Katharina Schütte-Nütgen - Academia.edu (original) (raw)
Papers by Katharina Schütte-Nütgen
Intensive and Critical Care Nursing, Dec 1, 2022
ObjectiveThe Covid 19 pandemic has created a situation in which critical care staff experience mo... more ObjectiveThe Covid 19 pandemic has created a situation in which critical care staff experience moral distress. For reducing moral distress, resources such as spirituality can be used. The aim of this scoping review is to explore whether spirituality mitigates the moral distress of critical care staff and strengthens their resilience. The spiritual resources will be identified and the ability of the staff to use spiritual resources will be explored.MethodologyA scoping review of studies reporting on the association between spirituality, moral distress, and resilience. Qualitative and quantitative studies from 2020 that examined critical care staff are included. This scoping review used the five-step framework proposed by Arksey and O'Malley and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in 12 databases.Results13 studies met inclusion criteria. Critical care staff declaring themselves as spiritual have a higher risk of moral distress and are often not able to use spiritual resources on their own. For effective use of spiritual resources to reduce moral distress, staff need to be skilled in the practice of spirituality with the aim to find inner peace, focus on the positive, and regain a sense of purpose in the work.ConclusionSpirituality does not automatically help the critical care staff to cope with moral distress and strengthen resilience. Institutions need to create conditions in which the critical care staff are supported to use their spiritual resources.Implication for clinical practiceInstitutions need to involve staff more in the design, implementation, and delivery of spiritual interventions to minimise moral distress. Further research is necessary to examine the impact of critical care staff’s demographic characteristics on their spirituality, moral distress, and resilience.
International Journal of Environmental Research and Public Health
Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and ... more Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). Aim: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. Methods: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire w...
Deutsche Zeitschrift für Onkologie
ZusammenfassungSowohl aufgrund der demografischen Entwicklung in Deutschland, als auch angesichts... more ZusammenfassungSowohl aufgrund der demografischen Entwicklung in Deutschland, als auch angesichts des raschen Fortschritts der modernen Hochleistungsmedizin ist die Forderung nach einem bedarfsdeckenden Ausbau der Palliativmedizin lauter geworden. Trotz der bedeutsamen Weiterentwicklung dieses Fachgebiets wird die Palliativmedizin nicht nur in der Öffentlichkeit, sondern auch in vielen Bereichen der Medizin noch immer ausschließlich mit dem nahenden Lebensende in Verbindung gebracht und es herrscht die Vorstellung, dass Sterben und Tod in eigens dafür eingerichteten Bereichen wie der Palliativstation stattfinden, außerhalb der Gesellschaft und getrennt von den übrigen medizinischen Versorgungsstrukturen. In dieser Falldarstellung berichten wir über eine 36-jährige Patientin, die durch den palliativmedizinischen Dienst betreut wurde. Das Fallbeispiel spiegelt die vielfältigen Aspekte der palliativmedizinischen Versorgung wider und zeigt, dass das Sterben aus der Akutmedizin nicht aus...
Journal of Clinical Medicine, 2021
Organ scarcity demands critical decision-making regarding eligible transplant candidates and graf... more Organ scarcity demands critical decision-making regarding eligible transplant candidates and graft allocation to ensure best benefit from renal transplantation (RTx). Among the controversial relative contraindications is a history of pretransplant malignancy (PTM). While oncological outcomes of PTM-RTx recipients are well described, data on graft-specific outcome are scarce. A retrospective double case control matched pair analysis (60 months follow-up) was carried out and RTx-recipients were stratified for history of PTM. First, PTM-RTx recipients were matched according to age, sex and duration of immunosuppressive therapy. Next, PTM-RTx recipients were matched 1:1 for age, sex and cause of end-stage renal disease. Five-year patient and graft survival as well as oncological outcomes were analyzed. A total of 65 PTM-RTx recipients were identified. Post-RTx recurrence rate was 5%, while 20% developed second de novo malignancy, comparable to 14% in the control group. PTM-RTx recipient...
Journal of Clinical Medicine, 2019
The authors wish to make the following corrections to this paper [...]
PLOS ONE, 2018
Background The weekend effect describes a phenomenon whereby patients admitted to hospitals on we... more Background The weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications compared to those admitted during weekdays. However, if a weekend effect exists in orthotopic liver transplantation (oLT). Methods We analyzed oLT between 2006 and 2016 and stratified patients into weekday (Monday to Friday) and weekend (Saturday, Sunday) groups. Primary outcome measures were oneyear patient and graft survival. Results 364 deceased donor livers were transplanted into 329 patients with 246 weekday (74.77%) and 83 weekend (25.23%) patients. Potential confounders (e.g. age, ischemia time, MELD score) were comparable. One-year patient and graft survival were similar. Frequencies of rejections, primary-non function or re-transplantation were not different. The day of transplantation was not associated with one-year patient and graft survival in multivariate analysis. Conclusions We provide the first data for the Eurotransplant region on oLT stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT. While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week.
