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P Neuhauser

Publications and source records attributed to P Neuhauser.

7 recordsLinked to original sources
PubMed2005

Monitoring C2 level predicts exposure in maintenance lung transplant patients receiving the microemulsion formulation of cyclosporine (Neoral).

BACKGROUND: Dosing of the microemulsion formulation of cyclosporine (Neoral) is conventionally based on trough levels (C(0)). However, experience in renal transplantation has shown that cyclosporine exposure during the absorption phase (AUC(0-4)) is critical for optimizing immunosuppression, and that cyclosporine (CsA) concentration at 2 hours post-dose (C(2)) shows the closest correlation with AUC(0-4). This study evaluated whether C(2) values correlate more closely with AUC(0-4) than C(0) in lung transplant patients. METHODS: Pharmacokinetic data were collected prospectively from 20 clinically stable adult lung allograft recipients receiving CsA, mycophenolate mofetil and steroids. Indications for transplantation were emphysema (n = 15), idiopathic fibrosis (n = 2), primary pulmonary hypertension (n = 1), cystic fibrosis (n = 1) and lymphangioleiomyomatosis LAM (n = 1). Blood samples were collected at 0, 1, 2, 3 and 4 hours after administration of CsA, and then AUC(0-4) was calculated. The Correlation between cyclosporine concentration at each time-point and AUC(0-4) was also calculated. RESULTS: C(2) showed the closest correlation with AUC(0-4) (r(2) = 0.85). C(0) had the poorest correlation of all time-points (r(2) = 0.64). Two patients with radiologic signs of gastroparesis had no peak cyclosporine levels at all and were excluded from the correlation analysis. Mean AUC(0-4) was 3,700 ng . h/ml during Year 1 post-transplant, 2,400 ng . h/ml during Years 1 to 3, and 1,500 ng . h/ml thereafter. Mean C(2) values were 1.2 microg/ml during Year 1, 0.8 microg/ml during Years 1 to 3, and 0.5 microg/ml thereafter. CONCLUSIONS: C(2) is the single time-point that correlates most closely with AUC(0-4) in lung transplant recipients without gastroparesis. It remains to be demonstrated whether monitoring CsA based on C(2) levels results in a lower incidence of rejection without additional toxicity.

Adult↗
PubMed2003

Single running suture--the new standard technique for bronchial anastomoses in lung transplantation.

OBJECTIVE: The aim of this retrospective study is to assess the results of a single running suture technique for bronchial anastomoses in lung transplantation. In a previous pilot study, equal results compared to the established standard technique --using single stitches on the cartilaginous part--have been described by our group. This report reviews the results obtained over a period of 3 years. METHODS: Between January 1999 and December 2001, 154 consecutive lung transplantations (91 bilateral sequential, 35 right single lung and 28 left single lung) were performed in 141 patients using single running sutures for bronchial anastomoses. Thirteen transplantations (25 anastomoses) were performed in lobar or split lung technique. Bronchial healing was assessed at routine bronchoscopes performed in increasing time intervals from 7 days to 1 year postoperatively and depending upon clinical necessity. RESULTS: Six patients (4.2%) died earlier than 7 days postoperatively and were excluded from further analysis. No bronchial complication was observed in any of them. Three months and 1-year survival rates were 82.9 and 72.7%, respectively. Two hundred and thirty-four anastomoses were subjected to examination. Mean ischemic time was 5.1h (+/-1.5). In 228 anastomoses (97.4%), excellent primary airway healing was observed. In four anastomoses (1.7%), small healing defects less than 5mm without necessity for intervention were detected. Two anastomoses (0.9%) developed a cicatriceal stenosis requiring intraluminal stenting. CONCLUSIONS: The single running suture technique for bronchial anastomoses in lung transplantation provides excellent results with regard to primary and long-term airway healing and its use as a standard suturing technique is, therefore, recommended.

Adolescent↗
PubMed2001

[Bronchial anastomoses after lung transplantation: results with single running suture technique].

BACKGROUND: The standard technique for the bronchial anastomosis in LTX is a running suture on the membranous and single stitches on the cartilaginous portion of the bronchus. The aim of this retrospective study was to compare the results of this technique to the new single running suture technique. METHODS: Between January and December 1998, 56 consecutive single (n = 17) and bilateral (n = 39) lung transplants in 52 patients were performed. Eighty-three bronchial anastomoses were retrospectively analyzed and evaluated by separating into two groups: group 1 (24 patients, 39 anastomoses) with standard technique and group 2 (24 patients, 44 anastomoses) with single running suture. The two groups were comparable with regard to age, primary diagnosis, intraoperative use of extracorporeal circulation, ischemia time, duration of mechanical ventilation, ICU and number of acute rejections/100 days. Bronchial healing was assessed with bronchoscopic follow-up (5-16 months). RESULTS: Primary excellent airway healing was observed in 36 anastomoses (92%) in group 1 and in 41 (93%) in group 2. In 2 anastomoses in group 1 (5%) and in 2 anastomoses in group 2 (4.6%) necrosis less than 5 mm was observed. In one anastomosis in group 1 (2.7%) a 10-mm bronchial necrosis with partial occlusion of the bronchial lumen by necrotic tissue necessitated temporary intraluminal stenting. In one anastomosis in group 2 (2.3%) malacia of the bronchus intermedius occurred. CONCLUSION: The single running suture technique for bronchial anastomosis is a safe technique providing the same results as the established technique and we advocate its use for bronchial anastomosis.

Adult↗