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Helms F, Poyanmehr R, Krüger H, Schmack B, Weymann A, Popov AF, Ruhparwar A, Martens A, Natanov R. Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience. J Clin Med 2024; 13:832. [PMID: 38337526 PMCID: PMC10856124 DOI: 10.3390/jcm13030832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Intercostal artery reinsertion (ICAR) during thoracoabdominal aortic replacement remains controversial. While some groups recommend the reinsertion of as many arteries as possible, others consider the sacrifice of multiple intercostals practicable. This study investigates the impact of intercostal artery reinsertion or sacrifice on neurological outcomes and long-term survival after thoracoabdominal aortic repair. METHODS A total of 349 consecutive patients undergoing thoracoabdominal aortic replacement at our institution between 1996 and 2021 were analyzed in a retrospective single-center study. ICAR was performed in 213 patients, while all intercostal arteries were ligated and sacrificed in the remaining cases. The neurological outcome was analyzed regarding temporary and permanent paraplegia or paraparesis. RESULTS No statistically significant differences were observed between the ICAR and non ICAR groups regarding the cumulative endpoint of transient and permanent spinal cord-related complications (12.2% vs. 11.8%, p = 0.9). Operation, bypass, and cross-clamp times were significantly longer in the ICAR group. Likewise, prolonged mechanical ventilation was more often necessary in the ICAR group (26.4% vs. 16.9%, p = 0.03). Overall long-term survival was similar in both groups in the Kaplan-Meier analysis. CONCLUSION Omitting ICAR during thoracoabdominal aortic replacement may reduce operation and cross-clamp times and thus minimize the duration of intraoperative spinal cord hypoperfusion.
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Affiliation(s)
- Florian Helms
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Reza Poyanmehr
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Heike Krüger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bastian Schmack
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alexander Weymann
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Aron-Frederik Popov
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Arjang Ruhparwar
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andreas Martens
- Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany
| | - Ruslan Natanov
- Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany
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Soleimani M, Deo R, Hudobivnik B, Poyanmehr R, Haverich A, Wriggers P. Mathematical modeling and numerical simulation of arterial dissection based on a novel surgeon's view. Biomech Model Mechanobiol 2023; 22:2097-2116. [PMID: 37552344 PMCID: PMC10613153 DOI: 10.1007/s10237-023-01753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/09/2023]
Abstract
This paper presents a mathematical model for arterial dissection based on a novel hypothesis proposed by a surgeon, Axel Haverich, see Haverich (Circulation 135(3):205-207, 2017. https://doi.org/10.1161/circulationaha.116.025407 ). In an attempt and based on clinical observations, he explained how three different arterial diseases, namely atherosclerosis, aneurysm and dissection have the same root in malfunctioning Vasa Vasorums (VVs) which are micro capillaries responsible for artery wall nourishment. The authors already proposed a mathematical framework for the modeling of atherosclerosis which is the thickening of the artery walls due to an inflammatory response to VVs dysfunction. A multiphysics model based on a phase-field approach coupled with mechanical deformation was proposed for this purpose. The kinematics of mechanical deformation was described using finite strain theory. The entire model is three-dimensional and fully based on a macroscopic continuum description. The objective here is to extend that model by incorporating a damage mechanism in order to capture the tearing (rupture) in the artery wall as a result of micro-injuries in VV. Unlike the existing damage-based model of the dissection in the literature, here the damage is driven by the internal bleeding (hematoma) rather than purely mechanical external loading. The numerical implementation is carried out using finite element method (FEM).
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Affiliation(s)
- Meisam Soleimani
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany.
| | - Rohan Deo
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany
| | - Blaz Hudobivnik
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany
| | - Reza Poyanmehr
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medical School, Hannover, Germany
| | - Axel Haverich
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medical School, Hannover, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany
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Natanov R, Shrestha ML, Martens A, Beckmann E, Krueger H, Arar M, Rudolph L, Ruemke S, Poyanmehr R, Korte W, Schilling T, Haverich A, Kaufeld T. Acute Aortic Dissection Type A in Younger Patients (< 60 Years Old) - Does Full Arch Replacement Provide Benefits Compared to Limited Approach? Braz J Cardiovasc Surg 2023; 39:e20220434. [PMID: 37943993 PMCID: PMC10653677 DOI: 10.21470/1678-9741-2022-0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/12/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Acute aortic dissection Stanford type A (AADA) is a surgical emergency associated with high morbidity and mortality. Although surgical management has improved, the optimal therapy is a matter of debate. Different surgical strategies have been proposed for patients under 60 years old. This paper evaluates the postoperative outcome and the need for secondary aortic operation after a limited surgical approach (proximal arch replacement) vs. extended arch repair. METHODS Between January 2000 and January 2018, 530 patients received surgical treatment for AADA at our hospital; 182 were under 60 years old and were enrolled in this study - Group A (n=68), limited arch repair (proximal arch replacement), and group B (n=114), extended arch repair (> proximal arch replacement). RESULTS More pericardial tamponade (P=0.005) and preoperative mechanical resuscitation (P=0.014) were seen in Group A. More need for renal replacement therapy (P=0.047) was seen in the full arch group. Mechanical ventilation time (P=0.022) and intensive care unit stay (P<0.001) were shorter in the limited repair group. Thirty-day mortality was comparable (P=0.117). New onset of postoperative stroke was comparable (Group A four patients [5.9%] vs. Group B 15 patients [13.2%]; P=0.120). Long-term follow-up did not differ significantly for secondary aortic surgery. CONCLUSION Even though young patients received only limited arch repair, the outcome was comparable. Full-arch replacement was not beneficial in the long-time follow-up. A limited approach is justified in the cohort of young AADA patients. Exemptions, like known Marfan syndrome and the presence of an intimal tear in the arch, should be considered.