Journal of Clinical Medicine, 2019
Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation ... more Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation (RTx). However, its metabolism rate is highly variable. A fast Tac metabolism rate, defined by the Tac blood trough concentration (C) divided by the daily dose (D), is associated with inferior renal function after RTx. Therefore, we hypothesize that the Tac metabolism rate impacts patient and graft survival after RTx. We analyzed all patients who received a RTx between January 2007 and December 2012 and were initially treated with an immunosuppressive regimen containing Tac (Prograf®), mycophenolate mofetil, prednisolone and induction therapy. Patients with a Tac C/D ratio <1.05 ng/mL × 1/mg at three months after RTx were characterized as fast metabolizers and those with a C/D ratio ≥1.05 ng/mL×1/mg as slow metabolizers. Five-year patient and overall graft survival were noticeably reduced in fast metabolizers. Further, fast metabolizers showed a faster decline of eGFR (estimated glome...
PLOS ONE, 2019
Background Given the gap between patients in need of a renal transplantation (RTx) and organs ava... more Background Given the gap between patients in need of a renal transplantation (RTx) and organs available, transplantation centers increasingly accept organs of suboptimal quality, e.g. from donors with acute kidney injury (AKI). Methods To determine the outcome of kidney transplants from deceased donors with AKI (defined as � AKIN stage 1), all 107 patients who received a RTx from donors with AKI between August 2004 and July 2014 at our center were compared to their respective consecutively transplanted patients receiving kidneys from donors without AKI. 5-year patient and graft survival, frequencies of delayed graft function (DGF), acute rejections and glomerular filtration rate (eGFR, CKD-EPI) were assessed. Results Patient survival was similar in both groups, whereas death-censored and overall graft survival were decreased in AKI kidney recipients. AKI kidney recipients showed higher frequencies of DGF and had a reduced eGFR at 7 days, three months and one and three years after RTx. However, mortality was noticeably lower compared to waiting list candidates. Rejection-free survival was similar between groups. Conclusions In our cohort, both short-term and long-term renal function was inferior in recipients of AKI kidneys, while patient survival was similar. Our data indicates that recipients of donor AKI
The American journal of pathology, 2017
Costimulatory molecules, such as the programmed death ligand (PD-L1), might exert differential ef... more Costimulatory molecules, such as the programmed death ligand (PD-L1), might exert differential effects on T-cell function, depending on the clinical setting and/or immunological environment. Given the impact of T cells on bronchiolitis obliterans (BO) in lung transplantation, we used an established tracheal transplant model inducing BO-like lesions to investigate the impact of PD-L1 on alloimmune responses and histopathological outcome in BO. In contrast to other transplant models in which PD-L1 generally shows protective functions, we demonstrated that PD-L1 has divergent effects depending on its location in donor versus recipient tissue. Although PD-L1 deficiency in donor tissue worsened histopathological outcome, and increased systemic inflammatory response, recipient PD-L1 deficiency induced opposite effects. Mechanistic studies revealed PD-L1-deficient recipients were hyporesponsive toward alloantigen, despite increased numbers of CD8(+) effector T cells. The function of PD-L1 ...
Stem Cells International, 2014
Obliterative bronchiolitis (OB) remains the most significant cause of death in long-term survival... more Obliterative bronchiolitis (OB) remains the most significant cause of death in long-term survival of lung transplantation. Using an established murine heterotopic tracheal allograft model, the effects of different routes of administration of bone marrow-derived multipotent stromal cells (MSCs) on the development of OB were evaluated. Tracheas from BALB/c mice were implanted into the subcutaneous tissue of major histocompatibility complex- (MHC-) disparate C57BL/6 mice. At the time of transplant, bone marrow-derived MSCs were administered either systemically or locally or via a combination of the two routes. The allografts were explanted at various time points after transplantation and were evaluated for epithelial integrity, inflammatory cell infiltration, fibrosis, and luminal obliteration. We found that the most effective route of bone marrow-derived MSC administration is the combination of systemic and local delivery. Treatment of recipient mice with MSCs suppressed neutrophil, m...
