Humoralno odbacivanje srčanog presatka

master's thesis

• Title (english): Humoral rejection of the cardiac transplant
• Author: Nikola Rogina
• Mentor: Boško Skorić (mentor)
• Committee member: Davor Miličić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Humoralno odbacivanje srca, također poznato pod nazivima vaskularno te odbacivanje posredovano protutijelima (engl. AMR), jest donedavno bila slabo definirana dijagnoza. Ona je trenutno definirana kao histopatološka dijagnoza temeljena na kriterijima koje je donijelo Internacionalno društvo za transplantaciju srca i pluća (ISHLT) 2013. godine. Budući da humoralno odbacivanje dugo nije imalo usuglašene kriterije za dijagnozu, ostaje nepoznata točna incidencija (spominje se u rasponu od 3-85%) i prevalencija tog tipa odbacivanja. Postoji više faktora rizika za razvoj humoralnog odbacivanja, poput prethodne transplantacije, trudnoće, senzitizacije indukcijskom terapijom OKT3, CMV infekcija te korištenja VAD prethodno transplantaciji. Dijagnoza se postavlja primarno na temelju histološke te imunohistološke analize srčanog bioptata te se klasificira po pAMR stupnjevima (0-3). Dodatni pokazatelji AMR uključuju cirkulirajuća DSA, ehokardiografiju, kliničke znakove zatajenje srca te u novije vrijeme mogućnosti genetskog testiranja uzorka periferne krvi. Terapijske mogućnosti humoralnog odbacivanja su slabo definirane, bez konkretnih smjernica i preporuka za liječenje temeljenim na randomiziranim kliničkim studijama. Postoji široka paleta lijekova i postupaka koje je moguće primijeniti, no ne zna se koji od njih i / ili kombinacija kojih jest najbolji odabir za pacijenta. S ujednačenijim dijagnostičkim kriterijima stvara se stabilnija podloga za procjenu trenutnog stanja te bolje mogućnosti za evaluaciju, razvoj i standardizaciju terapije.

Abstract (english)

Humoral cardiac rejection, also known as vascular and antibody mediated rejection (AMR), was, until recently, a poorly defined diagnosis. Currently, it is defined as a histopatologic diagnosis based on criteria assembled by International Society for Heart and Lung Transplantation (ISHLT) in year 2013. Since the diagnostic criteria weren't standardized for a long time, true incidence (it varies from 3-85%) and prevalence of humoral rejection remain unknown. There are multiple risk factors for development of humoral rejection. They include previous transplantation, pregnancy, sensitization using OKT3 induction therapy, CMV infection and using VAD prior to transplantation. Diagnosis is based primarily on the histologic and immunohistologic analysis of endomiocardial biopsy and it is classified by pAMR categories (0-3). Additional supporting tests include circulating DSA, echocardiographic or/and clinical signs of heart failure and recently the possibility of genetic testing of peripheral blood. Therapeutic options for humoral rejection are poorly defined, without specific treatment guidlines and recommendations based on randomized clinical trials. There is a wide pallete of drugs and procedures which can be applied, but which one or which combination is the best choice for patient remains unknown. Better defined and more unoform diagnostic criteria for humoral rejection will reduce variations in the diagnosis and provide a more stable platform for evaluation, development and standardization of theraphy.

• Keywords: AMR; humoralno odbacivanje; transplantacija srca; donor specifična antitijela; liječenje AMR
• Keywords (english): antibody mediated rejection; AMR; humoral rejection; heart transplantation; donor specific antibodies; treatment of AMR
• Language: croatian
• URN:NBN: urn:nbn:hr:105:384174
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-04-03 11:53:06