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Markers of transplantation tolerance in kidney transplantation
Krepsová, Eva ; Viklický, Ondřej (advisor) ; Krejčí, Karel (referee) ; Živný, Jan (referee)
Long-term renal graft acceptance still requires long-term immunosuppressive therapy, which is accompanied by many adverse effects. Contrarily insufficient immunosuppression could lead to graft rejection and its failure. Therefore, research continues for biomarkers that reflect a patient's immunological status and thus allowing for individualized immunosuppressive therapy. In our study we showed lower incidence of acute rejection in kidney transplant recipients treated with rabbit anti-thymocyte globulin (rATG) or basiliximab induction within the first three months after transplantation. The rATG induction caused profound decrease of recipient's peripheral blood T and NK cells, as well as transcripts that are exclusively expressed by these cell types together with expansion of regulatory T cells (Tregs) among CD4+ T cells. In rATG group the increase of two transcripts associated with rejection (MAN1A1 and TLR5) was also observed in early post-transplant period. After the basiliximab induction we transiently detected CD4+CD25low/-FoxP3+ cell population along with disappearance of CD4+CD25+FoxP3+ Tregs. Basiliximab induction resulted in a transient increase in CD4+FoxP3+ Tregs, accompanied by the highest peripheral expression levels of markers associated with operational tolerance (FOXP3 and TCAIM)....
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BK virus infection in kidney transplant patients.
Girmanová, Eva ; Viklický, Ondřej (advisor) ; Stříž, Ilja (referee) ; Krejčí, Karel (referee)
Polyoma BK virus is associated with graft dysfunction leading to BK viral nephropathy (BKVN) in 1-10% of kidney transplant recipients, moreover 30-80% of kidney transplant recipients experience asymptomatic reactivation of the virus that does not result in BKV associated damage of the renal allograft. The first aim of this study was to introduce monitoring of BK virus replication in the blood and urine of patients within first year after transplantation. Risk factors were evaluated and limit values for viremia and viruria for BKVN development was established. Positive BK viruria >107 copies/ml and positive BK viremia >104 copies/ml occurred in 25.8% and 5%; respectively. 3 patients out of monitoring study developed BKVN. Using ROC analysis, limit values for the development of BKVN were set at 103 copies/ml serum for BK viremia and 6.7x107 copies/ml BK viruria. The second objective was to determine the expression profile of the immune genes in kidney biopsies in three groups of patients with varying degrees of reactivation of the BK virus (without virus reactivation, with asymptomatic viruria, BKVN). 90 genes of immune response were measured by the TaqMan® low density array RT-qPCR. The analysis of biopsies from patients with non-signalling viruses led to the identification of 5 differentially...
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Alternative methods in managing postoperative pain in living donor renal transplantant recipients
Nová, Michaela ; Hocková, Jana (advisor) ; Dynáková, Šárka (referee)
The main criteria for managing good postoperative care include the effective and appropriate choice of pain therapy. Experiencing pain is a purely individual feeling for each of us, so it is very important to have adequate and sufficient analgesia during this period. Modern management of post-operative pain therapy uses preparations of various pharmacological groups that potentiate and thereby more effectively reduce pain. By this mechanism, we can reduce the total dose of analgesics given, and more particularly, reduce the dose of opioids that have a higher risk of side effects. In this project i want to show how the analgesic catheter could be useful as alternative possibility in algorithm therapy of postoperative pain. Analgesic catheter enable continual local anesthetics administration, exactly 0,5% bupivacaine, which is operating in surgical wound. Main goal of the study is to find out and verify if analgesic catheter is method which provides continual analgesia strong enough to results in lower use of opioids. The research data will be determined by quantitative research using a questionnaire survey. Non standardized self-production questionnaire. will be given in a paper form to non-medical healthcare staff, who perform nursing activities The spectrum of patients is very specific; they are...
