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1.
Introduction
Endocan is a novel soluble dermatan sulfate proteoglycan derived from endothelium. It has the capacity of binding to different biologically active molecules associated with cellular signaling, adhesion and regulating proliferation, differentiation, migration, and adhesion of different cell types in health and pathology. Elevated endocan levels are connected with endothelial activation/damage, neo-angiogenesis, and inflammation or carcinogenesis.Materials and methods
The level of serum endocan among 63 kidney transplant recipients on three immunosuppressives (calcineurin inhibitors, mycophenolate mofetil, steroids) in correlation with other markers of endothelial damage was estimated. Additionally, 22 healthy volunteers were studied. Using a cross-sectional study design, the markers of endothelial damage like endocan, von Willebrand factor (vWF), intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM); markers of inflammation high-sensitivity C-reactive protein (hsCRP) and IL-6; and marker of kidney function cystatin C were measured using commercially available assays.Results
Endocan, vWF, IL-6, hsCRP, ICAM, and VCAM levels were significantly higher in kidney transplant recipients comparing to healthy volunteers. In kidney transplant recipients, endocan levels correlated with renal function (estimated glomerular filtration rate by Modification of Diet in Renal Disease, r = -0.24, P < .05, creatinine r = 0.26, P < .05), time after transplantation r = -0.24, P < .05, activity of aspartate aminotransferase r = -0.46, P < .001, alanine aminotransferase r = 0.34, P < .01), ICAM r = -0.53, P < .001, VCAM r = -0.34, P < .01, hsCRP r = 0.35, P < .01, IL-6 r = 0.28, P < .05, vWF r = 0.26, P < .05. In a multifactorial analysis, the predictors of endocan levels were creatinine, ICAM, and VCAM predicting 59% of variability.Conclusion
Endocan concentration among kidney transplant recipients is potentially connected with endothelial damage dependent upon graft function and time after transplantation. 相似文献2.
M. Rydzewska N.A. Drobek M.E. Małyszko A. Zajkowska E.M. Guzik-Makaruk E.W. Pływaczewski J. Malyszko 《Transplantation proceedings》2018,50(7):1946-1952
In 2016 the total number of solid organ transplantations in Poland was 1469; the number of patients on waiting lists was approximately 1600 every month, and demand for organs is increasing every year. Transplantation has achieved increasing support and acceptance among Polish people; however, there are still many ethical, moral, and legal barriers related to this form of treatment of end-stage organ failure.
Material and Methods
The research method is a diagnostic survey of 347 law students from the Faculty of Law, University of Bialystok, Poland. The research tool was the authors' questionnaire.Results
Responders were 21.172 ± 1.34 years old (67.4% female, 74.4% urban residence). Organ procurement and transplantation from living donors are accepted by 95.6% of respondents; 97.4% are accepted from deceased donors. More than 80.4% of the respondents would agree to organ donation from their family members after death and to be donors after their death. The majority of students (80.1%) believe that the final decision of deceased organ donation should be made by the family. Despite positive attitude towards transplantation (97%), about 2% have submitted their objection to the central registry. Refusal of organ donation was associated mainly with emotions related to death (89%) and religion (47.6%). According to responders, the transplantation should be managed by patients and donors (42.1%) and universities (31.7%).Conclusions
Law students generally accept procurement of organs from deceased and living donors, but in situations related to family members, their acceptance rates drop significantly. According to future lawyers, patients, donors, and universities should educate society about issues related to organ transplantation. 相似文献3.
