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Experience of a heart transplant from patient´s perspective.
MAZÁK, Vít
This bachelor thesis deals with the topic of the experience of the whole process of a heart transplant from the patient's perspective. The aim of this thesis is to map the needs of patients during the process of heart transplantation. This goal was achieved using research questions about how the patient perceives nursing care, what feelings they experience, what their needs are and subsequently how they comply with the precautions after the heart transplant. The theoretical part focuses on the history of organ transplantation with a closer look on the history of heart transplantation and approaches the transplantation law in the Czech Republic, and includes the topic of the most common causes of a heart transplant. Then, it elaborates on the conditions of the heart transplant and the subsequent inclusions of the patient on the waiting list. It also briefly describes selected examinations preceding the heart transplantation, the patient's preparation and the general course of the operation. It explains the nursing care of the patient after the heart transplant, patient's needs and rehabilitation after the surgery and early complications. After that, the thesis follows up with describing the nursing care in the hospital and the patient's home rehabilitation. It also focuses on the psyche during the transplantation process, on the description of immunosuppressive drugs and the contexts of their use. The research part of this work utilizes the qualitative research method. A semi-structured interview consisting of 29 questions was used to collect the data. The research group consisted of six patients, who have undergone a heart transplant. During the research that was to map the needs of informants, it has become clear that the needs of a heart transplant patient are usually met thanks to the high level of nursing care, which is provided to them. The quality of nursing care identified in this cases is highly adapted to the individual needs of the interviewed. Most patients do not have a problem receiving a foreign organ, but in some cases they would need more time to absorb a fact, that it is an organ from other human. What emerged from other results is, that some patients have a feeling they are insufficiently informed about the heart transplantation before the operation itself.
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Allooimmunosensitization in left ventricular assist device recipients and impact on post-transplantation outcome
Urban, Marián ; Netuka, Ivan (advisor) ; Ošťádal, Petr (referee) ; Mrázek, František (referee)
Background: In recent years mechanical circulatory assist devices became an established option in bridging patients with refractory heart failure to heart transplantation. One of the alleged limitations of mechanical devices is a high degree of antibody production with possible deleterious effect on subsequent heart transplantation outcome. Aim: The main goal of this study is to assess the role of antibodies on the outcome of surgical treatment of patients with end- stage heart failure. Method: Firstly, we present a literature review on the current state of knowledge of possible immunologic mechanisms involved in antibody production in left ventricular assist device (LVAD) recipients, new methods of antibody detection, desensitization strategies and overview of published evidence assessing the impact of sensitization on post-transplantation outcome. In the experimental part of our study we prospectively evaluated the presence of anti-Angiotensin II Type 1 Receptor (AT1R) antibodies in 83 Heart Mate II (HMII) recipients who were implanted at our institution between 2008 and 2012 and survived the first 60 days. On-device survival and device malfunction, major infection, major bleeding and neurologic dysfunction were compared between antibody positive and antibody negative recipients. Out of a total...
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Life after a heart transplant
Kováčová, Anna ; Kordulová, Pavla (advisor) ; Dynáková, Šárka (referee)
Patients with terminal heart failure that cannot be treated with conventional therapies are indicated for heart transplantation. In acute deterioration, patients can be brought to transplant using a mechanical cardiac support that is able to partially or completely take over the role of the heart and allow the restoration of sufficient cardiac output (Fila et al., 2014). The period before and after transplantation represents a very challenging period for patients, when they feel not only physical, but especially mental and social needs, which change during their phases of life and at the same time affect their entire subsequent experience. The main goal of this diploma thesis was to monitor how the previous implantation of long-term mechanical cardiac support and the subsequent heart transplantation affect the needs and feelings of patients. Respondents were selected from patients who had been implanted with mechanical cardiac support prior to heart transplantation. The diploma thesis contained another five sub- objectives, which dealt with mapping the needs of patients before and after implantation of long- term mechanical cardiac support and after heart transplantation, as well as during compliance with regimen measures, information retrieval and education. For qualitative research, the method of...
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Experimental and clinical aspect of calcineurin inhibitors-induced nephrotoxicity.
Hošková, Lenka ; Málek, Ivan (advisor) ; Tesař, Vladimír (referee) ; Špinarová, Lenka (referee)
The introduction of calcineurin inhibitors (CNI) into immunosuppressive regimens significantly improved patients prognosis after heart transplantation. Some of the most significant complications have been recognized, such as the development of arterial hypertension and renal impairment due to calcineurin inhibitor toxicity. The aim of the study was to compare the effect of the dual blockade of the renin-angiotensin system (dual RAS combination) with standard antihypertensive medication on blood pressure control. The second aim was to evaluate whether effective antihypertensive combination therapy (dual RAS or a standard antihypertensive drugs combination) would reduce the progression of chronic kidney disease in patients with chronic immunosuppressive prophylaxis. Treatment of arterial hypertension involving the combination of angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blocker (ARB) was similarly effective compared to the standard combination of antihypertensives. Blood pressure treatment targets were achieved in both studies. Administration of antihypertensive combination therapy including dual blockade of RAS alleviated the progression of chronic renal disease in the experimental and clinical part, where the nephroprotective effect of dual RAS blockade...
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Gender differences in myocardial apoptosis of the patients after heart tranplantation.
