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Stoleriu MG, Gerckens M, Zimmermann J, Schön J, Damirov F, Samm N, Kovács J, Stacher-Priehse E, Kellerer C, Jörres RA, Kauke T, Ketscher C, Grützner U, Hatz R. Preoperative risk factors predict perioperative allogenic blood transfusion in patients undergoing primary lung cancer resections: a retrospective cohort study from a high-volume thoracic surgery center. BMC Surg 2023; 23:44. [PMID: 36849951 PMCID: PMC9972742 DOI: 10.1186/s12893-023-01924-9] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Our study aimed to identify preoperative predictors for perioperative allogenic blood transfusion (ABT) in patients undergoing major lung cancer resections in order to improve the perioperative management of patients at risk for ABT. METHODS Patients admitted between 2014 and 2016 in a high-volume thoracic surgery clinic were retrospectively evaluated in a cohort study based on a control group without ABT and the ABT group requiring packed red blood cell units within 15 days postoperatively until discharge. The association of ABT with clinically established parameters (sex, preoperative anemia, liver and coagulation function, blood groups, multilobar resections) was analyzed by contingency tables, receiver operating characteristics (ROC) and logistic regression analysis, taking into account potential covariates. RESULTS 60 out of 529 patients (11.3%) required ABT. N1 and non-T1 tumors, thoracotomy approach, multilobar resections, thoracic wall resections and Rhesus negativity were more frequent in the ABT group. In multivariable analyses, female sex, preoperative anemia, multilobar resections, as well as serum alanine-aminotransferase levels, thrombocyte counts and Rhesus negativity were identified as independent predictors of ABT, being associated with OR (95% Confidence interval, p-value) of 2.44 (1.23-4.88, p = 0.0112), 18.16 (8.73-37.78, p < 0.0001), 5.79 (2.50-13.38, p < 0.0001), 3.98 (1.73-9.16, p = 0.0012), 2.04 (1.04-4.02, p = 0.0390) and 2.84 (1.23-6.59, p = 0.0150), respectively. CONCLUSIONS In patients undergoing major lung cancer resections, multiple independent risk factors for perioperative ABT apart from preoperative anemia and multilobar resections were identified. Assessment of these predictors might help to identify high risk patients preoperatively and to improve the strategies that reduce perioperative ABT.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany. .,Comprehensive Pneumology Center (CPC), Member of the German Lung Research Center, Helmholtz Zentrum Muenchen, Institute for Lung Biology and Disease, 81377, Munich, Germany. .,Asklepios Lung Clinic Munich-GautingDivision of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU) and Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany.
| | - Michael Gerckens
- grid.4567.00000 0004 0483 2525Comprehensive Pneumology Center (CPC), Member of the German Lung Research Center, Helmholtz Zentrum Muenchen, Institute for Lung Biology and Disease, 81377 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Internal Medicine V, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Julia Zimmermann
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Johannes Schön
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Fuad Damirov
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Nicole Samm
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Julia Kovács
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Elvira Stacher-Priehse
- Department of Pathology, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Christina Kellerer
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany ,grid.6936.a0000000123222966School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstr. 47, 81667 Munich, Germany
| | - Rudolf A. Jörres
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany
| | - Teresa Kauke
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Ketscher
- Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Uwe Grützner
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Rudolf Hatz
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
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Stoleriu MG, Gerckens M, Ströh K, Kovács J, Samm N, Obereisenbuchner F, Hetrodt J, Schmidt FM, Reinmuth N, Heiß-Neumann M, Stacher-Priehse E, Koch I, Behr J, Ketscher C, Grützner U, Hatz R. Prevention of COVID-19 in Thoracic Surgery Patients: Lessons Learned during the First Pandemic Wave. Pneumologie 2021; 75:960-970. [PMID: 34261146 DOI: 10.1055/a-1526-9979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this retrospective study was to investigate the implementation of measures to prevent perioperative COVID-19 in thoracic surgery during the first wave of the COVID-19 pandemic 2020 allowing a continued surgical treatment of patients. METHODS The implemented preventive measures in patient management of the thoracic surgery department of the Asklepios Lung Clinic Munich-Gauting, Germany were retrospectively analyzed. Postoperative COVID-19 incidence before and after implementation of preventive measures was investigated. Patients admitted for thoracic surgical procedures between March and May 2020 were included in the study. Patient characteristics were analyzed. For the early detection of putative postoperative COVID-19 symptoms, typical post-discharge symptomatology of thoracic surgery patients was compared to non-surgical patients hospitalized for COVID-19. RESULTS Thirty-five surgical procedures and fifty-seven surgical procedures were performed before and after implementation of the preventive measures, respectively. Three patients undergoing thoracic surgery before implementation of preventive measures developed a COVID-19 pneumonia