Standards of Psychological Care for Pediatric Patients Awaiting Heart Transplantation and Those Requiring Mechanical Circulatory Support.

Children waiting for a heart transplant who require mechanical circulatory support often experience many months of hospitalization. This has a significant impact on their mental health and their development. Additional risk factors for these disorders are neurologic complications associated with the used treatment. To counteract developmental dysfunctions (despite successful heart transplantation) and possible disability in the sphere of mental health as well as to improve executive functions of children after a neurologic incident, there is a need for comprehensive care provided by a clinical psychologist who is a member of a multidisciplinary medical team taking care of the patient. Based on our own experience, standards of psychological care were developed for pediatric patients awaiting heart transplantation and those requiring mechanical circulatory support.

Patient-Related Preoperative Clinical Factors Influencing 1-Year Survival After Orthotopic Heart Transplantation - A Single Center Polish Experience.

BACKGROUND End-stage heart failure is a growing problem in Poland. Orthotopic heart transplantation remains the best treatment option. Although increasing, the number of heart transplants is disproportionately low compared with patient need. Therefore, it is crucial to identify factors contributing to improvement of heart transplantation outcomes. To find factors providing best survival and optimal recipient selection, we analyzed pretransplant patient-related clinical factors. MATERIAL AND METHODS Between May 2015 and May 2020, we performed 258 cardiac transplants at our institution. We reviewed possible patient-related clinical factors affecting the 1-year survival of our patients and analyzed factors related to survival. Mean age at transplant was 53.5 (±11.8) years; 22.9% of patients were women. Preoperative factors were analyzed using univariable and multivariable analyses. RESULTS In this cohort, 31.8% were diabetic, 43% had ischemic etiology of heart failure, and 15.3% had reversible pulmonary hypertension. Mechanical circulatory support was used in 22%. During 1-year observation, 64 (24.8%) patients died. Univariable analysis showed ischemic etiology (hazard ratio [HR]=2.05, CI=1.227-3.429; P=0.01) and left ventricular assist device were associated with 1-year risk of death (HR=1.953, CI=1.090-3.499; P=0.02). Urgent listing trended toward worsened prognosis (HR=1.509, CI=0.95-2.397; P=0.08). Multivariable analysis showed ischemic etiology (HR=1.81, CI=1.075-3.059; P=0.03), total mechanical circulatory support (HR=1.93, CI=1.080-3.437; P=0.03), decreased eGFR (HR=0.987, CI=0.975-0.998; P=0.03), and protein level (HR=0.97, CI=0.951-0.998; P=0.04) were independently associated with worse 1-year survival after transplantation. CONCLUSIONS Ischemic etiology and mechanical circulatory support were the most important preoperative factors. Malnutrition and renal failure were additional risk factors. Age alone did not influence 1-year survival.

A modified heterotopic heart transplantation in the rat - as an important model in experimental regeneration and replacement of the failing organ.

The qualification of new knowledge is one of the oldest problems in experimental medicine that provides a link between fundamental discovery, hypothesis, 'proof of concept' preclinical studies and development of clinical trials. The biggest challenge in animal models is the proper evaluation of all the aspects that are crucial in specific studied pathologies as well as the prediction of their progression. The aim of this review was to describe and discuss the rat animal model of heart transplant. The rat model of heart transplantation is an excellent yet underestimated method of research of prevention, monitoring and treatment of acute and chronic, immune and nonimmune response to organ transplantation. Despite being a technically and logistically demanding model, it provides a tool for reproducible experiments with longterm animal survival and excellent graft survival.

Graft vasculopathy in a Wistar rat model of heterotopic heart transplantation depending on gender matching between donors and recipients.

INTRODUCTION: Heart transplant is an accepted treatment modality in end-stage heart failure. The graft coronary artery vasculopathy is a main concern to explain the heterogeneity of the rejection process according to the gender of the donor and recipient. AIM: To assess the severity and type of mechanisms leading to failure of the graft. MATERIAL AND METHODS: Experimental allogenic heart transplantation in the abdomen was performed on Wistar rats depending on the gender of the donor and recipient (F - female; M - male) in four groups (FF, FM, MM MF). The donor heart was implanted in the abdominal cavity of the recipient. Complete time of observation was 10 weeks. Bromodeoxyuridine was administered intraperitoneally to detect proliferating cells. RESULTS: There was 42.5% graft survival in all experiments. The mean time of graft survival was 60 ±18, 54 ±29, 58 ±23 and 64 ±18 days (FF, FM, MM and MF) and no significant difference was found in graft survival time among the four experimental groups (p = 0.73). None of the heart weight changes reached statistical significance. CONCLUSIONS: The use of an animal experimental model helps to understand the mechanisms leading to graft failure and to compare the changes that occur in rats to human hearts. The gender matching affects the survival of the transplanted heart and severity of the graft vasculopathy.