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Affiliation(s)
- Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Malakh Lal Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Erik Beckmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Heike Krueger
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Morsi Arar
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Linda Rudolph
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Stefan Ruemke
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Wilhelm Korte
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Tobias Schilling
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
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Franz M, Siemeni T, Aburahma K, Yablonski P, Poyanmehr R, Avsar M, Bobylev D, Sommer W, Boethig D, Greer M, Gottlieb J, Tudorache I, Hoeper MM, Warnecke G, Haverich A, Kuehn C, Ius F, Salman J. Lung transplantation and severe coronary artery disease: results from a single-centre experience. Eur J Cardiothorac Surg 2022; 62:6608696. [PMID: 35703921 DOI: 10.1093/ejcts/ezac348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The management of severe coronary artery disease at the time of lung transplantation remains a challenge. We analyzed the short- and long-term-outcomes of lung transplant recipients with severe coronary artery disease. METHODS Records of adult patients transplanted at our institution between April 2010 and February 2021 were retrospectively reviewed. Severe coronary artery disease was defined by coronary stenosis ≥70% (main stem ≥50%) at the coronary angiography performed before or at the time of listing. Patient characteristics, perioperative- and long-term-outcomes were compared between patients with and without severe coronary artery disease. RESULTS Among 896 lung-transplanted patients who had undergone a coronary angiography before transplantation, 77 (8.5%) showed severe coronary artery disease, the remaining 819 (91.5%) did not. Patients with severe coronary artery disease were older (p < 0.0001), more often male (p < 0.0001) and were transplanted more often for pulmonary fibrosis (p = 0.0007). The median (interquartile range) follow-up was 46 (20-76) months. At the Cox multivariable analysis severe coronary artery disease was not associated with mortality. Patients with pretransplant percutaneous transluminal coronary angioplasty and patients with coronary artery bypass graft surgery concomitant to transplantation had equivalent survival compared to patients without severe coronary artery disease (p = 0.513, p = 0.556). CONCLUSIONS Severe coronary artery disease was not associated with decreased survival after lung transplantation. Concomitant coronary artery bypass graft surgery and pretransplant percutaneous transluminal coronary angioplasty can be used for revascularization.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Yablonski
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Medical Faculty of St-Petersburg State University, St-Petersburg, Russia
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiac surgery, Heidelberg Medical School, Heidelberg, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac surgery, Heidelberg Medical School, Heidelberg, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
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Flöthmann K, Aburahma K, Franz M, Poyanmehr R, Iablonskii P, Saipbaev A, Greer M, Avsar M, Bobylev D, Schwerk N, Niehaus A, Sommer W, Warnecke G, Haverich A, Kühn C, Salman J, Ius F. Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 11-Year Single-Center Experience Using the Eurotransplant Lung Donor Score. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- K. Flöthmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - K. Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Franz
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - R. Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - P. Iablonskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - M. Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Deutschland
| | - M. Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Deutschland
| | - A. Niehaus
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - W. Sommer
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - G. Warnecke
- Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Deutschland
| | - A. Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Deutschland
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Salman J, Kaufeld T, Aburahma K, Bara C, Niehaus A, Poyanmehr R, Avsar M, Falk C, Sommer W, Haverich A, Warnecke G, Lus F. Treatment of Anti-HLA Donor-Specific Antibodies in Heart Transplantation: A Single-Center Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.835] [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: 11/29/2022] Open
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Salman J, Kaufeld T, Aburahma K, Bara C, Niehaus A, Poyanmehr R, Franz M, Falk C, Sommer W, Warnecke G, Haverich A, Avsar M, Ius F. Treatment of ANTI-HLA Donor-Specific Antibodies and Antibody-Mediated Rejection in Heart Transplantation: A Single-Center 3-Year Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hacker KS, Jansson K, Pichler J, Salman J, Avsar M, Siemeni T, Knöfel AK, Höffler K, Gottlieb J, Frühauf J, Werner M, Poyanmehr R, Jonigk D, Balzer MS, Hewicker-Trautwein M, Haverich A, Sommer W, Warnecke G. Delayed non-myeloablative irradiation to induce long-term allograft acceptance in a large animal lung transplantation model. Transpl Immunol 2020; 65:101350. [PMID: 33127498 DOI: 10.1016/j.trim.2020.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
We previously induced long-term allograft acceptance in an allogeneic lung transplantation (LTx) model in miniature swine using perioperative non-myeloablative irradiation (IRR) combined with infusion of donor specific alloantigen. In order to improve clinical applicability, we delayed induction with irradiation in this study. Left sided single LTx was performed in minipigs. Group 1 received non-myeloablative irradiation (7Gy thymus and 1.5Gy whole body IRR) before LTx and a perioperative donor specific splenocyte infusion (SpTx). Group 2 received perioperative SpTx but delayed IRR three days after LTx. Group 3 was exposed to delayed IRR without SpTx. Whereas 4 out of 7 animals from the non-delayed group never rejected their grafts and were electively sacrificed on postoperative day (POD) +500, all animals from group 2 rejected their grafts before POD 108. In group 3, 3 out of 8 animals developed long-term allograft acceptance. In all groups, donor leukocyte chimerism peaked up to 20% in peripheral blood one hour after reperfusion of the lung. Group 1 maintained prolonged chimerism beyond POD 7, whereas chimerism levels in groups 2 and 3 decreased continuously thereafter. Delayed irradiation has the potential to improve long-term graft survival, yet not as efficient as a perioperative conditioning protocol.
