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1.
Background
Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent monogenic renal disease, responsible for 10% of the patients on renal replacement therapy, including kidney transplantation. Recently, it was reported that the serum CA 19-9 level is significantly elevated in ADPKD patients without malignancy. Exclusion of malignancy, including tumor marker analysis, is essential in pretransplant evaluation, as well as in assessment of kidney transplantation recipients.Methods
In this study the serum CA 19-9 level in ADPKD patients without malignancy was retrospectively analyzed. The mean level of CA 19-9 was 30.3 U/mL (0.8 U/L–612 U/L).Results
Overall, in 24 patients (18.8%) the serum CA 19-9 level was increased above the normal level found in the general population (35 U/L), and 5 of them (4.2%) did not experience polycystic liver disease. In 4 patients (3.4%) CA 19-9 level was increased 2-fold above the norm and in 3 of them (2.5%) 3-fold over the norm and higher. A statistically significant negative correlation between serum CA 19-9 level and estimated glomerular filtration rate, both in patients with and without hepatic cysts was observed. In nearly 1 in 5 patients with ADPKD, serum CA 19-9 level should be expected to be above the norm found in the general population, despite the lack of coexistence of a tumor or cholangitis.Conclusion
This finding should be considered during transplantation qualification and in follow-up examination after kidney transplantation. 相似文献2.
Influence of Sudden Cardiac Arrest in Deceased Kidney Donors on Organ Function After Transplantation
M. Jonas K. Warzyszyńska N. Olszewska A. Ostaszewska M. Kosieradzki 《Transplantation proceedings》2018,50(7):1979-1981
Introduction
Due to the increasing number of organ recipients, expanded criteria donors (ECD) are qualified for transplantation, including donors after sudden cardiac arrest (SCA). The aim of this study was to evaluate the influence of SCA on kidney function immediately after transplantation.Patients and Methods
The analysis includes 186 kidney recipients, mean age 49 years (19–74), who were transplanted between January 2014 to July 2015. In 44 cases, kidneys were retrieved from donors after SCA (23.6%). Delayed graft function (DGF) was recognized if the patient needed at least one hemodialysis after the kidney transplant. Acute rejection (AR) was confirmed by biopsy.Results
Sixty-five (34.9%) patients presented with DGF, 14 of them received kidneys from donors after SCA (31.8% of the SCA group), and 51 of them are from donors without SCA (35.9% of the non-SCA group). Eleven AR episodes were observed in the first month, including 4 cases in the SCA group. The study revealed no influence of donors' SCA on the frequency of DGF and AR or high creatine level after transplantation. The differences between both groups were not significant (P > .05).Conclusions
SCA episodes in donors during ICU treatment before organ retrieval had no influence on immediate kidney function after kidney transplant. There is no correlation between SCA and episodes of DGF or AR. SCA donors should be considered as standard criteria donors. 相似文献3.
M. Osiak D. Szubińska-Lelonkiewicz P. Wychowański E. Karakulska-Prystupiuk W. Jędrzejczak A. Wojtowicz P. Fiedor 《Transplantation proceedings》2018,50(7):2176-2178
Introduction
Patients subjected to long-term immunosuppressive therapy after organ and cells transplantation are more susceptible than healthy people to the development of the pathologic changes in the oral cavity, including precancerous lesions, oral cancers, lesions following viral infections (herpes simplex virus, Epstein-Barr virus, and cytomegalovirus), fungal infections mainly caused by Candida albicans, drug-induced gingival overgrowth, stomatitis, and tongue disorders.Material and methods
Clinical case material included 38 patients after kidney, liver, or blood-forming cells transplantation subjected to various immunosuppressive therapy schemes. The study comprised standard case taking and physical examination of the patient, including detailed intraoral and extraoral stomatological examinations.Results
Extraoral examination confirmed 1 case of multifocal basal cell carcinoma in the auricular region and one case of systemic lupus erythematosus. Intraoral examination revealed gingivitis (60.5%), gingival recession (58%), periodontitis (55.26%), macroglossia (15.8%), lingual papillary atrophy (13.16%), leukoplakia aphthae/ulcerations (10.5%), lichen planus, pallor of mucous membranes (7.9%), pathologic pigmentation of oral mucosa, geographic tongue (5.26%) and erythroplakia (2.6%). When their histories were taken, patients reported xerostomia (68.42%), halitosis (23.68%), gum bleeding while brushing teeth (18.42%), and dysgeusia (15.78%).Discussion
Both the patients after organ and hematopoietic stem cells transplantations and those qualified for a transplant should undergo multispecialty treatment, particularly dental treatment, to enable the detection of pathologies at an early stage and commencement of effective therapy. Cooperation between the main doctor and the dentist is crucial in the process of treatment of this group of patients. 相似文献4.