post-discharge. After implementation of preventive measures, no postoperative COVID-19 cases were identified. Fever, dyspnea, dry cough and diarrhea were significantly more prevalent in COVID-19 patients compared to normally recovering thoracic surgery patients, while anosmia, phlegm, low energy levels, body ache and nausea were similarly frequent in both groups. CONCLUSIONS Based on the lessons learned during the first pandemic wave, we here provide a blueprint for successful easily implementable preventive measures minimizing SARS-CoV-2 transmission to thoracic surgery patients perioperatively. While symptoms of COVID-19 and the normal postoperative course of thoracic surgery patients substantially overlap, we found dyspnea, fever, cough, and diarrhea significantly more prevalent in COVID-19 patients than in normally recovering thoracic surgery patients. These symptoms should trigger further diagnostic testing for postoperative COVID-19 in thoracic surgery patients.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center
| | - Michael Gerckens
- Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center.,Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Katja Ströh
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Julia Kovács
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Nicole Samm
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | | | - Justin Hetrodt
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | | | - Niels Reinmuth
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | - Marion Heiß-Neumann
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | | | - Ina Koch
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center
| | - Jürgen Behr
- Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center.,Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany.,Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Christian Ketscher
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Uwe Grützner
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Rudolf Hatz
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center
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3
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Stoleriu MG, Gerckens M, Hetrodt J, Heiß-Neumann M, Koch I, Stacher-Priehse E, Dinkel J, Behr J, Grützner U, Hatz R. Clinical Course of Three Postoperative Symptomatic COVID-19 Cases in Patients After Lung Lobectomy. Ann Thorac Surg 2020; 110:e461-e463. [PMID: 32522632 PMCID: PMC7833962 DOI: 10.1016/j.athoracsur.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
The novel coronavirus disease 2019 is a highly contagious viral infection caused by the severe acute respiratory syndrome coronavirus 2 virus. Its rapid spread and severe clinical presentation influence patient management in all specialties including thoracic surgery. We report 3 cases of coronavirus disease 2019 occurring in patients shortly after thoracotomy and thoracoscopy procedures, illustrating the imminent threat of severe acute respiratory syndrome coronavirus 2 infection for thoracic surgery patients.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Michael Gerckens
- Comprehensive Pneumology Center, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | | | - Ina Koch
- Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | - Julien Dinkel
- Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Uwe Grützner
- Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | - Rudolf Hatz
- Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
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Ried M, Eichhorn M, Winter H, Grützner U, Lindner M, Hatz RA, Haager B, Passlick B, Galetin T, Lopez-Pastorini A, Stoelben E, Hofmann HS. [Expert Recommendation for the Implementation of Hyperthermic Intrathoracic Chemotherapy (HITOC) in Germany]. Zentralbl Chir 2019; 145:89-98. [PMID: 31291667 DOI: 10.1055/a-0934-7806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION During the last few years, hyperthermic intrathoracic chemotherapy (HITOC) has been performed in several departments for thoracic surgery in Germany. The objective of this expert recommendation is to provide elementary recommendations for a standardised HITOC treatment, which are based on clinical experiences and research data. METHODS Between October and December 2018, a group of experts for thoracic surgery in five departments of thoracic surgery developed recommendations for the HITOC procedure in Germany. These experts were selected by the latest national survey for HITOC and had the most clinical experience with HITOC. All recommendations are based on clinical experience, the experts' research data and recent literature. RESULTS All recommendations were evaluated by all participating departments in one consensus survey. Finally, a total of six main conclusions including a total of 17 recommendations were developed. For each recommendation, the strength of the consensus is presented in percentages. 100% agreement was established for nomenclature, technique, the chemotherapeutic agent, the perioperative management, the safety measures and the indications for HITOC. All experts recommended cisplatin as the first choice chemotherapeutic agent for HITOC. The dosage of cisplatin is specified in mg/m2 body surface area (BSA) and should be between 150 and 175 mg/m2 BSA. The volume of the perfusion fluid (approximately 4 - 5 l) seems to play a role for the concentration gradient of cisplatin and should therefore also be taken into account. CONCLUSIONS These expert recommendations provide a standardised and consistent implementation of the HITOC procedure. On this basis, postoperative complications associated to HITOC should be reduced and comparison of the results should be improved.
