The effect of faecal enema on five microflora-associated characteristics in patients with antibiotic-associated diarrhoea.

BACKGROUND: Patients with antibiotic-associated diarrhoea (AAD) show significant disturbances in short-chain fatty acid pattern. In the present study five more microflora-associated characteristics (MACs) were investigated before and after administration of an enema containing faecal microflora from a healthy person on a Western diet. METHODS: The functions of the microflora were determined with gas chromatography, electrophoresis, and spectrophotometry. RESULTS: The conversion of cholesterol to coprostanol and the concentration of urobilinogen and trypsin were significantly reduced in comparison with healthy persons. The pattern of mucin was altered, but beta-aspartylglycine remained the same as in healthy persons. Enema treatment influenced these functions to different extents. CONCLUSION: Most MACs were significantly disturbed in patients with AAD. Administration of a human faecal enema modified these changes and relieved diarrhoea, usually within 4 days.     

Estimated glomerular filtration rate in stable older kidney transplant recipients—are present algorithms valid? A national cross‐sectional cohort study

Several equations have been developed for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD), but none were developed based on data from elderly kidney transplant recipients (KTR). The primary aim of this study was to evaluate different creatinine‐based equations in stable elderly KTR. A national cross‐sectional study was performed using data from 263 consecutive kidney transplant recipients 60 years or older who performed a routine GFR measurement one year after engraftment. GFR was measured by iohexol clearance calculation based on two samples. eGFR was calculated from a range of different creatinine‐based equations using information obtained at the time of GFR measurement. Bias, precision, and accuracy were evaluated for each equation. All equations apart from Nankivell had accuracy (P30) > 80%. The BIS1, FAS, LMR_CR, and Cockcroft & Gault equations in recipients older than 70 years and the FAS, LMR_CR, and MDRD in recipients 60–69 years old had nonsignificant bias. The CKD‐EPI had significant bias in both groups. If one should choose a single equation for follow‐up of individual CKD progression in all recipients ≥ 60 years, the FAS or LMR_CR equations are probably the best alternatives.     

Kidney allograft subclinical rejection modulates systemic inflammation measured by C‐reactive protein at 1 year after transplantation

Kidney allograft inflammation is associated with proinflammatory modifications of peripheral blood mononuclear cells, suggesting that renal inflammation contributes to systemic inflammation. Thus, the aim of this study was to evaluate the relationship between subclinical inflammation in surveillance biopsies performed at 1 year and systemic inflammation assessed by C‐reactive protein (CRP) levels at the time of biopsy. We analyzed 544 surveillance biopsies performed at 1 year that were classified as normal (n = 368), borderline (n = 148), or subclinical rejection (SCR) (n = 28). CRP levels were divided into quartiles. Patients in 1st, 2nd, and 3rd quartile were classified as low CRP (n = 408) and patients in the 4th quartile as high CRP (n = 136). Univariate analysis showed that the proportion of patients with SCR was higher in the high CRP group (10.3% vs 3.4%, P = 0.0067). Multivariate analysis showed that independent predictors of high CRP were body mass index (odds ratio [OR] 1.072 and 95% confidence interval [CI] 1.027‐1.119), a positive urine culture at the day of the biopsy (OR 2.760 and 95% CI 1.205‐6.323), and the presence of SCR at 1‐year surveillance biopsy (OR 7.260 and 95% CI 3.530‐14.935). In summary, we describe that subclinical acute rejection constitutes an independent predictor of systemic inflammation as measured by CRP.     

Development of gut microbiota in infants not exposed to medical interventions

Knowledge of the composition of a normal healthy gut microbiota during infancy is important for understanding the role of gut microbiota in disease. A limitation of previous studies is that they are based on infants who have been subject to factors, which can have a profound disruptive effect on the natural colonization process. We describe the colonization process, during the first 4 months after birth, in 85 infants who have experienced no major medical or dietary interventions. They were all vaginally delivered, healthy, term infants, who were not exposed to antibiotics, exclusively breastfed during their first month of life and at least partially breastfed up to 4 months. Selected microbial groups were identified by targeting small subunit microbial ribosomal RNA genes. In contrast to more recent studies, but in agreement with older studies, almost all our infants harbored γ-Proteobacteria and Bifidobacterium. Yet undefined non-cultivable species belonging to Bacteroides, as well as microbes identified as Lachnospiraceae 2, were common. Strong associations were observed between some specific constituents of microbiota at day 4 and the concentration of specific microbial groups at day 120, indicating that early gut microbiota may influence later microbiota. Novel information of the undisturbed composition of early gut microbiota in babies is presented.     

