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1.
M. Puślecki M. Ligowski S. Stefaniak M. Dąbrowski M. Zieliński A. Pawlak T. Kłosiewicz M. Sip M. Karczewski T. Małkiewicz Ł. Gąsiorowski W. Telec M. Ładzińska K. Baumgart P. Ładziński B. Perek M. Misterski W. Mrówczyński M. Jemielity 《Transplantation proceedings》2018,50(7):1957-1961
The “ECMO for Greater Poland” program takes full advantage of the extracorporeal membrane oxygenation (ECMO) perfusion therapy opportunities to promote the health of the 3.5 million inhabitants in the region. The main implementation areas are treatment of patients with hypothermia; severe reversible respiratory failure (RRF); critical states resulting in heart failure, that is, cardiac arrest, cardiogenic shock, or acute intoxication; and promotion of the donor after circulatory death (DCD) strategy in selected organ donor cases, after unsuccessful life-saving treatment, to achieve organ recovery.This organizational model is complex and expensive, so we used advanced high-fidelity medical simulation tests to prepare for real-life experience. Over the course of 4 months we performed scenarios including “ECMO for DCD,” “ECMO for extended cardiopulmonary resuscitation,” “ECMO for RRF,” and “ECMO in hypothermia.”Soon after these simulations, Maastricht category II DCD procedures were performed involving real patients and resulting in 2 successful double kidney transplantations for the first time in Poland. One month later we treated 2 hypothermia patients (7 adult patients with heart failure and 5 patients with reversible respiratory failure) with ECMO for the first time in the region.Fortunately, we have discovered an important new role of medical simulation. It can be used not only for skills testing but also as a tool to create non-existing procedures and unavailable algorithms. The result of these program activities will promote the care and treatment of patients in critical condition with ECMO therapy as well as increase the potential organ pool from DCDs in the Greater Poland region of Poland. 相似文献
2.
J. Czerwiński J. Haberko A. Dębska-Ślizień J. Bicki R. Bohatyrewicz W. Czapiewski A. Milecka I. Uhrynowska-Tyszkiewicz M. Kramska D. Kawecki A. Woderska 《Transplantation proceedings》2018,50(7):1971-1974
Due to increasing global mobility, the number of non-residents who are potential deceased organ donors is likely to increase as well. Since 2014, 14 deceased foreigners have been referred as potential organ donors in Poland. There are, however, no precise international agreements between Poland and other countries regulating this issue. The aim of this paper is to provide guidelines on this subject for transplant coordinators. While there are no differences in the algorithms of potential donor identification, death diagnosis, donor management, organ procurement and preservation, allocation, transportation and transplantation, and the medical evaluation of a foreigner as a potential organ donor may differ. In certain cases, the risk of tropical or endemic infections should be evaluated. The authorization of the procurement may differ as well—foreigners who are not listed in the Polish Electronic System for Registration of Population cannot be registered in Polish Central Registry of Objection. They may have also not expressed refusal or consent for donation due to different legal solutions in their home countries. The donor's family and the proper diplomatic representative must be involved in donation process in order to obtain authorization for organ donation, to acquire essential medical information about the donor, and to ensure the transparency of the process. The procurement of organs, tissues and cells from foreigners deceased in Poland may be performed provided that a proper donor qualification process is conducted, the deceased had not objected to donation, there is no objection on the part of the donor's family or the prosecutor (if required), and the donation and procurement are properly described in medical documentation. 相似文献
3.
P. Przybyłowski G. Wasilewski E. Koc-Żórawska J. Małyszko 《Transplantation proceedings》2018,50(7):2105-2109
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. 相似文献4.
