Successful Orthotopic Heart Transplantation With Positive Crossmatch in a Hyperimmunized Child on Mechanical Circulatory Support-Case Report.

In the pediatric population there is a shortage in the number of hearts available for transplantation. However, sometimes a heart transplant is urgently required to save lives. The problem arises when the patient is hyperimmunized and there is a positive crossmatch with the only available donor. We present such a case of a 9-year-old patient with dilated cardiomyopathy on ventricular assist device, in whom it was possible to perform a successful HT and also apply a successive prevention against graft rejection.

Heart Transplantation as a Result of Pediatric Inflammatory Multisystem Syndrome in an Adolescent.

Several reviews have shown that COVID-19 in children is a relatively mild disease. However, a rare complication affecting children and adolescents after COVID-19 has been identified. Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), which in some cases manifests itself as a hyperinflammatory syndrome with a multiorgan failure, may lead to death. We report a case of a 17-year-old patient who was admitted to the hospital with cardiogenic shock of unknown etiology. The disease was life-threatening, thus necessitating mechanical ventilation, circulatory support, and extracorporeal therapy due to renal and liver dysfunction. The patient tested negative for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction. Other infectious causes of illness were excluded. However, the patient had a positive IgG antibody test result and high levels of interleukin-6, which helped to diagnose PIMS-TS. Intravenous immunoglobulin and steroid therapies were initiated, unfortunately, with poor outcome. The patient's critical condition, particularly end-stage heart failure, led to mechanical circulatory support implantation and finally orthotopic heart transplantation. After the surgery, the patient's condition improved gradually. PIMS-TS manifests itself with different clinical images and as a state of varying severity, ultimately causing multiorgan dysfunction with shock resembling toxic shock syndrome. Ultimately, myocardial complications of PIMS-TS necessitated heart transplantation in the described patient.

Role of Empathy and Altruism in Organ Donation Decisionmaking Among Nursing and Paramedic Students.

BACKGROUND: Organ transplantation offers patients with organ failure an improved quality of life and a life-saving opportunity. Despite universal acceptance of posthumous organ donation, only a minority of candidates become actual donors. Empathy and altruism as a moral issues can influence organ donation decisionmaking The aim of this study was to assess the role of empathy and altruism in the organ donation decisionmaking process in a group of nursing and paramedic students. METHODS: Our study was conducted with 111 nursing and paramedic students (aged 19-59 years, 84 females and 27 males). Self-administered questionnaires were then used to collect data, including the Individual Questionnaire: Study of Attitudes Toward Transplantation; Davis's Interpersonal Reactivity Index (Empathy); and Questionnaire A-N by J. Sliwak (Altruism). RESULTS: Overall, 99% of respondents accepted the idea of organ donation during life and 98% posthumously. Eighty-one percent opted for donating their organ during life and 88% posthumously. The levels of empathy on the subscales Fantasy, Perspective Taking, Personal Distress, and Empathic Concern were significantly associated with agreement to be a donor, willingness to sign a donor card, and attitude toward organ donation. Altruism was associated with posthumous organ donation and the willingness to sign a donor card. Perspective Taking was a statistically significant predictor of attitude toward organ donation. CONCLUSION: Both empathy and altruism could influence decisionmaking about organ donation in a group of nursing and paramedic students.

Serum Adipokine Levels in Patients Considered for Lung Transplantation.

