FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As cirurgias de transplante de ÃrgÃos sÃlidos foram um dos principais avanÃos da medicina no Ãltimo sÃculo, tornando-se viÃveis apenas com o advento das drogas imunossupressoras, que possuem a capacidade de inibir a resposta do receptor contra o enxerto. Juntamente à evoluÃÃo dos fÃrmacos imunossupressores e das tÃcnicas cirÃrgicas, os riscos pÃs-operatÃrios passaram a ser mais conhecidos, sendo a infecÃÃo, principalmente a bacteriana, um dos principais motivos do insucesso do transplante. Dessa maneira, microorganismos orais tornam-se uma ameaÃa em potencial, embora estes nÃo sejam comumente citados como promotores de infecÃÃes pÃs-transplante na literatura. Dessa forma, à fundamental que o cirurgiÃo-dentista esteja ciente das principais alteraÃÃes orais encontradas nestes pacientes, e que conheÃa suas necessidades de tratamento, a fim de adotar condutas visando à remoÃÃo dos focos infecciosos e eliminaÃÃo do risco pÃs-operatÃrio. O objetivo deste trabalho foi descrever as condiÃÃes de saÃde oral e necessidade de tratamento odontolÃgico de um grupo de pacientes prÃ-transplante de ÃrgÃos sÃlidos. Foi realizado um estudo transversal observacional, mediante de coleta de dados e por exame intra-oral feito por um examinador calibrado. Foram examinados 113 pacientes, sendo 71 (62,83%) indicados para transplante renal, 37 (32,74%) para o hepÃtico e 05 (4,43%) para o cardÃaco. A mÃdia de idade foi de 42,13 anos e a comorbidade mais prevalente foi a hipertensÃo. O Ãndice CPOD mÃdio da amostra foi de 17,27 e o Ãndice Periodontal ComunitÃrio (CPI) mais prevalente durante o exame foi o 02, encontrado em 56 (49,6%) pacientes, indicando alta prevalÃncia de sangramento à sondagem gengival e presenÃa de cÃlculo. A maioria dos pacientes do estudo (81,32%) nÃo mostrou lesÃes de tecidos moles. Avaliando os exames radiogrÃficos, 56 (49,5%) dos indivÃduos apresentavam reabsorÃÃo Ãssea alveolar horizontal e 05 (4,43%) pacientes possuÃam terceiros molares parcialmente erupcionados. Quanto à necessidade de tratamento odontolÃgico, terapia periodontal era indicada em 81,5% dos pacientes, 69,9% possuÃam indicaÃÃo restauradora, 48,6% necessitavam realizar procedimentos cirÃrgicos e 9,7% com indicaÃÃo para tratamento endodÃntico. NÃo houve diferenÃa estatÃstica das variÃveis analisadas entre as trÃs indicaÃÃes de transplantes. Este estudo permitiu concluir que os pacientes examinados possuÃam alta prevalÃncia de doenÃas orais, como cÃrie e gengivite/periodontite, e, consequentemente, grande necessidade de tratamento odontolÃgico. Criteriosa avaliaÃÃo clÃnica deve ser realizada para submeter tais pacientes a procedimentos cruentos, minimizando os riscos hemorrÃgicos. AlÃm disso, hà a necessidade do enfoque à saÃde oral dentro dos serviÃos mÃdicos em pacientes portadores de graus diferentes de insuficiÃncia renal, hepÃtica ou cardÃaca, e nÃo somente durante a fase prÃ-transplante, minimizando as complicaÃÃes clÃnicas no curso do tratamento odontolÃgico trazidas pela doenÃa-base. / The replacement of diseased solid organs by healthy ones was one of the greatest advances in medicine in the last century, becoming viable only with the advent of immunosuppressive drugs, which have the ability to inhibit the response of the recipient against the graft. With the development of immunosuppressive drugs and surgical techniques, post-operative risks have become more known, being infection, mainly bacterial, one of the main reasons for the failure of the transplant. Then, microorganisms present in oral infections become a potential threat, even though they are not commonly cited as post-transplant infections promoters on literature. So, it is essential that dentists known the major oral alterations in these patients, and their needs for treatment in order to adopt a conduct to remove oral infections, and eliminating the postoperative risk. The objective of this study was to assess the oral health status and necessity of dental procedures in a group of solid organ transplant candidates. A cross sectional observational study was realized, collecting data from medical records and by an intra-oral exam, realized by a calibrated examiner. A total of 113 patients were examined, being 71 (62.83%) indicated for renal transplantation, 37 (32.74%) for hepatic and 05 (4.43%) for cardiac. The mean age was 42.13 years, and the most prevalent comorbidity was hypertension. The average DMFT index was 17.27 and the most prevalent Community Periodontal Index (CPI) was 02, found in 56 (49.6%) patients, indicating a high prevalence of gingival bleeding on probing and presence of calculus. Most patients in the study (81.32%) showed no soft-tissue lesions. Evaluating the radiographic exams, 56 (49.5%) individuals had horizontal alveolar bone resorption, and 05 (4.43%) patients had partially erupted third molars. Assessing the necessity of dental treatment, periodontal therapy was indicated in 81.5% of patients, 69.9% had restorative indication, 48.6% needed surgical procedures, and 9.7% had indication for endodontic treatment. There was no statistical difference of variables between the three transplant indications. This study concluded that the examined patients had high prevalence of oral diseases, such as caries and gingivitis/periodontitis, and, therefore, a high indication for dental treatment. Careful clinical evaluation should be performed for patients with indication for surgical procedures, minimizing the hemorrhagic risk. Moreover, there is a necessity to focus on oral health promotion within the medical services in patients with different degrees of renal, liver or heart failure, not only during the pre-transplant period, reducing the clinical complications caused by the systemic disease during dental treatment.