M. Wójciak J. Gozdowska D. Dęborska-Materkowska A. Perkowska-Ptasińska M. Kosieradzki S. Nazarewski M. Durlik 《Transplantation proceedings》2018,50(7):2154-2158
Introduction
Posttransplant lymphoproliferative disorder (PTLD) is a heterogeneous group of lymphoid malignant neoplasms arising after solid organ transplantation or hematopoietic stem cell transplantation. The current World Health Organization classification identified 4 basic histologic types of PTLD: early, polymorphic variant, monomorphic variant, and classical Hodgkin lymphoma-type lesions.Methods
Data of 12 PTLD cases of was retrospectively analyzed in terms of the transplanted organs, time to diagnosis of PTLD, type of immunosuppressive treatment in regard to the induction treatment and acute transplant rejection, and long-term survival.Results
Most of the analyzed cases of PTLD occurred in men (n?=?8, 67%); 83% of patients were renal transplant recipients and 17% were liver transplant recipients. Of the kidney recipients, 8% received induction of antithymocyte globulin and 17% received daclizumab. An episode of acute rejection occurred in 6 (50%) patients. All patients were treated with pulses of methylprednisolone and received triple immunosuppressive regimen. Histopathologic examination revealed polymorphic form of PTLD in 5 (42%) patients and classical Hodgkin lymphoma in 3 (25%) cases. Diffuse large B-cell lymphoma was diagnosed in 3 (25%) patients, and diffuse large B-cell lymphoma rich in T lymphocytes and histiocytes was diagnosed in 1 (8%) patient. ALK4? anaplastic lymphoma was diagnosed in 1 (8%) recipient. Four (25%) patients died as a result of PTLD progression (including all 3 patients with central nervous system involvement), and 8 survived with stable graft function.Conclusions
PTLD is a heterogeneous group of lymphoproliferative disorders occurring in organ recipients. The unusual location changes (especially central nervous system or intestine) can impede the proper diagnosis. 相似文献5.
G. Moszkowska M. Zieliński H. Zielińska A. Dukat-Mazurek J. Dębska-Zielkowska A. Dębska-Ślizień B. Rutkowski P. Trzonkowski 《Transplantation proceedings》2018,50(6):1625-1630
Donor-recipient crossmatching for kidney transplantation is an obligatory step for the transplant work-up process. Attention is currently put on single bead assay (SBA) that enables virtual crossmatching. In contrast, methods developed for complement binding capacity are still not routinely established. We compared modified, cytolytic flow cytometry crossmatch (cFC-XM) with complement-dependent serological crossmatch (CDC-XM), SBA, and flow cytometry crossmatch (FC-XM) to verify whether newly developed techniques may be beneficial for transplant immunological matching. Also, the cutoff value for donor-specific alloantibodies levels currently used for virtual crossmatch was verified. Serum from 22 sensitized patients was crossmatched with surrogate donors by CDC-XM, FC-XM, and cFC-XM, while anti-HLA antibodies were measured by SBA. In all cases, virtual crossmatch was positive at 5000 mean fluorescence intensity cutoff. Among 22 tested sera with donor-specific alloantibodies above 5000 mean fluorescence intensity, the positive CDC-XM result was noted only in 41% of patients (n = 9), but positive FC-XM was noted in 86% (n = 19), and further lytic antibodies (cFC-XM) were confirmed in 27% of cases (n = 6). Our results suggest that donor-recipient immunological matching for kidney transplantation requires different methods to verify the importance of alloantibodies, and improvement in laboratory investigation is needed. This is especially important for immunized patients that have many types of alloantibodies and virtual crossmatching used as a tool for deceased donor allocation should balance between the likelihood of transplantation and risk of positive crossmatch result. 相似文献
6.
M. Jankowska I. Kuźmiuk-Glembin P. Skonieczny A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1863-1867
Introduction
Patients with autosomal dominant polycystic kidney disease (ADPKD) represent about 10% of kidney transplant recipients (KTR) and have unique needs regarding acceptance for this procedure. Whether native kidney nephrectomy (NKN) affects kidney transplantation (KT) outcomes remains a matter of debate, and more data is needed to establish a standard approach to KTR with ADPKD.Aim
To analyze the prevalence, timing, and short- and long-term outcomes of NKN in a cohort of ADPKD recipients in a single institution.Method
Retrospective, observational study.Results
In the years 1993 to 2016 we identified 162 KTR with ADPKD; of those, 149 had known NKN status. A high proportion of ADPKD KTR (n = 72) underwent NKN, the majority of which (69.4%) were performed before KT. There was no difference in short-term and long-term transplantation outcomes (including death, graft loss, delayed graft function, acute rejection, bacterial and cytomegalovirus [CMV] infection, and post-transplant diabetes mellitus) between NKN and non-NKN groups in a median of 98 months of follow-up. However, we found a significant difference in time on a waiting list, which was longer in the NKN group vs non-NKN.Conclusions
There is a need for a consensus regarding indications and timing for NKN in recipients with ADPKD. The systematic acquisition, sharing, and analysis of accessible data on NKN between institutions is an important step toward meeting this need. In our cohort, we found no impact of the NKN procedure on KT impact. However, undergoing NKN significantly prolonged the time on the waiting list. 相似文献7.