Experimental Lung Research, 2011
Lung transplantation has the worst outcome compared to all solid organ transplants due to chronic... more Lung transplantation has the worst outcome compared to all solid organ transplants due to chronic rejection known as obliterative bronchiolitis (OB). Pathogenesis of OB is a complex interplay of alloimmune-dependent and-independent factors, which leads to the development of inflammation, fibrosis, and airway obliteration that have been resistant to therapy. The alloimmune-independent inflammatory pathway has been the recent focus in the pathogenesis of rejection, suggesting that targeting this may offer therapeutic benefits. As a potent anti-inflammatory agent, epigallocatechin-galleate (EGCG), a green tea catechin, has been very effective in ameliorating inflammation in a variety of diseases, providing the rationale for its use in this study in a murine heterotopic tracheal allograft model of OB. Mice treated with EGCG had reduced inflammation, with significantly less neutrophil and macrophage infiltration and significantly reduced fibrosis. On further investigation into the mechanisms, inflammatory cytokines keratinocyte (KC), interleukin-17 (IL-17), and tumor necrosis factor-α (TNF-α), involved in neutrophil recruitment, were reduced in the EGCG-treated mice. In addition, monocyte chemokine monocyte chemoattractant protein-1 (MCP-1) was significantly reduced by EGCG treatment. Antifibrotic cytokine interferon-γ-inducible protein-10 (IP-10) was increased and profibrotic cytokine transforming growth factor-β (TGF-β) was reduced, further characterizing the antifibrotic effects of EGCG. These findings suggest that EGCG has great potential in ameliorating the development of obliterative airway disease.
Circulation, 2007
Background— Growth-differentiation factor-15 (GDF-15) is a member of the transforming growth fact... more Background— Growth-differentiation factor-15 (GDF-15) is a member of the transforming growth factor-β cytokine superfamily that is induced in the heart after ischemia-and-reperfusion injury. Circulating levels of GDF-15 may provide prognostic information in patients with non–ST-elevation acute coronary syndrome. Methods and Results— Blood samples were obtained on admission from 2081 patients with acute chest pain and either ST-segment depression or troponin elevation who were included in the Global Utilization of Strategies to Open Occluded Arteries (GUSTO)-IV Non–ST-Elevation Acute Coronary Syndrome trial and from a matching cohort of 429 apparently healthy individuals. GDF-15 levels were determined by immunoradiometric assay. Approximately two thirds of patients presented with GDF-15 levels above the upper limit of normal in healthy controls (1200 ng/L); one third presented with levels >1800 ng/L. Increasing tertiles of GDF-15 were associated with an enhanced risk of death at 1...
British Journal of Haematology, 2003
The urokinase-type plasminogen activator (uPA) system, which consists of a proteinase (uPA), a re... more The urokinase-type plasminogen activator (uPA) system, which consists of a proteinase (uPA), a receptor (uPAR or CD87) and inhibitors, is involved in proteolysis, cell migration, tissue remodelling, angiogenesis and cell adhesion. Recent findings suggest that malignant plasma cells express uPA and uPAR. The expression of these factors could represent a process by which myeloma plasma cells interact with the bone marrow (BM) environment and influence important biological events such as bone matrix degradation, plasma cell invasion and homing and, possibly, clinical evolution. We evaluated uPAR (CD87) and its soluble form (suPAR) in 49 multiple myeloma (MM) patients and correlated their expression and levels with clinicobiological characteristics of the disease. Flow cytometric analysis demonstrated that CD87 was expressed in all MM patients. High CD87 expression was associated with higher intensity of expression of CD56 (P ¼ 0AE038), CD38 (P ¼ 0AE058) and CD138 (P ¼ 0AE054) and CD45 bright positivity (P ¼ 0AE014). suPAR levels correlated positively with soluble serum CD138 (P ¼ 0AE001), creatinine (P ¼ 0AE001), beta 2-microglobulin (P < 0AE001), disease stage (P ¼ 0AE017) and extra-BM involvement (P ¼ 0AE002). In the 46 evaluable patients, multivariate analysis showed that high levels of suPAR (P ¼ 0AE0214) and disease stage (P ¼ 0AE0064) were predictive of extra-BM involvement. In multivariate Cox analysis, 13q deletion (P ¼ 0AE0278), high soluble serum CD138 (P ¼ 0AE0201) and high suPAR (P ¼ 0AE0229) were the only parameters that independently affected survival. We conclude that CD87 is expressed on myeloma plasma cells and that suPAR, which predicts extra-BM involvement and poor prognosis, possibly represents a molecule with a relevant role in the biology of MM.