M. Rydzewska N.A. Drobek M.E. Małyszko A. Zajkowska J. Malyszko 《Transplantation proceedings》2018,50(7):1939-1945
Background
Although transplantation has gained more support and acceptance, there are still many ethical, moral, and legal barriers associated with this form of treatment. The demand for organs is higher than what can be accommodated. Current medical students are forming their views about transplantation.Methods
The aim of this study was to investigate the perspectives of 569 students from the Faculty of Medicine, Medical University of Bialystok, Poland, with regard to their beliefs about organ donation.Results
Respondents included in this study were 21.77 ± 2.03 years of age (73.6% female, 80.1% living in an urban setting). Organ procurement and transplantation from living donors was found to be acceptable by 97.54% of respondents, and 98.77% found deceased donor procurement to be acceptable. More than 90% of respondents agreed with organ donation from family members after death, and agreed to donation after their own death. However, only 54.77% indicated an agreement to donate in their lifetime for nonrelatives. It was found that 70.74% believe the final decision on cadaveric organ donation should be made by the family. A positive attitude toward organ transplantation was expressed by 96.47% of respondents, but 2% submitted an objection to placement on a central registry. Refusals for organ donation included emotions associated with death (88%), religious beliefs (42%), and lack of knowledge of medical terminology (24.78%). According to respondents, the concept of transplantation should be managed by patients and donors (65.38%), universities (49.56%), or the media (44.64%).Conclusion
Medical students generally agree on procurement of organs from deceased and living donors. However, their enthusiasm for organ donation after death diminished with regard to their family members. An educational campaign promoting organ transplantation should be considered. 相似文献4.
Renal transplant is the best form of treatment for most patients with end-stage renal disease. The aim of this study was to examine the prevalence of eye problems in patients with end-stage renal disease on the kidney transplantation waiting list in regard to their status (active vs temporarily disqualified).The cross-sectional study was conducted on 90 prevalent patients in 1 regional qualification center. There were 24 peritoneally dialyzed patients, 5 patients registered for preemptive transplantation, and 61 hemodialyzed patients. Average age of patients who had been registered on the cadaver kidney waiting list was 50 (±?14) years, with a balanced sex ratio and median dialysis duration of 38 months. The primary cause of end-stage renal failure was chronic glomerulonephritis in 42 cases, diabetic nephropathy in 10 cases, hypertensive nephropathy in 12 cases, autosomal dominant polycystic kidney disease in 7 cases, and other or unknown in the remaining patients. The major diagnosis was hypertensive angiopathy (related to the presence of long-term hypertension and history of kidney disease) in 56 patients, diabetic retinopathy in 8 patients, blindness in 4 cases (due to solvent intoxication in 1 case), and eyesight abnormalities (myopia, hyperopia, anisometropia) in 7 cases. Cataracts were described in 10 patients in addition to other findings. In 15 patients ophthalmology examination was normal, predominantly in younger patients. Abnormalities were more common in patients on the inactive list.In the vast majority of potential kidney transplant recipients, ophthalmology disturbances are primarily related to the underlying disease. The ophthalmology consult is part of the qualification, but the abnormalities are not the exclusion criteria. 相似文献
5.
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6.
E. Wlodarczyk Z. Wlodarczyk L. Paczek A. Szymanska M. Glyda A. Adamowicz G. Baczyk A. Ulatowska 《Transplantation proceedings》2018,50(6):1900-1903
Kidney transplantation is an optimal method of renal replacement therapy in patients with phase V chronic kidney disease. Elderly patients (older than 60 years) with a kidney transplant create a significant and constantly growing pool of patients with this type of organ transplantation. In this group of patients, long-term care should be particularly stringent and vigilant. Apart from typical conditions associated with chronic kidney disease and possible post-transplant complications as well as side effects of immunosuppressive treatment, the patient also experiences changes and limitations associated with the progress of age and diseases typical for old age, characterized by a higher risk of infection, and changed pharmacokinetics/pharmacodynamics. Undoubtedly, patients should remain under the medical care of qualified transplantologists, but constant cooperation with a general practitioner and geriatrician would be of added value. Study results show that although most of the elderly kidney recipients have constant contact with their general practitioners, and almost half of them use private care, contribution of the geriatrician to the transplant care system is unsatisfactory, and elderly kidney recipients would expect more extensive outpatient care. 相似文献
7.
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8.
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
9.
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10.