M. Wojtowicz P. Wilkowski E. Hryniewiecka T. Cieciura L. Paczek M. Ciszek 《Transplantation proceedings》2018,50(7):2027-2030
Background
Hepatitis C virus (HCV) infection deregulates function of many organs and systems, affecting patient's daily functioning. The results of treatment of HCV infection recurrence after liver transplantation have improved significantly as a result of the introduction of direct-acting antiviral agents (DAA). This study was aimed at prospective assessment of the effect of HCV elimination with DAA on physical performance of liver transplant recipients.Methods
Eight women and 21 men, median age 61.3 (range, 20.1–71.5) years, participated in the study. Assessment of serum total bilirubin, alanine and aspartate aminotransferase, muscle strength, body composition, and 6-minute walk test (6MWT) were performed before treatment and 12 weeks after the end of the treatment period.Results
In the 6MWT test we observed significant subjective (dyspnea: 58.3% pretreatment vs 27.6% posttreatment, P = .018; fatigue: 96.6% pretreatment vs 51.7% posttreatment, P = .0001) and objective improvement (distance: 415.4 meters pretreatment vs 505.2 meters posttreatment, P < .0000001). We did not observe an increase in muscle mass nor improvement in blood biochemical parameters.Conclusion
A significant objective and subjective improvement in physical performance was seen in liver transplant recipients after successful treatment of HCV infection with DAA. 相似文献5.
A. Furmańczyk-Zawiska T. Bączkowska D. Dęborska-Materkowska S. Nazarewski M. Kosieradzki M. Durlik 《Transplantation proceedings》2018,50(6):1715-1719
Background
Optimization of immunosuppressive therapy reduced the incidence of acute rejection, and therefore vascular complications, including graft thrombosis, which have emerged as the main cause of graft loss in the early post-transplant period. A thrombophilic condition may lead to renal graft loss. The aim of the study was to assess renal graft function in thrombophilic renal recipients receiving anticoagulation treatment.Methods
This is a retrospective study including 29 renal recipients (ktx group) with a history of thrombosis and confirmed thrombophilic factor. Graft function was evaluated by median serum creatinine concentration at the third month after ktx (SCr1) and at the end of the observation (SCr2) with respect to hypercoagulability (factor V Leiden [FVL], mutation G20210A, antiphospholipid antibodies, deficiency of protein S [PS] or C [PC], factor VIII >200%).Results
Recipients underwent retransplantation because of graft thrombosis (P < .001). They more often underwent urgent transplantation (P = .008), received induction therapy (P = .021), underwent an indication other than protocol biopsy (P = .001), or experienced acute rejection (P = .042). Differences in graft function (SCr2) were found at the end of observation (ktx group vs controls 1.9 mg/dL vs 1.3 mg/dL, respectively, P = .014). Multivariate analysis revealed inferior thrombophilic graft function in the model with SCr1 <2 mg/dL (odds ratio 0.07, 95% confidence interval 0.01–0.57, P = .014) and in the model with SCr2 <2 mg/dL (odds ratio 0.15; 95% confidence interval 0.04–0.54, P = .004). The incidence of antiphospholipid syndrome was 31%; FVIII, 31%; FVL, 24.1%; and PC/PS, 13.8%. After anticoagulation was introduced no thromboembolic events or bleeding complications occurred.Conclusion
Hypercoagulability is not a contraindication to ktx but may worsen graft function. Post-transplant care in thrombophilic recipients is demanding (retransplantation, immunization, protocol biopsy, anticoagulation), but is the only means by which to maintain a graft. 相似文献6.
