Krzysztof Pabisiak

Experience With Autosomal Dominant Polycystic Kidney Disease in Patients Before and After Renal Transplantation : A 7-Year Observation

OBJECTIVE Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the presence of multiple cysts in both kidneys. Symptoms of the disease may arise either from the presence of cysts or from increasing loss of kidney function. First symptoms usually appear in the third decade of life: lumbar pain, urinary tract infections, arterial hypertension, or renal colic due to cyst rupture or coexistent nephrolithiasis. An early diagnosis, male gender, large kidneys by sonography, arterial hypertension, hematuria, and urinary tract infections are predictive factors of a faster progression of the disease. Our aim was to establish the indications for nephrectomy among symptomatic ADPKD patients before kidney transplantation and to assess the risks of posttransplantation complications among ADPKD patients without nephrectomy. PATIENTS AND METHODS The observed group consisted of 183 patients with ADPKD among whom 50 (27.3%) underwent kidney transplantation during a 7-year observation period (2000-2007). Among those subjects were 3 groups: (I) nephrectomy preceding transplantation; (II) nephrectomy during kidney transplantation; and (III) without nephrectomy. RESULTS Among group I before transplantation we observed: arterial hemorrhage, wound infections, and splenectomy 4 weeks after ADPKD nephrectomy; afterward we observed: urinary tract infections and contralateral cyst infection. Among group II we only observed 1 case of wound infection. Among group III we observed: ascending urinary tract infections, cyst infections, and cyst hemorrhage. Cyst hemorrhage and cyst infections led mainly to ADPKD kidney nephrectomy. During the observation time, 80.95% of grafts were functioning. CONCLUSIONS Unilateral nephrectomy is a well-founded preliminary surgical treatment before kidney transplantation. Bilateral nephrectomy before or during transplantation eliminates ADPKD complications and does not significantly increase general complications. The greatest numbers of complications and of graft losses were observed among the group without pretransplantation nephrectomy.

Autosomal Dominant Polycystic Kidney Disease Is Not a Risk Factor for Post-transplant Diabetes Mellitus. Matched-pair Design Multicenter Study

BACKGROUND Post-transplant diabetes mellitus (PTDM) is a relatively common complication of kidney transplantation. The aim of our work was to compare the incidence of PTDM in kidney transplant recipients with and without autosomal dominant polycystic kidney disease (ADPKD) in a matched-pair design study. METHODS In total, 98 pairs of graft recipients, all of Caucasian origin and who received a kidney from the same cadaveric donor, were included in the study. The following clinical data were collected for statistical analysis: age, body mass index (BMI) before transplant, length and type of dialysis treatment, residual diuresis, and cold and warm graft ischemia time. Diabetes was diagnosed based on American Diabetes Association (ADA) criteria. RESULTS Incidence of PTDM was 19.4% in the ADPKD group and 18.4% in the non-ADPKD group, with no significant differences between groups. Multivariate logistic regression analysis of the PTDM risk in the ADPKD group including age, gender, BMI, and dialysis time as independent variables indicated that only higher residual diuresis is a significant independent risk factor (OR = 5.64 per every L/24 h, 95% CI = 1.31-24.33, p = 0.017). Similarly, logistic regression analysis adjusted for age and gender in the non-ADPKD group has shown that significant independent risk factors are BMI (OR = 1.30 per every kg/m(2), 95% CI = 1.06-1.59, p = 0.0094), longer dialysis time prior to transplant (OR = 1.036 per each month, 95% CI = 1.004-1.070, p = 0.025), and a history of arterial hypertension (OR = 9.09, 95% CI = 1.20-68.66, p = 0.030). CONCLUSIONS In this paired analysis, our results suggest that diagnosis of ADPKD does not increase risk of PTDM.

Factors that impact on immediate graft function in patients after renal transplantation.

Kidney transplantation has become therapy of choice for patients with end-stage renal failure. However, many factors may cause graft rejection or delayed graft function, both of which decrease the prognosis for graft survival. For transplantologists the most important endeavor is to eliminate factors responsible for shortening graft function and to find those predictive of immediate graft function. The aim of the study was to investigate which factors influence early graft function. We retrospectively reviewed 442 renal transplant patients performed between 1990 and 1995 in two Szezecin units. All patients received an identical immunosuppressive drug schedule. Three hundred twelve patients who displayed immediate graft function were included in the study group to analyze donor and recipient age and sex, etiology of ESRD, HLA compatibility AB0 and Rh compatibility cold ischemia time, warm ischemia time, antileukocytes antibodies (PRA), and period of dialysis therapy before transplantation. We observed statistical significance for HLA and AB0 compatibility, younger donor age, and shorter cold ischemia time as the most important factors predictive of early graft function and an improved prognosis for graft survival.

