Transplantation is an acceptable treatment for end-stage lung and liver disease patients. In lung transplantation, long-term survival is limited due to Bronchiolitis Obliterans Syndrome (BOS) and in liver transplantation, Hepatitis C Virus (HCV) disease recurrence significantly impacts long-term survival. Treatment options are limited and often not successful. It is therefore important to conduct research on the factors contributing to the pathogenesis and disease severity of BOS and HCV to improve our understanding of the mechanisms and potentially reduce morbidity and mortality. Several factors may play a role. The focus of this thesis is to assess the role of Oxidative Stress (OxS) and nutrition on these patient populations.
BOS is a frequent complication of lung transplantation. OxS may contribute to its pathogenesis and induce further tissue injury and inflammation. OxS can be influenced by several factors including nutrition. The cross-sectional study showed that BOS lung recipients have elevated markers of OxS in their Bronchoalveolar Lavage Fluid (BALF) compared to those without BOS. However, there was no difference in nutritional factors potentially affecting OxS.
HCV reinfection post transplant is universal, significantly increasing morbidity and mortality. OxS is involved in the pathogenesis of chronic HCV but its role in HCV disease recurrence is unknown. A first study determined whether HCV liver recipients (HCV-LT) were more oxidatively stressed when compared to controls or HCV non-transplant patients. A second study assessed OxS at six-and 12 months post transplant and compared results between those with and without recurrence.
The results showed that HCV-LT were more oxidatively stressed, vitamin A intakes were significantly lower and plasma gamma- tocopherol was significantly higher in HCV-LT. Additionally, those with recurrence were more oxidatively stressed at six-months (before recurrence) and 12 months compared to those without recurrence. No differences were seen regarding nutrition parameters.
These results suggest that OxS is present in transplant recipients but that nutritional factors do not play a significant role. Other causes of OxS likely play a more significant role such as the presence of inflammation due to immunological reactions associated with BOS and the generation of reactive oxygen species (ROS/RNS) seen in patients with HCV disease.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/24364 |
| Date | 21 April 2010 |
| Creators | Madill, Janet |
| Contributors | Allard, Johane |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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