The aim of the study was to investigate serum concentration of visfatin, irisin, and omentin in patients diagnosed as having end-stage lung diseases who qualified for lung transplantation (LTx) and to find the relationship between adipokine levels and clinical status. MATERIAL AND METHODS: The study population consisted of 23 consecutive patients (10 patients diagnosed as having cystic fibrosis, 6 patients diagnosed as having chronic obstructive pulmonary disease, and 7 patients diagnosed as having idiopathic pulmonary fibrosis) who qualified for LTx. Patients performed pulmonary function tests; visfatin, irisin, and omentin serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits. RESULTS: Mean visfatin serum level was 4.99 ± 3.83 pg/mL; mean irisin serum level was 2.82 ± 0.24 ng/mL; mean omentin serum level was 389.99 ± 320.85 ng/mL. Mean distance in 6-minute walk test (6MWT) was 310.62 ± 147.09 m. Average partial pressure of oxygen (pO2) was 55.79 ± 10.33 mm Hg, forced expiratory volume (FEV1) was 26.25 ± 22.38%, and forced vital capacity (FVC) was 56.95 ± 21.91% of a due value. There was no statistically significant correlation between adipokine levels and 6MWT, pO2, FEV1, and FVC in patients waiting for LTx, regardless of underlying lung disease. Significant difference between patients was noted only in 6MWT, FEV1, and pO2 in connection to lung disease. CONCLUSION: Our findings indicate that adipokines may not have a statistically significant effect on parameters of pulmonary function. Results require further investigation on a larger study group, especially comparison of adipokine serum levels between groups of overweight patients, obese patients, and patients with normal weight who qualify for LTx.

Prognostic Value of Mean, Diastolic, and Systolic Pulmonary Artery Pressure in Patients With End-stage Lung Disease Referred for Lung Transplantation.

BACKGROUND: Pulmonary hypertension (PH) is a common complication in end-stage lung disease (esLD). The aim of this study was to establish the best threshold values for mean, systolic, and diastolic artery pressure (mPAP, dPAP, and sPAP, respectively) to identify patients with esLD referred for lung transplantation and to predict 1-year prognosis. METHODS: Sixty-five patients were enrolled in the study (75% men) with a mean age of 53.3 ± 9.5 years; 31% had chronic obstructive pulmonary disease (COPD), 57% had idiopathic pulmonary fibrosis (IPF), and 12% had interstitial lung diseases (ILDs). The mean period of observation was 14.4 ± 5 months. We assessed invasively mPAP, dPAP, and sPAP, as well as pulmonary capillary wedge pressure (PCWP), using a Swan-Ganz catheter. Receiver-operating characteristic (ROC) curves were constructed to identify the best cutoff points for mPAP, dPAP, and sPAP to predict survival. The study endpoint was defined as 1-year mortality before transplantation. Survival analysis was completed according to the Kaplan-Meier method. RESULTS: During follow-up, 30 (46.1%) patients died and 19 (29%) underwent lung transplantation. Based on ROC curve analysis, we estimated mPAP ≥30 mm Hg, dPAP ≥20 mm Hg, and sPAP ≥44 mm Hg as the best threshold values with the highest sensitivity (70%, 70%, and 73%, respectively) and specificity (76%, 69%, and 72%, respectively) and the acceptable area under curve (0.67, 0.68, and 0.72, respectively). The negative predictive values for mPAP, dPAP, and sPAP were higher than the positive predictive values (79%, 77%, and 81% vs 67%, 61%, and 64%, respectively). We also constructed Kaplan-Meier curves for mPAP, dPAP, and sPAP threshold values. There were significant differences in 1-year survival between patients with and without PH for mPAP, dPAP, and sPAP threshold values (P = .005, P = .035, and P < .001; respectively). CONCLUSION: Elevated mPAP, dPAP, and sPAP are related to worse prognosis in patients with esLD referred for lung transplantation.

Nordic Walking in Pulmonary Rehabilitation of Patients Referred for Lung Transplantation.

BACKGROUND: Although the effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung disease, cystic fibrosis, and interstitial lung disease is well documented, little is known about pulmonary rehabilitation in patients who are referred for lung transplantation. Nordic walking is a low-cost and accessible form of physical exercise with proven benefits. The purpose of this prospective study was to examine the effects of Nordic walking on lung function, perception of dyspnea, and health-related quality of life in patients referred for lung transplantation. METHODS: Twenty-two of 40 patients who was qualified for lung transplantation at the Department of Lung Diseases in Zabrze, Poland, completed a rehabilitation program consisting of 12 weeks of Nordic walking. Lung function tests, exercise tolerance, and perception of dyspnea and quality of life were assessed before and after completion of the program. RESULTS: No adverse events were observed during the rehabilitation program. After 12 weeks, there was a significant increase in mean 6-minute walk distance (374 meters vs 288 meters, P < .034) and a significant reduction in perception of dyspnea after completion of the rehabilitation program. Assessment of general health and quality of life showed significant improvement (P < .05). No significant changes in lung function tests were noted. CONCLUSION: Nordic walking is a safe and feasible physical activity for pulmonary rehabilitation in patients with end-stage lung disease who are referred for lung transplantation. This rehabilitation technique results in significant improvements in patient mobility and quality of life.

