Zaburzenia funkcji nerek u chorych po przeszczepieniu serca

Chronic kidney disease (CKD) developed after hearttransplantation is one of the major factors to influencinglong-term results and survival rate. The verycareful evaluation of kidney function should be performedprior to transplantation. Moreover, probabilityof reversibility of kidney dysfunction and the riskof progression to end stage renal disease should beassessed. The ability to identify CKD may allow earlyimplementation of treatments that could arrest ordelay the progression of renal damage, enable effectivetreatment of its complications, and reduce therisk of drug-induced nephrotoxicity. Kidney functionshould be monitored in heart transplant recipientsas an important risk factor of morbidity and mortalitycomparable with neoplasm and graft vasculopathymortality. In presence of existing nephron sparingimmunosuppressive regimens, early detection ofdeteriorating kidney function gives the opportunityto tailor the treatment or delay the progression ofrenal failure. The ability to identify CKD may allowearly implementation of treatments that could arrestor delay the progression of renal damage, enable effectivetreatment of its complications, and reducethe risk of drug-induced nephrotoxicity by tailoringthe treatment.Przewlekła choroba nerek po przeszczepieniu serca, obok nowotworów i waskulopatii, jest głównym czynnikiem ograniczającym długość i komfort życia. W okresie kwalifikacji do przeszczepienia serca zaleca się wykonanie szczegółowej diagnostyki funkcji nerek, z ewentualnym określeniem ryzyka pogorszenia tej funkcji po przeszczepieniu. W wielu przypadkach zła czynność nerki w okresie poprzedzającym przeszczepienie jest wynikiem długotrwałej hipoperfuzji spowodowanej krańcową niewydolnością serca. Dokładne monitorowanie funkcji nerek, wraz z redukcją dodatkowych czynników wpływających na pogorszenie ich czynności, należy do rutynowego postępowania w opiece nad chorym po przeszczepieniu serca. Współczesne schematy immunosupresji umożliwiają odpowiednią indywidualizację leczenia w celu spowolnienia zmian zachodzących w obrębie nerek

A modified heterotopic heart transplantation in the rat - as an important model in experimental regeneration and replacement of the failing organ

The qualification of new knowledge is one of the oldest problems in experimental medicine that provides a link between fundamental discovery, hypothesis, ‘proof of concept’ preclinical studies and development of clinical trials. The biggest challenge in animal models is the proper evaluation of all the aspects that are crucial in specific studied pathologies as well as the prediction of their progression. The aim of this review was to describe and discuss the rat animal model of heart transplant. The rat model of heart transplantation is an excellent yet underestimated method of research of prevention, monitoring and treatment of acute and chronic, immune and nonimmune response to organ transplantation. Despite being a technically and logistically demanding model, it provides a tool for reproducible experiments with longterm animal survival and excellent graft survival

The influence of sense of coherence on emotional response in heart transplant recipients : a preliminary report

INTRODUCTION: The success of heart transplantation in prolonging life and well-being must be considered in reference to its psycho-social outcomes, which intrinsically affect the long-term post-transplant morbidity. Sense of coherence and emotional response to organ reception are important factors in this group of patients. THE AIM OF THIS STUDY: The aim of this study was to assess the contribution of sense of coherence to emotional response to transplantation in heart transplant recipients. MATERIAL AND METHODS: The study was conducted on a group of 46 heart transplant recipients. The following research tools were applied in the assessment of personal resources (sense of coherence) and emotional response to heart transplant surgery: the Sense of Coherence Questionnaire developed by Antonovsky (SOC-29) and the Transplant Effects Questionnaire (TxEQ). The data were analyzed statistically. RESULTS: Heart transplant recipients do not experience guilt toward the donors and have no difficulties in disclosing their identities as heart transplant recipients. The study reports good adherence to immunosuppressive treatment recommendations and both a moderate concern about and a sense of responsibility for the transplanted organs among the patients. Global SOC was associated with guilt toward the donor, concern about the transplanted heart, and disclosure of the recipient's identity. CONCLUSIONS: The strength of the patients’ global sense of coherence is related to the level of their emotional response to the heart transplant surgery

Adherence to antihypertensive therapy among heart transplant recipients

INTRODUCTION: Adherence to therapeutic recommendations, concerning in particular drug administration, diet and healthy life style, is essential to obtain optimal medical treatment effects. Elevated blood pressure is an extremely important risk factor for cardiovascular diseases such as coronary artery disease, chronic heart failure and stroke, as well as chronic kidney disease. AIM: The aim of the study was to assess the level of adherence among heart transplant recipients and to explain the reasons for non-adherence phenomenon. MATERIAL AND METHODS: The study was performed on 55 heart allograft recipients: 11 women (20%) and 44 men (80%), all hypertensive. Participation in the study was voluntary and the three-part questionnaire was anonymous to obtain reliable answers. The second part was designed using the Modified Morisky Scale (MMS) consisting of questions assessing motivation and knowledge among patients. The third included questions concerning lifestyle, reasons for non-adherence and methods to improve it. RESULTS: In self-assessment of the adherence to medical recommendations on a scale of 0 to 10 the analyzed population estimated their level of adherence to be on average 8.49 ± 1.33, which is a considerably high result. It was discovered that both the level of motivation (2.20) and knowledge (2.83) are high among heart transplant recipients. Still, the level of knowledge was significantly higher than the motivation (p < 0.005). Correlation analysis revealed that the self-assessed adherence level correlated positively with the level of motivation (r = 0.357; p < 0.007). CONCLUSIONS: Creation of an active attitude of the patient in the process of treatment is a crucial and at the same time often difficult task demanding cooperation of the patient, the patient's close family and the whole therapeutic team