M. Yanishi H. Kinoshita H. Tsukaguchi Y. Kimura Y. Koito M. Sugi T. Matsuda 《Transplantation proceedings》2018,50(10):3371-3375
Introduction
Sarcopenia and osteopenia are highly prevalent in older patients, and are associated with a high risk for falls, fractures, and further functional decline. However, related factors in kidney transplant recipients suffering from osteosarcopenia, the combination of sarcopenia and osteopenia, remain unknown.Material and methods
Fifty-eight transplant recipients (42 men and 16 women), with a mean age of 46.6 ± 12.7 years, were enrolled in this study. Sarcopenia was diagnosed according to the criteria of the Asia Working Group for Sarcopenia. Osteopenia was diagnosed according to World Health Organization criteria using bone mineral density (BMD) of the lumbar spine. Patients who met the diagnostic criteria of both diseases were defined as having osteosarcopenia.Results
Ten patients had osteosarcopenia. According to univariate analyses, there were significant differences between osteosarcopenia group and non osteosarcopenia group in age (P = .002), duration of dialysis (P = .013), vitamin D levels (P = .002), and MET (P = .007). There was a significant positive correlation between vitamin D level and MET (r = .464; P < .001). The results of the multivariate analysis indicated that only MET was a relevant factor in osteosarcopenia.Conclusion
Duration of dialysis, low vitamin D levels, and physical activity after kidney transplantation were related to osteosarcopenia. These results suggested that osteosarcopenia in kidney transplant recipients is a carryover from the dialysis period. 相似文献11.
K. Komorowska-Jagielska Z. Heleniak A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1868-1873
Background
Cytomegalovirus (CMV) infection is associated with an increased risk of cardiac complications in kidney transplant recipients (KTRs). Some data suggest that CMV may be involved in atherogenesis. The aim of the study was the analysis of CMV medical history in KTRs and its influence on cardiovascular (CV) incidents.Materials and Methods
The study observed 254 patients (165 male/89 female) with mean age of 47.2 (range, 15–81) years and duration of dialysis before transplantation 29.2 months who received transplants in 1 university unit (2007–2013). Thirty-six patients were transplanted preemptively. The mean time of observation lasted 7 years. KTRs suffered from diabetes, hypertension, and hyperlipidemia (17.3%, 88.5%, and 61%, respectively). Coronary artery disease was diagnosed in 19.6% patients, 3.5% underwent elective coronary surgery operation, and 9.05% had CV incidents before transplantation. The following CMV donor/recipient (D/R) viral statuses were noticed in the study group: D+/R+ (68.9%), D+/R? (16.9%), D?/R+ (10.2%), and D?/B? (3.9%). D+/R? received universal CMV prophylaxis; the rest were under preemptive CMV prophylaxis. CMV infection affected 87 (34.25%) patients; there were 24 primary infections and 85 secondary infections (some patients had more than 1 CMV). Mean time of diagnosis of the primary and secondary CMV infection was 190.7 and 160.5 days, respectively.Results
During observation 22 patients experienced 26 CV incidents: 15 were D+/R+, 6 were D+/R?, and 1 was D?/R+. CMV infections occurred in 40.9% of patients with CV incidents after kidney transplantation. In comparison, 33.6% patients without CV incidents after kidney transplantation suffered from CMV infection.Conclusions
CMV infection in KTRs was not a crucial risk factor for CV incidents. 相似文献12.
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13.
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14.