P. Przybyłowski G. Wasilewski E. Koc-Żórawska J. Małyszko 《Transplantation proceedings》2018,50(7):2100-2104
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. 相似文献8.
S. Lizakowski A. Kolonko B. Imko-Walczuk K. Komorowska-Jagielska B. Rutkowski A. Więcek A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1881-1888
Background
Incidence of malignancy in transplant recipients is higher than in the general population. Malignancy is a major cause of mortality following solid organ transplantation and a major barrier to long-term survival for the kidney. The aim of this study was to estimate the incidence of solid organ malignancy (SOM) and melanoma in renal transplant recipients (RTR) transplanted at 2 representative transplant centers in Poland based on data from the Polish Tumor Registry.Material and Methods
We analyzed the medical data of 3069 patients who underwent kidney transplantation (KTx) between 1995 and 2015.Results
In our study 112 SOM (3.6%) were diagnosed. The majority of patients were male (n = 71; 63.4%; P < .01). The mean age at KTx was 48.0 ± 13.1 years and the mean age at the time of cancer diagnosis was 55.9 ± 12.7 years. The average time of malignancy occurrence was 5.9 ± 5.0 years after KTx. SOM was the cause of death in 60 patients (53%). The most common were malignancies of gastrointestinal tract (25%), urinary tract tumors (23.2%), lung cancer (n = 18; 16%), and lymphoma (13.4%). We found an increase in the percentage of chronic glomerular nephropathy in the group of SOM (n = 56; 50%) compared with renal insufficiency of other etiologies.Conclusions
RTR in Poland are at a significant risk of malignancy development in a variety of organs, primarily urinary tract tumors and lymphoma. Cancers most frequently occurring in the general population such as lung and colorectal cancer are common in our RTR. On this basis an appropriate tumor screening schedule can be developed in individual countries. 相似文献9.
Z. Heleniak K. Komorowska-Jagielska A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1813-1817
Background
Cardiovascular (CV) diseases are the most common cause of death in patients with chronic kidney disease, including patients after kidney transplantation. The aim of the study was to do a retrospective analysis of CV risk in renal transplant recipients (RTRs).Methods
The analysis of CV risk was based on the following scales: QRISK2, Framingham (assessment of development of CV disease), PROCAM (assessment of any CV incident), and Pol-SCORE (assessment of CV death) within a 10-year period. Out of 150 RTRs transplanted in 2007–2009, 100 RTRs (65 male/35 female) with an average age of 48.4 years were enrolled in the study. Coronary heart disease and diabetes mellitus were diagnosed in 7% and 15% of participants, respectively. Coronarography was performed in 38% of patients. Hypertension was diagnosed in 98% of participants, myocardial infarction was diagnosed in 6% of participants, and stroke was diagnosed in 2% of participants.Results
High and very high risk of CV endpoint according to QRISK2, PROCAM, Framingham, and Pol-SCORE scales was found in 41%, 8%, 10%, and 41% of patients, respectively. After 5 years of follow-up, a total of 13 CV events (myocardial infarction and stroke) were observed in 11 patients. Among these patients, the highest risk of endpoint according to QRISK2, PROCAM, Framingham, and Pol-SCORE scales was found in 36%, 9%, 18%, and 45% of patients, respectively.Conclusions
The QRISK2 and Pol-SCORE scales seem to be the most predictive in assessing CV risk in RTRs. 相似文献10.
D. Kamińska M. Łukaszewski N. Kozera K. Kościelska-Kasprzak D. Bartoszek O. Mazanowska W. Goździk P. Chudoba P. Zaleska A. Lepiesza M. Klinger 《Transplantation proceedings》2018,50(6):1919-1921
Previously transplanted highly sensitized patients experience problems with subsequent transplantation. It is also difficult to provide optimal hemodynamic conditions during successive kidney transplantation in heart transplant recipients.