Arteriosclerosis, Thrombosis, and Vascular Biology, 2010
Objective— To determine the role of monocyte chemoattractant protein-1 (Mcp-1) on the progression... more Objective— To determine the role of monocyte chemoattractant protein-1 (Mcp-1) on the progression of visceral fat-induced atherosclerosis. Methods and Results— Visceral fat inflammation was induced by transplantation of perigonadal fat. To determine whether recipient Mcp-1 status affected atherosclerosis induced by inflammatory fat, apolipoprotein E-deficient ( ApoE −/− ) and ApoE −/− and Mcp-1-deficient ( Mcp-1 −/− ) mice underwent visceral fat transplantation. Intravital microscopy was used to study leukocyte-endothelial interactions. To study the primary tissue source of circulating Mcp-1, both fat and bone marrow transplantation experiments were used. Transplantation of visceral fat increased atherosclerosis in ApoE −/− mice but had no effect on atherosclerosis in ApoE −/− , Mcp-1 −/− mice. Intravital microscopy revealed increased leukocyte attachment to the endothelium in ApoE −/− mice compared with ApoE −/− , Mcp-1 −/− mice after receiving visceral fat transplants. Transplanta...
Journal of Clinical Medicine, 2021
Background: The prone position (PP) is increasingly used in mechanically ventilated coronavirus d... more Background: The prone position (PP) is increasingly used in mechanically ventilated coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. However, studies investigating the influence of the PP are currently lacking in these patients. This is the first study to investigate the influence of the PP on the oxygenation and decarboxylation in COVID-19 patients. Methods: A prospective bicentric study design was used, and in mechanically ventilated COVID-19 patients, PP was indicated from a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FIO2) ratio of <200. Patients were left prone for 16 h each. Pressure levels, FIO2, were adjusted to ensure a PaO2 greater than 60 mmHg. Blood gas analyses were performed before (baseline 0.5 h), during (1/2/5.5/9.5/13 h), and after being in the PP (1 h), the circulatory/ventilation parameters were continuously monitored, and lung compliance (LC) was roughly calculated. Responders were d...
American Journal of Transplantation
Spiritual Care
Objective The objective of this scoping review (Registration DOI:10.17605/OSF.IO/UYV9G) is to und... more Objective The objective of this scoping review (Registration DOI:10.17605/OSF.IO/UYV9G) is to understand how critical care professionals’ (CCP) moral distress and spiritual resources impact on their resilience. Introduction Previous reviews failed in obtaining evidence for tailored intervention reducing CCPs’ moral distress. Although frequently mentioned, spiritual resources were not thoroughly explored. Inclusion criteria In order to describe elements of the inclusion criteria, the PCC-framework (Population, Concept, Context) will be applied. Participants are all CCP (nurses, physicians, physiotherapists, psychologists …). The concept is resilience, taking into account moral distress and spirituality. The context is critical care (preclinical emergency care, emergency room, intensive care unit). Other contexts such as palliative care wards are excluded. Methods We will search 13 databases and grey literature published in 2020–2022. A two-stage screening process by at least two inde...
Objective: The objective of this scoping review is to understand how critical care professionals&... more Objective: The objective of this scoping review is to understand how critical care professionals' (CCP) moral distress and spiritual resources impact on their resilience. Introduction: Previous reviews failed in obtaining evidence for tailored intervention reducing CCP' moral distress. Although frequently mentioned, spiritual resources were not thoroughly explored. Inclusion criteria: Participants are all CCP (nurses, physicians, physiotherapists, psychologists…). The concept is resilience, taking into account moral distress and spirituality. The context is critical care (preclinical emergency care, emergency room, intensive care unit). Other contexts such as palliative care wards are excluded. Methods: We will search 12 databases and grey literature published in 2020-2022. A two-stage screening process by two independent reviewers will be used. First titles and abstracts will be scanned and then a full-text review of relevant articles will be done. Data will be extracted in...
Journal of Clinical Medicine
Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplant... more Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplantation (RTx), mainly due to cardiovascular events. Because dyslipidemia is a leading cause of cardiovascular death, we hypothesized that most RTx patients do not achieve recommended target low-density lipoprotein cholesterol (LDL-C) levels (European cardiology society guidelines) and that fast Tac metabolizers have higher dyslipidemia rates. This study included RTx recipients who received initial immunosuppression with immediate-release tacrolimus (IR-Tac), mycophenolate, and prednisolone. Patients were grouped according to their Tac concentration-to-dose ratio (C/D ratio) 3 months after RTx. Dyslipidemia parameters were analyzed at RTx, 3 months, and 12 months after RTx. Statin use and renal function were documented in a 12-month follow-up, and death was documented in a 60-month follow-up. Ninety-six RTx recipients were divided into two groups: 31 fast Tac metabolizers (C/D ratio < 1....