Usefulness of the Impulse Oscillometry System in Graft Function Monitoring in Lung Transplant Recipients.

BACKGROUND: After successful lung transplantation, patients are monitored for chronic lung allograft dysfunction. Pulmonary function tests and 6-minute-walk tests are commonly used for functional graft monitoring. As these methods require substantial effort, however, many patients are unable to complete testing fully. The impulse oscillometry system is a noninvasive method that requires minimal patient cooperation and is suitable for use for patients incapable of strenuous activity. We compared impulse oscillometry system with pulmonary function tests and 6-minute-walk tests to determine if impulse oscillometry system could serve as a substitute measure. METHODS: This prospective, observational study evaluated 25 consecutive patients (19 men, median age 54.5 years) admitted to a single institution from January to October 2016 (double-lung = 13, single-lung = 13). Patients were assessed using pulmonary function tests, impulse oscillometry system, and 6-minute-walk tests. RESULTS: Eighty-eight percent of patients reached high-resonance frequency (Fres) and, in 84% of patients, the value of Ax (area of reactance) increased above the norm (N < 0.33 kPa/L) indicating peripheral airways obstruction. High resistance of small airways, measured with an R5 - R20 difference, followed higher Ax values. The increase of resistance at 5 Hz in 31% of patients (R5 >150% predicted value) also indicated small airway obstruction. Airway obturation in patients with elevated Ax and R5 was confirmed by decreased FEV1 (<75% predictive value) and FEV1/FVC ratio in 38% of patients. CONCLUSIONS: Study results confirm the impulse oscillometry system method could be a substitute for pulmonary function tests in determining the occurrence of chronic lung allograft dysfunction. 6-minute-walk tests showed neither strong correlations regarding impulse oscillometry system and pulmonary function tests nor any base for differentiation of results regarding main factor codes.

Predictive Value of Models for End-Stage Liver Disease Score in Patients With Pulsatile Flow POLVAD MEV Left Ventricular Assist Device Support.

BACKGROUND: Model for End-Stage Liver Disease (MELD) score predicts multisystem dysfunction and death in patients with heart failure (HF). Left ventricular assist devices (LVADs) have been used for the treatment of end-stage HF. AIM OF THE STUDY: We evaluated the prognostic values of MELD, MELD-XI, and MELD-Na scores in patients with POLVAD MEV LVAD. MATERIALS AND METHODS: We retrospectively analyzed data of 25 consecutive pulsatile flow POLVAD MEV LVAD patients (22 men and 3 women) divided in 2 groups: Group S (survivors), 20 patients (18 men and 2 women), and Group NS (nonsurvivors), 5 patients (4 men and 1 woman). Patients were qualified in INTERMACS class 1 (7 patients) and class 2 (18 patients). Clinical data and laboratory parameters for MELD, MELD-XI, and MELD-Na score calculation were obtained on postoperative days 1, 2, and 3. Study endpoints were mortality or 30 days survival. MELD scores and complications were compared between Groups S and NS. RESULTS: 20 patients survived, and 5 (4 men and 1 woman) died during observation. Demographics did not differ. MELD scores were insignificantly higher in patients who died (Group 2). Values were as follows: 1. MELD preoperatively (21.71 vs 15.28, P = .225) in day 1 (22.03 vs 17.14, P = .126), day 2 (20.52 vs 17.03, P = .296); 2. MELD-XI preoperatively (19.28 vs 16.39, P = .48), day 1 (21.55 vs 18.14, P = .2662), day 2 (20.45 vs 17.2, P = .461); and 3. MELD-Na preoperatively (20.78 vs 18.7, P = .46), day 1 23.68 vs 18.12, P = .083), day 2 (22.00 vs 19.19, P = .295) consecutively. CONCLUSIONS: The MELD scores do not identify patients with pulsatile LVAD at high risk for mortality in our series. Further investigation is needed.