M.S. Gniewkiewicz M. Czerwińska J. Gozdowska J. Wyzgał T. Grochowiecki S. Nazarewski M. Kosieradzki M. Durlik 《Transplantation proceedings》2018,50(7):2128-2131
Background
Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with end-stage renal disease (ESRD) due to type 1 diabetes mellitus (DM1). Since the 1980s, pancreas transplantation has become the most effective strategy to restore normoglycemia in patients with DM1. The aim of this study was to present long-term outcomes data for SPKT.Methods
We performed a retrospective analysis of 73 SPKT recipients followed in our outpatient center who underwent transplantation between 1988 and 2015.Results
A total of 50.7% of the patients were male. At the time of surgery, patients' mean age was 37.38 ± 7.44 years. Patients were diagnosed with DM1 at an average of 25 ± 6.08 years before SPKT. For 21.9% of patients, the transplant was done preemptively. Most (91.8%) had enteric drainage. All patients received induction of immunosuppression (either polyclonal immunoglobulins anti-thymocyte globulin or thymoglobulin [64.4%] or monoclonal globulins daclizumab or basiliximab [35.6%]). Patient survival at 1, 5, 10, 15 years was 99%, 97%, 89%, and 75%; kidney survival was 99%, 96%, 84%, and 67%; and pancreas survival was 95%, 92%, 84%, and 64%, respectively. There was a notable tendency toward increased creatinine level (from 1.18 at 1 year to 1.78 at 15 years) and decreased hemoglobin level (from 13.84 at 1 year to 12.65 at 15 years).Conclusion
Diabetic patients with ESRD have a poor prognosis without transplantation. SPKT provides marked prolongation of the patient's life and freedom from insulin injections. Enteric drainage is currently the surgical technique of choice. SPKT should remain as the treatment of choice in this patient population. 相似文献15.
K. Krzyżowska A. Kolonko P. Giza J. Chudek A. Więcek 《Transplantation proceedings》2018,50(6):1755-1759
Background
Nowadays, a reduced initial daily dose of tacrolimus (Tac) (0.1–0.15 mg/kg) is recommended for the majority of kidney transplant recipients (KTRs). The aim of the study was to analyze the safety of such a regimen, including the risk of first inadequately low Tac blood level, acute rejection (AR) occurrence, or early graft dysfunction.Methods
In 2011, we introduced a modified (0.1–0.15 mg/kg/d) initial Tac dosing regimen in older (>55 years) and/or overweight KTRs. To assure the safety of this protocol, we monitored the risk of inadequately low blood Tac level (<6 ng/mL) and incidence of AR or delayed graft function (DGF). The historical cohort with the higher Tac dosing regimen (0.2 mg/kg/d, n = 208) served as a control group.Results
The mean Tac daily dose in 78 KTRs (group with reduced dosing) was 0.133 (95% confidence interval [CI], 0.130–0.136) mg/kg and was significantly lower than the standard, previously prescribed dose of 0.195 (95% CI, 0.194–0.197) mg/kg. Of note, induction therapy was employed twice more often in the reduced Tac dosing group. The dose reduction resulted in a slight, nonsignificant decrease in first Tac trough level. The percentages of patients with first Tac troughs <6 ng/mL (5.1% vs 4.8%), AR (6.4% vs 5.8%), and DGF (25.6% vs 31.2%) were similar in the reduced and standard dosing groups.Conclusion
The currently recommended reduction in Tac initial dosing does not increase the risk of inadequate immunosuppression and does not affect the early graft function. Regardless of Tac dose reduction, there is still a substantial risk of Tac overdosing in older or overweight KTRs. 相似文献16.
Mark D. Brigham Lauren P. Radeck Clive M. Mendonca Isabel Lang Justin W. Li Jeffrey D. Kent Brian LaMoreaux Brian F. Mandell Richard J. Johnson 《Transplantation proceedings》2019,51(6):1816-1821
PurposeThis retrospective analysis of medical chart data was performed to compare severity and treatment of gout in patients with or without a history of kidney transplantation (KT).MethodsVia an online survey, a panel of board-certified US nephrologists (N = 104) provided the following deidentified chart data for their 3 most recent patients with gout: age, sex, serum uric acid, numbers of swollen or tender joints, visible tophi, gout flare events (prior 12 months), gout drug treatment history, and KT history. The presence of “severe, uncontrolled gout” was defined as: serum uric acid ≥ 7.0 mg/dL, ≥1 tophi and ≥2 flares in the last 12 months, and history of xanthine oxidase inhibitor treatment.ResultsTwenty-five out of 312 (8.0%) gout patients had a history of KT. Univariate analysis found that patients with gout and history of kidney transplants had: greater prevalence of severe uncontrolled gout (27% vs 8%, P = .007) and tophi (36% vs 17%, P = .030), and higher rates of failure or physician perceived contraindication to allopurinol (44% vs 23%, P = .028).ConclusionThis study provides preliminary evidence that gout in patients with history of KT is more severe and poses greater challenges to pharmacologic management. Although gout has been linked to worse outcomes among kidney recipients in the literature, there are presently no publications on gout severity among patients with KT in comparison to other patients with gout. Further investigation of disease severity and appropriate, effective treatment options in recipients of kidney transplant with a diagnosis of gout, especially prior to the transplant, is warranted. 相似文献
17.