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Although the short-term outcomes of solid allograft survival have improved substantially over the last few decades, there has been no significant improvement in long-term survival of solid allografts. This thesis presents the initial characterisation of alloantibody mediated rejection in a murine heart transplant model, with particular focus on the impact of the different phases of the humoral alloimmune response (follicular or germinal centre) on graft rejection.

Background: The incidence of inadequate empiric antibiotic therapy (IET) and its clinical importance as a risk factor for hospital mortality in Canadian solid-organ transplant patients remains unknown. Methods: This retrospective cohort study evaluated all patients admitted to a transplant unit from May/2002-April/2004. Therapy was considered adequate when the organism cultured was found to be susceptible to an antibiotic administered within 24 hours of the index sample collection time. Univariate and multivariate regression analyses were conducted to determine associations between potential determinants, IET, and mortality. Results: IET was administered in 169/312 (54%) transplant patients. Regression analysis demonstrated that an increasing duration of IET (adjusted OR at 24h, 1.33; p < 0.001), ICU-associated infections (adjusted OR, 6.27; p < 0.001), prior antibiotic use (adjusted OR, 3.56; p = 0.004), and increasing APACHE-II scores (adjusted OR, 1.26; p < 0.001), were independent determinants of hospital mortality. Conclusions: IET is common and appears to be an important determinant of hospital mortality in the Canadian transplant population.

Background: The incidence of inadequate empiric antibiotic therapy (IET) and its clinical importance as a risk factor for hospital mortality in Canadian solid-organ transplant patients remains unknown. Methods: This retrospective cohort study evaluated all patients admitted to a transplant unit from May/2002-April/2004. Therapy was considered adequate when the organism cultured was found to be susceptible to an antibiotic administered within 24 hours of the index sample collection time. Univariate and multivariate regression analyses were conducted to determine associations between potential determinants, IET, and mortality. Results: IET was administered in 169/312 (54%) transplant patients. Regression analysis demonstrated that an increasing duration of IET (adjusted OR at 24h, 1.33; p < 0.001), ICU-associated infections (adjusted OR, 6.27; p < 0.001), prior antibiotic use (adjusted OR, 3.56; p = 0.004), and increasing APACHE-II scores (adjusted OR, 1.26; p < 0.001), were independent determinants of hospital mortality. Conclusions: IET is common and appears to be an important determinant of hospital mortality in the Canadian transplant population.

Background: For patients with end-stage organ failure receiving an organ is lifesaving. To be transplanted means a big change and adjustment in life with lifelong medication. The ambition for these patients is to go back and live as normal of life as possible. Aim: The aim of this study was to describe patients experiences of being organ transplanted. Method: The method used was a literature-based study based on qualitative scientific articles. A total of 9articles were analyzed with a qualitative content analysis. Result: After analysis 5 categories emerged; indebted, limitations in daily life, fear of organ rejection, concerns about medicine and a positive attitude to life. It showed that patient´s experiences of being organ transplanted are individual and unique. Some experiences are harder to deal with than others. Conclusion: Patients describe both negative as well as positive experiences of being transplanted. They express a need for more knowledge about their condition and a need that health care staff enhance their knowledge and understanding about their unique situation.