Left Ventricular Assist Device Implantation in Patients With Optimal and Borderline Echocardiographic Assessment of Right Ventricle Function.

BACKGROUND: Left ventricular assist devices (LVADs) are used for treatment of end-stage heart failure. Outcomes are dependent on right ventricle (RV) function. Prediction of RV function after LVAD implantation is crucial for device selection and patient outcome. The aim of our study was to compare early LVAD course in patients with optimal and borderline echocardiographic parameters of RV function. MATERIAL AND METHODS: We retrospectively reviewed 24 male patients with LVAD implantation. The following echocardiographic data of RV function were collected: FAC (fractional area change) with optimal value > 20%, tricuspid annulus plane systolic excursion >15 mm, RV diameter < 50mm, and right-to-left ventricle ratio < 0.57 (RV/LV). Patients were divided into group 1 (12 patients) with transthoracic echocardiography parameters in optimal ranges and group 2 (12 patients) with suboptimal transthoracic echocardiography findings. Study endpoints were mortality, discharge from the intensive care unit, and RV dysfunction. Demographics, postoperative clinical outcomes, comorbidities, complications, and results in a 30-day period were analyzed between groups. RESULTS: Echocardiography parameters differed significantly between groups 1 and 2 according to FAC (31.8% vs 24.08%; P = .005), RV4 (45.08 mm vs 51.69 mm; P = .02), and RV/LV ratio (0.6 vs 0.7; P = .009). Patients did not differ according to course of disease, comorbidities before implantation, or complications. One patient from each group died. Patients in group 2 experienced more pulmonary hypertension, required increased doses of catecholamines, and stayed in the intensive care unit longer. No RV dysfunction was noted. CONCLUSIONS: Borderline FAC, tricuspid annulus plane systolic excursion, and RV4 add RV/LV ratio prolonged recovery after LVAD implantation even with no RV failure. Parameters chosen for qualification are in safe ranges.

Vitamin D Concentration in Patients After Heart and Kidney Transplantation.

BACKGROUND: One of the main actions of vitamin D is bone mineralization regulation. Vitamin D is linked also to hypertension, diabetes, and cardiovascular disease. Vitamin D deficiency may result in osteomalacia, but its excess may result in bone calcium mobilization. Kidney transplant recipients are also at risk of hypovitaminosis D because of impaired graft function. The aim of the study was to assess vitamin D concentration in patients after heart and kidney transplantation. MATERIAL AND METHODS: Ninety-eight stable heart transplant recipients were enrolled in the study; 80 kidney transplant recipients and 22 healthy volunteers served as controls. The laboratory tests, including parameters of 25-hydroxyvitamin D (calcidiol), were assayed using commercially available kits. RESULTS: Calcidiol deficiency (level below 10 ng/mL) was observed in 10% of the transplant group and in 55 % of the orthotopic heart transplant recipients (OHT). There was positive correlation between calcidiol concentration, hemoglobin, kidney function, and serum glucose in kidney transplant recipients. In OHT, vitamin D correlated with age, kidney function, hemoglobin, cholesterol, low-density lipoprotein cholesterol, and glucose. Both groups had similar kidney function. In both groups of patients with estimated glomerular filtration rate above 60 mL/min/1.72 m2, vitamin D was significantly higher. In OHT, vitamin D was higher in nondiabetic patients. In OHT in multivariate analysis, vitamin D was predicted in 24% by kidney function (beta = -0.30; P = .02) and hemoglobin concentration (beta = 0.25; P = .03). CONCLUSIONS: Vitamin D deficiency is more common in patients after heart transplantation than in kidney allograft recipients despite similar kidney function. The possible associations between the cardiovascular system and vitamin D merit further studies.

Kallistatin Concentration and Hypertension in Heart Transplant Recipients.