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Affiliation(s)
- Michael Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Uwe Grützner
- Thoraxchirurgisches Zentrum München, Klinikum der Universität München, Deutschland
| | - Michael Lindner
- Asklepios Fachkliniken München-Gauting, Klinikum der Universität München, Thoraxchirurgisches Zentrum München, Deutschland
| | - Rudolf A Hatz
- Thoraxchirurgisches Zentrum München, Klinikum der Universität München, Deutschland
| | - Benedikt Haager
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - Bernward Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - Thomas Galetin
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Private Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Alberto Lopez-Pastorini
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Private Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Erich Stoelben
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Private Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Hans-Stefan Hofmann
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland.,KH Barmherzige Brüder Regensburg, Klinik für Thoraxchirurgie, Deutschland
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Klotz LV, Lindner M, Eichhorn ME, Grützner U, Koch I, Winter H, Kauke T, Duell T, Hatz RA. Pleurectomy/decortication and hyperthermic intrathoracic chemoperfusion using cisplatin and doxorubicin for malignant pleural mesothelioma. J Thorac Dis 2019; 11:1963-1972. [PMID: 31285889 DOI: 10.21037/jtd.2019.04.93] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Malignant pleural mesothelioma (MPM) is an aggressive malignancy with few long-term survivors. Despite the dismal prognosis, hyperthermic intrathoracic chemoperfusion (HITHOC) was shown to improve survival in a selective group of patients. We analyzed the influence of HITHOC following pleurectomy and decortication on postoperative morbidity and overall survival for patients suffering from localized mesothelioma. Methods From 2009 until 2013, 71 patients with localized pleural mesothelioma underwent pleurectomy and decortication followed by HITHOC with cisplatin and doxorubicin. We analyzed postoperative morbidity, age, overall survival and influence of macroscopic resection on survival. Results Median patient age was 70 years (range, 65-73 years). Patients having the sarcomatoid subtype of mesothelioma showed a poor median survival of 9.2 months. In contrast, patients having the epithelioid subtype had a median survival of 17.9 months. Patients following macroscopic complete resection had a significantly better survival with 28.2 months compared to 13.1 months in patients with incomplete resection of the mesothelioma (P<0.0001). HITHOC was performed in all patients after tumor resection using cisplatin and doxorubicin. Conclusions Taken together, HITHOC following pleurectomy and decortication is supposed to be a safe therapeutic option for selected patients with localized epithelial pleural mesothelioma.
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Affiliation(s)
- Laura V Klotz
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich/Asklepios Lung Clinic Gauting, Gauting, Germany.,Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Comprehensive Pneumology Center, Helmholtz Zentrum Munich, Munich, Germany
| | - Michael Lindner
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich/Asklepios Lung Clinic Gauting, Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Zentrum Munich, Munich, Germany
| | - Martin E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Uwe Grützner
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich/Asklepios Lung Clinic Gauting, Gauting, Germany
| | - Ina Koch
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich/Asklepios Lung Clinic Gauting, Gauting, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Teresa Kauke
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich/Asklepios Lung Clinic Gauting, Gauting, Germany
| | - Thomas Duell
- Department of Pneumology, Asklepios Lung Clinic Gauting, Gauting, Germany
| | - Rudolf A Hatz
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich/Asklepios Lung Clinic Gauting, Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Zentrum Munich, Munich, Germany
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Pratschke S, Bilzer M, Grützner U, Angele M, Tufman A, Jauch KW, Schauer RJ. Tacrolimus Preconditioning of Rat Liver Allografts Impacts Glutathione Homeostasis and Early Reperfusion Injury. J Surg Res 2012; 176:309-16. [DOI: 10.1016/j.jss.2011.07.045] [Citation(s) in RCA: 20] [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] [Received: 03/22/2011] [Revised: 07/21/2011] [Accepted: 07/29/2011] [Indexed: 12/26/2022]
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7
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Grützner U, Lindner M, Sklarek J, Feske S, Duell T, Hatz RA. Die multimodale Therapie des malignen Pleuramesothelioms durch Pleurektomie/Dekortikation und hypertherme intrathorakale Chemoperfusion (HITHOC). Pneumologie 2012. [DOI: 10.1055/s-0032-1302881] [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: 10/28/2022]
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Pratschke S, Angele M, Grützner U, Tufman A, Bilzer M, Loehe F, Jauch KW, Schauer R. GSH Attenuates Organ Injury and Improves Function after Transplantation of Fatty Livers. Eur Surg Res 2010; 45:13-9. [DOI: 10.1159/000316643] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 06/06/2010] [Indexed: 11/19/2022]
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10
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Vavricka SR, Jung D, Fried M, Grützner U, Meier PJ, Kullak-Ublick GA. The human organic anion transporting polypeptide 8 (SLCO1B3) gene is transcriptionally repressed by hepatocyte nuclear factor 3beta in hepatocellular carcinoma. J Hepatol 2004; 40:212-8. [PMID: 14739090 DOI: 10.1016/j.jhep.2003.10.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS The organic anion transporting polypeptides (OATPs) mediate the uptake of numerous amphipathic compounds into hepatocytes. Our aim was to study the expression and regulation of OATP8 (OATP1B3, SLC21A8/SLCO1B3) and OATP-C (OATP1B1, SLC21A6/SLCO1B1) in hepatocellular carcinomas (HCC). METHODS RNA and protein levels in 13 paired HCC and adjacent non-tumor liver samples were quantified by real-time polymerase chain reaction or Western blot, respectively. The OATP8 and OATP-C gene promoters were characterized by luciferase reporter assays and electrophoretic mobility shift assays (EMSA). RESULTS The expression of OATP8 was decreased in 60% of HCC compared to surrounding non-tumor liver tissue, on both the mRNA and protein levels. Expression of the liver-enriched transcription factor hepatocyte nuclear factor 3beta (HNF3beta) was increased in 70% of HCC and correlated inversely with OATP8 mRNA (r=-0.75, P<0.05) and protein. In contrast to OATP8, expression of OATP-C was not significantly decreased in HCC. In transfected Huh7 cells, OATP8 promoter activity was inhibited by 70% when HNF3beta was cotransfected. An HNF3beta binding site was located at nt -39/-23 by EMSA. The OATP-C promoter was not inhibited by HNF3beta. CONCLUSIONS HNF3beta represses transcription of the OATP8 but not the OATP-C gene, providing a mechanism for reduced expression of OATP8 in HCC.
