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Original title:
Einflussfaktoren und prognostische Bedeutung der sympathischen Reinnervation am orthotop transplantierten Herzen 
Original subtitle:
Eine retrospektive Studie 
Translated title:
Clinical determinants and prognostic value of ventricular sympathetic reinnervation after orthotopic heart transplantation 
Translated subtitle:
A retrospect study 
Year:
2005 
Document type:
Dissertation 
Institution:
Fakultät für Medizin 
Advisor:
Bengel, Frank M. (Priv.-Doz. Dr. med.) 
Referee:
Halle, Martin (Prof. Dr.); Neumeier, Dieter (Prof. Dr.) 
Format:
Text 
Language:
de 
Subject group:
MED Medizin 
Keywords:
Reinnervation; Herztransplantation; HED-PET 
Translated keywords:
reinnervation; heart transplant; HED-PET 
Controlled terms:
Herztransplantation Nervenregeneration Nervus sympathicus Transplantat Einflussgröße Prognose 
TUM classification:
MED 410d; MED 537d; MED 606d 
Abstract:
Im Laufe der Zeit nach Herztransplantation kommt es in vielen Fällen zur sympathischen Reinnervation des Transplantates. 77 herztransplantierte Patienten wurden mit dem Noradrenalinanalogon 11C-Hydroxyephedrin als Tracer einer PET-Untersuchung unterzogen. Damit wurde der neuronale Uptake 1-Mechanismus dargestellt, der sympathische Nervenenden repräsentiert. Die Patientenakten und Spenderdaten wurden retrospektiv ausgewertet. Reinnervation fand sich bei 52 Patienten. Sie korreliert positiv mit de...    »
 
Translated abstract:
Seventy-seven nonrejecting transplant recipients were cross-sectionally studied by positron emission tomography with the catecholamine analogue C-11 hydroxyephedrine at 4.8 - 3.5 years after transplantation. Results were compared with history-derived parameters related to recipient‘s clinical course before, during and after surgery, donor characteristics and immunogenetics. Partial reinnervation was observed in 52 patients (extent 25 - 16% of left ventricle). Complete denervation was found in 25 patients at various times after transplantation. Reinnervation extent correlated with time after surgery (r=0.387; P<0.001), but also inversely with donor (r=-0.309, P=0.006) and recipient age (r=-0.243, P=0.032). Maximal hydroxyephedrine retention correlated inversely with frequency of rejection episodes (r=-0.267, P=0.019), was reduced when aortic complications occurred perioperatively (9 patients), and correlated inversely with aortic cross clamp time (r=-0.331, P=0.006). Other parameters were not associated with reinnervation. Patients were surveyed for clinical complications over >12 months after PET (until 7.3 - 4.2 years after transplantation), but significant effects of reinnervation on outcome were not observed. Conclusion – The present data suggest that sympathetic reinnervation after cardiac transplantation is not only a function of time. Reinnervation is more likely in case of young age, fast and uncomplicated surgery and low rejection frequency. Despite little effects on prognosis in otherwise healthy recipients, improved understanding of clinical determinants may contribute to enhance allograft reinnervation and thereby augment exercise capacity in the future. 
Publication :
Universitätsbibliothek der Technischen Universität München 
Oral examination:
05.07.2005 
File size:
1730520 bytes 
Pages:
110 
Last change:
18.10.2006