Development of arterial hypertension is to some extent related to decreased activity of the kallikrein-kinin system. This poorly understood hormonal system consists of blood proteins playing a role in the process of inflammation, coagulation, blood pressure control, and pain conduction. The system consists of kallikreins (plasma and tissue), kallistatin, kininogens, kinins (bradykinin, kallidin-lizynobradykinin), kininases (I and II), and membrane receptors of bradykinin. The aim of the study was the assessment of kallistatin in correlation to blood pressure value in heart transplant recipients. PATIENTS AND METHODS: Kallistatin level was estimated in 131 heart transplant recipients on standard 3 drugs immunosuppressive regimens (calcineurin inhibitor, mycophenolate mofetil/mycophenolic acid, and steroids) in correlation to inflammation markers and blood pressure values. Additionally, 22 healthy volunteers served as controls. In cross-sectional study, kallistatin and catecholamine concentrations were assessed using commercially available assays. RESULTS: Kallistatin concentration did not differ significantly among heart transplant recipients in comparison with controls; serum noradrenaline concentration was lower in the study group. In the orthotopic heart transplant group, kallistatin correlated with renal function; estimated glomerular filtration rate was calculated by Modification of Diet in Renal Disease formula (r = -0.28, P < .01; hemoglobin r = -0.19, P < .05; cholesterol level r = -0.23, P < .01; low-density lipoprotein r = 0.25, P < .01; ferritin r = 0.21, P < .05; noradrenaline r = -0.28, P < .01). No correlation with blood pressure values were revealed. In multivariate analysis, cholesterol serum level and age predicted 32% of variability of kallistatin concentration. CONCLUSION: Kallistatin among heart transplant recipients does not seem to be the pathogenetic factor of arterial hypertension but may be involved in the development of hyperlipidemia often present in this group of patients.

Relationship Between Satisfaction With Social Support and Self-Efficacy and the Occurrence of Depressive Symptoms and Stress in Heart Transplant Recipients.

Heart transplantation is a recognized and effective therapeutic method for treating end-stage circulatory failure. Physical factors and psychosocial issues among heart transplant recipients have been addressed in an increasing number of studies. According to the transactional model of stress, social support is one of the resources that facilitate coping with stress. The use of social support is related to a lower severity of depression and stress. The research objective was to assess the relationship between satisfaction with social support and self-efficacy and the occurrence of depressive symptoms and stress in heart transplant recipients. MATERIAL AND METHODOLOGY: The study involved 123 participants, including 30 women and 93 men with mean age of 54.8 years (SD = 13.25). Berlin Social Support Scales, Beck Depression Inventory, and General Self-Efficacy Scale were used in the study. RESULTS: According to the analysis, the degree of depression decreased with increased emotional social support (r = -34; P < .001), instrumental social support (r = -378; P < .01), and perceived support (r=-387; P < .001); the degree of stress decreased with an increase in the application of instrumental support (r= 0.36; P<.001), emotional support (r=-0.31; P<.001), and perceived support (r=0,363; P<.001). The level of self-efficacy had a positive impact on emotional and instrumental support as well as on the perceived and actually received support. A regression analysis proved the level of (instrumental) social support and self-efficacy act as predictors of the incidence of depression (R2 = 0.43; P < .05) and stress (R2 = 0.36; P < .05) among heart transplant recipients. CONCLUSION: The obtained results support the positive impact of social support and self-efficacy on the occurrence of depressive symptoms and stress.

Evaluation of the Motivation to Consent to and to Refuse Organ Donation Among Participants of Educational Meetings Concerning Organ Transplantation.

BACKGROUND: Improvement of the consent rate for solid organ donation from deceased donors is a key component of strategies applied in many countries aiming to increase the availability of organs for transplantation. Attitudes toward living and posthumous donation are favorable. Research shows that the outlook on organ donation and the degree of the willingness to become an organ donor are associated with a wide range of variables. The main objective of this study was to identify factors that influence the willingness to donate organs and the reasons for refusing consent. MATERIALS AND METHODS: The study included 191 participants (135 female and 56 male) aged 16 to 61 years (mean age 26.86 ± 12.88). A cross-sectional study was conducted during educational meetings concerning organ donation that was addressed to students, teachers, and nurses. Survey tools included the Individual Questionnaire: Study of attitudes toward transplantation, consisting of 26 closed questions (with the consent of the Statistical Office in Krakow). RESULTS: In all, 97.4% of the respondents accepted transplantation from living donors, and 95.8% accepted deceased donations. Of the respondents, 78.5% agreed to posthumous life-saving organ donation. There was a significant difference between the respondents' sex, age, social group, place of living, and the reasons for their willingness to donate organs both posthumously and during their lifetime, as well as reasons for refusal. CONCLUSIONS: Our findings showed that the study group in general had favorable views on treatment involving transplantation and declared willingness to make a posthumous organ donation. These views vary depending on demographic variables. The education on the subject of organ and tissue donation has a positive impact on donation and transplantation rates.