Journal of Clinical Medicine, 2022
Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We here... more Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n ...
Intensive and Critical Care Nursing, Dec 1, 2022
ObjectiveThe Covid 19 pandemic has created a situation in which critical care staff experience mo... more ObjectiveThe Covid 19 pandemic has created a situation in which critical care staff experience moral distress. For reducing moral distress, resources such as spirituality can be used. The aim of this scoping review is to explore whether spirituality mitigates the moral distress of critical care staff and strengthens their resilience. The spiritual resources will be identified and the ability of the staff to use spiritual resources will be explored.MethodologyA scoping review of studies reporting on the association between spirituality, moral distress, and resilience. Qualitative and quantitative studies from 2020 that examined critical care staff are included. This scoping review used the five-step framework proposed by Arksey and O'Malley and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in 12 databases.Results13 studies met inclusion criteria. Critical care staff declaring themselves as spiritual have a higher risk of moral distress and are often not able to use spiritual resources on their own. For effective use of spiritual resources to reduce moral distress, staff need to be skilled in the practice of spirituality with the aim to find inner peace, focus on the positive, and regain a sense of purpose in the work.ConclusionSpirituality does not automatically help the critical care staff to cope with moral distress and strengthen resilience. Institutions need to create conditions in which the critical care staff are supported to use their spiritual resources.Implication for clinical practiceInstitutions need to involve staff more in the design, implementation, and delivery of spiritual interventions to minimise moral distress. Further research is necessary to examine the impact of critical care staff’s demographic characteristics on their spirituality, moral distress, and resilience.
International Journal of Environmental Research and Public Health
Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and ... more Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). Aim: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. Methods: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire w...
Deutsche Zeitschrift für Onkologie
ZusammenfassungSowohl aufgrund der demografischen Entwicklung in Deutschland, als auch angesichts... more ZusammenfassungSowohl aufgrund der demografischen Entwicklung in Deutschland, als auch angesichts des raschen Fortschritts der modernen Hochleistungsmedizin ist die Forderung nach einem bedarfsdeckenden Ausbau der Palliativmedizin lauter geworden. Trotz der bedeutsamen Weiterentwicklung dieses Fachgebiets wird die Palliativmedizin nicht nur in der Öffentlichkeit, sondern auch in vielen Bereichen der Medizin noch immer ausschließlich mit dem nahenden Lebensende in Verbindung gebracht und es herrscht die Vorstellung, dass Sterben und Tod in eigens dafür eingerichteten Bereichen wie der Palliativstation stattfinden, außerhalb der Gesellschaft und getrennt von den übrigen medizinischen Versorgungsstrukturen. In dieser Falldarstellung berichten wir über eine 36-jährige Patientin, die durch den palliativmedizinischen Dienst betreut wurde. Das Fallbeispiel spiegelt die vielfältigen Aspekte der palliativmedizinischen Versorgung wider und zeigt, dass das Sterben aus der Akutmedizin nicht aus...
Journal of Clinical Medicine, 2021
Organ scarcity demands critical decision-making regarding eligible transplant candidates and graf... more Organ scarcity demands critical decision-making regarding eligible transplant candidates and graft allocation to ensure best benefit from renal transplantation (RTx). Among the controversial relative contraindications is a history of pretransplant malignancy (PTM). While oncological outcomes of PTM-RTx recipients are well described, data on graft-specific outcome are scarce. A retrospective double case control matched pair analysis (60 months follow-up) was carried out and RTx-recipients were stratified for history of PTM. First, PTM-RTx recipients were matched according to age, sex and duration of immunosuppressive therapy. Next, PTM-RTx recipients were matched 1:1 for age, sex and cause of end-stage renal disease. Five-year patient and graft survival as well as oncological outcomes were analyzed. A total of 65 PTM-RTx recipients were identified. Post-RTx recurrence rate was 5%, while 20% developed second de novo malignancy, comparable to 14% in the control group. PTM-RTx recipient...
Journal of Clinical Medicine, 2019
The authors wish to make the following corrections to this paper [...]
PLOS ONE, 2018
Background The weekend effect describes a phenomenon whereby patients admitted to hospitals on we... more Background The weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications compared to those admitted during weekdays. However, if a weekend effect exists in orthotopic liver transplantation (oLT). Methods We analyzed oLT between 2006 and 2016 and stratified patients into weekday (Monday to Friday) and weekend (Saturday, Sunday) groups. Primary outcome measures were oneyear patient and graft survival. Results 364 deceased donor livers were transplanted into 329 patients with 246 weekday (74.77%) and 83 weekend (25.23%) patients. Potential confounders (e.g. age, ischemia time, MELD score) were comparable. One-year patient and graft survival were similar. Frequencies of rejections, primary-non function or re-transplantation were not different. The day of transplantation was not associated with one-year patient and graft survival in multivariate analysis. Conclusions We provide the first data for the Eurotransplant region on oLT stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT. While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week.