Spontaneous regression of initially elevated peak systolic velocity in renal transplant artery

There is limited knowledge about the incidence, clinical implication and spontaneous course of transplant renal artery stenosis detected early after renal transplantation. We performed Doppler ultrasound examination of the transplant artery(s) 2 months after transplantation in 98 consecutive patients and peak systolic velocity (PSV) was measured. All patients with an elevated PSV ≥1.8 m/s were reexamined 20 months later and clinical data were followed for 3 years. At the initial examination 2 months after transplantation 15 recipients had a PSV ≥1.8 m/s, mean value for PSV 2.5 (1.8–3.6) m/s, whereas 83 recipients had a normal PSV of 1.3 (0.7–1.7) m/s (P < 0.01). At baseline there were no statistical significant differences in clinical parameters between the high PSV versus normal PSV recipients. Twenty (15–28) months after transplantation 14 patients with initial elevated PSV were re‐examined. There was an overall mean reduction in PSV of 0.5 (?0.7 to 1.2) m/s from 2.4 (1.8–3.4) m/s to 1.9 (1.2–3.1) m/s (P = 0.02). Detection of a high PSV early after transplantation did not affect graft function or blood pressure 3 years after engraftment. We conclude that a high PSV, at 2 months after engraftment, seems to be more of an ‘incidental finding’ that should be re‐challenged and carefully interpreted.     

Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients

Background. Post-transplant diabetes mellitus is a known complication of steroid therapy in renal transplant recipients. Both insulin resistance and insulin deficiency have been shown to be necessary for development of post-transplant diabetes mellitus. It is not known whether recipients with impaired glucose tolerance have similar degree of insulin resistance or deficient insulin response as recipients with post-transplant diabetes mellitus. Methods. To address this question, we used an oral glucose tolerance test to categorize 46 renal transplant recipients on triple immunosuppressive medication to groups with normal glucose tolerance, impaired glucose tolerance or post-transplant diabetes mellitus. Insulin sensitivity was measured using a hyperinsulinaemic euglycaemic clamp. Insulin response was calculated from the increase in serum insulin concentration during the oral glucose tolerance test. Results. Twenty-five were categorized to normal glucose tolerance, 15 to impaired glucose tolerance and six to post-transplant diabetes mellitus. There were no statistically significant differences between the groups regarding prednisolone dose, azathiprine dose, use of {beta}-blocker, age, gender, weight, waist-hip ratio, body mass index, donor source, smoking habits, or first-degree relatives with histories of diabetes mellitus. The impaired glucose tolerance and post-transplant diabetes mellitus groups showed a significant reduction in insulin-stimulated glucose disposal rate (mg/kg^.min) compared to the normal glucose tolerance group (4.6±1.6 and 3.4±1.3 respectively vs 7.1±2.4, P<0.05). The insulin response (picomol/l) was not different between the normal glucose tolerance and impaired glucose tolerance groups but was significantly reduced in the post-transplant diabetes mellitus group (448±310 and 450±291 respectively vs 170±128, P<0.05).Conclusion. Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients.     

A prospective study on size and function of paediatric kidneys (<10 years) transplanted to adults

BACKGROUND: There is increasing evidence that paediatric kidneys transplanted to adults have good graft function and satisfactory graft survival. The relationship between size increment and functional potential of paediatric kidneys following transplantation is not defined in detail. We therefore initiated a prospective single centre study, comprising detailed and repeated measurements of size and function of paediatric kidneys transplanted to adults. METHODS: Nineteen adults receiving a first kidney transplant from a paediatric donor (<10 years of age) were included in the study. All patients were followed for 12 months post-transplant. Increment in size and function of the transplanted kidneys were assessed by ultrasound, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). All tests were performed during the first week, post-transplant and subsequently repeated at 1, 3, 6 and 12 months. RESULTS: Kidney volume increased 2.6-fold at 12 months (P < 0.001). GFR and ERPF showed a slightly more moderate increase, 1.8-fold and 1.6-fold, respectively. Patient and graft survival at 1 year were 100% and serum creatinine was 91 micromol/l (66-169). CONCLUSION: The study indicates that paediatric kidneys for transplantation may be considered as excellent rather than being referred to as suboptimal for adult recipients, at least the first year after transplantation.