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Affiliation(s)
- Karolin S Hacker
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Katharina Jansson
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jeanette Pichler
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jawad Salman
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Murat Avsar
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Thierry Siemeni
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ann-Kathrin Knöfel
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Klaus Höffler
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jens Gottlieb
- German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jörg Frühauf
- Department of Radiation Therapy and Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Werner
- Department of Radiation Therapy and Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Reza Poyanmehr
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Danny Jonigk
- Institute for Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Michael S Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Marion Hewicker-Trautwein
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559 Hannover, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Wiebke Sommer
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Gregor Warnecke
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; German Centre for Lung Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Salman J, Bernhard BA, Ius F, Poyanmehr R, Sommer W, Aburahma K, Alhadidi H, Siemeni T, Kuehn C, Avsar M, Haverich A, Warnecke G, Tudorache I. Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis. Ann Thorac Surg 2020; 111:1316-1324. [PMID: 32890486 DOI: 10.1016/j.athoracsur.2020.06.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/10/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Venous-arterial extracorporeal membrane oxygenation (ECMO) is an established technique for intraoperative cardiopulmonary support in patients undergoing lung transplantation. Patients with pulmonary fibrosis have a higher risk to require it. The aim of this study was to identify risk factors for the need of intraoperative ECMO use. METHODS Records of patients undergoing lung transplantation for pulmonary fibrosis at our institution between January 2010 and May 2018 were retrospectively reviewed. Univariate logistic regression analysis was used for statistical identification of risk factors. RESULTS There were 105 patients (34%) who required intraoperative ECMO support (ECMO+ group), and 203 (66%) did not (ECMO- group). Preoperative proof of pulmonary hypertension was identified as a risk factor for intraoperative ECMO support (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2-6.5; P < .01). Revealed mean pulmonary arterial pressure values exceeding 50 mm Hg and pulmonary vascular resistance values exceeding 9.4 Wood units were identified as risk factors for the need of intraoperative ECMO use with a prediction probability of 70%. Increased recipient body surface area (OR, 0.2; 95% CI, 0.1-0.5; P < .01) emerged as a protective factor against intraoperative ECMO (Hosmer-Lemeshow statistic, P = .71) as well as higher cardiac output (OR, 0.7; 95% CI, 0.6-0.9; P < .01). The postoperative course was more complicated in the ECMO+ group, whereas survival at 5 years did not differ among groups (70% vs 69%, P = .79). CONCLUSIONS Pulmonary hypertension with elevated pulmonary vascular resistance values predicts the need of intraoperative ECMO in patients receiving lung transplantation for pulmonary fibrosis. Although the postoperative course was more complicated in the ECMO+ group, long-term survival did not differ significantly.
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Affiliation(s)
- Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Beeke-Alina Bernhard
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research (DZL/BREATH), Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hani Alhadidi
- Division of Thoracic Surgery, King Hussein Medical Center, Amman, Jordan
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research (DZL/BREATH), Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research (DZL/BREATH), Hannover, Germany
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10
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Ius F, Sommer W, Rojas S, Kaufeld T, Bara C, Salman J, Poyanmehr R, Avsar M, Tudorache I, Falk C, Haverich A, Warnecke G. Treatment of Anti-HLA Donor-Specific Antibodies in Heart Transplantation: A Single-Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.916] [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: 10/24/2022] Open
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11
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Ius F, Salman J, Sommer W, Poyanmehr R, Avsar M, Siemeni T, Bobylev D, Schwerk N, Müller C, Haverich A, Kühn C, Warnecke G, Tudorache I. Extracorporeal Membrane Oxygenation during Lung Transplantation and Long-Term Graft Function: Results from a 9-Year Single-Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.961] [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: 10/24/2022] Open
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12
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Ius F, Müller C, Sommer W, Verboom M, Hallensleben M, Salman J, Siemeni T, Kühn C, Avsar M, Bobylev D, Poyanmehr R, Erdfelder C, Böthig D, Carlens J, Bayir L, Hansen G, Blasczyk R, Falk C, Tecklenburg A, Haverich A, Tudorache I, Schwerk N, Warnecke G. Six-year experience with treatment of early donor-specific anti-HLA antibodies in pediatric lung transplantation using a human immunoglobulin-based protocol. Pediatr Pulmonol 2020; 55:754-764. [PMID: 31909902 DOI: 10.1002/ppul.24639] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Experience with the treatment of early donor-specific anti-HLA antibodies (eDSA) after lung transplantation in children is very limited. At our institution, we have treated patients with eDSA since 2013 with successive infusions of intravenous human immunoglobulins (IVIG), combined in some cases with a single dose of Rituximab and plasmapheresis (therapeutic plasma exchange [tPE]) or immunoabsorption. The aim of this study was to present the 6-year results of IVIG-based therapy in pediatric lung recipients. METHODS Records of pediatric (<18 years old) patients transplanted at our institution between 01/2013 and 03/2019 were reviewed. Outcomes were compared between patients with eDSA treated with IVIG (IVIG group) and without eDSA (control group). Median (interquartile range [IQR]) follow-up amounted to 28 (12-52) months. RESULTS During the study period, 66 lung-transplanted pediatric patients were included, of which 27 (41%) formed the IVIG group and 38 (57%) the control group. Among the IVIG patients, 14 (52%) patients showed concomitant graft dysfunction (possible clinical antibody-mediated rejection). The median time to eDSA detection was 24 (14-63) days after transplantation. eDSA were cleared in 25 (96%) of the 26 patients which completed treatment. At 3 years, graft survival (%) was 73 vs 85 (P = .65); freedom (%) from chronic lung allograft rejection (CLAD) was 89 vs 78 (P = .82); and from infection 47 vs 31 (P = .15), in IVIG vs control patients, respectively. CONCLUSIONS After lung transplantation, an IVIG-based treatment for eDSA yielded high eDSA clearance. IVIG and control patients showed similar CLAD-free and graft survival.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Murielle Verboom
