9 results on '"C. Bara"'
Search Results
2. MicroRNA 628-5p as a Novel Biomarker for Cardiac Allograft Vasculopathy.
- Author
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Neumann A, Napp LC, Kleeberger JA, Benecke N, Pfanne A, Haverich A, Thum T, and Bara C
- Subjects
- Adult, Aged, Allografts, Area Under Curve, Case-Control Studies, Coronary Artery Disease blood, Coronary Artery Disease diagnosis, Female, Gene Expression Profiling methods, Genetic Markers, Humans, Male, MicroRNAs blood, Middle Aged, Oligonucleotide Array Sequence Analysis, Pilot Projects, Predictive Value of Tests, ROC Curve, Reproducibility of Results, Reverse Transcriptase Polymerase Chain Reaction, Time Factors, Treatment Outcome, Up-Regulation, Young Adult, Coronary Artery Disease genetics, Heart Transplantation adverse effects, MicroRNAs genetics
- Abstract
Background: Cardiac allograft vasculopathy (CAV) remains the leading cause of morbidity and mortality after orthotopic heart transplantation (OHT). Because of its clinically silent progression and lack of symptoms, detection is often difficult and invasive coronary angiography is performed routinely. To date, there are no established noninvasive biomarkers available for prediction of CAV in transplanted patients.MicroRNAs (miRNAs) are highly conserved, small noncoding RNA molecules that negatively regulate gene expression. As they are detectable in peripheral blood, recent studies have suggested miRNAs as biomarkers for various cardiovascular diseases. Thus, we hypothesized that circulating miRNAs may serve as noninvasive biomarkers for CAV., Methods: To determine the regulation of circulating miRNAs, we performed miRNA profiling studies in plasma samples of OHT patients with confirmed high-degree CAV and a matched control group consisting of patients without any signs of CAV at least 5 years after OHT. Candidate miRNAs were verified by quantitative reverse transcriptase polymerase chain reaction., Results: Microarray analysis revealed 5 candidate miRNAs (miR-34a, miR-98, miR-155, miR-204, miR-628-5p) that were differentially regulated in plasma samples of patients with CAV and therefore were selected for verification by quantitative reverse transcriptase polymerase chain reaction. In CAV patients, plasma levels of miR-628-5p and miR-155 were significantly increased (P = 0.001 and P = 0.028, respectively). A miR628-5p value above 1.336 was able to predict CAV with a sensitivity of 72% and a specificity of 83%., Conclusions: For the first time, the present study identifies the circulating miRNA miR-628-5p as a novel potential biomarker of CAV in patients after OHT.
- Published
- 2017
- Full Text
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3. Lung transplantation for severe pulmonary hypertension--awake extracorporeal membrane oxygenation for postoperative left ventricular remodelling.
- Author
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Tudorache I, Sommer W, Kühn C, Wiesner O, Hadem J, Fühner T, Ius F, Avsar M, Schwerk N, Böthig D, Gottlieb J, Welte T, Bara C, Haverich A, Hoeper MM, and Warnecke G
- Subjects
- Adolescent, Adult, Airway Extubation, Case-Control Studies, Child, Female, Hemodynamics, Humans, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary mortality, Hypertension, Pulmonary physiopathology, Kaplan-Meier Estimate, Male, Middle Aged, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Ventilator Weaning adverse effects, Ventilator Weaning mortality, Ventricular Dysfunction, Left etiology, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Young Adult, Extracorporeal Membrane Oxygenation adverse effects, Extracorporeal Membrane Oxygenation mortality, Hypertension, Pulmonary surgery, Lung Transplantation adverse effects, Lung Transplantation mortality, Ventilator Weaning methods, Ventricular Dysfunction, Left therapy, Ventricular Function, Left, Ventricular Remodeling, Wakefulness
- Abstract
Background: Bilateral lung transplantation (BLTx) is an established treatment for end-stage pulmonary hypertension (PH). Ventilator weaning failure and death are more common as in BLTx for other indications. We hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and investigated a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO)., Methods: In 23 BLTx for severe PH, ECMO used during BLTx was continued for a minimum of 5 days (BLTx-ECMO group). Echocardiography, left atrial (LA) and Swan-Ganz catheters were used for monitoring. Early extubation after transplantation was attempted under continued ECMO., Results: Preoperatively, all patients had severely reduced cardiac index (mean, 2.1 L/min/m2). On postoperative day 2, reduction of ECMO flow resulted in increasing LA and decreasing systemic blood pressures. On the day of ECMO explantation (median, postoperative day 8), LV diameter had increased; LA and blood pressures remained stable. Survival rates at 3 and 12 months were 100% and 96%, respectively. Data were compared to two historic control groups of BLTx without ECMO (BLTx ventilation) or combined heart-lung transplantation for severe PH., Conclusion: Early after BLTx for severe PH, the LV may be unable to handle normalized LV preload. This can be effectively bridged with awake venoarterial ECMO.