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Perfusion of a Kidney Graft from a Donor After Cardiac Death Based on Immediately Started Pulsatile Machine Perfusion
Opatrný, Václav ; Moláček, Jiří (advisor) ; Bachleda, Petr (referee) ; Havránek, Pavel (referee)
Immediately started pulsatile machine perfusion of a kidney graft from a DCD (donor after cardiac death) as a way to improve its properties Opatrný V. Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague Introduction: The number of kidneys available for transplantation still does not match the number of patients on the waiting list, which gets longer every year. At the same time, kidney transplantation is the only chance for the long-term survival of patients with good quality of life. Therefore, organs from marginal donors, including donors after cardiac death (DCD), have recently been used. The most common cause of death of these donors is severe trauma, especially craniocerebral trauma, or sudden cardiac arrest, followed by unsuccessful resuscitation. Kidneys can be harvested once an individual is declared dead according to the exact criteria. This involves initial washing of the grafts in the donor's body using a perfusion solution, followed by their removal and storage using selected preservation method. Mechanical pulsatile perfusion using special instrumentation is the most frequently used technique in the area of DCD. Despite of good long-term outcomes of grafts from DCDs, this group is burdened by a greater number of delayed graft...
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Post-operative care of the patient after kidney transplant
Rebcová, Adéla ; Kordulová, Pavla (advisor) ; Chvojková, Kateřina (referee)
(v AJ) Transplantation medicine has undergone considerable development over the last twenty years. Organs Transplantation has become a routine part of treatment and often the only option for patients with severe kidney damage. Due to the development of immunosuppressive drugs and the improvement of surgical techniques, the outcomes of kidney transplants have greatly improved in recent years. The bachelor thesis describes the issue of nursing care for patients after kidney transplantation. In the theoretical part of the thesis I describe the issue of treatment of renal failure. I also focus on the period before the transplant itself and after the transplant. I can't forget to mention the professional organizations dealing with this issue, so I also provide a short overview of transplantation centres' in the Czech Republic. At the end of this section I present a very important part namely, patient education. Each patient needs to know what regimen in the homecare environment is to be followed so that transplantation is successful. The thesis I worked out on the basis of searching for relevant sources on the topic. I used resources from the National Medical Library, where I was made a literature search, through Medlain, from the Pub Med, Embase and Web of Science databases. The information were...
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Differences in the quality of life in patients undergoing hemodialysis, peritoneal dialysis and kidney transplantation
Horníková, Dita ; Di Cara, Veronika (advisor) ; Vaňková, Milena (referee)
The literature indicates that treatment by means of elimination methods is extremely challenging for patients, bringing a fundamental change to their lives. The aim of the thesis was to identify and describe the challenges of treatment in patients with renal failure and how a given method of treatment affects the patient's quality of life and needs, as well as to understand the subjective difficulties and problems. A data collection method in the form of non-standardized semi-structured interviews was selected for qualitative research. The surveyed sample consisted of six patients of a dialysis centre. The respondents taking part in the qualitative research were informed in advance of the course, circumstances and ethical aspects of the research. The obtained data was analyzed, colour-coded and then sorted into subcategories. The results were interpreted using the "showdown" technique. The interviewed sample of respondents was subjected to multiple elimination methods in the treatment of their disease. Kidney transplant patients subjectively evaluated the quality of their lives as very high, talking about "a life of a normal man". Peritoneal dialysis patients also evaluated their quality of life as relatively high, highlighting a certain feeling of independence. Haemodialysis patients describe...
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Living donor kidney transplantation
Stöcklová, Lucie ; Heczková, Jana (advisor) ; Nejdlová, Tereza (referee)
Kidney transplantation is still the most succesful method of kidney failure treatment. Transplantations from living donors get ahead of transplantations from cadaveric donors due to better results. Transplantations from living donor can be planned and have less complications. Indisputable advantage is the possibility to perform transplantation before the onset of dialysis-premptively, which provides up to twice better patient survival compared to survival on dialysis. The empirical part is elaborated using the case study describing hospital stay of living kidney donors which describes the postoperative and specific nursing care of kidney transplant recipient. The aim of this thesis is to get to know nursing algorithms in the care of patients after kidney transplantation in intensive care unit and to give comprehensive review of kidney transplantation. keywords: Kidney transplantation - predialysis - living donor - nursing procedures - intensive care - care of kidney transplant recipient
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Physical, mental and social integrity of renal transplant recipients.
