Tomasz Pilecki

Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity

Renal failure, mainly due to calcineurin inhibitor (CNI) nephrotoxicity, is the most common complication following orthotopic liver transplantation (ltx). The aim of this study was to evaluate the incidence and course of renal failure in adult ltx patients. Severe acute renal failure in early postoperative period due to impaired hemodynamics and CNI nephrotoxicity, occurred in 14 patients, 3 of whom required dialysis. The creatinine clearance after ltx showed a tendency to decrease, but there was no statistically significant difference (P >.05) in the change in serum creatinine clearance levels between patients treated with tacrolimus (TAC) versus Cyclosporine (CsA) during the first 2 years of follow-up. Fourteen patients required conversion of their regimen because of CNI nephrotoxicity namely, dose reduction (n = 7) or discontinuation of CNI therapy with the replacement by mycophenolate mofetil (MMF) (n = 5) or SRL (n = 5). Dose reduction or CNI withdrawal significantly improved the creatinine clearance (P <.05) without affecting lives graft function. No episode of acute rejection was observed after conversion. Neither conversion of CsA to TAC nor the reverse maneuver significantly influenced the serum creatinine level (P >.05). Reduction of the CNI dose or CNI discontinuation or replacement with MMF or SRL in patients with stable liver but impaired renal function is safe, resulting in a significant improvement in renal function.

Rehabilitation and 6-minute walk test after liver transplantation.

BACKGROUND Measurement of exercise capacity is an integral element to assess patients after surgery. Although the 6-minute walk test (6MWT) provides information regarding functional capacity, response to therapy, and prognosis across a range of conditions, its applicability for liver transplant recipients remains to be established. The aim of our study was to examine whether the 6MWT in combination with a subjective rating of perceived exertion (Borg Scale [BS]) could be used to evaluate exercise capacity among patients after liver transplantation (OLT). METHODS Thirteen consecutive subjects were enrolled in this single-center study during routine rehabilitation of the 6MWT and BS. At days 7 and 14 after OLT seeking to assess objective and subjective exercise capacities, we recorded basic clinical parameters, including body weight, blood pressure, heart rate and temperature. The results as compared between days 7 and 14 were related to the reference values for age-, height- and weight-matched healthy subjects. RESULTS On day 7, normal 6MWT was achieved by one patient and at day 14-, by three patients. At days 7 and 14, the average distances of 6MWT were 326.7 m and 421 m, respectively (P<.05), indicating a significant increase in exercise capacity. The average BS rating did not change significantly between days 7 and 14, indicating, that the increased exercise capacity was achieved without excessive effort. CONCLUSIONS Our study indicated that the 6MWT and BS may represent inexpensive and safe assessment methods for exercise capacity after OLT. This evaluation may be helpful to plan and optimize post-OLT rehabilitation.

Blood pressure and intracranial aneurysms in autosomal dominant polycystic kidney disease.

Background/Aims: Autosomal dominant polycystic kidney disease (ADPKD) is correlated with an increased frequency of both intracranial aneurysms (ICANs), and arterial hypertension (AH). The aim of our study was to search for the association between blood pressure (BP) and ICANs in ADPKD patients. Methods: Sixty-eight adult, pre-dialysis phase ADPKD patients underwent both screening for ICANs with magnetic resonance angiography of the brain, and ambulatory blood pressure monitoring (ABPM). Results: ICANs were diagnosed in 10 patients (ICAN(+) group), while in 58 were not (ICAN(-) group). The nighttime maximum diastolic blood pressure (DBP), maximum increase in DBP from measurement to measurement (positive delta of DBP) at night, and the standard deviation of the daytime mean arterial pressure were significantly higher in ICAN(+) compared to ICAN(-) patients. Additionally, in a subgroup of patients after 45 years-of-age, ICAN(+) patients had significantly higher maximum 24-hour and daytime systolic blood pressure, maximum 24-hour, daytime, nighttime DBP, maximum daytime and nighttime positive delta of DBP compared to ICAN(-) cases. Conclusions: Development of ICANs in hypertensive ADPKD patients is accompanied with higher values of some BP parameters measured by ABPM. Hypertensive ADPKD patients with substantial fluctuations in BP assessed by ABPM, especially those after 45 years-of-age, should become candidates for screening for ICANs.

