
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Morath C, Schmied B, Mehrabi A, Weitz J, Schmidt J, Werner J, Buchler M, Morcos M, Nawroth P, Schwenger V, Doehler B, Opelz G, Zeier M. Simultaneous pancreas-kidney transplantation in type 1 diabetes. Clin Transplant 2009; 23 Suppl 21:115-20. [DOI: 10.1111/j.1399-0012.2009.01116.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Steen H, Schwenger V, Ritz E, Zeier M. Reply. Nephrol Dial Transplant 2009. [DOI: 10.1093/ndt/gfp043] [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: 11/13/2022] Open
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Furkert J, Zeier M, Schwenger V. CAPD: developments during changing times. Perit Dial Int 2009; 29:115-116. [PMID: 19164262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Affiliation(s)
- J. Furkert
- Nephrology and Gastroenterology SLK-Kliniken, Heidelberg, Germany
| | - M. Zeier
- Department of Nephrology University Hospital Heidelberg Heidelberg, Germany
| | - V. Schwenger
- Department of Nephrology University Hospital Heidelberg Heidelberg, Germany
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