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With improved survival following cardiac transplantation, attention has focused upon the quality of that survival and some of the variables that may impact quality of life. The present study objectively measured subjective aspects of quality of life in order to discover its pre- and postoperative predictors. Results indicate that immunosuppression following heart transplantation creates a significant number of complications and symptoms for the recipient and is significantly related to elevated levels of psychological distress, particularly depression and anxiety, and decreased self-esteem. These findings emphasize the importance of careful symptom evaluation and targeting of distressed patients for psychological intervention in clinical settings and underscore the importance of continued medical research to improve immunosuppression therapy. Descriptive statistics reveal a rather mixed picture of postoperative quality of life which may result from the difficult clinical reality in which heart transplant patients often trade one set of preoperative cardiac symptoms for another set of postoperative symptoms related to immunosuppression therapy.

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Die Lebertransplantation ist ein etabliertes Therapieverfahren bei akuten sowie chronischen Leberversagen. Aufgrund des stetig steigenden Bedarfs an Transplantationsorganen stellt die Verteilung der Spenderorgane eine immense Herausforderung dar. Im Jahr 2006 wurde ein neues Allokationssystem eingeführt, welches objektiv anhand vorliegender Labordaten die Dringlichkeit einer Organtransplantation einschätzt. Die hier vorliegende Dissertation zeigt die Auswirkungen des neuen Allokationssystems auf die Ergebnisse nach einer Lebertransplantation am Universitätsklinikum Leipzig. Die Einführung des neuen Allokationssystems führte zu einer Verkürzung der Wartezeit auf der Transplantationsliste und zu einer niedrigeren Wartelistenmortalität. Dem gegenüber stehen erhöhte postoperative Komplikationsraten sowie Kosten. Um die limitiert verfügbaren Spenderorgane mit größtmöglicher Erfolgsaussicht transplantieren zu können, sind prädiktive Modelle zur Abschätzung des outcomes nach Lebertransplantation etabliert worden. In dem betrachteten Patientenkollektiv am Universitätsklinikum Leipzig konnten sowohl der SALT-Wert als auch die präoperative intensivmedizinische Trias als Prognosefaktoren für das Überleben nach Lebertransplantation beschrieben werden. In Zukunft wird die Anwendung eines Prognosefaktors bereits im Organallokationsprozess eine immer größere Rolle einnehmen um im ethischen Problemfeld aus Organknappheit und erhöhtem Organbedarf den gesellschaftlichen Ansprüchen gerecht zu werden.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Transplantation is the best therapeutic solution for patients with chronic renal failure. Due to the great advances in immunosuppressive therapy in the last decades, graft and patient survival have improved significantly. On the other hand, immunosuppressive therapy has serious side effects - too strong immunosuppression may lead to infection or malignancies, conversely insufficient immunosuppression may lead to graft rejection. Due to the grave consequences of acute rejection, the main goal of cooperation of clinicians and transplant immunologists is to stratify patients into groups with low, moderate and high risk of rejection based on the evaluation of various immunologic risk factors. There are reports in the literature that the numbers (frequencies) of interferon gamma (IFNγ) producing cells before transplantation may be helpful to identify patients with high risk of acute cellular rejection and to predict long-term survival of the graft. In this retrospective study we determined the pre-transplant frequencies of activated donor specific T lymphocytes producing IFNγ after short stimulation (24 hrs) by ELISpot (Enzyme-linked immunosorbent spot assay). The results were correlated with the incidence of acute cellular (ACR) and antibody-mediated (AMR) rejection and with other risk factors. In our...

Current immunogenetic tests before organ transplantation include HLA typing and detection of HLA-specific antibodies. However, these tests do not provide information about the B cells participating in the humoral response against the transplanted organ. BAFF (B activating factor) plays an important role in the proliferation, maturation and differentiation of B cells. A soluble form of the cytokine arises after splicing the membrane form of BAFF. The soluble cytokine binds to three types of receptors - TACI, BCMA and BCMA. Some recent studies suggest that BAFF could serve as a marker or predictor of antibody-mediated (humoral) rejection in kidney transplant recipients. Our study consists of two parts. The first part is focused on the detection of soluble BAFF levels in patients after renal transplantation. The aim of our study was therefore to correlate levels of soluble BAFF cytokine in patients before and after transplantation with the clinical course and incidence of rejection after transplantation. The study included 92 kidney recipients. Humoral rejection was diagnosed on the basis of a positive finding of C4d deposits in peritubular capillaries (imunoflorescenční detection), and the presence of donor- specific antibodies. BAFF levels were determined using Xmap methodology by the Luminex method...

Etablierung und Untersuchung Diabetischer Schweine Transplantation isolierter Langerhansinseln Optimierung der Isolierungsergbnisse