- Institute of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | | | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Böthig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Lale Bayir
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- German Center for Lung Research (DZL/BREATH), Hannover, Germany.,Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
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13
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Ius F, Salman J, Knoefel AK, Sommer W, Nakagiri T, Verboom M, Siemeni T, Poyanmehr R, Bobylev D, Kuehn C, Avsar M, Erdfelder C, Hallensleben M, Boethig D, Hecker H, Schwerk N, Mueller C, Welte T, Falk C, Preissler G, Haverich A, Tudorache I, Warnecke G. Increased frequency of CD4 + CD25 high CD127 low T cells early after lung transplant is associated with improved graft survival - a retrospective study. Transpl Int 2020; 33:503-516. [PMID: 31903646 DOI: 10.1111/tri.13568] [Citation(s) in RCA: 12] [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] [Received: 02/06/2019] [Revised: 05/04/2019] [Accepted: 12/20/2019] [Indexed: 12/30/2022]
Abstract
In this retrospective study, we analyzed the presence of any association of three CD4+ CD25high regulatory T-cell subpopulations at 3 weeks after lung transplantation with the later incidence of chronic lung allograft dysfunction and graft survival. Among lung-transplanted patients between January 2009 and April 2018, only patients with sufficient T-cell measurements at 3 weeks after transplantation were included into the study. Putative regulatory T cells were defined as CD4+ CD25high T cells, detected in peripheral blood and further analyzed for CD127low , FoxP3+ , and CD152+ using fluorescence-activated cell sorting (FACS) analysis. Associations of regulatory T cells with chronic lung allograft dysfunction (CLAD) and graft survival were evaluated using Cox analysis. During the study period, 724 (71%) patients were included into the study. Freedom from chronic lung allograft dysfunction (CLAD) and graft survival amounted to 66% and 68% at 5 years. At the multivariable analysis, increasing frequencies of CD127low were associated with better freedom from CLAD (hazard ratio for each 1% increase of %CD127low , HR = 0.989, 95% CI = 0.981-0.996, P = 0.003) and better graft survival (HR = 0.991, 95% CI = 0.984-0.999, P = 0.026). A higher frequency of CD127low regulatory T cells in peripheral blood early after lung transplantation estimated a protective effect against chronic lung allograft dysfunction, mortality, and re-transplantation.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ann-Kathrin Knoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Tomoyuki Nakagiri
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murielle Verboom
- Department of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hartmut Hecker
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Mueller
- Department of pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Gerhard Preissler
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Surgery, Munich Lung Transplant Group, Ludwig-Maximilian's University, Munich, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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14
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Rojas SV, Ius F, Kaufeld T, Sommer W, Goecke T, Poyanmehr R, Avsar M, Bara C, Haverich A, Warnecke G. Ex vivo Heart Perfusion for Heart Transplantation: A Single-Center Update after 5 Years. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Ius F, Natanov R, Salman J, Kuehn C, Sommer W, Avsar M, Siemeni T, Bobylev D, Poyanmehr R, Boethig D, Optenhoefel J, Schwerk N, Haverich A, Warnecke G, Tudorache I. Extracorporeal membrane oxygenation as a bridge to lung transplantation may not impact overall mortality risk after transplantation: results from a 7-year single-centre experience. Eur J Cardiothorac Surg 2019; 54:334-340. [PMID: 29444222 DOI: 10.1093/ejcts/ezy036] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Extracorporeal membrane oxygenation (ECMO) has an important role in bridging patients to lung transplantation. In this study, we present our experience with pretransplant ECMO during the last 7 years and investigate its impact on graft outcomes. METHODS Records of all lung-transplanted patients at our institution between January 2010 and April 2017 were retrospectively reviewed. Graft survival was compared between patients who required pretransplant ECMO (pre-Tx ECMO+) and patients who did not (pre-Tx ECMO-). Risk factors for in-hospital mortality and graft survival were identified using a binary logistic regression and the Cox regression analyses, respectively. RESULTS Among the 917 patients transplanted during the study period, 68 (7%) required ECMO as a bridge to transplantation [awake strategy, n = 57 (84%) patients]. Median bridging time was 9 days. Among pre-Tx ECMO+ patients, the need for haemodialysis at any point during bridging emerged as an independent risk factor for in-hospital mortality (odds ratio 7.79, 95% confidence interval 1.21-50.24; P = 0.031). Although in-hospital mortality was significantly higher in pre-Tx ECMO+ versus pre-Tx ECMO- patients (15% vs 5%, P = 0.003), overall graft survival did not differ between groups (79% vs 90% and 61% vs 68% at 1 and 5 years, respectively, P = 0.13). Pretransplant ECMO did not emerge as a risk factor for graft survival in the multivariable analysis. CONCLUSIONS If applied in selected patients in a high-volume centre, pretransplant ECMO as a bridge to transplantation results in impaired, but still high in-hospital, survival and does not impact graft survival.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Giessen, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Joerg Optenhoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Giessen, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Giessen, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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16
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Poyanmehr R, Feldmann C, Hanke J, Schmitto J. Urgent Driveline Repair Under Catecholamine Support After Total Driveline Cut. Artif Organs 2019; 41:686-687. [PMID: 28703370 DOI: 10.1111/aor.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Reza Poyanmehr
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christina Feldmann
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jasmin Hanke
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan Schmitto
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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17
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Siemeni T, Knöfel A, Ius F, Salman J, Sommer W, Avsar M, Poyanmehr R, Kühn C, Falk C, Tudorache I, Haverich A, Warnecke G. Linking CLAD in Lung Transplant Recipients after 3 Years Follow Up with Transplant Arteriosclerosis in Humanized Mice. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.327] [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: 11/28/2022] Open
