共查询到12条相似文献，搜索用时 15 毫秒
1.
G. Oczkowicz A. Caban G. Budziński A. Suszka-Świtek B. Dolińska E. Czech R. Wiaderkiewicz F. Ryszka L. Cierpka R. Król 《Transplantation proceedings》2018,50(7):2240-2244
The aim of this paper was to describe the differences in vascular endothelial growth factor (VEGF) concentration in porcine kidneys removed from living donors (group I), donors after prior induction of brain death by brain herniation (group II), and donors after cardiopulmonary arrest (group III). The groups consisted of 6 animals which underwent dual renal removal procedures; kidneys were rinsed, stored for 24 hours at 4°C and rinsed again. Renal specimens (4g) were collected before and after perfusion (time 0 and 1), after 12 hours (time 2), and after reperfusion (time 3). A Western blot was used to evaluate VEGF concentration in collected tissues homogenates. Additionally, the levels of VEGF, interleukin 1β, tumor necrosis factor α, and endothelial nitric oxide synthase (eNOS) were detected with enzyme-linked immunosorbent assays. Directly after the removal procedure, no significant differences in VEGF levels (IOD) were observed depending on the donor (moderate levels were observed in all groups: 1.51 in group I, 1.48 in group II, and 1.35 in group III). As a consequence of perfusion and 12 hours of storage, a stable concentration in groups I and III was observed with a gradual increase of VEGF levels in group II (1.23, 2.08, and 1.67 in the respective groups at time 1; 1.49, 2.12, and 1.63 in the respective groups at time 2). After the following 12 hours, a statistically significant (P < .05) higher level of VEGF was observed in group II (2.34) in comparison to groups I and III (1.58 and 1.81, respectively). In group I, a correlation between VEGF concentration and IL-1β was observed, while in group II there was correlation between VEGF and eNOS levels. 相似文献
2.
A. Kurek J. Pawlicki A. Lekstan D. Bula L. Cierpka A. Więcek R. Król 《Transplantation proceedings》2018,50(7):1985-1991
Background
Liver transplantation (LTx) is one of the most complex transplant procedures. The aim of the present study was to determine whether the learning process can be observed after the introduction of LTx in a center with extensive previous experience in renal transplantation.Methods
This retrospective analysis included 264 primary LTx procedures performed with the piggyback technique (2005–2016). The procedures were divided into 4 equal groups. The characteristics of the recipients, data related to the surgery, and the postoperative course and complications were analyzed.Results
We observed a significant reduction in surgical time and in the anhepatic phase duration between Group 1 and the other groups (median surgical time was 455 minutes vs 415 minutes, 410 minutes and 387 minutes, respectively, P < .05; median anhepatic phase duration was 75 min vs 60 min, 62 min, 60 min, respectively, P < .05). There was a decrease in the number of transfused blood units (median in Group 1 of 6 packs vs 3 packs in Group 4, P < .05) and a decrease in blood recovered from the operating field using the Cell Saver system (median in Group 1 of 1570 mL vs 1057 mL, 1123 mL, and 1045 mL, respectively, P < .05). A significant reduction in the number of hemorrhages was found (1.5% in Group 4 vs 13.6%, 10.6%, and 7.6% in the other groups P < .05). The remaining studied parameters were not statistically significant.Conclusions
Extensive previous transplantation experience affected the lack of typical features of the learning process. 相似文献3.
K. Derbisz M. Nylec P. Chrząszcz W. Wrońska A. Kunsdorf-Wnuk W. Wystrychowski R. Król 《Transplantation proceedings》2018,50(7):2018-2021
Introduction
Primary graft dysfunction (PGD) is a multifactorial syndrome related to the most adverse outcomes after liver transplantation. Ischemia–reperfusion injury is recognized as the predominant cause of this complication. PGD may be subdivided into early allograft dysfunction, diagnosed by the presence of a serum bilirubin level ≥10 mg/dL (171 μmol/L), International Normalized Ratio ≥1.6, or alanine and aspartate transaminase levels ≥2000 IU/L on the seventh postoperative day; and primary nonfunction, defined as either a need for retransplantation or patient death within the first 7 days. We aimed to determine the preoperative and intraoperative risk factors for PGD.Materials and Methods
We enrolled 109 patients who underwent orthotopic liver transplantation between 2012 and 2016. Analysis included inter alia: biochemical parameters, morphology, blood transfusions, as well as intraoperative fluctuations of blood pressure.Results
Fourteen percent of patients were diagnosed with PGD. Using logistic regression and multivariate and receiver operating characteristic and area under the curve analysis, a preoperative neutrophils level above 4030/μL (OR = 4.03, P = .012) and decrease of the mean arterial pressure after reperfusion were recognized as the major independent PGD risk factors.Conclusions
A high preoperative neutrophils level may be a novel recipient-related risk factor for PGD. A decrease of the arterial blood pressure after graft reperfusion may influence the development of PGD. 相似文献4.