Impact of selected factors on early graft function in patients after renal transplantation

Transplantation is the best treatment for end-stage renal diseases. For transplantologists, it is most important to know the factors that worsen graft survival prognosis. The aim of the study was to investigate factors predictive of graft loss and shortened graft survival. We retrospectively reviewed 442 renal transplant patients between 1990 and 1995 in two Szczecin units, all of whom received a triple-drug immunosuppressive regimen. One hundred thirty patients showed graft disorders such as delayed graft function or primary nonfunction. The occurrence of these disorders was examined as a function of donor and recipient age and sex, cause of ESRD, HLA compatibility, ABO and Rh compatibility, cold ischemia time, warm ischemia time, antileukocyte antibody level (PRA), and period of dialysis therapy before transplantation. The study showed that a high maximal PRA level, incompatibility for ABO group, and a longer warm ischemia time increase the probability of early graft function disorders.

Does Calcium Channel Blocker Improvement of Perfusion Impact the Functioning of Kidney Graft in Early Period After Transplantation

The aim of the study was to evaluate the influence of reduced vascular resistance following calcium channel blocker verapamil administration on kidney function at 3 months after transplantation. A group of 48 kidneys received 100 microg verapamil by injection directly into renal artery before starting perfusion. The control group included 48 paired kidneys without verapamil addition. Calcium channel blocker therapy with verapamil greatly decreased renal vascular resistance but it did not affect graft function. Administration of calcium channel blockers improved kidney function in the early period after transplantation. A better-functioning graft seems to be based more on metabolic than hemodynamic effects.

Epidemiology of infections in kidney transplant recipients – data miner's approach

Infections remain a frequent complication following organ transplantation. Agents present within the general population remain common in recurrent infections among renal transplant recipients. Data mining methodology has become a promising source of information about patterns in the organ transplant recipient population. The aim of the study was to use data mining to describe the factors influencing single and recurrent infections in kidney transplant recipients. A group of 159 recipients who underwent kidney transplantation between 2005 and 2008 was analysed. RapidMiner and Statistica softwares were used to create decision tree models based on CART Quinlan and C&RT algorithms. There were 171 microbiologically confirmed episodes among 67 recipients (41%), and 191 separate species isolations were performed. Over 50% of the infected patients underwent two or more infectious episodes. Two classification decision tree models were created. The following features were enabled to differentiate the groups with single or recurrent infections: the duration of cold ischaemia, the post‐transplant hospitalization period, the cause of chronic kidney disease and pathogens. The post‐transplant hospitalization period and the length of cold ischaemia appear to be the principal parameters differentiating the subpopulations analysed. These coexisting factors, connected with recurrent infections in kidney transplant recipients, resemble a network which requires an advanced analysis to support the traditional statistics.

Authorisation of organ procurement — is it influential factor for the identification of potential organ donors?

For many years, the authorisation of organ procurement has been discussed as a contributory factor to the number of potential organ donors. This paper presents different forms of authorisation and their influence on the decisions of both individuals and society. The general legal framework for the authorisation of organ procurement in Poland is described along with the solutions implemented by countries in which both implicit and explicit consent models are in effect. The presented arguments suggest that the form of authorisation does not directly influence the number of organs procured for transplantation.

Bone marrow of multiorgan donors underutilized: implications for improvement of accessibility of hematopoietic cells for transplantations.

Background. The demand for human hematopoietic stem and progenitor cells (HSPCs) for transplantation is increasing. Thus, effective alternative sources of HSPCs are required. Consequently, we sought to expand the accessibility of hematopoietic cells for clinical purposes by the investigation of hematopoietic reconstitution after transplantation of human HSPCs harvested from the bone marrow (BM) of heparinized deceased organ donors (HDODs). Methods. For multipart research comparison, human BM HDODs-, healthy donor-derived, umbilical cord blood nuclear cells, or CD34+ cells were transplanted into sublethally irradiated NOD/SCID mice. Twenty-eight days after transplantation nuclear cells were isolated from the murine BM, spleen, and peripheral blood and were used to quantitatively detect human CD45 antigen by quantitative real-time reverse transcriptase–polymerase chain reaction and flow cytometry. The clonogenic growth of human colony-forming units was also investigated. Results. We found that umbilical cord blood-derived HSPCs showed the greatest transplantation potential in our in vivo model. Interestingly, the transplantation potential of HSPCs collected from the BM of HDODs was of the same quality as cells obtained from healthy BM donors. Conclusion. Based on these results, we conclude that HDODs are a strongly underappreciated source of HSPCs that are ready to use for clinical purposes.