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18
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Rojas S, Ius F, Schibilsky D, Kaufeld T, Sommer W, Benk C, Goecke T, Siemeni T, Poyanmehr R, Rümke S, Mogaldea A, Bobylev D, Salman J, Avsar M, Tudorache I, Bara C, Beyersdorf F, Haverich A, Siepe M, Warnecke G. Cardiac Transplantation in Higher Risk Patients: Is Ex Vivo Heart Perfusion a Safe Preservation Technique? A Two Center Experience. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Sommer W, Salman J, Avsar M, Hoeffler K, Jansson K, Siemeni TN, Knoefel AK, Ahrens L, Poyanmehr R, Tudorache I, Braubach P, Jonigk D, Haverich A, Warnecke G. Prediction of transplant outcome after 24-hour ex vivo lung perfusion using the Organ Care System in a porcine lung transplantation model. Am J Transplant 2019; 19:345-355. [PMID: 30106236 DOI: 10.1111/ajt.15075] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/24/2017] [Revised: 07/22/2018] [Accepted: 07/22/2018] [Indexed: 01/25/2023]
Abstract
Ex vivo lung perfusion (EVLP) has become routine practice in lung transplantation. Still, running periods exceeding 12 hours have not been undertaken clinically to date, and it remains unclear how the perfusion solution for extended running periods should be composed and which parameters may predict outcomes. Twenty-four porcine lungs underwent EVLP for 24 hours using the Organ Care System (OCS). Lungs were ventilated and perfused with STEEN's solution enriched with erythrocytes (n = 8), acellular STEEN's solution (n = 8), or low-potassium dextran (LPD) solution enriched with erythrocytes (n = 8). After 24 hours, the left lungs were transplanted into recipient pigs. After clamping of the contralateral lung, the recipients were observed for 6 hours. The most favorable outcome was observed in organs utilizing STEEN solution enriched with erythrocytes as perfusate, whereas the least favorable outcome was seen with LPD solution enriched with erythrocytes for perfusion. Animals surviving the observation period showed lower peak airway pressure (PAWP) and pulmonary vascular resistance (PVR) during OCS preservation. The results suggest that transplantation of lungs following 24 hours of EVLP is feasible but dependent on the composition of the perfusate. PAWP and PVR during EVLP are early and late predictors of transplant outcome, respectively.
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Affiliation(s)
- Wiebke Sommer
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Klaus Hoeffler
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Jansson
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry N Siemeni
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ann-Kathrin Knoefel
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Linda Ahrens
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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20
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Rojas S, Ius F, Schibilsky D, Kaufeld T, Benk C, Goecke T, Avsar M, Poyanmehr R, Rümke S, Mogaldea A, Bobylev D, Salman J, Siemeni T, Bara C, Beyersdorf F, Haverich A, Siepe M, Warnecke G. Ex Vivo Heart Perfusion for Higher Risk Cardiac Transplantations: A Retrospective Analysis from Two German Centers. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S. Rojas
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - F. Ius
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - D. Schibilsky
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - T. Kaufeld
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - C. Benk
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - T. Goecke
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - M. Avsar
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - R. Poyanmehr
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - S. Rümke
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - A. Mogaldea
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - D. Bobylev
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - J. Salman
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - T. Siemeni
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - C. Bara
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - F. Beyersdorf
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - A. Haverich
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
| | - M. Siepe
- Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - G. Warnecke
- Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
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Ius F, Verboom M, Sommer W, Poyanmehr R, Knoefel A, Salman J, Kuehn C, Avsar M, Siemeni T, Erdfelder C, Hallensleben M, Boethig D, Schwerk N, Mueller C, Welte T, Falk C, Haverich A, Tudorache I, Warnecke G. Preemptive treatment of early donor-specific antibodies with IgA- and IgM-enriched intravenous human immunoglobulins in lung transplantation. Am J Transplant 2018; 18:2295-2304. [PMID: 29719115 PMCID: PMC6585979 DOI: 10.1111/ajt.14912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 01/25/2023]
Abstract
This retrospective study presents our 4-year experience of preemptive treatment of early anti-HLA donor specific antibodies with IgA- and IgM-enriched immunoglobulins. We compared outcomes between patients with antibodies and treatment (case patients) and patients without antibodies (control patients). Records of patients transplanted at our institution between March 2013 and November 2017 were reviewed. The treatment protocol included one single 2 g/kg immunoglobulin infusion followed by successive 0.5 g/kg infusions for a maximum of 6 months, usually combined with a single dose of anti-CD20 antibody and, in case of clinical rejection or positive crossmatch, with plasmapheresis or immunoabsorption. Among the 598 transplanted patients, 128 (21%) patients formed the case group and 452 (76%) the control group. In 116 (91%) patients who completed treatment, 106 (91%) showed no antibodies at treatment end. Fourteen (13%) patients showed antibody recurrence thereafter. In case versus control patients and at 4-year follow-up, respectively, graft survival (%) was 79 versus 81 (P = .59), freedom (%) from biopsy-confirmed rejection 57 versus 53 (P = .34), and from chronic lung allograft dysfunction 82 versus 78 (P = .83). After lung transplantation, patients with early donor-specific antibodies and treated with IgA- and IgM-enriched immunoglobulins had 4-year graft survival similar to patients without antibodies and showed high antibody clearance.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Murielle Verboom
- Department of TransfusionMedicine Hannover Medical SchoolHannoverGermany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany,German Center for Lung Research (DZL/BREATH)HannoverGermany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Ann‐Kathrin Knoefel
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | | | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Nicolaus Schwerk