D. Szubińska-Lelonkiewicz M. Osiak P. Wychowański M. Siewert-Gutowska P. Fiedor 《Transplantation proceedings》2018,50(6):1878-1880
Recipients of allotransplants are more susceptible to viral infections, among which the human papilloma virus infection is an independent factor inducing precancerous lesions and cancers of both the anogenital and the cervicocephalic region.
Materials and methods
The study included a group of 69 allogenic kidney transplantation recipients aged 20 to 70, who were treated with cyclosporine, azathioprine, and prednisone. The patients in whom the macroscopic examination of the oral mucosa revealed lesions were qualified for a biopsy. The infection with human papilloma virus (HPV) was confirmed by a histopathological examination and genotyping with the use of polymerase chain reaction (PCR) and Hybrid Capture II test.Results
Papillomatous lesions in the oral cavity occurred in 36.1% of the research group participants. The HPV16 virus was the most common genotype in this group of patients (25%). The pathologic changes in the oral cavity were predominantly situated on the gingivae. In the group of transplant recipients, clinical changes resulting from HPV infection occurred within a period of 2 years following the transplantation.Cyclosporine used in the immunosuppression scheme has correlated in as many as 53.7% of cases of allogenic kidney transplant recipients with the appearance of clinical signs and symptoms of HPV infection. In 50% of cases there was a correlation with acute kidney transplant rejection. When induction therapy (anti-thymocyte globulin [ATG] and muromonab-CD3 [OKT3]) was applied, at least 1 oral cavity lesion in each case of allogenic transplant recipients was reported.Conclusions
Typing of HPV with the use of molecular methods should be a standard diagnostic technique. 相似文献7.
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8.
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9.
M. Skalski B. Gierej Ł. Nazarewski B. Ziarkiewicz-Wróblewska K. Zieniewicz 《Transplantation proceedings》2018,50(7):1982-1984
Introduction
Prostate cancer has become an important clinical issue within deceased organ donors. There is still a considerable number of undiagnosed cancers, especially in early stage, despite frozen section analysis. The aim of the study was to evaluate outcomes of orthotopic liver transplants (OLTx) with organs from donors with prostate cancer.Material and Methods
A retrospective analysis was performed in deceased liver donors whose prostate glands were harvested for histologic examinations because of prostate cancer suspicion. The study group consisted of 72 men reported as potential liver donors between 2011 and November 2017. Prostate glands were primarily assessed by frozen sections and afterward in routine examination. Generally cancer diagnosed in frozen specimen was not considered for OLTx. Recipients who received an organ from the donor with prostate cancer were actively surveilled.Results
There were 19 cases (26.40%) of prostate cancer diagnosed among the study group. In 12 cases diagnosis was made by frozen section assessment, of which 11 organs were disqualified from OLTx and 1 was transplanted. In 7 cases prostate cancer was diagnosed after OLTx in final routine histologic examination. Finally, 8 recipients (5 men and 3 women) received a new organ. Only 1 died during the perioperative period. In the remaining 7 patients the perioperative period was uneventful and no disease transmission was observed during follow-up.Conclusions
Diagnosis of prostate cancer in donors should not be treated as a contraindication for OLTx because the risk of disease transmission is low. Potential recipients must be fully informed and kept under oncological surveillance. 相似文献10.