Journal of Clinical Medicine, 2019
Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation ... more Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation (RTx). However, its metabolism rate is highly variable. A fast Tac metabolism rate, defined by the Tac blood trough concentration (C) divided by the daily dose (D), is associated with inferior renal function after RTx. Therefore, we hypothesize that the Tac metabolism rate impacts patient and graft survival after RTx. We analyzed all patients who received a RTx between January 2007 and December 2012 and were initially treated with an immunosuppressive regimen containing Tac (Prograf®), mycophenolate mofetil, prednisolone and induction therapy. Patients with a Tac C/D ratio <1.05 ng/mL × 1/mg at three months after RTx were characterized as fast metabolizers and those with a C/D ratio ≥1.05 ng/mL×1/mg as slow metabolizers. Five-year patient and overall graft survival were noticeably reduced in fast metabolizers. Further, fast metabolizers showed a faster decline of eGFR (estimated glome...
PLOS ONE, 2019
Background Given the gap between patients in need of a renal transplantation (RTx) and organs ava... more Background Given the gap between patients in need of a renal transplantation (RTx) and organs available, transplantation centers increasingly accept organs of suboptimal quality, e.g. from donors with acute kidney injury (AKI). Methods To determine the outcome of kidney transplants from deceased donors with AKI (defined as � AKIN stage 1), all 107 patients who received a RTx from donors with AKI between August 2004 and July 2014 at our center were compared to their respective consecutively transplanted patients receiving kidneys from donors without AKI. 5-year patient and graft survival, frequencies of delayed graft function (DGF), acute rejections and glomerular filtration rate (eGFR, CKD-EPI) were assessed. Results Patient survival was similar in both groups, whereas death-censored and overall graft survival were decreased in AKI kidney recipients. AKI kidney recipients showed higher frequencies of DGF and had a reduced eGFR at 7 days, three months and one and three years after RTx. However, mortality was noticeably lower compared to waiting list candidates. Rejection-free survival was similar between groups. Conclusions In our cohort, both short-term and long-term renal function was inferior in recipients of AKI kidneys, while patient survival was similar. Our data indicates that recipients of donor AKI
The American journal of pathology, 2017
Costimulatory molecules, such as the programmed death ligand (PD-L1), might exert differential ef... more Costimulatory molecules, such as the programmed death ligand (PD-L1), might exert differential effects on T-cell function, depending on the clinical setting and/or immunological environment. Given the impact of T cells on bronchiolitis obliterans (BO) in lung transplantation, we used an established tracheal transplant model inducing BO-like lesions to investigate the impact of PD-L1 on alloimmune responses and histopathological outcome in BO. In contrast to other transplant models in which PD-L1 generally shows protective functions, we demonstrated that PD-L1 has divergent effects depending on its location in donor versus recipient tissue. Although PD-L1 deficiency in donor tissue worsened histopathological outcome, and increased systemic inflammatory response, recipient PD-L1 deficiency induced opposite effects. Mechanistic studies revealed PD-L1-deficient recipients were hyporesponsive toward alloantigen, despite increased numbers of CD8(+) effector T cells. The function of PD-L1 ...
Stem Cells International, 2014
Obliterative bronchiolitis (OB) remains the most significant cause of death in long-term survival... more Obliterative bronchiolitis (OB) remains the most significant cause of death in long-term survival of lung transplantation. Using an established murine heterotopic tracheal allograft model, the effects of different routes of administration of bone marrow-derived multipotent stromal cells (MSCs) on the development of OB were evaluated. Tracheas from BALB/c mice were implanted into the subcutaneous tissue of major histocompatibility complex- (MHC-) disparate C57BL/6 mice. At the time of transplant, bone marrow-derived MSCs were administered either systemically or locally or via a combination of the two routes. The allografts were explanted at various time points after transplantation and were evaluated for epithelial integrity, inflammatory cell infiltration, fibrosis, and luminal obliteration. We found that the most effective route of bone marrow-derived MSC administration is the combination of systemic and local delivery. Treatment of recipient mice with MSCs suppressed neutrophil, m...