Patient and methods
We present a case of a 56-year old patient with end-stage renal failure after heart transplantation performed 21 years ago and hemodialyzed using arteriovenous fistula. The patient had 69% panel-reactive antibodies, had been on the active waiting list since 2013, and presented 335 positive crossmatches with deceased donors. He also positively crossmatched with a potential living donor. Detailed examination of anti-HLA antibodies revealed the absence of IgG donor-specific antibodies and negative crossmatch with dithiothreitol-treated serum. The transplantation from his wife was performed with positive crossmatch after 4 plasma exchanges and thymoglobulin induction. Because sympathetic and parasympathetic denervation of the transplanted heart and the presence of arteriovenous fistula induced volume overload of the right heart, we used central venous pressure (CVP) and the PiCCO2 for postsurgical assessment of cardiac output.Results
Monitoring, like CVP and other static exponents of preload obtained by PICCO (extravascular lung water, global end-diastolic volume index) as well as the dynamic parameters obtained by PiCCO2 (pulse pressure variation, stroke volume variation), was not sensitive enough to describe recipient volume status. The immediate graft function was observed, and after 11 months satisfactory estimated glomerular filtration rate is noted with the absence of donor-specific antibodies.Conclusion
The history of heart transplantation with existing arteriovenous fistula makes clinical tools such as continuous cardiac output monitoring and CVP parameter inadequate for describing the hemodynamic situation. The high level of panel-reactive antibodies and positive crossmatch possibly caused by IgM antibodies do not have to withdraw the recipient from kidney transplantation. 相似文献11.
A. Pacek Ł. Czyżewski M. Saran J. Wyzgał Ł. Szarpak 《Transplantation proceedings》2018,50(6):1824-1828
Introduction
Laboratory tests and anthropometric assessments are essential in determining the risk for cardiovascular disease in patients after kidney transplantation (KTx). Patients with hypertension and elevated pulse wave velocity (PWV) are at a higher risk of cardiovascular mortality. The purpose of this study was to determine the role of blood pressure, arterial stiffness, and selected laboratory and anthropometric parameters in estimating the risk of cardiovascular disease in KTx patients.Methods
A total of 17 KTx patients of the Clinical Department of Gastroenterological Surgery and Transplantation at Central Clinical Hospital of Ministry of the Interior and Administration (MSWiA Hospital) in Warsaw, Poland, were enrolled in this study between 3 to 7 days after undergoing kidney transplantation. Medical records of these patients were reviewed for the selected laboratory parameters. The patients' blood pressure and PWV values were monitored for 24 hours and their body mass index (BMI) values were calculated (BMI ≥ 25.0 is considered overweight).Results
Hemoglobin concentration showed a negative correlation with PWV (r = –0.6), whereas red blood cell distribution width (RDW) showed a positive correlation with the PWV value (r = 0.29). There was a significant correlation (r = 0.21) between overweight measured via BMI and the PWV values. For results of kidney function blood tests, the estimated glomerular filtration rate (GFR) and creatinine levels showed no significant correlation with 24-hour PWV values (GFR r = ?0.03; creatinine r = 0.03).Conclusions
The following were shown to be important indices of cardiovascular risk in the evaluated population of KTx patients: age, BMI, blood pressure, PWV, hemoglobin levels, red blood cells, and RDW%. 相似文献12.