M. Ciszek B. Kisiel J. Czerwinski E. Hryniewiecka D. Lewandowska S. Borczon W. Tlustochowicz L. Paczek 《Transplantation proceedings》2018,50(6):1654-1657
Chronic kidney disease (CKD) is a common complication of rheumatic disorders. We analyzed the incidence of different rheumatic conditions as a primary diagnosis of end-stage renal disease (ESRD) in kidney transplant recipients in Poland.Data were received from the national waiting list for organ transplantation (Poltransplant) registries. Primary diagnosis leading to ESRD were analyzed in 15,984 patients who received kidney transplants between 1998 and 2015. There was no information about primary diagnosis in 4981 cases (31%) and in 1482 cases (9%) the diagnosis was described as unknown.Rheumatic diseases were specified in 566 (5.14%) kidney transplant recipients: lupus erythematosus, (systemic lupus erythematous nephritis) in 211 (1.92%), vasculitis in 176 (1.60%), amyloidosis AA in 82 (0.75%), hemolytic uremic syndrome in 59 (0.54%), secondary glomerulonephritis in 24 (0.22%), scleroderma in 9 (0.08%), rheumatoid arthritis in 4 (0.04%) and Sjögren syndrome in 1 (0.01%). Graft survival at 1 and 5 years were significantly better in the nonrheumatic versus rheumatic group (90 vs 87% and 76 vs 72% respectively, P = .04). Recipient survival at 5 years was significantly better in the nonrheumatic versus the rheumatic group (88 vs 84%, P = .02).Our study showed that systemic lupus erythematosus and systemic vasculitides are the major rheumatic causes of ESRD in the Polish population. Long-term graft and recipient survival were significantly better in the nonrheumatic versus the rheumatic group in the Poltransplant cohort. 相似文献
11.
M. Bieniasz R. Kieszek A. Jakubowska-Winecka M. Zatorski M. Kwapisz K. Jędrzejko M. Nita M. Durlik L. Pączek A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1637-1639
Background
Living kidney transplantation is the optimal treatment of end-stage renal disease. The benefits for recipients are obvious. The psychological consequences for living kidney donors in Poland are not known.Objective
The objective of the study was to evaluate the psychological aspects of living kidney donation in Poland.Patients and methods
A total of 66 living donor open nephrectomies were performed in our institution between 1995 and 2005. The psychological aspects were assessed in 40 donors after nephrectomy. The study applied the Satisfaction With Life Scale (SWLS), the Situation Assessment Questionnaire, the Health Behaviors Survey, and our own questionnaire. The mean observation period was 65.6 months.Results
There was a trend toward better life satisfaction in living kidney donors compared to Polish adults. Donor life satisfaction was significantly lower when the recipient was dead than when the recipient was alive. Most donors perceived the kidney donation as a challenge in cognitive judgment. The mean score of the Health Behaviors Survey was not significantly different than in the general population in Poland. The mean pain score after donation was 3.2 in a 5-item scale (1 = severe pain, 5 = mild pain). The mean time of return to work was 3.5 months. No donors regretted their decisions about kidney donation.Conclusion
Living kidney donation in Poland has a positive impact on donors' quality of life. Among living kidney donors, the sense of danger concerning the risk of donation depends on the degree of the relationship with the recipient. 相似文献12.
P. Wilkowski K. Gajko M. Marczak E. Hryniewiecka M. Wojtowicz K. Dobrzaniecka G. Mlynarczyk L. Paczek M. Ciszek 《Transplantation proceedings》2018,50(6):1874-1877
The burden of Klebsiella pneumoniae (KP) producing extended-spectrum beta-lactamases (ESBL+) urinary tract infections (UTIs) is a growing problem after kidney transplantation (KTX). The study was aimed at evaluating the incidence of KP ESBL+ gut colonization in KTX recipients and its correlation with clinical outcomes with special regard to UTIs.The study included all KTX patients hospitalized in our department between January 2014 and December 2016. During this period 2018 KTX patients were admitted: 605 in 2014, 750 in 2015, and 663 in 2016, respectively. Screening for drug-multiresistant Enterobacteriaceae gut carriage was performed in 104 patients (2014), 122 (2015), and 166 (2016).In 2014, 2015, and 2016, 18 (17.3%), 26 (21.3%), and 30 (18.1%) patients had positive test results, and 44 (42.3%), 36 (29.5%), and 45 (27.4%) KTX patients were diagnosed with KP ESBL+ UTI. In 2014, KP ESBL+ UTI was diagnosed in 30 (34.9%) cases with negative anal swab and in 14 patients (77.8%) with positive test result (P = .0008). In 2015, KP ESBL+ UTI was diagnosed in 21 patients (21.9%) with negative anal swab and in 15 (57.7%) with positive test result (P = .0004). In 2016, KP ESBL+ UTI was diagnosed in 24 patients (17.8%) with negative anal swab and in 21 (72.4%) with positive test result (P = .000001).In conclusion, we have revealed a strong association between gut K. pneumoniae colonization, female sex, and MPA intake and KP ESBL+ urinary tract infections in kidney transplant recipients. Our results indicate the very important role of KP ESBL+ screening, while strategies of identified carriers require further research. 相似文献
13.