Circadian and short-term blood pressure abnormalities after liver transplantation

ABSTRACT Liver transplantation remains the only therapeutic method in end-stage liver disease. Cardiovascular system diseases, including arterial hypertension, are considered one of the main risk factors increasing mortality in this population. The aim of the study was the evaluation of circadian blood pressure patterns in liver transplant recipients. In a group of 107 liver transplant recipients, a 24-hour ambulatory blood pressure monitoring (ABPM) was performed. The ABPM revealed arterial hypertension in 88.79% and unsatisfactory blood pressure (BP) control in 71.03% of the study participants. The abnormal circadian BP pattern was observed in 90.65% of liver recipients. The subgroup of patients with preserved BP circadian rhythm was characterized by higher standard deviation (SD) and coefficient of variation (CV) values for 24-hour systolic, diastolic and mean arterial blood pressure (SBP, DBP, and MAP). There were no such differences for other short-term blood pressure variability (ST BPV) parameters: SD and CV of day-time and night-time SBP, DBP and MAP values. Arterial hypertension and circadian BP abnormalities are present in a majority of liver transplant recipients. BP circadian rhythm is not associated with ST BPV parameters assessed separately during awake and sleep period which suggests that both groups of parameters could reflect different cardiovascular phenomena after liver transplantation.

CXCL12 in Patients with Chronic Kidney Disease and Healthy Controls: Relationships to Ambulatory 24-Hour Blood Pressure and Echocardiographic Measures

Background/Aims: Chronic kidney disease is a pro-inflammatory condition where the interplay between different regulatory pathways and immune cells mediates an unfavorable remodeling of the vascular wall and myocardial hypertrophy. These mechanisms include the action of CXCL12. The aim of this study is to evaluate the association between serum CXCL12 with left ventricular hypertrophy (LVH) and blood pressure control in chronic kidney disease (CKD) patients. Methods: This single-center observational study involved 90 stable CKD stage 1–5 patients (including 33 renal transplant recipients) and 25 healthy age- and sex-matched control subjects. CXCL12 was quantified by ELISA. 24-h ambulatory blood pressure monitoring was performed in 90 patients and 25 healthy controls. Left ventricular mass index (LVMI) was calculated based on the transthoracic echocardiography measurements in 27 patients out of the CKD population and in the whole control group. Results: CXCL12 correlated significantly with LVMI by multivariate regression analysis (coefficient B = 0.33, p = 0.02) together with age (B = 0.30, p = 0.03) and gender (B = 0.41, p = 0.003). A positive correlation was observed between CXCL12 and average 24-h systolic blood pressure (SBP) (rho = 0.35, p = 0.001), daytime SBP (rho = 0.35, p = 0.001), and nocturnal SBP (rho = 0.30, p = 0.002). Nocturnal hypertension was frequent (46% of CKD patients). Conclusions: The results of our study point towards a link between CXCL12 and LVH as well as blood pressure control among patients with CKD, supporting the thesis that CXCL12 may be regarded as a new potential uremic toxin.

Young patient with arterial stenosis: follow-up, medical treatment, and time for dental implant?

Maciej R. Czerniuk, Tomasz Pilecki, Beata Wożakowska-Kapłon , Krzysztof J. Filipiak, Renata Górska 1Zakład Chorób Błony Śluzowej i Przyzębia, Warszawski Uniwersytet Medyczny, Warszawa 2Klinika Immunologii, Transplantologii i Chorób Wewnętrznych, Warszawski Uniwersytet Medyczny, Warszawa 3I Kliniczny Oddział Kardiologii, Świętokrzyskie Centrum Kardiologii, Kielce 4Wydział Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego, Kielce 5I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa

[Octogenarian with cardiovascular history: is it contraindication for dental implants?].

Maciej R. Czerniuk, Tomasz Pilecki, Krzysztof J. Filipiak, Beata Wożakowska-Kapłon , Renata Górska 1Zakład Chorób Błony Śluzowej i Przyzębia, Warszawski Uniwersytet Medyczny, Warszawa 2Klinika Immunologii, Transplantologii i Chorób Wewnętrznych, Warszawski Uniwersytet Medyczny, Warszawa 3I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 4I Kliniczny Oddział Kardiologii, Świętokrzyskie Centrum Kardiologii, Kielce 5Wydział Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego, Kielce

Simple platelet markers: Mean platelet volume and congestive heart failure coexistent with periodontal disease. Pilot studies

BACKGROUND Conducted pilot study concerning mean platelet volume parameter among patients suffering from congestive heart failure and periodontal disease. METHODS Examination of dynamic changes of platelet and periodontal markers in group of 50 patients before and an average of 6 months subsequent to professional periodontal treatment. RESULTS Both platelet and periodontal parameters decreased after periodontal treatment, what is more, the decrease of mean platelet volume (MPV) value due to periodontal disease/mm improvement was shown to be statistically significant (p = 0.05). CONCLUSIONS Improvement of periodontal status may influence decrease of MPV value andincrease of congestive heart failure treatment efficacy and effect patient comfort. It is a new, not frequently used pattern of chronic disease treatment optimalization.