First Experience With Extracorporeal Cytokine Adsorption Therapy After Lung Transplantation

Peyneau, Marine; Chaisemartin, Luc de; Faille, Dorothée; Messika, Jonathan; Mal, Hervé; Castier, Yves; Mordant, Pierre; Carrasco, José Luís; Tanaka, Sébastien; Jacob, Brice Lortat; Arrault, Xavier; Ajzenberg, Nadine; Chollet-Martin, Sylvie; Montravers, Philippe; Tran-Dinh, Alexy

doi:10.3389/ti.2022.10319

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…After excluding irrelevant articles (i.e., reviews, meta-analyses, protocols, letters), 60 studies were retrieved ( Figure 2 ). Of these, 22 were excluded due to their focus on veno-arterial ECMO (V-A ECMO) or extracorporeal cardiopulmonary resuscitation (ECPR) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Fourteen studies were excluded for lack or scarcity of data on CytoSorb© use [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], four because of the lack of specific data for the ECMO subgroup [ 67 , 68 , 69 , 70 ], four because CytoSorb© was not used concomitantly with ECMO therapy [ 71 , 72 , 73 , 74 ], two because outcomes of interest for the simultaneous use of CytoSorb© and ECMO were not reported [ 75 , 76 ], and one because it focused on a different device [ 77 ].…”

Section: Resultsmentioning

confidence: 99%

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Akil¹,

Napp

Rao

et al. 2022

JCM

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Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in severe ARDS, and to assess the effects on inflammatory, laboratory and clinical parameters, as well as on patient outcomes. A systematic literature review was conducted and reported in compliance with principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. When applicable, a before-and-after analysis for relevant biomarkers and clinical parameters was carried out. CytoSorb© use was associated with significant reductions in circulating levels of C-reactive protein and interleukin-6 (p = 0.039 and p = 0.049, respectively). Increases in PaO2/FiO2 reached significance as well (p = 0.028), while norepinephrine dosage reductions showed a non-significant trend (p = 0.067). Mortality rates in CytoSorb© patients tended to be lower than those of control groups of most included studies, which, however, were characterized by high heterogeneity and low power. In an exploratory analysis on 90-day mortality in COVID-19 patients supported with V-V ECMO, the therapy was associated with a significantly reduced risk of death. Based on the reviewed data, CytoSorb© therapy is able to reduce inflammation and potentially improves survival in ARDS patients treated with V-V ECMO. Early initiation of CytoSorb© in conjunction with ECMO might offer a new approach to enhance lung rest and promote recovery in patients with severe ARDS.

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Section: Resultsmentioning

confidence: 99%

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Akil¹,

Napp

Rao

et al. 2022

JCM

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“…However, the effectiveness of the CytoSorb device in LTx has yet to be established. Other than our feasibility study (NCT05242289) and a smaller case series that was rescued with extracorporeal cytokine adsorption therapy following LTx [ 10 ], this tool has not been applied to human LTx by any clinic within our network or in any trials that are registered at ClinicalTrials.gov or other registries. Therefore, this clinical investigation is justified and relevant as it will establish the effectiveness of cytokine reduction by cytokine filtration using the CytoSorb device in improving lung function following LTx, an area where there is a high unmet need.…”

Section: Discussionmentioning

confidence: 99%

Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial

Lindstedt,

Silverborn,

Lannemyr

et al. 2023

JMIR Res Protoc

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Background Lung transplantation (LTx) is the only treatment option for end-stage lung disease. Despite improvements, primary graft dysfunction (PGD) remains the leading cause of early mortality and precipitates chronic lung allograft dysfunction, the main factor in late mortality after LTx. PGD develops within the first 72 hours and impairs the oxygenation capacity of the lung, measured as partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2). Increasing the PaO2/FiO2 ratio is thus critical and has an impact on survival. There is a general lack of effective treatments for PGD. When a transplanted lung is not accepted by the immune system in the recipient, a systemic inflammatory response starts where cytokines play a critical role in initiating, amplifying, and maintaining the inflammation leading to PGD. Cytokine filtration can remove these cytokines from the circulation, thus reducing inflammation. In a proof-of-concept preclinical porcine model of LTx, cytokine filtration improved oxygenation and decreased PGD. In a feasibility study, we successfully treated patients undergoing LTx with cytokine filtration (ClinicalTrials.gov; NCT05242289). Objective The purpose of this clinical trial is to demonstrate the superiority of cytokine filtration in improving LTx outcome, based on its effects on oxygenation ratio, plasma levels of inflammatory markers, PGD incidence and severity, lung function, kidney function, survival, and quality of life compared with standard treatment with no cytokine filtration. Methods This study is a Swedish national interventional randomized controlled trial involving 116 patients. Its primary objective is to investigate the potential benefits of cytokine filtration when used in conjunction with LTx. Specifically, this study aims to determine whether the application of cytokine filtration, administered for a duration of 12 hours within the initial 24 hours following a LTx procedure, can lead to improved patient outcomes. This study seeks to assess various aspects of patient recovery and overall health to ascertain the potential positive impact of this intervention on the posttransplantation course. Results The process of patient recruitment for this study is scheduled to commence subsequent to a site initiation visit, which was slated to take place on August 28, 2023. The primary outcome measure that will be assessed in this research endeavor is the oxygenation ratio, a metric denoted as the highest PaO2/FiO2 ratio achieved by patients within a 72-hour timeframe following their LTx procedure. Conclusions We propose that cytokine filtration could enhance the overall outcomes of LTx. Our hypothesis suggests potential improvements in LTx outcome and patient care. Trial Registration ClinicalTrials.gov NCT05526950; https://www.clinicaltrials.gov/study/NCT05526950 International Registered Report Identifier (IRRID) PRR1-10.2196/52553

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“… 11 Similarly, in a pilot study involving humans, adsorption during the initial 24 hours after lung transplantation did not yield any significant differences in plasma IL-6 and IL-8 levels. 10 …”

Section: Discussionmentioning

confidence: 99%

“… 18 Moreover, a recent pilot study in 6 humans demonstrated the safety of CytoSorb when used within the first 24 hour after lung transplantation in an ECMO setting, with no adverse events reported except for one cartridge clotting at 12 hours. 10 A recent review of 170 clinical studies also concluded positively on the safety of the adsorber. 19 …”

Section: Discussionmentioning

confidence: 99%

“…In a recent pilot study, CytoSorb was tested in patients who underwent lung transplantation who were still on extracorporeal membrane oxygenation (ECMO). 10 During a 24-hour period of extracorporeal adsorption, no adverse events were reported, and there was a promising systemic reduction of neutrophil activation. In a pig left lung transplant study with lipopolysaccharide-injured donor lungs, a significant improvement of lung function and reduction of PGD was reported following a 12-hour period of extracorporeal hemoadsorption.…”

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confidence: 93%

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Extracorporeal cytokine adsorption reduces systemic cytokine storm and improves graft function in lung transplantation

Ehrsam,

Arni,

Weisskopf

et al. 2023

JTCVS Open

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First Experience With Extracorporeal Cytokine Adsorption Therapy After Lung Transplantation

Cited by 6 publications

References 7 publications

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial

Extracorporeal cytokine adsorption reduces systemic cytokine storm and improves graft function in lung transplantation

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