- Published
- 2015
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4. Health-related quality of life after solid organ transplantation: a prospective, multiorgan cohort study.
- Author
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Kugler C, Gottlieb J, Warnecke G, Schwarz A, Weissenborn K, Barg-Hock H, Bara C, Einhorn I, Haverich A, and Haller H
- Subjects
- Adult, Aged, Cohort Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Organ Transplantation psychology, Quality of Life
- Abstract
Background: Short-term posttransplantation survival and health-related quality of life (HRQoL) is exceptionally high for all patients after organ transplantation; however, predictors of the HRQoL outcome are not well understood. Trajectories of patients' perceived benefit/burden ratio associated with the transplant procedure may differ when taking the organ type for transplantation into account., Methods: A prospective, single-center cohort study assessed the trajectories of 354 patients after kidney (n=165), liver (n=53), heart (n=24), and lung (n=112) transplantation at 2, 6, 12, and 24 months with respect to psychosocial outcomes (HRQoL, anxiety, depression, social support, and work performance)., Results: Mean age was 50±13 years, and 61.6% were male in the overall sample. Demographics differed with respect to organ type. HRQoL measured by the mean SF-36 Physical Component Scale was 36.8 (95% confidence interval, 35.7-37.8) and 48.9 (95% confidence interval, 47.2-49.7) for the Psychosocial Component Scale for the entire sample at 2 months and showed a marginal decrease until 24 months after transplantation. Overall, HRQoL increased for all organ types with differing trajectories. Liver patients reported the lowest HRQoL benefit for the majority of the physical (P≤0.01) and psychosocial (P≤0.01) SF-36 subscales. Anxiety (17.4%) and depression (13.8%) were prevalent in the overall sample. Depression symptoms impaired HRQoL outcomes in both SF-36 components and unemployment impacted the SF-36 psychosocial outcomes., Conclusions: HRQoL improved after transplantation for all four types of transplant, but the trajectories were different. Regular screening for depression symptoms may diminish psychologic disorders and distress after transplantation and thus may further improve outcomes.
- Published
- 2013
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5. Concordance among pathologists in the second Cardiac Allograft Rejection Gene Expression Observational Study (CARGO II).
- Author
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Crespo-Leiro MG, Zuckermann A, Bara C, Mohacsi P, Schulz U, Boyle A, Ross HJ, Parameshwar J, Zakliczyński M, Fiocchi R, Stypmann J, Hoefer D, Lehmkuhl H, Deng MC, Leprince P, Berry G, Marboe CC, Stewart S, Tazelaar HD, Baron HM, Coleman IC, and Vanhaecke J
- Subjects
- Biopsy standards, Coloring Agents, Eosine Yellowish-(YS), Europe, Gene Expression Regulation, Graft Rejection immunology, Hematoxylin, Humans, Observer Variation, Predictive Value of Tests, Reproducibility of Results, Severity of Illness Index, Staining and Labeling standards, United States, Graft Rejection genetics, Graft Rejection pathology, Heart Transplantation adverse effects, Pathology, Clinical standards
- Abstract
Background: There has been no large evaluation of the ISHLT 2004 acute cellular rejection grading scheme for heart graft endomyocardial biopsy specimens (EMBs)., Methods: We evaluated agreement within the CARGO II pathology panel and between the panel (acting by majority) and the collaborating centers (treated as a single entity), regarding the ISHLT grades of 937 EMBs (with all grades ≥2R merged because of small numbers)., Results: Overall all-grade agreement was almost 71% both within the panel and between the panel and the collaborating centers but, in both cases, was largely because of agreement on grade 0: for the average pair of pathologists, fewer than a third of the EMBs assigned grade ≥2R by at least one were assigned this grade by both., Conclusion: The 2004 revision has done little to improve agreement on the higher ISHLT grades. An EMB grade ≥2R is not by itself sufficient as a basis for clinical decisions or as a research criterion. Steps should be taken toward greater uniformity in EMB grading, and efforts should be made to replace the ISHLT classification with diagnostic criteria--EMB based or otherwise--that correspond better with the pathophysiology of the transplanted heart.