Experimental Lung Research, 2011
Lung transplantation has the worst outcome compared to all solid organ transplants due to chronic... more Lung transplantation has the worst outcome compared to all solid organ transplants due to chronic rejection known as obliterative bronchiolitis (OB). Pathogenesis of OB is a complex interplay of alloimmune-dependent and-independent factors, which leads to the development of inflammation, fibrosis, and airway obliteration that have been resistant to therapy. The alloimmune-independent inflammatory pathway has been the recent focus in the pathogenesis of rejection, suggesting that targeting this may offer therapeutic benefits. As a potent anti-inflammatory agent, epigallocatechin-galleate (EGCG), a green tea catechin, has been very effective in ameliorating inflammation in a variety of diseases, providing the rationale for its use in this study in a murine heterotopic tracheal allograft model of OB. Mice treated with EGCG had reduced inflammation, with significantly less neutrophil and macrophage infiltration and significantly reduced fibrosis. On further investigation into the mechanisms, inflammatory cytokines keratinocyte (KC), interleukin-17 (IL-17), and tumor necrosis factor-α (TNF-α), involved in neutrophil recruitment, were reduced in the EGCG-treated mice. In addition, monocyte chemokine monocyte chemoattractant protein-1 (MCP-1) was significantly reduced by EGCG treatment. Antifibrotic cytokine interferon-γ-inducible protein-10 (IP-10) was increased and profibrotic cytokine transforming growth factor-β (TGF-β) was reduced, further characterizing the antifibrotic effects of EGCG. These findings suggest that EGCG has great potential in ameliorating the development of obliterative airway disease.
Circulation, 2007
Background— Growth-differentiation factor-15 (GDF-15) is a member of the transforming growth fact... more Background— Growth-differentiation factor-15 (GDF-15) is a member of the transforming growth factor-β cytokine superfamily that is induced in the heart after ischemia-and-reperfusion injury. Circulating levels of GDF-15 may provide prognostic information in patients with non–ST-elevation acute coronary syndrome. Methods and Results— Blood samples were obtained on admission from 2081 patients with acute chest pain and either ST-segment depression or troponin elevation who were included in the Global Utilization of Strategies to Open Occluded Arteries (GUSTO)-IV Non–ST-Elevation Acute Coronary Syndrome trial and from a matching cohort of 429 apparently healthy individuals. GDF-15 levels were determined by immunoradiometric assay. Approximately two thirds of patients presented with GDF-15 levels above the upper limit of normal in healthy controls (1200 ng/L); one third presented with levels >1800 ng/L. Increasing tertiles of GDF-15 were associated with an enhanced risk of death at 1...
British Journal of Haematology, 2003
The urokinase-type plasminogen activator (uPA) system, which consists of a proteinase (uPA), a re... more The urokinase-type plasminogen activator (uPA) system, which consists of a proteinase (uPA), a receptor (uPAR or CD87) and inhibitors, is involved in proteolysis, cell migration, tissue remodelling, angiogenesis and cell adhesion. Recent findings suggest that malignant plasma cells express uPA and uPAR. The expression of these factors could represent a process by which myeloma plasma cells interact with the bone marrow (BM) environment and influence important biological events such as bone matrix degradation, plasma cell invasion and homing and, possibly, clinical evolution. We evaluated uPAR (CD87) and its soluble form (suPAR) in 49 multiple myeloma (MM) patients and correlated their expression and levels with clinicobiological characteristics of the disease. Flow cytometric analysis demonstrated that CD87 was expressed in all MM patients. High CD87 expression was associated with higher intensity of expression of CD56 (P ¼ 0AE038), CD38 (P ¼ 0AE058) and CD138 (P ¼ 0AE054) and CD45 bright positivity (P ¼ 0AE014). suPAR levels correlated positively with soluble serum CD138 (P ¼ 0AE001), creatinine (P ¼ 0AE001), beta 2-microglobulin (P < 0AE001), disease stage (P ¼ 0AE017) and extra-BM involvement (P ¼ 0AE002). In the 46 evaluable patients, multivariate analysis showed that high levels of suPAR (P ¼ 0AE0214) and disease stage (P ¼ 0AE0064) were predictive of extra-BM involvement. In multivariate Cox analysis, 13q deletion (P ¼ 0AE0278), high soluble serum CD138 (P ¼ 0AE0201) and high suPAR (P ¼ 0AE0229) were the only parameters that independently affected survival. We conclude that CD87 is expressed on myeloma plasma cells and that suPAR, which predicts extra-BM involvement and poor prognosis, possibly represents a molecule with a relevant role in the biology of MM.
