Publications (161) View all
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Article: Everolimus in different combinations as maintenance immunosuppressive therapy in heart transplant recipients.
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ABSTRACT: We examined the experiences of heart transplant recipients receiving everolimus as maintenance therapy in different combinations over a long time. Between 2004 and 2009, forty patients (29 men, 11 women; mean age, 51.6 y) were switched from a routine immunosuppressive regimen to everolimus. Indications were other (2), renal insufficiency (17), cardiac allograft vasculopathy (14), and ongoing cellular rejection (7). Combinations were either along with cyclosporine (24), mycophenolate mofetil (14), or others (2). Indications for the introduction of everolimus including safety, efficacy, different combinations of everolimus, biopsy-proven acute rejections, renal function, and infections were evaluated retrospectively. Five patients died, 4 of them were still on everolimus at the time of death; they died from intracerebral hemorrhage (1), embolism (1), cardiac arrest (2), and unknown (1). Everolimus was discontinued in 6 patients owing to severe adverse effects: Edema (2), gastrointestinal adverse effects (3), and dermal adverse effects (1). Mean everolimus trough levels were 5.8 μmol/L at 6 months and 4.9 at 60 months. Mean cyclosporine levels were 67.62 μmol/L at 6 months and 47.3 μmol/L at 60 months. Mean serum creatinine levels were stable (147.9 μmol/L after 60 months). Four life-threatening infections (all pneumonia) occurred but resulted in complete recovery. Everolimus is safe with different immunosuppressive combinations after receiving a heart transplant.Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 06/2012; 10(3):273-7. -
Article: Energy status of pig donor organs after ischemia is independent of donor type.
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ABSTRACT: BACKGROUND: Literature is controversial whether organs from living donors have a better graft function than brain dead (BD) and non-heart-beating donor organs. Success of transplantation has been correlated with high-energy phosphate (HEP) contents of the graft. METHODS: HEP contents in heart, liver, kidney, and pancreas from living, BD, and donation after cardiac death in a pig model (n=6 per donor type) were evaluated systematically. BD was induced under general anesthesia by inflating a balloon in the epidural space. Ten hours after confirmation, organs were retrieved. Cardiac arrest was induced by 9V direct current. After 10min of ventricular fibrillation without cardiac output, mechanical and medical reanimation was performed for 30min before organ retrieval. In living donors, organs were explanted immediately. Freeze-clamped biopsies were taken before perfusion with Celsior solution (heart) or University of Wisconsin solution (abdominal organs) in BD and living donors or with Histidine-Tryptophan-Ketoglutaric solution (all organs) in non-heart-beating donors, after perfusion, and after cold ischemia (4h for heart, 6h for liver and pancreas, and 12h for kidney). HEPs (adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, and phosphocreatine), xanthine, and hypoxanthine were measured by high-performance liquid chromatography. Energy charge and adenosine triphosphate-to-adenosine diphosphate ratio were calculated. RESULTS: After ischemia, organs from different donor types showed no difference in energy status. In all organs, a decrease of HEP and an increase in hypoxanthine contents were observed during perfusion and ischemia, irrespective of the donor type. CONCLUSION: Organs from BD or non-heart-beating donors do not differ from living donor organs in their energy status after average tolerable ischemia.Journal of Surgical Research 05/2012; · 2.25 Impact Factor -
Article: A Three-State Mathematical Model of Hyperthermic Cell Death
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ABSTRACT: Thermal treatments for tissue ablation rely upon the heating of cells past a threshold beyond which the cells are considered destroyed, denatured, or killed. In this article, a novel three-state model for cell death is proposed where there exists a vulnerable state positioned between the alive and dead states used in a number of existing cell death models. Proposed rate coefficients include temperature dependence and the model is fitted to experimental data of heated co-cultures of hepatocytes and lung fibroblasts with very small RMS error. The experimental data utilized include further reductions in cell viabilities over 24 and 48h post-heating and these data are used to extend the three-state model to account for slow cell death. For the two cell lines employed in the experimental data, the three parameters for fast cell death appear to be linearly increasing with % content of lung fibroblast, while the sparse nature of the data did not indicate any co-culture make-up dependence for the parameters for slow cell death. A critical post-heating cell viability threshold is proposed beyond which cells progress to death; and these results are of practical importance with potential for more accurate prediction of cell death. KeywordsCell death–HyperthermiaAnnals of Biomedical Engineering 04/2012; 39(1):570-579. · 2.37 Impact Factor -
Article: Impact of temperature on cell death in a cell-culture model of hepatocellular carcinoma.
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ABSTRACT: Radiofrequency ablation (RFA) is one treatment option for hepatocellular carcinoma (HCC) where tumour cells are destroyed by heat. However, there is lack of knowledge about cellular reactions after heating. Therefore, we studied cell death after heat application in a cell-culture setting mimicking HCC. Intracellularly stained hepatic stellate cells (LX-1) and HCC cells (HepG2) were cultivated in co-culture or alone. Apoptosis was determined by flow cytometry using AnnexinV-PE and eFluor®450. Heating resulted in early apoptosis for 20-30% of HepG2 cells and 10-15% of LX-1 cells. Late apoptosis was observed in a large percentage of cells 24 h after heating at 65°C for 15 min or 75°C for 5 min; 65°C for 10 min resulted in a moderate increase and 55°C for 15 min resulted in a minor percentage of late apoptotic cells. Heat-treated LX-1 and HepG2 cells die by apoptosis. This finding is important for future planning tools to ameliorate RFA outcome in clinic.Anticancer research 03/2012; 32(3):915-21. · 1.73 Impact Factor -
Article: The assessment of GFR after orthotopic liver transplantation using cystatin C and creatinine-based equations.
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ABSTRACT: The measurement of kidney function after orthotopic liver transplantation (OLT) is still a clinical challenge. Cystatin C (CysC) has been proposed as a more accurate marker of renal function than serum creatinine (sCr). The aim of this study was to evaluate sCr- and CysC-based equations including the Chronic kidney disease (CKD)-EPI to determine renal function in liver transplant recipients. CysC and sCr were measured in 49 patients 24 months after OLT. The glomerular filtration rate (GFR) was calculated using the MDRD 4, the Cockroft-Gault, Hoek, Larsson, and the CKD-EPI equations based on sCr and/or CysC. As reference method, inulin clearance (IC) was estimated. Bias, precision, and accuracy of each equation were assessed and compared with respect to IC. Forty-five percent had a GFR < 60 ml/min/1.73 m(2) according to the IC. The Larsson, the Hoek and the CKD-EPI-CysC formula identified the highest percentage of patients with CKD correctly (88%, 88%, and 84%, respectively). The sCr-based equations showed less bias than CysC-based formulas with a similar precision. All CysC-based equations were superior as compared with sCr-based equations in the assessment of renal function in patients with an IC < 60 ml/min/1.73 m(2).Transplant International 02/2012; 25(5):527-36. · 2.92 Impact Factor