Background
Despite an increasing utilization of kidneys procured from expanded-criteria donors, little is known about the effects of particular expanded-criteria donors definition components, that is, hypertension, increased creatinine prior to procurement, and cerebrovascular cause of death on the kidney graft Doppler parameters measured shortly after transplantation, whose increased values are associated with unfavorable outcomes. Hence, we analyzed the relationship between expanded-criteria donors components and resistance index values measured within 2 to 3 days post-transplant.Material and Methods
The initial post-transplant resistance index value was measured in 676 consecutive successful first cadaveric kidney graft recipients without delayed graft function or early acute rejection episode. We analyzed resistance index values in 460 patients transplanted with organs from donors <50 years and in 216 recipients with organs from donors >50 years old.Results
In general, expanded-criteria donors status did not influence the initial resistance index values in the whole study group. Unexpectedly, in older donor groups, both the occurrence of donor hypertension and cerebrovascular cause of death resulted in significantly lower resistance index values in kidney graft recipients (0.73 ± 0.10 vs 0.76 ± 0.11 in the non-hypertension group, P = .013 and 0.74 ± 0.11 vs 0.78 ± 0.10 in the non-cerebrovascular cause of death group, P = .015, respectively). In the Cox proportional regression model for graft survival, cerebrovascular cause of death was increasing the risk of graft loss by 55%, while recipient's age had the opposite effect, decreasing the risk of graft loss by 2% per year.Conclusions
Regardless of the limited influence of expanded-criteria donor status on first post-transplant resistance index value, the long-term observation shows moderate but significantly worse kidney graft survival, mostly as a result of the cerebrovascular cause of donor's death. 相似文献5.
I. Woźniak A. Kolonko J. Chudek Ł. Nowak M. Farnik A. Więcek 《Transplantation proceedings》2018,50(6):1896-1899
Background
Kidney transplant recipients are frequently treated for other medical conditions and experience polypharmacy. The aim of our study was to evaluate quality of life in relation to medicines' burden in these patients.Methods
We studied 136 unselected patients with mean post-transplant time of 7.2 ± 4.6 years. Quality of life was evaluated using a validated Polish version of the Kidney Disease Quality of Life–Short Form questionnaire. Data concerning the type (generic name) and number of currently prescribed medications were collected by interview survey. The participants were divided into 3 groups: group 1, patients with a maximum of 4 different medications (n = 37); group 2, patients with 4 to 9 medications (n = 76); and group 3, patients receiving at least 10 different medications (n = 23).Results
The number of medicines taken regularly ranged from 2 to 16. Patients with ≥10 drugs had the highest body mass index and lowest estimated glomerular filtration rate. Patients treated with ≥10 drugs, compared to patients from the 2 other groups, had presented lower subscales results concerning the physical functioning (65.9 vs 84.5 in group 1 and 83.4 in group 2, P < .001 for both comparisons), pain (57.2 vs 82.7 and 76.5, respectively, P < .001 for both), social function (66.8 vs 82.1 and 80.4, respectively, P = .04 for both), and energy/fatigue (54.8 vs 67.7, P = .03 and 65.4, P < .05). Multivariate regression analysis revealed that the number of drugs independently influenced physical functioning, pain, and social function subscales.Conclusions
Polypharmacy is associated with lower quality of life in patients after successful kidney transplantation. The negative impact of polypharmacy is particularly seen regarding physical functioning and pain severity. 相似文献6.
Y. Nakamura Y. Kihara T. Yokoyama O. Konno H. Iwamoto 《Transplantation proceedings》2018,50(8):2404-2411
Background
To increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively use organs from all donors. Since the revision of the Organ Transplant Law, the number of organ donors after cardiac death (DCD) has decreased but the number of organ donors after brain death (DBD) has increased; however, the number of donor organs and awareness of cadaveric transplantation have increased.Methods
At our institution, 28 patients underwent cadaveric kidney transplantation from January 2001 to December 2016. These patients were classified into 2 groups according to DBD or DCD. Furthermore, 10 patients received transplants from expanded criteria donors (ECD) and 18 received them from standard criteria donors (SCD).Results
Kidney graft survival and engraftment were observed for all patients. There were no significant differences in renal function at 6 months for DBD and DCD transplant recipients. Renal function at 1, 3, and 5 years and serum creatinine levels were better for the ECD group. Renal function at 5 years after transplantation was significantly better for the SCD group than for the ECD group; however, there was no difference in delayed graft function between the SCD and ECD groups. Comparisons of the 3 groups showed good renal function for transplants from DBDs, but there was no significant difference in survival rates.Conclusions
Results were good for all patients. There were no significant differences in outcomes of our patients who received transplants from ECD or SCD. 相似文献7.