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18.
Shunta Hori Kazuki Ichikawa Yosuke Morizawa Daisuke Gotoh Yoshitaka Itami Yasushi Nakai Makito Miyake Tatsuo Yoneda Nobumichi Tanaka Katsunori Yoshida Kiyohide Fujimoto 《Transplantation proceedings》2019,51(6):1763-1772
BackgroundDespite advancements in the management of kidney transplantation (KT), kidney transplant recipients (KTRs) have a higher risk of mortality than the age-matched general population. Improvement of long-term graft and patient survival is a significant issue. Therefore we investigated the effects of postoperative nutritional status on graft and patient survival and explored the predictive factors involved in nutritional status.MethodsOur retrospective study included 118 KTRs who underwent KT at our hospital. Clinical and laboratory data were obtained from medical charts. The prognostic nutritional index (PNI) was used to assess nutritional status. Changes in nutritional status after KT were monitored and the effect of nutritional status on graft and patient survival was investigated. The variables involved in nutritional status were also explored.ResultsThe KTRs in this cohort comprised 66 men and 52 women with a median age of 47 years at KT. There were 16, 32, and 22 cases of cadaveric, preemptive, and ABO-incompatible KTs, respectively. Postoperative PNI gradually improved and was stable from 6 months after KT. Although graft survival was regulated by ABO-compatibility, independent predictors for patient survival were history of dialysis, PNI, and serum-corrected calcium levels. Preemptive KT and inflammatory status contributed to PNI.ConclusionsNutritional status of KTRs improved over time after KT and could contribute to patient survival. Optimal nutritional educational programs and interventions can lead to better outcomes in KTRs. Further studies are needed to validate our results and develop appropriate nutritional educational programs, interventions, and exercise programs. 相似文献
19.
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20.
Bulent Kaya Esra Ates Saime Paydas Yasar Sertdemir Mustafa Balal 《Transplantation proceedings》2019,51(7):2324-2329
PurposeIn this study, we evaluated the relationship between serum homocysteine level and proteinuria, parathyroid hormone, vitamin D, and bone mineral density in kidney transplant recipients (KTR).Materials and methodsA total of 117 stable KTR older than 18 years was followed in our outpatient clinic. Demographic data were recorded. Simultaneously biochemical parameters, including glucose, blood urea nitrogenous, creatinine, calcium, phosphorus, sodium, potassium, albumin, parathormone, vitamin D3, homocysteine, vitamin B12, folate, and 24-hour urine protein, and bone mineral density of the femoral neck and spine by dual-energy x-ray absorptiometry (DEXA) were measured.ResultsDEXA measurements were normal, osteoporotic, and osteopenic (12.3%, 36.3%, and 51.3%, respectively). There was a relationship between the serum homocysteine and usage of rapamycin (P = .05), statins (P = .057), and beta blockers (P = .01), DEXA measurements were not related with serum homocysteine levels and immunosuppressive drugs used. Serum homocysteine levels correlated negatively with blood urea nitrogen (P = .002), creatinine (P = .001), vitamin B12 (P < .001), and a positively daily proteinuria (rho = 0.203, P = .031). There was a negative relationship between proteinuria and serum level of vitamin D.ConclusionsThe bone mineral density decreased in more than 87% of our KTR. We did not find any relationship between DEXA measurements and levels of homocysteine, vitamin D, parathormone, and immunosuppressive drugs. It should be noted that some drugs used may affect serum homocysteine levels. Interestingly, there was a relationship between proteinuria and serum levels of homocysteine and vitamin D. Therefore, serum levels of homocysteine and vitamin D should be evaluated for preventing renal damage in KTR. 相似文献