K. Antończyk T. Niklewski R. Antończyk M. Zakliczyński M. Zembala T. Kukulski 《Transplantation proceedings》2018,50(7):2090-2094
Background
The diagnosis of acute cellular rejection (ACR) is a major objective in the management of heart transplant recipients. The aim of this study was to assess the utility of speckle-tracking derived parameters in identifying patients at risk of graft rejection.Methods
A prospective, single-center study was carried out involving 45 consecutive heart transplant patients who underwent a total of 220 routine endomyocardial biopsies (EMBs) with correlative echocardiographic examination.Results
No significant ACR (grade 0-1R) was seen in 190 biopsies (81.2% of the ACR-free group), and moderate ACR requiring specific treatment (grade 2R) was detected in 30 biopsies (13.6% of the ACR group). Grade 3R was not observed. All longitudinal left ventricular (LV) and right ventricular (RV) strain parameters were greater in the ACR-free group than in patients with ACR, while no differences were observed between radial and circumferential strain parameters. In our analysis, we selected RV free wall longitudinal strain (RV FW) ≤ 16.8% and 4-chamber longitudinal strain (4CH LS) ≤ 13.8%, which related to the presence of ACR requiring treatment. We assigned 1 point for each parameter (minimum 0, maximum 2 points) and derived a new echocardiographic index, the Strain Rejection Score (SRS). Our proposed approach—a combination of the 2 abovementioned indices—for screening patients at risk of ACR ≥ 2R, when expressed by a score 2 points, showed good specificity, strong negative predictive value, and the highest area under the curve.Conclusions
Our study demonstrated that combination of 4CH LS and RV FW as a new echocardiographic index, the Strain Rejection Score, can be useful as a noninvasive assessment of ACR during the first year of follow-up after heart transplant. 相似文献13.
T. Tefik H.Ş. Ciftci M.S. Karadeniz H. Yazici T. Oktar T. Kocak O. Ziylan A. Turkmen F.S. Oğuz I. Nane 《Transplantation proceedings》2019,51(4):1078-1081
IntroductionEarly diagnosis of rejection in kidney transplant (KTx) recipients is of paramount importance for long-term graft survival. Cytokines play an important role in rejection via activating T cells. Neutrophil accumulation in the graft indicates cell-mediated rejection. Cellular infiltration is mediated through chemoattractant factors. The aim of this study was to investigate the relationship between graft function and serum levels of interleukin 2 (IL-2) and interleukin 8 (IL-8) in KTx.MethodSixty-five patients undergoing KTx were enrolled in the study. Serum samples of IL-2 and IL-8 were collected the day before the operation, on postoperative days 1 and 7 day, and during the first and third month after the onset of rejection. The enzyme-linked immunosorbent assay method was used to determine the IL-2 and IL-8 values.ResultsA total of 9 (13.8%) patients had rejection documented on biopsy samples. Fifty-six patients had stable graft function (SGF). IL-2 and IL-8 values before KTx of both the rejected and SGF patients were not statistically different. Univariate analysis revealed that IL-2 and IL-8 were correlated with rejection (P = .046, P = .015). IL-8 levels were higher in the rejection group compared to the SGF group on the seventh day and first month postoperatively (P = .023, P = .038). The rejection group maintained higher levels of IL-8 for 11 days (range: 7–30) compared to the SGF group (P = .002) and the IL-8 levels correlated with serum creatinine levels (r = 0.621, P = .001). IL-2 levels were higher in the rejection group on days 1 and 7 compared to the SGF group (P = .042, P = .031). IL-2 and IL-8 levels were correlated with low eGFR in the third month in the rejection group (r = 0.421, P = .037; r = 0.518, P = .008).ConclusionDetermining the cytokine levels in the early post-KTx period may be helpful in tailoring immunosuppressive regimens in patients with a risk of rejection. 相似文献
14.
Z. Heleniak I. Kuźmiuk-Glembin D. Adrych H. Garnier J. Wiśniewski P. Rutkowski B. Rutkowski L. Tylicki A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1842-1846
Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are the cornerstone treatment in chronic kidney disease patients. Despite facilitating a reduction in blood pressure and albuminuria, there are insufficient data in kidney transplant recipients (KTRs). They are often administered for hypertension and polycythemia treatment. The aim of this study was to investigate the frequency and route of administration of ACEIs and ARBs and their early clinical effects in the KTR population. In a cross-sectional, retrospective study we analyzed 874 medical records of all KTRs treated in our unit in 2014. A total of 391 KTRs (44.7%) using ARBs or ACEIs were qualified for the study. The primary reasons for renin-angiotensin-aldosterone system antagonist administration were hypertension (59.1%), polycythemia (19.2%), and proteinuria (18.2%). Among the studied KTRs, 86.7% of patients were treated with ACEIs and 12.2% were treated with ARBs. The majority of patients treated with ACEIs and ARBs received these agents in a dose range below 25% and between 25% and 49% of their maximal dose, respectively. Both the mean serum creatinine level and estimated glomerular filtration rate (chronic kidney disease epidemiology collaboration) remained fairly stable and urine protein excretion (g/24 hours) was significantly reduced after 3 months of ACEI and ARB therapy. The serum potassium level increased significantly, while hemoglobin concentration dropped significantly.In KTRs, renin-angiotensin-aldosterone system antagonists were applied mainly due to hypertension, proteinuria, and polycythemia. ACEIs and ARBs were effective in the reduction of proteinuria and hemoglobin, but graft function was stable and the increase of serum potassium was not of clinical significance. 相似文献
15.
