DISEASE AREA COORDINATORS

Prof. Dr. Veronika Grau (UGMLC), Prof. Dr. Dr. Axel Haverich (BREATH)

(Administr. Coordinator: Dr. Annegret Zurawski (BREATH)

CONTRIBUTING PARTNER SITES

BREATH, CPC-M, UGMLC

OVERVIEW

Various acute and chronic lung disorders ultimately lead to endstage lung disease (ELD). Once all options for mechanical ventilation have been exhausted, only two treatment options remain for these patients on the brink of death:  extracorporeal lung oxygenation (ECMO) and lung transplantation (LTx)  Today ECMO therapy remains restricted to short-term application, primarily as bridge to transplantation and as bridge to recovery in acute pulmonary infectious disease (for example, H1N1). In chronic injury, LTx remains the only available therapy with the potential of true long-term survival. LTx, however, is limited to highly selected patients, excludes any pulmonary malignancy, and long-term survival can be severely compromised by chronic rejection. Regenerative therapies that promote endogenous repair, cell transplantation, or tissue engineering are currently not available.  The DZL ELD program aims to refine transplantation procedures and to minimize acute and chronic rejection.  It also aims to optimize ECMO therapy towards fully implantable devices and set the stage for regeneration of diseased lung tissue.

MAJOR RESEARCH GOALS

  •  Refine transplantation towards optimised long term function by avoiding acute and chronic rejection
  • Optimise ECMO therapy via improved membrane surface and cannulation techniques towards fully implantable devices
  • Regeneration of the diseased lung by cell therapy towards tissue engineering of the entire organ
  • Autotransplantation of the lung after ex vivo treatment during ECMO support of the recipient
  • Establishment of a Postgraduate School of Extra-Corporeal Circulation for training of health care personnel and physicians
  • Comparative healthcare assessment including quality of life and cost analyses for various disease subsets and after replacement therapies

Endstage Lung Disease:  Selected Publications from DZL Faculty Members Published Since 2010

Greer M, Dierich M, de Wall C, Suhling H, Rademacher J, Welte T, Haverich  A, Warnecke G, Ivanyi P, Buchholz S, Gottlieb J, Fuehner T. Phenotyping established chronic lung allograft dysfunction predicts extracorporeal photopheresis  response in lung transplant patients. Am J Transplant 2013; in Press.

Krüger M, Zinne N, Höffler H, Zhang R, Kropivnitskaja I, Schmitto J, Ciubotaru A, Haverich A. Ex situ tracheobronchoplastic operations using the organ care system. Chirurg 2013; 84(3), pp. 208-213.

Suhling H, de Wall C, Rademacher J, Greer M, Boemke A, Dettmer S, Haverich A, Warnecke G, Welte T, Gottlieb J. Low exercise tolerance correlates with reduced inspiratory capacity and respiratory muscle function in recipients with advanced Chronic Lung Allograft Dysfunction. Transplantation 2013; in Press.

Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, Olsson KM, Greer M, Sommer W, Welte T, Haverich A, Hoeper MM, Warnecke, G. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine 2012; 185 (7), pp. 763-768.

Ius F, Kuehn C, Tudorache I, Sommer W, Avsar M, Boethig D, Fuehner T, Gottlieb J, Hoeper M, Haverich A, Warnecke G. Lung transplantation on cardiopulmonary support: Venoarterial extracorporeal membrane oxygenation outperformed cardiopulmonary bypass.  Journal of Thoracic and Cardiovascular Surgery 2012; 144 (6), pp. 1510-1516.

Schmidt F, Sasse M, Boehne M, Mueller C, Bertram H, Kuehn C, Warnecke G, Ono M, Seidemann K, Jack T, Koeditz H, Concept of "awake venovenous extracorporeal membrane oxygenation" in pediatric patients awaiting lung transplantation.  Pediatric Transplantation. 2102; in Press.

Suhling H, Dettmer S, Rademacher J, Mark G, Shin H-O, Tudorache I, Kühn C, Haverich A, Welte T, Warnecke G, Gottlieb J. Spirometric obstructive lung function pattern early after lung transplantation.  Transplantation 2012; 93 (2), pp. 230-235.

Warnecke G, Haverich A, Lung re-transplantation: Review. Current Opinion in Organ Transplantation 2012; 17 (5), pp. 485-489.

Warnecke G, Moradiellos J, Tudorache I, Kühn C, Avsar M, Wiegmann B, Sommer W, Ius F, Kunze C, Gottlieb J, Varela A, Haverich A, Normothermic perfusion of donor lungs for, reservation and assessment with the Organ Care System Lung before bilateral transplantation: A pilot study of 12 patients.  The Lancet 2012; 380 (9856), pp. 1851-1858.

Wiesner O, Hadem J, Sommer W, Kühn C, Welte T, Hoeper MM, Extracorporeal membrane oxygenation in a nonintubated patient with acute respiratory distress syndrome.  European Respiratory Journal 2012; 40 (5), pp. 1296-1298.