Hjärta och lever är vitala organ och när de inte fungerar blir konsekvenserna förödande. Under 2013 genomfördes 55 hjärttransplantationer och 161 levertransplantationer i Sverige. Transplantation är en lång och svår process som generellt leder till förbättrad livskvalitet. Patienten går från att ha varit nära döden till att få en ny chans till livet. Det är en stor omställning som kan vara svår att förstå och hantera. Syftet var att beskriva patienters existentiella upplevelser efter en lever- eller hjärttransplantation. En litteraturöversikt gjordes där totalt 10 kvalitativa artiklar granskades och analyserades. Resultatet visar tre huvudteman. Det första temat var Det nya livet som visar hur patienten genomgår en känslomässig berg-och-dalbana när de försöker finna sitt nya jag i livet. Det andra temat benämns som Paradoxala känslor där tacksamhet blandat med skuld är centralt. Den andliga dimensionens betydelse är det sista temat där patienten vänder sig till högre makter för att klara av sin livssituation. Diskussionen tar upp huvudfynden från resultatet samt sjuksköterskans roll i patientens helandeprocess. Slutsatserna som dras är att patientens upplevelser är unika och att vårdpersonalen behöver mer utbildning i existentiella frågor för att bättre kunna bemöta patienten.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: Liver transplantation is a curative method for end-stage liver diseases, small unresectable hepatocellular carcinoma and acute liver failure. The discovery of immunosuppressive drugs increases the survival rate of liver transplanted recipients by reducing the incidence of graft rejection. Several complications such as renal dysfunction and increase risk of malignancy result from life-long treatment of transplanted recipients with immunosuppressant. If recipients are over-immunosuppressed, the risk of infection might be increased. On the other hands, if recipients are under-immunosuppressed, the risk of rejection would be increased. It should be useful if a test or a bio-marker that could predict and differentiate infection and rejection in transplanted recipients. Therefore, patients could be treated before adverse conditions. Although therapeutic drug monitoring has been performed as a routine test, it is mainly targeted for minimizing drug toxicity but little help in predicting infection and rejection. A new assay named Cylex? Immuknow? assay is designed to measure global cell mediated immunity of immunosuppressed population, by quantifying the amount of ATP synthesis by CD4+ T cells in response to PHA stimulation. It is undergoing evaluation in assessing the immune status of patients in order to predict the risk of infection and rejection, and also other conditions. (1, 2) Objectives: In this pilot study, we would like to evaluate ImmuKnow for predicting the risk of infection and rejection in liver transplanted recipients in Hong Kong. Methods: Blood samples were collected from liver transplanted recipients at different time intervals. The immune cell response of these patients was measured by Immuknow assay. Patients with low immune response might have a high risk of infection, patients with high immune response might have a high risk of rejection, and patients with moderate immune response should be clinically stable. Results and conclusion: Twenty-six blood samples were collected from eight transplanted recipients. The average Immuknow assay value for the post-transplant samples was 304.6 ng/mL ATP which represented moderate immune cell response according to the interpretation table. (Table 3) This was reasonable as the subjects were all clinically stable by well-controlled immunosuppression. The result was consistent with other studies. (1, 3) However, the association between low immune cell response and infection, and the association between high immune cell response and graft rejection could not be investigated as both of these conditions were not found in this pilot study. A larger study including episodes of infection and rejection should be conducted in order to evaluate the value of Immuknow assay more completely. / published_or_final_version / Pathology / Master / Master of Medical Sciences

Haematological stem cell transplantation (HSCT) is a revolutionary treatment for haematological malignancies. Although HSCT is potentially curative, patients usually develop stomatitis which is a common and debilitating complication after the transplantation. Furthermore, stomatitis may predispose patients to various complications which are associated with significantly increased morbidity and mortality. In some studies, ice water mouthwash has been shown to be an effective method for the prevention of stomatitis. However, a high-level evidence-based protocol on the prevention of stomatitis has not been fully developed and it is not commonly practiced in most HSCT centers at present. A well established protocol can help to minimize the patients’ suffering and avoid prolonged hospitalization. The nurses who are involved in patient education, assessment, care for, and coping with stomatitis, play an important role to bring these innovations into practice. In this regard, this translational research aims at developing an evidence-based protocol on using ice water mouthwash in the prevention of stomatitis for patients undergoing autologous HSCT. A systematic search for relevant literatures was performed with the use of five electronic databases. Six relevant studies were found. Critical appraisal on the relevant studies was conducted. The level of evidence extracted from the studies was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) and were synthesized to establish the protocol for patients in the proposed setting. The implementation potential of the protocol was assessed in terms of the transferability, feasibility, and cost benefit ratio. An implementation and evaluation plan was established for comprehensive evidence-based protocol development. The successful implementation of the protocol will be beneficial for the patients undergoing HSCT as it may hasten their recovery, shorten their hospital stay, and minimize their distressing experience and suffering. / published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medicine / Master / Doctor of Medicine