- Department of Respiratory MedicineHannover Medical SchoolHannoverGermany,Department of PaediatricsHannover Medical SchoolHannoverGermany
| | - Carsten Mueller
- Department of Respiratory MedicineHannover Medical SchoolHannoverGermany,Department of PaediatricsHannover Medical SchoolHannoverGermany
| | - Tobias Welte
- German Center for Lung Research (DZL/BREATH)HannoverGermany,Department of Respiratory MedicineHannover Medical SchoolHannoverGermany
| | - Christine Falk
- Institute of Transplant ImmunologyHannover Medical SchoolHannoverGermany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany,German Center for Lung Research (DZL/BREATH)HannoverGermany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany,German Center for Lung Research (DZL/BREATH)HannoverGermany
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Ius F, Knoefel A, Salman J, Sommer W, Nakagiri T, Siemeni T, Kuehn C, Avsar M, Bobylev D, Poyanmehr R, Boethig D, Welte T, Haverich A, Tudorache I, Warnecke G. Increasing Frequency of CD127 low Regulatory Cells Early After Lung Transplantation Improves Freedom From Chronic Lung Allograft Rejection and Graft Survival in 673 Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.063] [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: 11/28/2022] Open
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23
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Ius F, Sommer W, Verboom M, Hallensleben M, Salman J, Siemeni T, Kuehn C, Avsar M, Bobylev D, Poyanmehr R, Schwerk N, Mueller C, Haverich A, Tudorache I, Warnecke G. Long-term Results of an IgM-enriched Human Immunoglobulin-based Therapy for Early Donor Specific Antibodies After Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.262] [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: 10/17/2022] Open
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24
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Ius F, Sommer W, Knoefel A, Salman J, Nakagiri T, Siemeni T, Kuehn C, Avsar M, Bobylev D, Poyanmehr R, Welte T, Haverich A, Tudorache I, Warnecke G. Influence of an IgM-enriched Intravenous Immunoglobulin-based Treatment on Regulatory T Cells in Patients with Donor Specific Antibodies After Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.207] [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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25
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Rojas S, Avsar M, Ius F, Kaufeld T, Salman J, Siemeni T, Goecke T, Poyanmehr R, Uribarri A, Schmitto J, Bara C, Haverich A, Warnecke G. Cardiac Transplantation in the VAD Era: Twenty-Year Experience of a Single Center. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Rojas
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - M. Avsar
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - F. Ius
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - T. Kaufeld
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - J. Salman
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - T. Siemeni
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - T. Goecke
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - R. Poyanmehr
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - A. Uribarri
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - J. Schmitto
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - C. Bara
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - A. Haverich
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - G. Warnecke
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
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26
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Hanke JS, Rojas SV, Poyanmehr R, Deniz E, Avsar M, Berliner D, Shrestha M, Cebotari S, Haverich A, Schmitto JD. Left Ventricular Assist Device Implantation With Outflow Graft Tunneling Through the Transverse Sinus. Artif Organs 2016; 40:610-2. [DOI: 10.1111/aor.12590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jasmin S. Hanke
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Sebastian V. Rojas
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Reza Poyanmehr
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Ezin Deniz
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Murat Avsar
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | | | - Malakh Shrestha
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Serghei Cebotari
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Axel Haverich
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Jan D. Schmitto
- Departments of Cardiothoracic; Transplantation, and Vascular Surgery; Hannover Medical School; Hannover Germany
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27
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Ius F, Sommer W, Poyanmehr R, Tudorache I, Kuehn C, Avsar M, Siemeni T, Salman J, Molitoris U, Greer M, Verboom M, Boethig D, Schwerk N, Welte T, Haverich A, Warnecke G, Gottlieb J. Risk Factors and Impact of Bronchial Stenoses after Lung Transplantation: Ten Year Single Center Experience with over 1,100 Patients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.374] [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: 11/16/2022] Open
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28
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Rangrez AY, Eden M, Poyanmehr R, Kuhn C, Stiebeling K, Dierck F, Bernt A, Lüllmann-Rauch R, Weiler H, Kirchof P, Frank D, Frey N. Myozap Deficiency Promotes Adverse Cardiac Remodeling via Differential Regulation of Mitogen-activated Protein Kinase/Serum-response Factor and β-Catenin/GSK-3β Protein Signaling. J Biol Chem 2015; 291:4128-43. [PMID: 26719331 DOI: 10.1074/jbc.m115.689620] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/04/2015] [Indexed: 01/22/2023] Open
Abstract
The intercalated disc (ID) is a "hot spot" for heart disease, as several ID proteins have been found mutated in cardiomyopathy. Myozap is a recent addition to the list of ID proteins and has been implicated in serum-response factor signaling. To elucidate the cardiac consequences of targeted deletion of myozap in vivo, we generated myozap-null mutant (Mzp(-/-)) mice. Although Mzp(-/-) mice did not exhibit a baseline phenotype, increased biomechanical stress due to pressure overload led to accelerated cardiac hypertrophy, accompanied by "super"-induction of fetal genes, including natriuretic peptides A and B (Nppa/Nppb). Moreover, Mzp(-/-) mice manifested a severe reduction of contractile function, signs of heart failure, and increased mortality. Expression of other ID proteins like N-cadherin, desmoplakin, connexin-43, and ZO-1 was significantly perturbed upon pressure overload, underscored by disorganization of the IDs in Mzp(-/-) mice. Exploration of the molecular causes of enhanced cardiac hypertrophy revealed significant activation of β-catenin/GSK-3β signaling, whereas MAPK and MKL1/serum-response factor pathways were inhibited. In summary, myozap is required for proper adaptation to increased biomechanical stress. In broader terms, our data imply an essential function of the ID in cardiac remodeling beyond a mere structural role and emphasize the need for a better understanding of this molecular structure in the context of heart disease.