Polish Guidelines on Diagnosing Brain Death in Adults vs the International Perspective: Are We in Need of an Update?

INTRODUCTION: The Polish definition of brain death originated from the original Harvard criteria and has been revised several times. Practitioners worldwide are required to regularly update their national guidelines on the definition of brain death to fit the latest international research concerning this topic. AIMS: (1) Compare current Polish guidelines on diagnosing brain death in adults with the American, British, Australian, and New Zealand recommendations; and (2) evaluate existing differences for the purposes of updating the Polish guidelines. MATERIALS: Current guidelines on diagnosing brain death published by The American Academy of Neurology (USA, 2010), the Academy of Medical Royal Colleges (United Kingdom, 2008), the Australian and New Zealand Intensive Care Society (AU/NZ, 2013), and the Polish Ministry of Health (Poland, 2007). RESULTS: All guidelines outline similar recommendations regarding the need for a suitable observation period before clinical examination and for basic medical conditions and exclusions to be evaluated before testing, the obligatory role of clinical examination including brain stem reflexes and apnea testing, and the nonobligatory role of ancillary tests. There is no consensus regarding: the recommended time period of pretesting observation, the number, seniority, and specialty of clinicians performing the testing, the role of additional exclusion criteria, the repeatability of clinical tests, the methodology of apnea testing, and recommended confirmatory tests. CONCLUSIONS: Current Polish guidelines on diagnosing brain death in adults remain up-to-date in comparison to the guidelines analyzed, though additional recommendations concerning apnea testing, drug and toxin clearance, and medical exclusion criteria for potential brain dead patients might be considered an important point of interest in the future.

High-performance Liquid Chromatography Measured Metabolites of Endogenous Catecholamines and Their Relations to Chronic Kidney Disease and High Blood Pressure in Heart Transplant Recipients.

BACKGROUND: Patients after solid organ transplantation, especially heart and kidneys, are prone to be hypertensive. Recently chronic kidney disease and renalase metabolism of endogenous catecholamines are thought to make major contribution to the pathogenesis of hypertension. MATERIALS AND METHODS: We analyzed 75 heart recipients (80% male, 20% female), medium age 54.9 years (range, 25-75) at 0.5 to 22 years after heart transplantation (median, 10.74). Diagnosis of hypertension was made on the basis of ambulatory blood pressure monitoring. Complete blood count, urea, creatinine, estimated glomerular filtration rate (eGFR), renalase in serum, and levels of metanefrine, normetanefrine, and 3-metoxytyramine in 24-hour urine collection calculated with a high-performance liquid chromatography were recorded. RESULTS: Urine endogenous catecholamine metabolites were estimated according to creatinine clearance. Normetanefrine was correlated with age (r = 0.27; P < .05), urea (r = 0.64; P < .01), creatinine (r = 0.6; P < .01), eGFR (r = -0.51; P < .01), renalase (r = 0.5; P < .01), and diastolic blood pressure (r = 0.26; P < .05). Metanefrine was correlated with urea (r = 0.43; P < .01), creatinine (0.32; P < .01), eGFR (r = -0.4; P < .01), renalase (r = 0.34; P < .05), height (r = -0.26; P < .05), weight (r = -0.23; P < .05), and time after heart transplantation (r = 0.27; P < .05). 3-Metoxytyramine was correlated with urea (r = 0.43; P < .01), creatinine (r = 0.32; P < .01), and the eGFR (r = -0.24; P < .05). Creatinine was correlated with age (r = 0.36; P < .01), diastolic blood pressure (r = 0.26; P < .05), time after heart transplantation (r = 0.24; P < .05), and renalase (r = 0.69; P < .01). Systolic blood pressure was correlated with proteinuria (r = 0.26; P < .05). CONCLUSIONS: Chronic kidney disease and concomitant hypertension are the most prevalent comorbidities in the population of heart transplant recipients. Urine catecholamine metabolites were related to kidney function but not to blood pressure level in the studied population.