- Published
- 2012
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6. Acquired von Willebrand syndrome in patients with an axial flow left ventricular assist device.
- Author
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Meyer AL, Malehsa D, Bara C, Budde U, Slaughter MS, Haverich A, and Strueber M
- Subjects
- Adolescent, Adult, Cohort Studies, Collagen metabolism, Cross-Sectional Studies, Female, Follow-Up Studies, Heart Transplantation statistics & numerical data, Hemorrhage epidemiology, Hemorrhage etiology, Hemostasis, Humans, Incidence, Male, Middle Aged, Platelet Aggregation, Reoperation, Time Factors, Ventricular Dysfunction, Left blood, Young Adult, von Willebrand Disease, Type 2 complications, von Willebrand Factor chemistry, von Willebrand Factor metabolism, Heart-Assist Devices adverse effects, Ventricular Dysfunction, Left surgery, von Willebrand Disease, Type 2 etiology
- Abstract
Background: Rotary blood pumps used as left ventricular assist devices (LVADs) allow for long-term support and may become suitable alternatives to heart transplantation. Effects of this technology on the coagulation system are not completely understood, leading to controversial anticoagulation protocols. Thus, we investigated the primary hemostasis in patients with chronic LVAD therapy., Methods and Results: Twenty-six outpatients received axial flow LVAD (HeartMate II; Thoratec) for a median support time of 4.5 months. In a cross-sectional protocol, platelet aggregation in response to ADP and epinephrine, von Willebrand antigen (vWF:AG), and collagen-binding capacity (vWF:CB) were obtained. Von Willebrand factor (vWF) multimer analyses were performed, and patients were screened for bleeding events. This analysis was repeated after removal of the device for transplantation or recovery (n=12) and after a median of 15.5 months in ongoing patients (n=11). In all patients on devices, severe impairment of platelet aggregation as well as a loss of large vWF multimers were found. In 10 patients, a decreased vWF:CB/vWF:AG ratio was observed. Bleeding episodes occurred with an incidence of 0.17 per patient-year. After removal of the device, normal patterns of platelet aggregation, multimer analysis, and vWF:CB/vWF:AG ratio were recorded. In the second analysis of ongoing patients, impairment of platelet aggregation and loss of large vWF multimers were verified., Conclusions: A diagnosis of von Willebrand syndrome type 2 was established in all patients after LVAD implantation, and bleeding events confirmed this finding. Reversibility of this condition was found after removal of the device.
- Published
- 2010
- Full Text
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7. Health-related quality of life in long-term survivors after heart and lung transplantation: a prospective cohort study.