J. Radtke S. Scheidat E.G. Achilles J. Li L. Fischer U. Herden F. Thaiss U. Wenzel B. Nashan M. Koch 《Transplantation proceedings》2018,50(10):3211-3215
Background
An analysis of 2 kidney transplants from the same donor at the same center enables us to analyze the influence of risk factors on the outcome of the grafts in different recipients.Methods
We retrospectively analyzed 88 kidneys from 44 donors that were implanted in 88 recipients at our institution between 2007–2016. We defined unsatisfactory outcome as glomerular filtration rate <30 mL/min/1.73 m2 allograft loss or recipient death within the first year after transplantation. Fifty-three kidneys were allocated and age-matched to donors above the age of 65 years (via Eurotransplant Senior Program or center offer). We compared kidney pairs with satisfactory outcome in both recipients (group A) to pairs with divergent outcome (group B) and unsatisfactory outcome in both recipients (group C).Results
Thirty-four grafts (17 donors) had a satisfactory outcome for both recipients (group A), and 16 grafts (8 donors) had an unsatisfactory outcome for both recipients (group C). Donor age was significantly higher in group C vs group A (67.5 ± 6.7 vs 56.4 ± 16.0 years, P = .010). The 19 donors donating 1 kidney with satisfactory and the other with unsatisfactory outcome were 67.4 ± 10.7 years old (group B). A severe surgical complication occurred more often in recipients with an unsatisfactory outcome in comparison to patients with a satisfactory outcome.Conclusion
Donor age is an important risk factor for an unsatisfactory outcome, either in one or both kidneys of the same donor. 相似文献8.
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9.
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10.
A. Szczurowska M. Guziński W. Krajewski D. Kamińska K. Kościelska-Kasprzak A. Arruza Echevarria B. Małkiewicz P. Dębinski O. Mazanowska M. Klinger M. Sąsiadek 《Transplantation proceedings》2018,50(6):1597-1601
Introduction
After living kidney donation, a decrease of kidney function (described as estimated glomerular filtration rate [eGFR]) is observed in majority of donors. However, the loss is more significant in some patients without an explicable reason. The aim of this study was to identify quantitative parameters in computed tomography (CT) of the abdomen that would predict greater eGFR reduction after kidney removal.Material and Methods
One hundred and ten preoperative multiphase CT examinations of the abdomen of kidney donors were analyzed for the following renal parameters: cortex, parenchyma and pyramids volume, scarring thickness (low grade: <1 cm, high grade: >1 cm), cortical gaps, vascularisation, and cortex-to-aorta enhancement index (CAEI). The radiologic and biometric (eg, donor weight) parameters were correlated with eGFR (CKD-EPI formula) change between baseline and at discharge.Results
Donor weight was correlated with a loss of eGFR (P < .001). Kidney volumetric parameters including renal cortex and parenchyma volume, as well as renal artery cross-section area were associated with donor weight (r = 0.50 P < .001 and r = 0.39 P < .001). CAEI was correlated with a loss of eGFR (P = .003) and was related to the donor's sex in favor of men. Forty-one (37%) donors had an additional renal artery, which did not influence kidney function. No influence of cortical gaps or scarring on eGFR was observed.Conclusions
CAEI may be a helpful tool in predicting greater short-term kidney function decrease after living kidney donation.Male sex is the strongest risk factor of greater eGFR loss after kidney donation. 相似文献11.
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12.
A. Surowiecka-Pastewka M. Matejak-Górska M. Frączek M. Durlik 《Transplantation proceedings》2018,50(7):2136-2139
We present a case of a multiple renal artery reconstruction during simultaneous pancreas and kidney transplantation. The kidney graft had 6 renal arteries, the aorta patch was 10 cm long, and there were two renal veins. To perform anastomoses to the left external iliac vessels we had to reconstruct the renal arterial and venal patches. The results of the transplantation were very good. Both grafts had satisfactory function, even though a control computed tomography performed a year after transplantation revealed infarction of a lower renal pole. Anatomical anomalies should not be a contraindication for transplantation, although transplants involving a multiplicity of vessels is a challenge for surgeons and requires both knowledge and microsurgical skills. 相似文献