M. Kwapisz R. Kieszek K. Jędrzejko M. Bieniasz J. Gozdowska A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1590-1596
Background
The possibility of an increased risk of end-stage renal disease is a major concern associated with living kidney donation. Therefore, monitoring of residual kidney function becomes most essential.Methods
A data analysis of 156 living kidney donors (LKDs) was conducted. The efficacy of the long-term care system with regard to monitoring residual kidney function was evaluated.Results
The analyzed group consisted of 102 (65.4%) women. The mean follow-up period was 5.44 years. The rise in value of mean serum creatinine concentration after donation was observed, but it was within the range of normal during the observation period. Despite its initial decline after nephrectomy, mean glomerular filtration rate (GFR) remained >60 mL/min/1.73 m2. A MDRD (Modification of Diet in Renal Disease) GFR in the range of 45–60 mL/min/1.73 m2 was observed in 53 donors (33.97%). It was found to be <45.0 mL/min/1.73 m2 in 15 cases (9.6%). No patient developed end-stage renal disease. Only 25.0% of those analyzed had their CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) GFR estimated on 45–60 mL/min/1.73 m2 and 4.49% were found to have levels of <45 mL/min/1.73 m2 (down to 33.7 mL/min/1.73 m2). Mean postdonation CKD-EPI GFR was estimated at 69.99% of its predonation value.Conclusion
A reliable qualification process could minimize the probability of kidney donation by someone with an increased risk of chronic kidney failure. The CKD-EPI formula seems to be more precise than the MDRD for estimatation of LKDs' GFR, as their loss of GFR is a result of nephrectomy and not kidney or systemic disease. Using the MDRD formula may lead to inappropriate diagnosis of CKD in some cases. 相似文献14.
J. Czerwiński A. Pszenny A. Woderska R. Trześniewski M. Trujnara P. Malanowski T. Danek R. Danielewicz 《Transplantation proceedings》2018,50(7):1962-1966
Despite the good overall condition of Polish transplantation medicine there is a shortage of organs for transplantation. Health care is also in a stage of development with problems including insufficient funding and lack of personnel. In 2015 the number of deceased organ donors in Poland was 526, which was distinctly lower than in 2014 when it reached 594. The aim of this paper was to collect, elaborate on, and summarize the opinions of transplant coordinators regarding the decrease of donation indicators in Poland.
Materials and Methods
The opinions of the transplant coordinators were collected during training meetings and questionnaires performed in 2016. The questionnaires targeted coordinators of active hospitals (above 5 retrievals a year) and less active donor hospitals.Results and Discussion
Transplant coordinators indicated a number of factors that influence donor hospital activity, such as changing roles of intensive care units, changes in hospital flow of patients in critical condition, lack of nurses and anesthesiologists resulting in work overload, changes in forms of doctors' employment, low basic income of health professionals, difficulties in determination of brain death, decrease in engagement of transplant centers in cooperation with donors' hospitals, inadequate in-hospital training meetings, undermining of authority of doctors and medical personnel, change of attitude towards transplantation medicine (treated as profitable, regular specialty), insufficient funding of hospitals and personnel for deceased donor recruitment, and disobeying the rules of personnel remuneration for their engagement in donation and retrieval.Conclusions
Analyzing the opinions of the coordinators, we can state the following: 1. support of the hospital or hospital unit management is crucial for effective donation programs, 2. there is a need to build and implement a hospital quality systems covering each stage of donor recruitment as well as hospital trainings, 3. there should be a transplant coordination team rather than a single coordinator, 4. transplantation centers should maintain good cooperation with donor hospitals, and 5. intensive care unit personnel identification with their own hospital, which is less likely in the case of "locum" employment, is one of the major factors supporting donation programs. 相似文献15.