B. Bzoma J. Kostro A. Hellmann A. Chamienia S. Hać A. Dębska-Ślizień Z. Śledziński 《Transplantation proceedings》2018,50(6):1858-1862
Background
The role of ureteric stenting in kidney transplant recipients is still debatable. Stenting can reduce the incidence of urine leaks and ureter stenosis, but can be also associated with specific complications, particularly urinary tract infections (UTIs).Material and methods
To estimate the influence of ureteric stenting on urological complications in kidney transplantation (KTx), we retrospectively analyzed all KTx performed between January 2011 and December 2016 in Gdansk Transplantation Centre, a total of 628 patients. Ureteric stenting was used in 502 patients (80%)—double-J (DJ) group. Catheters were implanted during the surgical procedure and left in situ for a mean time of 30 days.Result
The frequency of urinary leaks was 10 times higher in patients without stenting (10%). Ureter stenosis was also more frequent in the non-DJ group (8.7% vs 1.6%, P < .05). Multiple-regression modeling showed that the urinary not stenting was a risk factor for urinary leak (adjusted odds ratio [AOR] = 0,1; 95% confidence interval [CI]: 0.03–0.26; P < .01), ureter stenosis (AOR = 0,16; 95% CI: 0.06–0.41; P < .01), and generally reoperation after KTx (AOR = 0,46; 95% CI: 0.28–0.77; P < .01). Acute rejection and delayed graft function were equal in both groups. Mean serum creatinine concentration 1 month after transplantation was similar in both groups (1.5 mg/dL in the DJ group and 1.44 mg/dL in the non-DJ group, P > .05). UTIs were more frequent in the DJ group (22.1% vs 16.7%), but the difference was not significant. Time of hospitalization was longer in patients with UTI (34 vs 22 days, P < .05).Conclusions
Ureteric stenting can protect patients from most frequent urological complications like urine leaks and ureter stenosis. The influence of ureteric stenting on UTI development is not strong in our material. 相似文献16.
M. Czerwińska M.S. Gniewkiewicz J. Gozdowska J. Wyzgał T. Grochowiecki S. Nazarewski M. Kosieradzki M. Durlik 《Transplantation proceedings》2018,50(7):2132-2135
Background
End-stage renal disease due to type 1 diabetes mellitus appears to be a regular indication for simultaneous pancreas and kidney transplantation (SPKT). Although transplantation improves a patient's health condition, it does not mean that all complications will be eliminated.Methods
We performed a retrospective analysis of 73 patients who underwent SPKT and follow-up between 1988 and 2015 at our institute. The number, duration, and reasons for hospitalization at 1, 5, 10, and 15 years after SPKT were analyzed.Results
The average number of hospitalizations at 1, 5, 10, 15 years after SPKT were 1.66, 0.39, 0.36, and 0.33, respectively. The main reason for hospitalization over the 15-year period was infections, at 32.4% (SD, 6.8%). Within the first year after SPKT, 6.8% of hospital admissions were caused by cytomegalovirus (CMV) infection. Over time, the percentage of hospitalizations for cardiovascular complications increased from 0.6% at 1 year to 29% at 12–15 years. Incidence of hospitalization due to cardiovascular complications correlated with a longer period of dialysis and a diagnosis of ischemic heart disease before transplant (r = 0.56, P = .004; r = 0.54, P < .0001, respectively). At 12–15 years after transplantation, 18.2% of hospitalizations were caused by secondary complications of diabetes.Conclusion
The most common reason for hospitalization after SPKT is infectious complications. In the first year posttransplant, there is a high percentage of CMV infections. Hospitalization associated with cardiovascular complications was found to be most common in the latter follow-up period and showed a correlation with longer dialysis period. 相似文献17.