Smetana, Michal ; Szárszoi, Ondrej (advisor) ; Brát, Radim (referee) ; Neckář, Jan (referee)
Gender differences in myocardial apoptosis of the patients after heart transplantation Background: Many functions of the cardiovascular apparatus are influenced by gender. The aim of our study was to find out the sensitivity to perioperative ischemia of the donor female and male myocardium; and determine how the organism affects the donor myocardium of the other sex after heart transplantation (detection of apoptosis), and whether the investigated biomarkers can predict primary graft dysfunction (PGD). Methods: The research was divided into three prospective studies. The Study 1 included 81 patients undergoing heart transplantation from September 2010 to January 2013. Patients were divided into two groups according to male allograft and female allograft. In order to prove myocardial necrosis the high-sensitive cardiac troponin T (hs-cTnT) method was used. Apoptosis was determined by immunohistochemical detection of caspase-3, Bcl-2, and by the TUNEL method. The Study 2 includeded 58 patients divided into four groups according to gender; both of the recipient and the donor. Apoptosis (caspase-3, Bcl-2, TUNEL) was analysed in these groups during the two-year follow-up. Into Study 3 64 patients were involved. We investigated the relationship in between these biomarkers and the development of PGD after...
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Heart transplantation in the Czech republic by economic view: international comparison
Havlíková, Marie ; Janíčko, Martin (advisor) ; Čermáková, Klára (referee)
In my bachelor thesis, I primarily focus on the economy of heart transplantation. At first there is an important topic of health economy and its specific features. Then I go deeper in the topic and mention the economy of transplantation, supply and demand of organs and define donors and the recipients of organs. I also describe the legal system of transplantation and organ donation and mention the history of heart transplantations (HTX). The second part of my thesis is concerned with the situation of heart transplantations in the USA. I compare how the situation about HTX changed there during the last decades and how is it with the costs and payments. Finally, the third part of my thesis deals with the heart transplantations in the Czech Republic and another six European countries. Using the econometric model, I try to estimate the average waiting period for heart transplantation and its determinants.
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Analysis of selected genetic markers in patients after heart transplant
Petříková, Nikola ; Hubáček, Jaroslav (advisor) ; Vrablík, Michal (referee)
Heart transplantation is performed in patients with end-stage heart failure, in whom all other methods of treatment failed. The most common causes of end-stage heart failure are dilated cardiomyopathy and coronary artery disease. The destiny of these patients is highly variable. Prediction of long term survival in patients after heart transplantation is not satisfactory and up to now has not been found reliable marker. Most of the patients die after heart transplantation due to cardiovascular disease. This thesis is focused on molecular genetics and statistical analysis of four single nucleotide polymorphisms, namely rs17817449 (16q12.2, FTO gene), rs2943634 (2q36.3; intergenic region), rs6922269 (6q25.1; MTHFD1L gene), and rs10757274 (9p21.3; intergenic region). According to genome wide association studies are these SNPs assosiated with cardiovascular diseases. We genotyped DNA samples of 364 heart donors and 364 heart recipients. The results were statistically compared (using OR and Pearson's χ2 test) with the control group, which consisted of samples of individuals from the general population MONICA study. We examined the genotype in patients whose hearts failed due to dilated cardiomyopathy or coronary artery disease and then in patients with cardiac allograft vasculopathy. Furthermore, we focused on...
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Problems of patients with long-term cardiac support
Ondráčková, Lucie ; Pavlíková, Pavla (advisor) ; Černá, Alena (referee)
Bachelor thesis is divided into theoretical and empirical part. The theoretical part is devoted to heart failure, given that it is patients with end stage heart failure is a long-term cardiac support implemented. It is described surgical treatment of heart failure and various cardiac support. A separate section is devoted to long-term cardiac support-Heart Mate II. Conclusion The theoretical part is devoted to the specifics of treatment of patients with established long-term cardiac support. The empirical part of the paper maps out the problems of patients with established long- term cardiac support. The method used to implement the survey questionnaire. The studied group consisted of 21 patients with established long-term cardiac support in outpatient care. Reconnaissance survey conducted in the outpatient department of heart failure IKEM in Prague. The work shows that although the introduction of cardiac support for patients and mentally demanding affects their daily life, most of them feel improvements in your health and well-established cardiac support perceived as a chance to wait for a heart transplant.
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Allooimmunosensitization in left ventricular assist device recipients and impact on post-transplantation outcome
Urban, Marián ; Netuka, Ivan (advisor) ; Ošťádal, Petr (referee) ; Mrázek, František (referee)
Background: In recent years mechanical circulatory assist devices became an established option in bridging patients with refractory heart failure to heart transplantation. One of the alleged limitations of mechanical devices is a high degree of antibody production with possible deleterious effect on subsequent heart transplantation outcome. Aim: The main goal of this study is to assess the role of antibodies on the outcome of surgical treatment of patients with end- stage heart failure. Method: Firstly, we present a literature review on the current state of knowledge of possible immunologic mechanisms involved in antibody production in left ventricular assist device (LVAD) recipients, new methods of antibody detection, desensitization strategies and overview of published evidence assessing the impact of sensitization on post-transplantation outcome. In the experimental part of our study we prospectively evaluated the presence of anti-Angiotensin II Type 1 Receptor (AT1R) antibodies in 83 Heart Mate II (HMII) recipients who were implanted at our institution between 2008 and 2012 and survived the first 60 days. On-device survival and device malfunction, major infection, major bleeding and neurologic dysfunction were compared between antibody positive and antibody negative recipients. Out of a total...
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