K. Kuczborska J. Gozdowska D. Lewandowska R. Grenda Z. Gałązka S. Nazarewski M. Durlik 《Transplantation proceedings》2019,51(2):545-547
Background
Cystinosis is a rare genetic disorder characterized by the abnormal accumulation of cystine in the lysosomes of various tissues and organs leading to their dysfunction. The most common type is the infantile nephropathic cystinosis which without treatment leads to renal failure and before the introduction of cysteamine was the cause of death before puberty.Case Presentation
A 27-year-old female patient with infantile cystinosis developed end-stage renal disease at the age of 10. The first kidney transplantation from patient's father was carried out at the age of 12. The recurrent urinary tract infections led to the graft failure after 6 years. Following the removal of right appendages due to the ovarian tumor, the patient underwent the second kidney transplantation from her mother at the age of 19. After the transplantation, the cysteamine treatment was irregular due to limited availability of the medicine. When it became regular in 2017 the patient did not tolerate full doses. Despite elevated blood levels of cystine and the removal of right appendages, the patient naturally became pregnant in August 2017. Except for recurrent urinary tract infections, the renal parameters remained normal throughout the entire pregnancy. However, in the 32nd week of gestation, due to preeclampsia a caesarean section was performed. A healthy daughter was born, 1400/41 and with a 9 point Apgar score.Conclusions
Due to the possibility of treatment with cysteamine and kidney transplantations, patients with cystinosis live longer and their quality of life improves. These female patients can even naturally become pregnant and give birth to healthy children. 相似文献16.
E. Hryniewiecka J. Zegarska D. Zochowska E. Samborowska R. Jazwiec M. Kosieradzki S. Nazarewski M. Dadlez L. Paczek 《Transplantation proceedings》2018,50(6):1850-1854
Cyclosporine A (CsA) is the first calcineurin inhibitor used as immunosuppressive agent. Its administration is associated with multiple adverse effects including cardiovascular diseases (CVDs), but their mechanisms have not been fully elucidated. Cyclosporine metabolites are not well studied in this context. This study was aimed at analysis of the incidence of CVDs and their association with concentrations of cyclosporine and its metabolites.Sixty patients after kidney transplantation (KTX) taking an immunosuppressive regimen including CsA participated in the study. There were 22 women (36.67%) and 38 men (63.33%), mean age 51.73 years, mean 109.38 months after KTX.We observed a correlation between mean diastolic blood pressure and concentrations of metabolite to parent drug ratios of AM1-CsA/CsA (r = 0.35, P = .006), dihydroxy-CsA/CsA (r = 0.42, P = .001), trihydroxy-CsA/CsA (r = 0.42; P = .003) and desmethyl-carboxy-CsA/CsA (r = 0.65, P = .003). There were no significant associations of other CsA metabolites' parameters with CVDs (coronary disease, hypertension, stroke, arrhythmia, diabetes mellitus, obesity).Study results suggest that blood pressure increases associated with CsA therapy could be caused by CsA metabolites that influence mainly diastolic blood pressure levels. A lack of such differences in relation with other CVDs may suggest that more complex mechanisms are involved in the development of cardiovascular injury and disease after kidney transplantation. 相似文献
17.
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18.
