P Fiedor

Human cystic and alveolar echinococcoses as indication to liver transplantation

The human cystic and alveolar echinococcoses are zoonotic diseases caused by larval stages of the tapeworms Echinococcus granulosus and E multilocularis. In man the liver form of the diseases develops most frequently. Recent epidemiological data indicate that the distribution of E multilocularis in the central Europe is wider than was previously anticipated; more cases of human alveococcosis during the last years have also been noted in Poland. In the present paper we analyzed several cases of human echinococcoses from Poland with respect to diagnosis and treatment as well as the indications for liver transplantation.

Amylase levels in preservation solutions as a marker of exocrine tissue injury and as a prognostic factor for pancreatic islet isolation

Occurrence of primary graft nonfunction of pancreatic islets demands research for new methods of organ preservation during cold ischemia conditions. Digestive enzymes released during preservation injure the islets for subsequent rewarming and islet isolation processes. The aim of our study was to assess the amylase level in preservation solution as a marker of exocrine tissue injury, allowing the prognosis of islet yield and viability. The experiments undertaken on rats used three commercially available preservation solutions: ViaSpan (UW); Custodiol (HTK); and Euro-Collins (EC). After 180 minutes of cold ischemia, the highest islet recovery was observed among pancreata stored in UW solution (508 +/- 139 vs HTK 344 +/- 103; P <.05 vs EC 322 +/- 113; P <.05). These islets also revealed the highest insulin stimulation index in glucose static tests (1.19 +/- 0.30 vs HTK, 0.87 +/- 0.43; P <.01, vs EC.25 +/-.06; P <.001). The highest amylase level in the preservation solution was associated with a decreased yield of islets during the isolation process and lowest insulin stimulation index (increasing 139 +/- 18% for EC, 108 +/- 12% for HTK; P <.05 vs 87 +/- 10% for UW; P <.05). Our data strongly suggest, that the dynamic of amylase release during pancreas preservation at 4 degrees C correlates with a reduced number and viability of isolated islets. These results suggest that measurement of amylase levels after pancreas preservation may have potential clinical application as a marker to evaluate pancreatic tissue injury.

Oral cavity as a potential source of infections in recipients with diabetes mellitus

Our previous observations showed alterations of oral cavity status among hemodialyzed patients and kidney allograft recipients as well as differences in the prevalence and composition of microorganisms occurring in the mouths of patients. In the present work, we analysed the results of oral cavity examinations, the identification of microorganisms, and the assessment of their importance to kidney allograft recipients or hemodialyzed patients with diabetes mellitus, in comparison with nondiabetic recipients, dialyzed patients, and control patients.

Proliferation of transplanted allogeneic pancreatic islets

Recent studies showed enhanced regeneration of pancreatic islets in some circumstances. The purpose of our study was to investigate the proliferate potential of rat pancreatic islet cells in allogeneic grafts. Adult Lewis female rats and WAG male rats served as recipients and donors, respectively. Diabetes was induced by single intravenous (IV) injection of streptozotocin producing diabetes as confirmed by nonfasting plasma glucose >300 mg% on 3 consecutive days. Islet rejection was considered complete when glycemia exceeded 250 mg% and was confirmed by histopathological examination. To obtain long survival of allogeneic islets a tolerance-inducing method used allogeneic UV-B irradiated bone marrow transplantation into nonlethally selectively cytoreducted recipients with a donor-type splenocyte infusion followed by cyclophosphamide 200 mg/kg bw. Endocrine cell proliferation was assessed morphometrically using double immunostaining for pKi-67 and insulin or glucagon. Double immunolabelling, propidium iodide staining, and TUNEL assay were used to identify both proliferating and apoptotic cells. The rise of glycemia >350 mg/dL after graftectomy in euglycemic recipients was correlated with immunohistological examination, showing that the euglycemia was due to properly functioning pancreatic islet allotransplants. The immunohistochemical examination confirmed the presence of endocrine beta and alpha cells. In comparison with normal pancreas which showed 0.4 +/- 0.12%, pKi-67-positive cells, long-surviving grafts had a significantly higher proliferation capacity (5.61 +/- 0.94%; P <.001). In contrast, rejected grafts/control groups did not show significantly enhanced proliferation (0.73 +/- 0.19%), and had endocrine cells undergoing apoptosis. The incidence of apoptosis in endocrine cells within long-surviving graft appeared to be extremely low. In conclusion, the growth and death of endocrine cells in allogeneic grafts differ between accepted and rejected cases. The level of proliferation in the graft at day 150 was significantly higher compared with normal pancreatic beta cells.

Algorithm of clinical protocol lowering the risk of systemic Mycosis infections in allografts recipients.

The aim of the study was to describe a diagnostic protocol to lower the risk of a mycotic invasive infection among allotransplant recipients and to suggest the use of preoperative prophylaxis and/or empiric therapy. We chose a group of 268 allograft recipients with transient or constant yeast colonization or confirmed yeast infection. Among 7744 clinical samples, 475 were positive for fungi. We used conventional fungal laboratory diagnosis, enzymatic activity tests, serologic tests, molecular diagnosis of samples from sterile body sites, and histopathologic examinations. The following clinical samples were examined: blood samples; swabs from mouth lesions, throat, and rectum; and sputum, urine, and fecal samples from kidney transplant recipients and simultaneous pancreas-kidney transplantation recipients who are highly predisposed to mycotic infections. We established microbiologic criteria of a systemic mycosis and principles to distinguish colonization from infection.