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Affiliation(s)
- Stephan R Vavricka
- Laboratory of Molecular Gastroenterology and Hepatology, Division of Gastroenterology and Hepatology, University Hospital, CH-8091 Zurich, Switzerland
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Kullak-Ublick GA, Glasa J, Böker C, Oswald M, Grützner U, Hagenbuch B, Stieger B, Meier PJ, Beuers U, Kramer W, Wess G, Paumgartner G. Chlorambucil-taurocholate is transported by bile acid carriers expressed in human hepatocellular carcinomas. Gastroenterology 1997; 113:1295-305. [PMID: 9322525 DOI: 10.1053/gast.1997.v113.pm9322525] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.0] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Chemotherapy of hepatocellular carcinomas is hampered by the insufficient accumulation of cytostatic drugs within the tumor cells. The aim of this study was to evaluate the feasibility of therapeutic strategies using antineoplastic agents coupled to bile acids. METHODS Expression of the Na(+)-taurocholate-cotransporting polypeptide (NTCP) was analyzed in six hepatocellular carcinomas and in nonmalignant liver tissue. Uptake of the cytostatic drug [3H]-chlorambucil-taurocholate (S2676) was measured in Xenopus laevis oocytes injected with total messenger RNA (mRNA) from the carcinomas or peritumor tissue or with complementary RNA encoding the NTCP or the organic anion-transporting polypeptide (OATP) of human liver. RESULTS Expression of hepatocellular carcinoma mRNA in oocytes resulted in mainly Na(+)-dependent uptake of chlorambucil-taurocholate. The level of NTCP mRNA in carcinomas amounted to 56% +/- 27% compared with peritumor tissue. Immunofluorescence studies confirmed the expression of NTCP on the surface of hepatocellular carcinoma cells. OATP expression, determined by immunoblotting, was similar in hepatocellular carcinomas and surrounding liver tissue (n = 3). NTCP mediated Na(+)-dependent uptake of chlorambucil-taurocholate (Michaelis constant, 11 mumol/L), whereas OATP mediated Na(+)-independent uptake. CONCLUSIONS Hepatocellular carcinomas express the Na(+)-dependent bile acid transporter NTCP. Because NTCP mediates high-affinity uptake of chlorambucil-taurocholate, targeting of cytostatic bile acids to hepatocellular carcinomas could become a feasible therapeutic strategy.
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Affiliation(s)
- G A Kullak-Ublick
- Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany
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Grützner-Könnecke H, Grützner P, Grützner B, Grützner U, Spalding-Grützner A, Spalding P. Higher order multiple births: natural wonder or failure of therapy? Acta Genet Med Gemellol (Roma) 1990; 39:491-5. [PMID: 2102593 DOI: 10.1017/s000156600000372x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Data of 601 families with triplets and higher multiples have been collected. Since about nine years the number of higher-order births has been increasing enormously. The average pregnancy duration and the average birthweight of these mostly premature children have been declining from year to year. Despite the progress in neonatology, the death rate and the rate of handicapped children is very high. To prevent such disastrous outcomes, treatments for infertility should be performed only by physicians in centers with strong controls. Selective abortions are no regular solution to the problem of higher multiple gestation.
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Affiliation(s)
- H Grützner-Könnecke
- ABC Club, International Organisation for Triplets and Higher Multiples, Darmstadt, West Germany
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