K. Jędrzejko R. Kieszek M. Kwapisz M. Nita M. Durlik A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1726-1729
Background
It has been determined that there are about 25% patients with renal allograft failure on the waiting lists.Methods
We analyzed 406 patients who received a kidney graft from 2013 to 2015 in a single center. The analysis resulted in 33 pairs of patients: for one recipient in the pair it was the first transplantation and for the other it was the second or a subsequent one. Graft and patient survival, graft function, delayed graft function episodes, primary nonfunction, and acute rejection episodes were analyzed to assess the outcome of kidney retransplantation. The follow-up period was 2 years.Delayed graft function was observed in both groups (P = .3303).Results
Although in the second group there were twice as many episodes of acute rejection than in the first group (8 to 4), the results are not statistically significant (P = .1420). Primary graft dysfunction was observed only in the second group. Five patients who had lost their kidney graft during the follow-up period were observed in the second group. The probability of graft loss in the second group was as follows: 3% on the day of the transplantation, 12% after 3 months, and 15% after 13 months. All of the patients survived during the 2-year follow-up period. A similar estimated glomerular filtration rate was observed in dialysis time in both groups.Conclusion
There are no statistically significant differences in kidney graft function between patients with the first transplantation and those with the repeat one. Good kidney transplantation results are attainable in both groups. It seems that retransplantation is the best treatment option for patients with primary graft failure. 相似文献18.
P. Skonieczny Z. Heleniak M. Karowiec M. Michalczuk M. Książek B. Pakuła I. Kuźmiuk-Glembin P. Rutkowski L. Tylicki A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1807-1812
Background
Hypertension is often recognized in both hemodialysis patients (HDp) and renal transplant recipients (RTRs). The aim of the study was the evaluation of hypertension prevalence and treatment schedule and the achievement of the control of blood pressure according to the Polish Society of Hypertension, European Society of Hypertension, Joint National Committee, and American College of Cardiology/American Heart Association 2017 recommendations.Materials and methods
Observations were done in 2 distinct periods of time: the year 2006 and the years 2014/2016. In 2006, 56 HDp and 316 RTRs were studied. In 2014/2016, 85 HDp and 818 RTRs were studied. The antihypertensive treatment analysis was based on medical records from visits in RTRs and dialyses in HDp.Results
Cardiovascular diseases were diagnosed in 71.4% (2006) and 65.9% (2016) in HDp; 17.7% (2006) and 21.5% (2014) in RTRs. Diabetes was observed in 39.3% (2006) and 34.1% (2016) in HDp; 16.5% (2006) and 23.2% (2014) in RTRs. The target blood pressure control was achieved in 64.3% (2006) and 49.4% (2016) of HDp and in 61.4% (2006) and 45.7% (2014) of RTRs. Three drugs (28.6% and 33.5% in 2006; 30.6% and 29.1% in 2016/2014) or 2 antihypertensive drugs (19.6% and 26.9% in 2006; 22.4% and 27.1% in 2016/2014) were used in HDp and RTRs, respectively. The majority of HDp and RTRs were treated with ß-blockers followed by calcium channel blockers.Conclusions
The target blood pressure control was achieved in a low percentage of HDp and RTRs. RTRs required multidrug antihypertensive therapy to control blood pressure more often than HDp. 相似文献19.
I. Milaniak E. Wilczek-Rużyczka K. Wierzbicki J. Piątek B. Kapelak P. Przybyłowski 《Transplantation proceedings》2018,50(7):2113-2118
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. 相似文献20.
A. Tarasewicz A. Dębska-Ślizień B. Rutkowska E. Szurowska M. Matuszewski 《Transplantation proceedings》2018,50(6):1904-1909
Mammalian target of rapamycin inhibitors (mTORI) are increasingly used in the treatment of tuberous sclerosis complex (TSC) and as immunosuppressants after organ transplantation. In TSC patients, mTORI are the treatment of choice after kidney transplantation. It is still under debate if benefits from long-term mTORI use will not be limited by side effects.