and Key words This diploma thesis is focused on assessing the potential benefit of HLA epitopes for the prediction of de novo antibody production at kidney transplant recipients. The topic and patient selection criteria were selected in accordance with the 18th International HLA and Immunogenetics workshop (IHIWS), which is taking place in May 2022 in the Netherlands, where our data will also be contributed. Our aims were to compare HLA antigens mismatches (counted as total number of mismatched alleles) defined on the high-resolution level by NGS sequencing, HLA eplets mismatches defined by HLA matchmaker, and amino acid mismatches defined by HLA EMMA in their capacity to predict de novo antibody production and compare these results to other works by different authors from this field. We have identified N= 28 patients who developed de novo antibodies and N= 19 who didn't develop de novo antibodies in 5 years follow up their transplant. These two cohorts were compared based on all three approaches and correlation between number of mismatches and number of patients with de novo antibodies were made using ROC curves. Superiority of eplet mismatches over HLA antigen mismatches (total number of mismatched alleles) defined on high resolution was not detected. The HLA epitopes identified by the HLA...

Varje år genomförs omkring 700 organtransplantationer i Sverige. Patienter som genomgått en organtransplantation har en ständig risk för avstötning. Avstötning innebär att det transplanterade organet stöts bort och slutar fungera på grund av kroppens immunförsvar. Oavsett var transplantationen utförs så följs patienterna upp på sin hemort. Därför är det av stor vikt att som sjuksköterska inneha kunskaper om patienters upplevelser om avstötning. Syftet med litteraturstudien var därför att beskriva patienters upplevelser om avstötning efter en organtransplantation. För att uppnå syftet med studien utfördes en litteraturstudie, där fyra kategorier framstod i resultatet: Det ständiga hotet, En oönskad livssituation, Fångad i behandlingsregimen och Att finna styrka i vardagen. Avstötning är en upplevelse av ett ständigt hot som även kan medföra att patienter upplever ett emotionellt trauma. Patienterna känner sig tvungna att följa den utvalda behandlingsregimen för att undvika en avstötning. Efter en upplevd avstötning behöver patienterna använda sig av olika strategier för att kunna hantera vardagen. Ytterligare forskning om ämnet behövs för att kunna möta denna patientgrupps vårdbehov. / Each year about 700 organ transplants are performed in Sweden. Patients who have had an organ transplant are at constant risk of graft rejection. Graft rejection means that the transplanted organ is rejected and stops functioning because of the body’s immune system. Regardless of where the transplant is performed the patients are followed up at their domicile. Therefore it is of great importance that the nurse has knowledge about patients’ experiences in conjunction with graft rejection. The purpose of this study was to describe patients' experiences of graft rejection after organ transplantation. To achieve the purpose of this study a literature review was conducted, in which four categories emerged in the results: The constant threat, An undesirable situation in life, Caught in the treatment regimen, and To find strength in everyday life. Rejection is an experience of a constant threat that may cause patients to experience an emotional trauma. Patients feel obliged to follow the chosen treatment regimen to prevent rejection. After an experienced rejection, patients need to use different strategies to cope with everyday life. Further research on the topic is needed to meet the care needs of this patient group.

Bakgrund: För många svårt sjuka patienter med organsvikt är organtransplantation deras enda chans till ett bättre och längre liv. Till följd av stora förändringar och framsteg har transplantationen utvecklats, men bristen på organ är global och beror på allmänhetens inställning. Förlorad kontroll är den mest centrala upplevelsen och upplevelsen av oförutsägbarhet och osäkerhet under väntetiden. Lagar och författningar som styr organdonation och organtransplantation ser olika ut i världen. Sverige har en samtyckeslag som betyder att personen är positivt inställd till donation, men närstående har vetorätt och kan motsätta sig ingreppet. Syfte: Syftet var att beskriva patienters upplevelse av att vänta på organtransplantation. Metod: En litteraturstudie med induktiv ansats som omfattas av tolv artiklar varav en kvantitativ. Databaserna Cinahl Complete och PubMed användes. Genom hela gransknings- och analysprocessen användes Polit och Becks niostegsmodell. Resultat: Fyra kategorier framkom: ”fysiska symtom”, ”den psykiska upplevelsen av att vänta”, ”copingstrategier” och ”sociala begränsningar”. Diskussion: Två huvudfynd framkom; det första beskriver fysiska symtom som genererar sociala begräsningar och det andra beskriver hur patienterna utvecklar copingstrategier, för att hantera den psykiska upplevelsen av att vänta. Dessa diskuteras med stöd från annan forskning och Antonovskys förhållningssätt KASAM.