Role of Personal Resources in Depression and Stress in Heart Transplant Recipients.

BACKGROUND: Heart transplantation is the primary option for heart failure treatment and increases the survival rate and the quality of life for recipients. However, this surgical intervention induces numerous psychological problems, such as depression and anxiety. Protective factors and personal recourses are a significant force behind healthy adjustment to life stresses. The aim of this study was to assess the role of personal recourses in terms of depression and stress in heart transplant recipients. METHODS: The study involved a sample of 131 post-heart transplant patients. Standardized instruments were used to measure the key constructs: Beck Depression Inventory Short Form for prevalence of depression, Perceived Stress Scale for prevalence distress, and Sense of Coherence (SOC-29), Life Orientation Test, and General Self-Efficacy Scale for measuring personal resources. RESULTS: We found that sense of coherence, optimism, and self-efficacy proved to be significant predictors for the prevalence of both depression and stress. CONCLUSIONS: These result suggest that the assessment of coping strategies and sense of coherence in heart transplant recipients requires exploration. Evaluating coping strategies and sense of coherence before surgery seems significant and begins with developing skills in this domain.

Endocan Concentration and Chronic Inflammatory Process Among Heart Transplant Recipients.

BACKGROUND: Endocan is a novel soluble dermatan sulfate proteoglycan derived from endothelium. It has the capacity of binding to different biologically active molecules associated with cellular signaling, adhesion, and regulating proliferation, differentiation, migration, and adhesion of different cell types in health and pathology. Its elevated level is connected with endothelial activation, neovascularization, and inflammation or carcinogenesis. METHODS: The level of serum endocan among 131 heart transplant recipients on 3-drug immunosuppression (calcineurin inhibitor, mycophenolate mofetil/mycophenolic acid, steroid) in correlation with other markers of endothelial damage was determined. In addition, 22 healthy volunteers were studied. In cross-sectional study, markers were measured with the use of commercially available assays of endothelial damage-endocan and von Willebrand factor (VWF)-inflammation-high-sensitivity C-reactive protein (hsCRP), interleukin (IL) 6-and kidney function-cystatin C. RESULTS: The endocan, VWF, IL-6, hsCRP, and cystatin C levels were significantly higher in heart transplant recipients compared with healthy volunteers. In our cohort, endocan level was correlated with renal function (estimated glomerular filtration rate: r = -0.21; P < .05), creatinine (r = 0.21; P < .05), erythrocyte count (r = -0.24; P < .01), hemoglobin (r = -0.33; P < .01), N-terminal pro-B-type natriuretic peptide (r = 0.25; P < .01), cholesterol (r = -0.22; P < .05), LDL (r = -0.21; P < .05), New York Heart Association functional class (r = 0.21; P < .05), hsCRP (r = 0.32; P < .01), IL-6 (r = 0.31; P < .01), and VWF (r = 0.27; P < .01). In multifactorial analysis, the predictors of endocan levels were cholesterol level, cystatin C, and IL-6, predicting 54% of variability. CONCLUSIONS: Endocan concentration among heart transplant recipients is potentially connected with endothelial damage caused by subclinical inflammation resulting from hyperlipidemia.

Absolute and Functional Iron Deficiency Is a Common Finding in Patients With Heart Failure and After Heart Transplantation.