Štollová, Milena ; Kulhavá, Miluše (advisor) ; Pírková, Vendula (referee)
The thesis for a baccalaureate degree addresses the topic of overall wellbeing of the renal transplant recipient. It is divided into a theoretical and an empirical section. The theoretical section discusses the status of the patient with irreversible kidney failure whereby the method is transplantation. The outputs for the empirical section derive from a questionnaire-based survey performed with 113 adult transplant recipients once their renal transplant function has stabilized. The aim of the thesis was to compare parameters of renal function and physical condition with overall quality of life. After having defined five partial goals, a survey was conducted using non-standardized questionnaires. Its results were compared with renal markers and data obtained from standardized questionnaires. The partial goals related to physical and psychical condition, sleep, concerns about one's future, and a socio-spiritual component. The quality of life was found to be inferior to that seen in the general population. No correlation was demonstrated between renal function markers on the one hand, and physical and psychical condition on the other. Individuals experiencing more immune system-related complications (rejection) only reported more tangible support from family and friends. Quite logically, the fact...
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Markers of transplantation tolerance in kidney transplantation
Krepsová, Eva ; Viklický, Ondřej (advisor) ; Krejčí, Karel (referee) ; Živný, Jan (referee)
Long-term renal graft acceptance still requires long-term immunosuppressive therapy, which is accompanied by many adverse effects. Contrarily insufficient immunosuppression could lead to graft rejection and its failure. Therefore, research continues for biomarkers that reflect a patient's immunological status and thus allowing for individualized immunosuppressive therapy. In our study we showed lower incidence of acute rejection in kidney transplant recipients treated with rabbit anti-thymocyte globulin (rATG) or basiliximab induction within the first three months after transplantation. The rATG induction caused profound decrease of recipient's peripheral blood T and NK cells, as well as transcripts that are exclusively expressed by these cell types together with expansion of regulatory T cells (Tregs) among CD4+ T cells. In rATG group the increase of two transcripts associated with rejection (MAN1A1 and TLR5) was also observed in early post-transplant period. After the basiliximab induction we transiently detected CD4+CD25low/-FoxP3+ cell population along with disappearance of CD4+CD25+FoxP3+ Tregs. Basiliximab induction resulted in a transient increase in CD4+FoxP3+ Tregs, accompanied by the highest peripheral expression levels of markers associated with operational tolerance (FOXP3 and TCAIM)....
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Role of BAFF cytokine in transplantation reactons
Sekerková, Zuzana ; Slavčev, Antonij (advisor) ; Krulová, Magdaléna (referee)
Current immunogenetic tests before organ transplantation include HLA typing and detection of HLA-specific antibodies. However, these tests do not provide information about the B cells participating in the humoral response against the transplanted organ. BAFF (B activating factor) plays an important role in the proliferation, maturation and differentiation of B cells. A soluble form of the cytokine arises after splicing the membrane form of BAFF. The soluble cytokine binds to three types of receptors - TACI, BCMA and BCMA. Some recent studies suggest that BAFF could serve as a marker or predictor of antibody-mediated (humoral) rejection in kidney transplant recipients. Our study consists of two parts. The first part is focused on the detection of soluble BAFF levels in patients after renal transplantation. The aim of our study was therefore to correlate levels of soluble BAFF cytokine in patients before and after transplantation with the clinical course and incidence of rejection after transplantation. The study included 92 kidney recipients. Humoral rejection was diagnosed on the basis of a positive finding of C4d deposits in peritubular capillaries (imunoflorescenční detection), and the presence of donor- specific antibodies. BAFF levels were determined using Xmap methodology by the Luminex method...
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