Long term results of heart transplantation in University hospital Dubrava

master's thesis

• Title (croatian): Dugoročni rezultati transplantacije srca u Kliničkoj bolnici Dubrava
• Author: Eva Rupert
• Mentor: Igor Rudež (mentor)
• Committee member: Igor Rudež (predsjednik povjerenstva)
• Committee member: Joško Bulum (član povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Heart transplantation is a life- saving and quality of life enhancing treatment option for patients with end- stage heart failure. Patients who are suitable candidates suffer from a terminal illness with prognosis of 1- year survival without transplantation less than 50%. The major limiting factor is donor organ availability, therefore it is important to choose recipients who are most likely to achieve long- term benefits and who tried other medical and surgical alternatives which did not work. Allocation of donor organs depends on recipient’s priority status, which is determined by strict criteria. Both donor and recipient must be thoroughly evaluated to rule out any contraindications that might prevent them from proceeding to the surgery. Only a good match between donor organ and recipient leads to a good short- term and long- term outcome of transplantation. Decades of surgical technique improvements, effective immunosuppressive agents and development of medicine in general, which supports patients’ preoperative and postoperative care, made heart transplantation a very successful treatment option with a very low perioperative mortality rate. The causes of early allograft failure are myocardial dysfunction due to donor instability, pulmonary hypertension, ischemic injury during preservation and sometimes acute rejection. Long- term complications which often tend to also become the cause of death are infections, allograft rejection, cardiac allograft vasculopathy and renal dysfunction. Chronic immunosuppression is associated with increased incidence of cancers, mostly lymphoproliferative disorders and skin cancer. Out of all complications, infection is the leading cause of morbidity and mortality. This study showed that in Clinical Hospital Dubrava, post heart transplantation survival rates at 1, 5, and 10 years were comparable to those reported by the International Society of Heart and Lung Transplantation (ISHLT).

Abstract (croatian)

Transplantacija srca je terapijska mogućnost liječenja i poboljšanje kvalitete života za bolesnike u završnoj fazi zatajenja srca. Bolesnici koji su prikladni kandidati boluju od terminalnog kroničnog srčanog zatajenja s prognozom od 1 godine preživljavanja bez transplantacije manjom od 50%. Glavni ograničavajući čimbenik je dostupnost organa davaoca, stoga je važno odabrati primatelje koji će najvjerojatnije postići dugoročnu korist i kod kojih su ostale medicinske i kirurške metode liječenja iscrpljene. Dodjela organa ovisi o prioritetnom statusu primatelja, što je određeno strogim kriterijima. I donor i primatelj moraju biti temeljito procijenjeni kako bi se isključile kontraindikacije. Samo dobra podudarnost između organa primatelja i donora dovodi do dobrog kratkoročnog i dugoročnog ishoda transplantacije. Desetljeća poboljšanja kirurške tehnike, učinkoviti imunosupresivni lijekovi i razvoj medicine općenito, učinili su transplantaciju srca vrlo uspješnom opcijom liječenja s vrlo niskim perioperativnim mortalitetom. Uzroci ranog otkazivanja alografta su disfunkcija miokarda uslijed nestabilnosti donora, plućne hipertenzije, ishemijske ozljede tijekom transporta srca i ponekad akutnog odbacivanja. Dugotrajne komplikacije koje često postaju uzrok smrti su različite infekcije, odbacivanje alografta, vaskulopatija srčanog alografta i disfunkcija bubrega. Kronična imunosupresija povezana je s povećanom učestalošću karcinoma, uglavnom limfoproliferativnih poremećaja i raka kože. Od svih komplikacija, infekcija je vodeći uzrok morbiditeta i mortaliteta. Ovo je istraživanje pokazalo da su u Kliničkoj bolnici Dubrava, stope preživljavanja nakon transplantacije srca na 1, 5 i 10 godina bile usporedive s onima koje je prijavilo Međunarodno društvo za transplantaciju srca i pluća (ISHLT).

• Keywords: heart transplantation; long term results; end- stage heart failure
• Keywords (croatian): transplantacija srca; dugoročni rezultati; terminalno zatajivanje srca
• Language: english
• URN:NBN: urn:nbn:hr:105:604419
• Study programme: Title: Medicine (in English language); 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: 2020-07-22 12:29:02