Agne Laucyte-Cibulskiene

Malignancy after Renal Transplantation: A Single-Center Experience

BACKGROUND The aim of this study was to evaluate the incidence and characteristics of malignant tumors in kidney transplant recipients (KTR) in Lithuania and to access the changes in KTR survival after developing cancer. We also analyzed and compared results with data from other centers worldwide. MATERIAL AND METHODS We performed a retrospective cohort study of all 395 patients transplanted at Renal Transplantation Center of Vilnius University Hospital Santariškių Klinikos (RTC of VUHSK) between 1 January 2000 and 31 December 2010. RESULTS Mean age at transplantation was 40.33 ± 11.46 years; 54.9% of recipients were male, 45.1% female; 23 (5.8%) recipients developed 25 malignancies, of which 1.5% had urinary system cancer, 0.8% had non-melanoma skin cancer, hematolymphopoetic cancer, or cancer of gastrointestinal tract, and 0.5% developed cancers of female reproductive system, breast, central nervous system cancer, or had more than 1 malignancy. Average time to first malignancy was 46.7 months. Cumulative incidence of malignancy was 1.8%, after 1 year, 4% after 5 years, and 14.2% after 10 years. There were 32 patients (8.1%) with pre-malignant lesions. Recipients older than 45 years had higher frequency of malignancies (p = 0.005). KTR who developed gastrointestinal cancer had significantly shorter survival time than patients without malignancy (p = 0.01). Recipients who had been on dialysis for more than 35 months also had a significantly shorter survival (p=0.001). CONCLUSIONS Older patients had higher risk for developing malignancies, and recipients with gastrointestinal cancer had the worst survival. That suggests we need better screening programs for this type of cancer and for older patients at RTC of VUSHK.

A Successful Implementation of Laparoscopic Living Donor Nephrectomy: First Experience in Lithuania

Introduction Almost two decades ago laparoscopic living donor nephrectomy (LLDN) technique was developed to reduce living donor complication rate. However, the requirement of experienced surgeons, the use of mainly left donor kidney and technical challenges for multiple arteries are the main limitations that inhibit the application of LLDN technique in some centers. We aimed to share the initial results of LLDN in high volume university center, which is performing laparoscopic nephrectomies for other indications. Materials and Methods During year 2017, we performed 4 LLDN. Transperitoneal approach was used in all cases and kidney was removed using suprapubic incision. All donors and recipients were prospectively analyzed within 6 months follow-up. Patient clinical, laboratory, operation-related data were collected from directly interviewing them and from medical records. All patients have their written informed consent. Results and Discussion 1 male and 3 female donated left kidney by using LLDN technique. Mean age 58 ∓9 y, 2 of them with history of previous cholecystectomy. All donated kidney had a single renal artery and renal vein. Pre-operative average eGFR was 94.2 ∓7.1 ml/min/1.73m2, immediately after LLDN – 57.5 ∓10.3 ml/min/1.73m2, after 1 month – 56.0 ∓9.1 ml/min/1.73m2. There were no intraoperative complications, surgery duration 223.75 ∓21.74min, cold ischemia time was 77.5 ∓28.77 min, warm ischemia time – 6.37 ∓3.14 min. The donors were discharged within 5-6 days after LLDN. Postoperative donor complications: acute kidney injury – 1; prolonged postoperative abdominal pain – 1. Posttransplant recipient complication: acute kidney rejection – 1 case of atypical hemolytic syndrome; no cases of delayed graft function. Conclusion Our initial experience confirms that LLDN is an approach which is easy to learn, especially in a high volume university hospital with expertise in performing laparoscopic nephrectomies for other indications. Therefore, we would like to encourage centers, which are still performing open living donor nephrectomies, to introduce laparoscopic method into everyday practice. We believe, that changing the nephrectomy technique could increase living donation numbers in the center.

Usefulness of pretransplant aortic arch calcification evaluation for kidney transplant outcome prediction in one year follow-up

Abstract Vascular calcification (VC) is linked to post-transplant cardiovascular events and hypercalcemia which may influence kidney graft function in the long term. We aimed to evaluate whether pretransplant aortic arch calcification (AoAC) can predict post-transplant cardiovascular or cerebrovascular events (CVEs), and to assess its association with post-transplant plasma calcium levels and renal function in one-year follow-up. Our single-center observational prospective study enrolled 37 kidney transplant recipients (KTR) without previous history of vascular events. Two radiologists evaluated pretransplant AoAC on chest X-ray as suggested by Ogawa et al. in 2009. Cohen’s kappa coefficient was 0.71. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry before and one year after transplantation. Patient clinical, biochemical data, and cardiovascular/CVE rate were monitored within 1 year. We found out that eGFR1year correlated with eGFRdischarge and calcium based on hospital discharge data (β = 0.563, p = .004 and β = 51.360, p = .026, respectively). Multivariate linear regression revealed that donor age, donor gender, and recipient eGFRdischarge (R-squared 0.65, p = .002) better predict eGFR1year than AoAC combined with recipient eGFRdischarge (R-squared 0.35, p = .006). During 1-year follow-up, four (10.81%) patients experienced cardiovascular events, which were predicted by PWV ratio (HR 7.549, p = .045), but not related to AoAC score (HR 1.044, p = .158). In conclusion, KTR without previous vascular events have quite low cardiovascular/CVE rate within 1-year follow-up. VC evaluated as AoAC on pretransplant chest X-ray together with recipient eGFRdischarge could be related to kidney function in one-year follow-up.

A case of successfully treated relapsing peritoneal dialysis-associated peritonitis caused by Gordonia bronchialis in a farmer

Gordonia species are aerobic, weakly acid-fast, Gram-positive pathogens that rarely cause human infections, usually in immunocompromised patients. It is uncommon bacilli in cases of peritoneal dialysis-related peritonitis. The small number of infections with Gordonia species reported for humans may be stipulated by the difficulty in identifying the organism using conventional techniques. Careful review of Gram stains and modified-acid-fast stains should be done, so that confusion with other actinomycetes is minimized, pending the genotypic identification. Here we report a case that was caused by Gordonia bronchialis and thus required different considerations of treatment.