BACKGROUND: Anemia is relatively common in patients with heart failure and heart transplant recipients. Both absolute and functional iron deficiency may contribute to the anemia in these populations. Functional iron deficiency (defined as ferritin greater than 200 ng/mL with TSAT (Transferrin saturation) less than 20%) is characterized by the presence of adequate iron stores as defined by conventional criteria, but with insufficient iron mobilization to adequately support. The aim of this study was to determine prevalence of absolute and functional iron deficiency in patients with heart failure (n = 269) and after heart transplantation (n = 130) and their relation to parameters of iron status and inflammation. METHODS: Iron status, complete blood count, and creatinine levels were assessed using standard laboratory methods. C-reactive protein, hepcidin and hemojuvelin were measured using commercially available kits. RESULTS: Absolute iron deficiency was present in 15% of patients with heart failure and 30% in heart transplant recipients, whereas functional iron deficiency was present in 18% of patients with heart failure and 17% in heart transplant recipients. Functional iron deficiency was associated with significantly higher C-reactive protein and hepcidin levels in heart failure patients, and higher hepcidin and lower estimate glomerular filtration rates in heart transplant recipients. Prevalence of anemia (according to the World Health Organization) was significantly higher in heart transplant recipients (40% vs 22%, P < .001), they were also younger, but with worse kidney function than patients with heart failure. CONCLUSIONS: Both absolute and functional iron deficiency were present in a considerable group of patients. This population should be carefully screened for possible reversible causes of inflammation.

Correlations between demographics, knowledge, beliefs, and attitudes regarding organ transplantation among academic students in Poland and their potential use in designing society-wide educational campaigns.

BACKGROUND: Family objection precludes 10% of cadaveric donations in Poland. Academic students represent a socially influential demographic group. Educational campaigns improving their attitudes may increase overall donation rates. The aim of this study was to assess correlations between knowledge, beliefs, and attitudes regarding organ transplantation and the identification of the most critical factors affecting one's donation preferences. METHODS: Eight hundred students from 4 public universities in Krakow, Poland, participated in the study; participants were diverse in age, sex, hometown population, and academic discipline (400 medical, 400 non-medical). This cross-sectional study was conducted with the use of a group-administered questionnaire inquiring into demographics, general and professional knowledge, beliefs, and attitudes toward organ transplantation. RESULTS: Attitudes toward organ donation correlate positively with beliefs (ρ = 0.36), general knowledge (ρ = 0.48), and professional knowledge (ρ = 0.23) scores. Beliefs were proven to correlate with general (ρ = 0.21) and professional (ρ = 0.26) knowledge as well. Misconceptions about the medical criteria allowing cadaveric organ recovery, distrust for brain death reliability, fear of "do not resuscitate" approach toward Organ Donor Card holders, a strong belief in organ trafficking, and unawareness of family members' attitudes are the most important factors influencing one's refusal/uncertainty to donate. CONCLUSIONS: Knowledge, attitudes, and refusal rates differ, depending on the academic discipline as well as other demographics, indicating a need for a specifically targeted approach in designing educational campaigns. Sources of knowledge are related to donation rates, with pre-academic education evaluated as unfavorable, as opposed to healthcare providers and the media.

Influence of empathy, beliefs, attitudes, and demographic variables on willingness to donate organs.

BACKGROUND: As organ transplantation has become a more routine medical procedure, there has been a growing interest in studying people's attitudes and knowledge concerning organ donation. Trait empathy and self-interest influence different pro-social behaviors to a great extent; still, their role in the promotion of organ donation registration and willingness to donate organs remains unclear. However, people with higher levels of empathy report more altruistic beliefs. We assessed the influence of empathy, beliefs, and demographic variables on willingness to donate organs. METHODS: We included 191 subjects (135 female, 56 male) aged 16-61 years (mean, 26.86 ± 12.88), who participated in educational meetings concerning organ donation. The group was composed of students, teachers, and nurses. Survey tools included the Individual Questionnaire: Study of Attitudes Towards Transplantation, consisting of 26 closed-ended questions (with the consent of the Krakow Statistical Office) and the Empathy Scale by Mehrabian and Epstein. RESULTS: Of the respondents, 97.4% accept transplantation from living donors, 95.8% accept deceased donations, and 78.5% agree with posthumous life-saving organ donation. The majority of respondents (73%) achieved an average level of empathy, and 20.4% of respondents exhibited considerably higher empathy levels. There was a significant difference between the respondents' sex and their agreement to make a life-saving organ donation. Differences were found among the groups, the attitudes and willingness to donate organs, and between the level of empathy and agreement/consent for organ donation. CONCLUSIONS: Our findings show that the group in general has favorable beliefs about transplantation and declares a willingness to make a posthumous organ donation. These beliefs vary based on demographic variables. Education about organ and tissue donation a has a positive impact on donation and transplantation rates.