D. Bartoszek O. Mazanowska K. Kościelska-Kasprzak D. Kamińska A. Lepiesza P. Chudoba M. Myszka M. Żabińska M. Klinger 《Transplantation proceedings》2018,50(6):1697-1700
Complement activation is considered one of the mediators of renal ischemia-reperfusion injury. Elevated levels of C5b-9, C3a, and C5a are detected in sera of deceased kidney donors. The goal of the study was to characterize the functional activity of complement pathways in donor sera and to assess their influence on transplant outcome.
Materials and methods
Sixty-four deceased kidney donors (age 45 ± 16 years; 28 female, 36 male) and 27 healthy controls (age 42 ± 12 years; 14 female, 13 male) were enrolled in the study. The results of transplantation for the respective 122 kidney recipients were included in the analysis. The functional activities of classical (CP), lectin (LP), and alternative (AP) pathways were measured using Wielisa-kit (reference normal level = 100%). In most cases, decreased functional activity reflects the activation status of the pathway.Results
The median (interquartile range) functional activities of the pathways in donor sera were CP 118 (89–150)%, LP 80 (20–127)%, and AP 74 (50–89)%, and did not differ from the control values CP 110 (102–115)%, LP 81 (26–106)%, AP 76 (61–88)%. The frequency of pathway activation observed in controls was CP 0%, LP 11%, and AP 0%. Deceased donors did not differ in activation of classical (11%) and lectin (13%) pathways, but presented a higher rate of alternative pathway activation (19%, P = .03). No significant influence of any pathway functional activity or its activation was proved to influence the transplant outcome.Conclusion
Complement activation via alternative pathway was observed in diseased donor sera. No predictive potential of donor complement functional activity on the transplant outcome could be proved. 相似文献19.
E. Karakulska-Prystupiuk J. Drozd-Sokołowska A. Waszczuk-Gajda A. Stefaniak J. Dwilewicz-Trojaczek A. Kulikowska E. Chmarzyńska-Mróz G. Basak M. Paluszewska P. Boguradzki W. Jędrzejczak 《Transplantation proceedings》2018,50(7):2212-2217
Background
Relapse is the leading cause of treatment failure for myeloid malignancies treated with allogeneic hematopoietic stem cell transplantation. Treatment options are very limited and use of azacitidine is one of the available options.Methods
This was a retrospective, single-institution study. Of 28 evaluated patients, 18 were males, and the median age was 60 years (range, 15–78). There were 15 patients with acute myeloid leukemia, 8 with myelodysplastic syndrome, 4 with chronic myelomonocytic leukemia, and 1 with primary myelofibrosis. Ten patients received azacitidine for overt relapse, 14 received it as a preemptive therapy, and 4 others received it as maintenance treatment after allo-hematopoietic cell transplant (HSCT). Eleven patients received a donor lymphocyte infusion (DLI).Results
The patients received median 5 (1–9) cycles of azacitidine in preemptive and maintenance therapy and median 2.5 (1–9) cycles in patients with relapse. Thirty-nine percent of patients received DLIs. Median overall survival was 6.1 months (95% CI, 0.7–13) for relapse therapy vs 21.2 months (95% CI, 8.4-inf) for preemptive therapy. Among patients treated for relapse, 30% achieved temporary disease control and underwent the second allo-HSCT. A complete, cytogenetic remission was achieved in 50% of patients and stable minimal residual disease in 14% of patients in a group with preemptive therapy. Toxicity was considerable; neutropenia (71%), anemia (14%), thrombocytopenia (36%), and serious infections (36%) were observed in the preemptive setting.Conclusions
These data support the notion that azacitidine is best used as a preemptive therapy against relapse for patients after allo-HSCT performed for myeloid malignancy. Applying azacitidine as therapy for ongoing relapse after allo-HSCT may lead to stable disease and allow for better performance of the second allo-HSCT. 相似文献20.
E. Karakulska-Prystupiuk G. Basak J. Dwilewicz-Trojaczek M. Paluszewska P. Boguradzki W. Jędrzejczak 《Transplantation proceedings》2018,50(7):2218-2222