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Background, objectives: Histological diagnosis of control biopsies in patients with heart transplant represents a significant step of monitoring, with a great influence on adjusting immunosuppressive treatment. Histological lesions are usually related to ischemia and reperfusion, with varying degrees of intensity. This study aimed to highlight the most important aspects of the histological diagnosis and differential diagnosis of postoperative myocardial lesions associated or unrelated to rejection in heart transplant. Materials and Methods: This retrospective study involved 53 patients who received cardiac transplant between 2000 and 2017. Patients were monitored by lesion quantification of endomyocardial biopsies, with diagnoses established based on biopsy material in the early, medium and late post-transplant periods. Hematoxylin eosin, Masson’s trichrome, and Van Gieson stains were used; immunohistochemical determinations used CD4, CD20, CD45, CD68, HLA-DR, VEGF and CD31. Results: Ischemia and reperfusion lesions were diagnosed on all biopsies in the first 6 weeks post-transplant. Nine cases of the Quilty effect were identified, and in 12 cases, the biopsies were performed on the same spot as previous biopsies. A significant number of transplanted patients presented cytomegalovirus that was difficult to diagnose on endomyocardial biopsies. Conclusions: The detailed study of ischemia and reperfusion lesions, as well as of changes un-related to rejection becomes a major objective in the short, medium and late post-transplant period. Overdiagnosis of rejection induces changes of the immunosuppressive therapeutic protocol, with alarming repercussions on cytomegalovirus reactivation, and risks of potentiating inflammation, myocyte destruction and the recurrence of disorders related to both inducing and aggravating heart failure.

Background: Heart transplantation is still the treatment of choice in patients with end-stage heart failure, refractory to medical treatment, in NYHA class III and IV, with dilated cardiomyopathy of various etiologies, including post-myocardial infarction. Objective: The aim of the study was to provide a descriptive analysis of the clinical, laboratory, and imaging parameters of patients undergoing heart transplantation during the pre- and postoperative period, as well as postoperative complications (including infections) and death rates. Material and methods: The variables collected from 53 patients who underwent a heart transplant were: age at heart transplant, gender, diagnosis at hospitalization, comorbidities, pre- and postoperative virology, pre- and postoperative laboratory analyses, pre- and postoperative echocardiography, post-transplant infections, complications, and treatment before and after the surgery. Results: Mean age at the time of transplant was 40.72 ± 14.07 years, and the majority (84.91%) of patients were males. The mean age of the donors was 31.92 ± 10.59 years. A proportion of 60.40% of patients were included in functional class NYHA IV, and 98.1% presented dilative cardiomyopathy of which 49.06% was due to previous myocardial infarction. No significant differences were observed between preand postoperative viral and bacterial serology. Left ventricular ejection fraction was significantly higher in the transplanted heart, and cardiac chamber diameters were significantly smaller after the transplant. Postoperative complications included 7 confirmed infections and 16 deaths, of which 5 had occurred during the surgical procedure. Conclusions: The present study brings important information in regard to the pre- and postoperative evaluation of patients with end-stage heart failure undergoing cardiac transplantation, from a clinical, laboratory, and imaging point of view, as well as in regard to postoperative complications and death.

Introduction: The widespread use of sevoflurane as an induction and maintenance volatile agent of general anesthesia demostrates an increased safety profile. Sevoflurane contact with CO2 absorbents lead to the occurrence of toxic compounds such as Compund A and Compound B. Among the side efffects of Sevoflurane remember the renal toxic effect much discussed in the literature but still unresolved. In previous research we have demonstrated the glomerular protein changes as a result of exposure to Sevoflurane. In the current study we intend to monitor the changes in blood urea nitrogen and serum creatinine after exposure to Sevoflurane. Material and method: We included in our study 90 patients who were anesthetized in the Department of Anesthesiology of the County Mure Hospital during 01.10.2009-01.10.2014. They had normal values for blood urea nitrogen and serum creatinine and had no preoperative proteinuria. Serum and urine samples were taken preoperatively and at 24 and 72 hours postanesthetic and were analyzed in the laboratory. Proteinuria was determined by spectrophotometry. Results: After protein quantitative determination by spectrophotometry and statistical anaysis we obtained significant differences by comparing the average preoperative/24 hours total protein (p Conclusions: Changes in glomerular filtered proteins following exposure to Sevoflurane demonstrate its toxic effect on glomerular tubules. Lack of perioperative significant wich is why we recommend determining perioperative urinary protein as a marker of glomerular damage.