- Author
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Kugler C, Tegtbur U, Gottlieb J, Bara C, Malehsa D, Dierich M, Simon A, and Haverich A
- Subjects
- Adult, Cohort Studies, Female, Follow-Up Studies, Heart-Lung Transplantation adverse effects, Heart-Lung Transplantation mortality, Heart-Lung Transplantation psychology, Humans, Male, Mental Health, Middle Aged, Neoplasms epidemiology, Prospective Studies, Skin Neoplasms epidemiology, Social Behavior, Time Factors, Heart-Lung Transplantation physiology, Quality of Life
- Abstract
Background: Health-related quality of life (HRQoL) represents an important outcome measure to assess the success of transplantation in the long term. This study evaluated HRQoL in heart (HTx) and lung (LTx) transplant survivors, and assessed potential outcome-related predictors from before to 5 years after transplantation., Methods: Study participants (n=170) were prospectively followed up from before to 5 years after HTx (n=82) or LTx (n=88), including HRQoL assessments (pretransplantation, 6, 12, and yearly between 24 and 60 months) using the Short Form-36, employment status index, and monitoring of adverse events., Results: Patient groups (HTx vs. LTx) differed with respect to gender (men 74% vs. 48%; P<0.03) and high-urgency waiting status (72% vs. 45%; P<0.0001). Both cohorts showed the most significant HRQoL improvements within the first year posttransplant (P<0.0001), and relatively stable conditions afterward. Marital (P<0.01) and employment status (P<0.01) impacted HRQoL in both groups. The incidence of bronchiolitis obliterans showed significantly lower HRQoL in LTx patients (29.3%; P<0.005)., Conclusions: HTx and LTx patients benefit from the transplant procedure with respect to HRQoL improvements for at least 5 years posttransplant; however, their trajectories during this time interval differ. Further research on organ-type-related predictors of HRQoL is necessary for the development of tailored psychosocial interventions.
- Published
- 2010
- Full Text
- View/download PDF
8. A lower incidence of cytomegalovirus infection in de novo heart transplant recipients randomized to everolimus.
- Author
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Hill JA, Hummel M, Starling RC, Kobashigawa JA, Perrone SV, Arizón JM, Simonsen S, Abeywickrama KH, and Bara C
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- Adolescent, Adult, Aged, Cytomegalovirus immunology, Cytomegalovirus Infections immunology, Cytomegalovirus Infections pathology, Cytomegalovirus Infections virology, Everolimus, Female, Humans, Male, Middle Aged, Sirolimus pharmacology, Time Factors, Tissue Donors, Cytomegalovirus drug effects, Cytomegalovirus Infections prevention & control, Heart Transplantation immunology, Immunosuppressive Agents pharmacology, Sirolimus analogs & derivatives
- Abstract
Background: Cytomegalovirus (CMV) infection in recipients of cardiac transplants is associated with higher rates of morbidity. A recent phase III trial showed highly significantly (P<0.001) lower CMV rates with the proliferation signal inhibitor everolimus compared to azathioprine (AZA). To better define this association, data on CMV risk factors were collected retrospectively and analyzed., Methods: Data on CMV risk factors from a multicenter phase III trial on de novo heart transplant recipients (n=634) receiving a triple immunosuppressive regimen randomized to everolimus 1.5 mg/day (group 1), everolimus 3 mg/day (group 2), or AZA (group 3) were merged with prospectively collected CMV-related outcome data and analyzed., Results: CMV-positive donors (D+) and CMV-negative recipients (R-) were evenly distributed across groups 1-3 at 36/209 (17.2%), 48/211 (22.7%), and 38/214 (17.8%), respectively. CMV prophylaxis had been given for a mean (SD) of 175 (127.8), 183 (137.1), and 177 (132.9) days, respectively. In the high-risk D+/R- subgroup with prophylaxis, the proportions of patients with CMV infection compared with group 3 (12/29 [41.4%]) were 3/25 (12.0%) in group 1 (P=0.031) and 6/36 (16.7%) in group 2 (P=0.049). In D+/R+ subgroups either with or without prophylaxis, the everolimus groups had less CMV disease (P<0.001). The incidence of CMV syndrome, organ involvement, and laboratory evidence was lower with everolimus use compared to AZA., Conclusions: Everolimus is associated with lower rates of CMV infection, syndrome, or organ involvement, suggesting an additional advantage from the use of everolimus in cardiac transplant recipients.
- Published
- 2007
- Full Text
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9. Anti-HBc seroconversion after transplantation of anti-HBc positive nonliver organs to anti-HBc negative recipients.
- Author
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Fytili P, Ciesek S, Manns MP, Wedemeyer H, Neipp M, Helfritz F, Klempnauer J, Bara C, and Haverich A
- Subjects
- Hepatitis B immunology, Hepatitis B virology, Humans, Kidney immunology, Kidney virology, Lung immunology, Lung virology, Hepatitis B diagnosis, Hepatitis B Antibodies blood, Hepatitis B Core Antigens blood, Kidney Transplantation immunology, Lung Transplantation immunology
- Published
- 2006
- Full Text
- View/download PDF
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