Relation Between Intensity of Religious Practices and Organ Donation in Poland

Background Acceptance of organ donation in the face of sudden death of a loved one is stressful for the relatives. In such circumstances, it is very valuable to know the opinion of the deceased on the matter. If this knowledge is unavailable, religion and opinions of spiritual leaders could be a of guidance in the process of making the decision regarding organ donation. Aim Establish the relation between religiousness and disposition to prosocial behaviors measured by organ donation in Polish population. Methods The axis for this survey was the split of the territory of Poland according to a quantitative index of religiousness referred further as percentage of dominicantes. The term describes number of people participating in weekly religious practices. Values above 40% were qualified as high dominicantes (HD), while those below labeled as low dominicantes (LD). Above mentioned setting was used as background for analysis of transplantation activity in Poland’s administrative regions (voivodeships n=16) in years 2014‐2015. Data taken to comparison were numbers of actual organ donors, recipients rates, people on waiting lists, count of objections in national register. All indices were converted to per million population (pmp). Results Proposed extrapolation of the index describing religiousness on the map of Poland has split it into two parts: low domicantes (LD; n=8) and high domincantes. Superimposing on that the data of transplantation acitvity yielded results as follows: in analyzed years actual donor rate in LD/HD regions were: 16,06 vs.13,91(p=0.64);14,83 vs.10,90(p=0,08),respectively. Rate of organ recipients reached 43 vs.36 pmp (p=0.06), respectively. Parallely objections rate for LD/HD regions reached 669/475 pmp (p=0.028). Conclusions Despite fluctuations in donations rate year by year, analysis revealed correlation between religiousness and geography of organ procurement in Poland. Donations indices were lower in regions with higher religiousness. Further research on identification of correlates important for this tendency in homogenous denomitional society is warranted. References 1. Saroglou V., 2013 Religion, spirituality and altruism. APA Handbook of Psychology, religion and spirituality, Washington DC,439-457. 2. Institute for Catholic Church Statistics and National Center for Culture (ICCS) Indices of dominicantes i communicantes upon dioceses in 2014 year. Available from:http://www.iskk.pl/kosciolnaswiecie/231-dominicantes-2014.html. (accessed February 2016). 3. Shariff, A.F, Willard, A.K, Andersen, T.,Norenzayan A., 2016.Religious Priming: A Meta-Analysis With a Focus on Prosociality. Pers Soc Psychol Rev. 20,27-48. Figure. No caption available. Figure. No caption available.

Pseudo-allergic symptoms as a rare manifestation of an ascending aortic aneurysm.

A 79-year-old man was admitted early in the morning to the emergency department (ED) due to oedema of the lips, tongue and dyspnoea. The symptoms awoke the patient from sleep in a supine position. On admission, heart rate was irregular about 80/min, blood pressure 150/80 mm Hg, respiratory rate 23/min, and temperature 36.8°C. Abnormal findings included visible, painless swelling of the lower part of the face, lips, mucous membranes of the mouth and throat, tongue and hoarseness. No itching was present. There were no obvious respiratory or cardiovascular abnormalities on physical examination. Medical history revealed ischaemic heart disease and myocardial infarct of the inferior wall 12 years ago and persistent atrial fibrillation. Aortic dilatation had been found on echocardiography ten years ago without follow up since that time. There was no history of exposure to chemicals or allergies but due to the swelling of the lips and tongue of unknown cause, the patient had twice attended the emergency department (in 2004 and 2005). The last episode of similar symptoms had occurred a year earlier during a long train trip and the symptoms subsided spontaneously. First line therapy at ED included oxygen mask and semi-supine position with some relief of symptoms. Chest X-ray (Fig. 1) detected the enlargement of the mediastinal shadow on the right side. Echocardiography revealed the extension of ascending aorta to the diameter of 56–57 mm at the height of 5 cm above the aortic valve (Figs. 2, 3). Acute superior vena cava syndrome (SVCS) was diagnosed based on the medical history and clinical picture, confirmed by echocardiography. The patient did not agree to further diagnostics and potential surgical intervention. Symptoms and signs of vena cava obstruction regressed within 4 hours of the observation. The patient left the ED in a stable general condition, without symptoms reported on admission. Currently, thrombosis caused by the presence of an intravascular device is the most common cause of nonmalignant SVCS. In most cases, thrombotic complications are revealed within 100 days from device introduction. The second major cause of SVCS is ascending aorta abnormality. The length of superior vena cava varies between 6 cm and 8 cm. It runs along the right edge of the sternum and then forms an arch whose concave margin is adjacent to the ascending aorta. The distension of aortic diameter is mainly due to degenerative changes of the aortic wall. The significantly dilated aorta (> 55 mm) may compress superior vena cava. In the case described above, swelling of the facial soft tissues was the main symptom and had to be differentiated from an allergic reaction which is present in 40% of patients admitted to ED with vasomotor response and urticaria. Demographic changes with increasing numbers of older patients will result in the more frequent occurrence of similar cases, and a differential diagnosis of obscure oedema located in the upper part of the body should involve the exclusion of an ascending aortic aneurysm as a possible cause.