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Affiliation(s)
- Ashraf Yusuf Rangrez
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Matthias Eden
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Reza Poyanmehr
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Christian Kuhn
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Katharina Stiebeling
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Franziska Dierck
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Alexander Bernt
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Renate Lüllmann-Rauch
- German Centre for Cardiovascular Research (DZHK, partner site Hamburg/Kiel/Lübeck), University Medical Center Schleswig-Holstein, Kiel D-24105, Germany
| | - Hartmut Weiler
- the Anatomical Institute, Christian Albrechts University of Kiel, Kiel D-24098, Germany
| | - Paulus Kirchof
- the Blood Research Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin 53233, and
| | - Derk Frank
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
| | - Norbert Frey
- From the Department of Internal Medicine III, Molecular Cardiology and Angiology, and
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Rangrez AY, Frank D, Poyanmehr R, Bernt A, Frey N. Abstract 181: Myozap Deficiency Promotes Adverse Remodeling And Cardiomyopathy In Response To Biomechanical Stress. Circ Res 2014. [DOI: 10.1161/res.115.suppl_1.181] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Myozap is a new addition to the list of intercalated disc (ID) proteins, which we previously identified using a bioinformatics screen. In vitro characterization of Myozap revealed that it activates Rho-dependent SRF signaling. Moreover, cardiac restricted overexpression of Myozap in mice resulted in protein aggregate-associated cardiomyopathy, whereas, knockdown of its ortholog in Zebrafish led to severe contractile dysfunction and cardiomyopathy. The objective of the current study was to elucidate the cardiac consequences of targeted deletion of Myozap in mice.
Methods and Results:
We generated a Myozap null mutant (MZP-ko) by global deletion of Myozap in mice. Unchallenged MZP-ko mice did not exhibit a baseline cardiac phenotype. However, upon biomechanical stress due to TAC (transverse aortic constriction), deficiency for Myozap led to accelerated cardiac hypertrophy (significant increases in the heart to body weight, left ventricular to body weight ratios) and fibrosis, accompanied by “super”-induction of the hypertrophic gene program (ANF/BNP). Moreover, MZP-ko mice revealed a severe reduction of fractional shortening and signs heart failure (increased lung/body weights) as well as a markedly increased mortality in response to TAC). Additional molecular data exhibited a significant decrease in the levels of native and phosphorylated Connexin 43 after transverse aortic constriction (TAC) in MZP-ko mice compared to wildtype animals. Finally, we observed a downregulation of dysbindin, a novel interaction partner of Myozap and known inducer of ERK1/2 signaling in TAC operated MZP-ko mice. Consistently, activation of ERK1/2 in response to TAC was blunted compared to wild-type littermates.
Conclusions:
We here show that myozap deficiency in vivo leads to a maladaptative response to increased biomechanical stress associated with cardiomyopathy, heart failure and cardiac death. Mechanistically, this phenotype can at least in part be explained by the interruption of the interaction between myozap and dysbindin with subsequent loss of ERK1/2 activation. Taken into a larger perspective, our data imply an essential role of the ID and its associated proteins in cardiac remodeling.
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Affiliation(s)
| | - Derk Frank
- Univ Med Cntr Campus Kiel, Kiel, Germany
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Frank D, Rangrez AY, Poyanmehr R, Seeger TS, Kuhn C, Eden M, Stiebeling K, Bernt A, Grund C, Franke WW, Frey N. Mice with cardiac-restricted overexpression of Myozap are sensitized to biomechanical stress and develop a protein-aggregate-associated cardiomyopathy. J Mol Cell Cardiol 2014; 72:196-207. [PMID: 24698889 DOI: 10.1016/j.yjmcc.2014.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 11/09/2013] [Revised: 03/03/2014] [Accepted: 03/21/2014] [Indexed: 02/05/2023]
Abstract
The intercalated disc (ID) is a major component of the cell-cell contact structures of cardiomyocytes and has been recognized as a hot spot for cardiomyopathy. We have previously identified Myozap as a novel cardiac-enriched ID protein, which interacts with several other ID proteins and is involved in RhoA/SRF signaling in vitro. To now study its potential role in vivo we generated a mouse model with cardiac overexpression of Myozap. Transgenic (Tg) mice developed cardiomyopathy with hypertrophy and LV dilation. Consistently, these mice displayed upregulation of the hypertrophy-associated and SRF-dependent gene expression. Pressure overload (transverse aortic constriction, TAC) caused exaggerated cardiac hypertrophy, further loss of contractility and LV dilation. Similarly, a physiological stimulus (voluntary running) also led to significant LV dysfunction. On the ultrastructural level, Myozap-Tg mouse hearts exhibited massive protein aggregates composed of Myozap, desmoplakin and other ID proteins. This aggregate-associated pathology closely resembled the alterations observed in desmin-related cardiomyopathy. Interestingly, desmin was not detectable in the aggregates, yet was largely displaced from the ID. Molecular analyses revealed induction of autophagy and dysregulation of the unfolded protein response (UPR), associated with apoptosis. Taken together, cardiac overexpression of Myozap leads to cardiomyopathy, mediated, at least in part by induction of Rho-dependent SRF signaling in vivo. Surprisingly, this phenotype was also accompanied by protein aggregates in cardiomyocytes, UPR alteration, accelerated autophagy and apoptosis. Thus, this mouse model may also offer additional insight into the pathogenesis of protein-aggregate-associated cardiomyopathies and represents a new candidate gene itself.
