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Contribution of New Immunosuppressants after Heart Transplantation
Skalická, Blanka ; Málek, Ivan (advisor) ; Horký, Karel (referee) ; Lischke, Robert (referee)
Background: Acute cellular rejection and graft vascular disease are major factors limiting the survival after orthotopic heart transplantation (OHTx). Tacrolimus could be more potent than cyclosporin A in therapy of recurrent acute rejection episodes in OHTx patients. Dyslipidemia is one of the risk factors involved in the development of graft vascular disease. Statins are common part of standard drug regimen after OHTx. On the other hand, they are potentially dangerous as they could interact with cyclosporin A. Study in healthy volunteers showed that tacrolimus should have no interactions with statins. Aim: In the first study we retrospectively assessed the effect of switching patients after OHTx with recurrent cellular rejection episodes from cyclosporin A to tacrolimus. In the second (prospective) study we evaluated the efficacy and safety of combined therapy with tacrolimus and atorvastatin in patients after OHTx with dyslipidemia. (...) Conclusions: Tacrolimus has a beneficial effect not only on recurrent acute rejection episodes in heart transplant recipients but it also decreases the incidence of future rejection episodes. In patients after OHTx with dyslipidemia switching to tacrolimus and atorvastatin could be a suitable therapeutic option, because this combination is safe and effective in...
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název v anglickém jazyce není uveden
Lischke, Robert ; Pafko, Pavel (advisor) ; Král, Vladimír (referee) ; Adamec, Miloš (referee)
Induction therapy in lung transplantation: initial single-center experience comparing daclizumab and anti-thymocyte globulin BACKGROUND: Acute and chronic rejection remain unresolved problems after lung transplantation, despite heavy multidrug immunosuppression. In turn, the strong immunosuppression has been responsible for mortality and pervasive morbidity. Because acute rejection is associated with inferior outcomes in lung transplantation, we have routinely employed anti-thymocyte globulin (ATG), or daclizumab as adjuncts to reduce rejection. Daclizumab is a human monoclonal antibody that binds to the interleukin-2 receptor. METHOD: We performed a controlled clinical trial of these 2 therapies to determine differences in post-operative rejection, infection, bronchiolitis obliterans syndrome (BOS) and survival. 25 consecutive lung transplant patients received ATG (n = 12)(Group 1) and daclizumab (n = 13)(Group2) as induction agents. The groups had similar demographics and immunosuppression protocols differing only in induction agents used. RESULTS: No differences were observed in immediate post-operative outcomes such as length of hospitalization, ICU stay, or time on ventilators. No patient receiving daclizumab developed drug specific side-effects. There were no significant differences in the...
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Ischemia-reperfusion injury in lungs after transplantation and the role of radical oxygen species
Mrázková, Hana ; Lischke, Robert (advisor) ; Třeška, Vladislav (referee) ; Kittnar, Otomar (referee)
Keywords: Lung Tx, EVLP, NHBD, IR injury, ROS, hypercapnia, gender differences This dissertation thesis deals with a very topical issue of the lack of donor organs for lung transplants. As with other organs, the number of patients on waiting lists in terminal stages of their diseases is also constantly rising but there is not an adequate increase in donor organs. We focused our experimental work on the development of research concerning the solution which is most successful in a long-term perspective, i.e. organ transplants from non- heart-beating donors (NHBDs), in an ex vivo lung transplant protocol (EVLP) on an animal model (Wistar rats). This is a method which is clinically established worldwide (in the Czech Republic only experimentally) and is constantly subject to further research. Based on earlier studies, we focused the first experimental part of this work on the potential protective effect of hypercapnic ventilation on ischemia-reperfusion (IR) lung injury in EVLP. The study proved that the hypercapnic ventilation has a protective effect on the generation of reactive oxygen species (ROS) in IR lung injury, but only when used in the period of reperfusion. In the second experimental study, we followed up a very topical issue of the effect of gender on IR lung injury in EVLP in...
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