Arteriosclerosis, Thrombosis, and Vascular Biology, 2010
Objective— To determine the role of monocyte chemoattractant protein-1 (Mcp-1) on the progression... more Objective— To determine the role of monocyte chemoattractant protein-1 (Mcp-1) on the progression of visceral fat-induced atherosclerosis. Methods and Results— Visceral fat inflammation was induced by transplantation of perigonadal fat. To determine whether recipient Mcp-1 status affected atherosclerosis induced by inflammatory fat, apolipoprotein E-deficient ( ApoE −/− ) and ApoE −/− and Mcp-1-deficient ( Mcp-1 −/− ) mice underwent visceral fat transplantation. Intravital microscopy was used to study leukocyte-endothelial interactions. To study the primary tissue source of circulating Mcp-1, both fat and bone marrow transplantation experiments were used. Transplantation of visceral fat increased atherosclerosis in ApoE −/− mice but had no effect on atherosclerosis in ApoE −/− , Mcp-1 −/− mice. Intravital microscopy revealed increased leukocyte attachment to the endothelium in ApoE −/− mice compared with ApoE −/− , Mcp-1 −/− mice after receiving visceral fat transplants. Transplanta...
Journal of Clinical Medicine, 2021
Background: The prone position (PP) is increasingly used in mechanically ventilated coronavirus d... more Background: The prone position (PP) is increasingly used in mechanically ventilated coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. However, studies investigating the influence of the PP are currently lacking in these patients. This is the first study to investigate the influence of the PP on the oxygenation and decarboxylation in COVID-19 patients. Methods: A prospective bicentric study design was used, and in mechanically ventilated COVID-19 patients, PP was indicated from a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FIO2) ratio of <200. Patients were left prone for 16 h each. Pressure levels, FIO2, were adjusted to ensure a PaO2 greater than 60 mmHg. Blood gas analyses were performed before (baseline 0.5 h), during (1/2/5.5/9.5/13 h), and after being in the PP (1 h), the circulatory/ventilation parameters were continuously monitored, and lung compliance (LC) was roughly calculated. Responders were d...
American Journal of Transplantation
Spiritual Care
Objective The objective of this scoping review (Registration DOI:10.17605/OSF.IO/UYV9G) is to und... more Objective The objective of this scoping review (Registration DOI:10.17605/OSF.IO/UYV9G) is to understand how critical care professionals’ (CCP) moral distress and spiritual resources impact on their resilience. Introduction Previous reviews failed in obtaining evidence for tailored intervention reducing CCPs’ moral distress. Although frequently mentioned, spiritual resources were not thoroughly explored. Inclusion criteria In order to describe elements of the inclusion criteria, the PCC-framework (Population, Concept, Context) will be applied. Participants are all CCP (nurses, physicians, physiotherapists, psychologists …). The concept is resilience, taking into account moral distress and spirituality. The context is critical care (preclinical emergency care, emergency room, intensive care unit). Other contexts such as palliative care wards are excluded. Methods We will search 13 databases and grey literature published in 2020–2022. A two-stage screening process by at least two inde...
Objective: The objective of this scoping review is to understand how critical care professionals&... more Objective: The objective of this scoping review is to understand how critical care professionals' (CCP) moral distress and spiritual resources impact on their resilience. Introduction: Previous reviews failed in obtaining evidence for tailored intervention reducing CCP' moral distress. Although frequently mentioned, spiritual resources were not thoroughly explored. Inclusion criteria: Participants are all CCP (nurses, physicians, physiotherapists, psychologists…). The concept is resilience, taking into account moral distress and spirituality. The context is critical care (preclinical emergency care, emergency room, intensive care unit). Other contexts such as palliative care wards are excluded. Methods: We will search 12 databases and grey literature published in 2020-2022. A two-stage screening process by two independent reviewers will be used. First titles and abstracts will be scanned and then a full-text review of relevant articles will be done. Data will be extracted in...
Journal of Clinical Medicine
Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplant... more Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplantation (RTx), mainly due to cardiovascular events. Because dyslipidemia is a leading cause of cardiovascular death, we hypothesized that most RTx patients do not achieve recommended target low-density lipoprotein cholesterol (LDL-C) levels (European cardiology society guidelines) and that fast Tac metabolizers have higher dyslipidemia rates. This study included RTx recipients who received initial immunosuppression with immediate-release tacrolimus (IR-Tac), mycophenolate, and prednisolone. Patients were grouped according to their Tac concentration-to-dose ratio (C/D ratio) 3 months after RTx. Dyslipidemia parameters were analyzed at RTx, 3 months, and 12 months after RTx. Statin use and renal function were documented in a 12-month follow-up, and death was documented in a 60-month follow-up. Ninety-six RTx recipients were divided into two groups: 31 fast Tac metabolizers (C/D ratio < 1....
Journal of Clinical Medicine, 2022
Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We here... more Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n ...