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Affiliation(s)
- Derk Frank
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
| | - Ashraf Y Rangrez
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Reza Poyanmehr
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Thalia S Seeger
- Dept of Molecular Hematology, University of Freiburg, Germany
| | - Christian Kuhn
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Matthias Eden
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Katharina Stiebeling
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Alexander Bernt
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | | | | | - Norbert Frey
- Dept of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
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Rangrez AY, Bernt A, Poyanmehr R, Harazin V, Boomgaarden I, Kuhn C, Rohrbeck A, Frank D, Frey N. Dysbindin is a potent inducer of RhoA-SRF-mediated cardiomyocyte hypertrophy. ACTA ACUST UNITED AC 2014; 203:643-56. [PMID: 24385487 PMCID: PMC3840930 DOI: 10.1083/jcb.201303052] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dysbindin activates RhoA–SRF and MEK1–ERK1 signaling pathways in cardiomyocytes to promote cardiac hypertrophy. Dysbindin is an established schizophrenia susceptibility gene thoroughly studied in the context of the brain. We have previously shown through a yeast two-hybrid screen that it is also a cardiac binding partner of the intercalated disc protein Myozap. Because Dysbindin is highly expressed in the heart, we aimed here at deciphering its cardiac function. Using a serum response factor (SRF) response element reporter-driven luciferase assay, we identified a robust activation of SRF signaling by Dysbindin overexpression that was associated with significant up-regulation of SRF gene targets, such as Acta1 and Actc1. Concurrently, we identified RhoA as a novel binding partner of Dysbindin. Further phenotypic and mechanistic characterization revealed that Dysbindin induced cardiac hypertrophy via RhoA–SRF and MEK1–ERK1 signaling pathways. In conclusion, we show a novel cardiac role of Dysbindin in the activation of RhoA–SRF and MEK1–ERK1 signaling pathways and in the induction of cardiac hypertrophy. Future in vivo studies should examine the significance of Dysbindin in cardiomyopathy.
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Affiliation(s)
- Ashraf Yusuf Rangrez
- Department of Internal Medicine III, University Medical Center Schleswig-Holstein, D-24105 Kiel, Germany
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Frank D, Poyanmehr R, Rangrez A, Kuhn C, Grund C, Franke WW, Frey N. Abstract 315: Mice With Cardiac-restricted Overexpression Of Myozap Are Sensitized To Biomechanical Stress And Develop A Protein-aggregate Associated Cardiomyopathy. Circ Res 2013. [DOI: 10.1161/res.113.suppl_1.a315] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intercalated disc (ID) is a major component of the cell-cell contact structures of cardiomyocytes ensuring their electro-mechanical coupling. In previous work, we could identify and characterize Myozap, a novel cardiac-enriched ID protein, which interacts with several other ID proteins.
We could now show in cardiomyocytes that overexpression of Myozap activates the Rho-dependent SRF pathway. Consistently, RNAi-mediated Myozap knockdown blocked Rho-mediated SRF activation linking the ID to gene regulation and actin dynamics.
For further analyses of Myozap’s functions in vivo, we generated a mouse model with cardiac overexpression of Myozap cDNA (αMHC promoter). 1 year old mice developed cardiomyopathy with significant hypertrophy (heart weight/tibia length +43%, p<0.01, n=8-10) as well as LV dilation (LVEDD +20%, p<0.01) and a trend towards LV dysfunction (fractional shortening 50% vs. 42%, n=10, p=0.07). Consistently, these mice displayed upregulation of the hypertrophy-associated gene program (nppa 4.3-fold, p<0.001, and nppb 2.2-fold, p<0.01, n=7-9).
On the ultrastructural level, we could detect bulky aggregates containing Myozap, desmoplakin and other ID proteins. This aggregate-associated pathology closely resembled the changes in the hearts of patients suffering from desminopathies. Interestingly, desmin was not detectable in the aggregates in MyozapTG mice, but appeared to be displaced from the ID. Further molecular analyses in the aged mice also revealed dysregulation of typical members of the unfolded protein response (UPR) associated with upregulation of UPR-related apoptosis (cleaved caspase 12).
Functionally, pressure overload via transverse aortic constriction (TAC) caused exaggerated cardiac hypertrophy (heart/body weight 7.9 mg/g in Myozap TG-TAC vs. 5.6 mg/g in WT-TAC, n=11 each group, p=0.002) and loss of contractility (fractional shortening of 15.3% in Myozap TG-TAC vs. 33.0% in WT-TAC, n=11 each group, p<0.001). Similarly, a physiological stimulus (voluntary running) led to a less dramatic but significant premature LV dysfunction.
In conclusion, Myozap overexpression offers new insights in the pathogenesis of protein aggregate-associated cardiomyopathies.
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