Prevalence of metabolic syndrome diagnosis in patients with obstructive sleep apnoea syndrome according to adopted definition

 WSTĘP: Zespół metaboliczny (ZM) jest związany ze zwiększonym ryzykiem chorób sercowo-naczyniowych i występuje często u chorych na OBS. Celem pracy jest cena częstości ZM w zależności od zastosowanej definicji (NCEP-ATP III z 2001 oraz IDF z 2005 roku) u chorych na OBS.MATERIAŁ I METODY: Materiał stanowiło 155 mężczyzn i 18 kobiet z OBS (AHI 44 ± 22 h-1), w większości otyłych (BMI 31,8 ± 5,0 kg/m2), w wieku 53,9 ± 9,3 roku (średnie ± SD). U badanych oznaczano w surowicy: lipidogram, stężenie glukozy oraz wykonano pomiar wskaźnika masy ciała (BMI), obwodu w pasie (OP) oraz wskaźnik talia-biodra (WHR).WYNIKI: Posługując się definicją pierwszą (NCEP-ATP III z 2001), zespół metaboliczny rozpoznano u 98 chorych (56% całej grupy — grupa ZM1), stosując definicję IDF z 2005 — u 120 osób (69% całej grupy — grupa ZM2) (p &lt; 0,05). Pomiędzy grupami nie stwierdzono istotnych różnic wielkości BMI i OP. Natomiast statystycznie istotną różnicę stwierdzono w WHR (ZM1: 1,005 ± 0,05 v. ZM2: 1,027 ± 0,06, p &lt; 0,05). W grupie ZM2 stwierdzono istotnie wyższe stężenie HDL w porównaniu z grupą ZM1 (52,3 ± 12,1 mg/dl v. 42,3 ± 12,1 mg/dl, p &lt; 0,05). W grupie ZM1 istotnie wyższe w porównaniu z grupą ZM2 było stężenie triglicerydów w surowicy (228,2 ± 122,5 mg/dl v. 122,5 ± 49,1 mg/dl, p &lt; 0,05). Grupy ZM1 i ZM2 nie różniły się istotnie stopniem ciężkości OBS. Zaobserwowano korelacje pomiędzy rozpoznaniem zespołu metabolicznego a wartością AHI (r = 0,19 dla ZM1 i r = 0,21 dla ZM2, p &lt; 0,05). Są one jednak klinicznie nieistotne.WNIOSKI: Definicja zespołu metabolicznego IDF z 2005 roku istotnie zwiększa częstość rozpoznawania zespołu metabolicznego u chorych na OBS. Nie zaobserwowano znamiennych klinicznie korelacji pomiędzy stopniem ciężkości OBS a rozpoznaniem zespołu metabolicznego. INTRODUCTION: Metabolic syndrome (MS), which is connected with enlarged cardiovascular risk, is common in patients with OSAS. The aim of the study was to estimate the prevalence of MS in patients with OSAS according to two definitions of MS (criteria from NCEP-ATP III from 2001 versus criteria from IDF 2005).MATERIAL AND METHODS: Materials consisted of 155 males and 18 females with OSAS (mean AHI 44 ± 22 h-1), obesity (BMI 31.8 ± 5.0 kg/m2), aged 53.9 ± 9.3 years (mean ± SD). Serum lipids, glucose, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were measured in all patients.RESULTS: According to first definition (NCEP — ATP III from 2001), MS was diagnosed in 98 patients (56% of the whole group — MS1 group) compared to 120 patients (69% of the whole group — MS2 group) diagnosed according to the second definition (IDF from 2005), p &lt; 0.05. No differences in BMI and WC between the groups were found. Significant differences in WHR were noted (MS1 group: 1.005 ± 0.05 vs. MS2 group: 1.027 ± 0.06, p &lt; 0.05). Patients from the MS2 group had higher cholesterol HDL compared to the MS1 group (52.3 ± 12.1 mg/dl vs. 42.3 ± 12.1 mg/dl, p &lt; 0.05). Serum triglyceride concentrations were significantly higher in the MS1 group than in the MS2 group (228 ± 122 mg/dl vs. 122 ± 49 mg/dl, p &lt; 0.05). There were no differences in OSAS severity between the MS1 and MS2 group. In both groups weak correlations between diagnosis of MS and AHI were f ound (r = 0.19 for MS1 and r = 0.21 for MS2, p &lt; 0.05) They are, however, clinically insignificant.CONCLUSIONS: The IDF definition from 2005 of metabolic syndrome indeed increases the frequency of diagnosis of metabolic syndrome in patients with OSAS. We did not observe essential clinical correlation among the degree of OSAS severity and recognition of metabolic syndrome in the MS1 or in the MS2 group

New onset diabetes after transplantation (NODAT) : scientific data review

New onset diabetes after transplantation (NODAT) is one of the most common and serious complications of solid organ transplantation. The incidence of NODAT is estimated to range from 2% to 53%. Patients who develop new onset diabetes after transplantation are significantly more frequently exposed to a higher risk of death and cardiovascular incidents as well as other adverse effects, such as decreased patient survival, higher infection rates and early graft loss. Identifying high-risk patients, undertaking preventive action and applying appropriate treatment can limit the development of new onset diabetes after transplantation and improve a patient’s long-term prognosis