published_or_final_version / Surgery / Master / Master of Surgery

The overall aim of this thesis was to determine if day old turkey gonads could be cryopreserved and transplanted into recipient poults. This would allow for grafts to develop and mature normally and potentially produce donor-derived offspring. In addition, the monitoring of folliculogenesis in chickens was studied to determine if ultrasonography would be a useful technique to study this biological process, with the intention of using this method in future studies on ovarian graft development. Three studies were conducted: cell and tissue viability of vitrified day old turkey gonads, transplantation of day old turkey gonads into recipient poults, and monitoring of follicle growth in chickens using ultrasonography. The objective of the first study was to determine if day old turkey gonads were viable after vitrification using a standard protocol or with variation in equilibrium solution (ES) and/or vitrification solution (VS) absorption times. Three different ES time points were tested 10, 15 and 20 min (10ES, 15ES and 20ES) and two different VS time points 2 and 3 min (2VS and 3 VS). The cell and tissue viability was determined by Trypan Blue Assay and light microscopy, respectively. Testicular cell viability was conducted using three vitrification protocols and fresh tissue. All vitrification protocols along with fresh tissue were assessed by light microscopy, to evaluate histological alterations, in ovarian and testicular tissue. Protocols with the highest cell viability and best morphological scores were selected as being the most suitable for cryopreservation. Testicular tissue vitrified using 15ES or 20ES with 3VS had the highest cell viability. Ovarian and testicular tissue vitrified using 15ES with (3VS or 2VS), showed the best morphological scores, out of all the protocols. The second study was broken down into two parts: Part A (Trial 1 & 2) was to determine the most suitable age group for poults pre-surgery to give the highest survivability; Part B (Trial 3) was to determine if previously vitrified day old turkey gonads could develop and mature normally, by retrieving grafts post-surgery, at- different time points. In Trial 1, large white turkeys (LWT) 1, 3, 4 and 7 days of age were used and for Trial 2, LWT’s aged 1, 3, 4, and 5 days of age were used. In Trial 3, bronze turkeys at 1 day of age were used, and graft tissue was used from day old LWT’s previously vitrified (10ES/2VS) or fresh. For all Trials, the survivability at each time point was analyzed, and for the third Trial, the grafts recovered were histologically analysed. From Trials 1 and 2, seven and three day old poults had the highest survivability ratios (3/5 and 6/8) respectively. For Trial 3, day old male poults (96%) had a higher survivability than the females (68%). From Trial 3, transplants were only recovered in females and males up until 4 days and 4 weeks post-surgery respectively, with no fresh tissue grafts recovered. The histological analysis of testicular transplants showed deteriorating structure, with a steady progression away from normal morphology, post-surgery. The third study’s objective was to determine the growth rates and patterns of folliculogenesis in Barred Plymouth Rock (BPR) hens by using ultrasonography. Two ultrasound Trials were performed: the first to determine the optimum time interval between serial ultrasound scans to accurately map follicles, and the second to tackle the main objective of the third part of this thesis. For the first Trial, BPR hens were scanned periodically over 24 hours, follicle diameter and position were recorded and mapped with respect to the ovary and neighbouring follicles. Proportional follicle growth, compared to the first scanning session showed that the 24hr time point had the only significant (P<0.001) proportional follicle growth. It is recommended here that scans occur twice a day (morning and afternoon) to capture a more precise growth rate of follicles. In the second Trial, BPR hens were scanned twice a day, over an 11-day period. Follicle diameters (height and width) were recorded to calculate follicle area. The growth of each follicle’s area was compared to the time before ovulation to determine the overall follicle growth rate. Additionally, it was determined if time (night, day) and type of preovulatory follicle (F1-F5) played a significant role in follicle growth rates. The overall follicle growth rate was best described by a cubic equation (R2=0.907, P<0.001). Follicle growth rates were influenced by both time (P=0.009) and type (P<0.001). With F2 and F3 follicles (P<0.05) having a higher growth rate than F1 and F5 types. In conclusion, modifications to the standard vitrification protocol used on quail gonads were necessary to increase cell viability and lower morphological alterations for turkey gonads left whole. For future work it has been shown that day old turkey poults can survive gonad transplantation. The lack of development of grafts is most likely due to a combination of tissue damage after vitrification-warming procedures and insufficient immunosuppression of the host. This work has paved the way for the poultry industry to be able to cryogenically store turkey gonads and revive lines when required. Additionally it was shown that serial ultrasound scans twice a day provided accurate monitoring of follicle growth in Barred Plymouth Rock hens. For BPR hen’s follicle growth rates and patterns were successfully measured. This gives the industry another tool to better select superior laying hens and to create a more homogeneous laying flock. Future application of ultrasonography on gonad monitoring has the potential to show growth and maturation of grafted tissue before the production of donor-derived offspring, enabling earlier detection of successful transplantation.

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