Serious adverse events and reactions in organ transplantation; a web-net tool-based nationwide system for reporting and monitoring

Organ transplantation is vulnerable to serious adverse reactions and events, which require a system for their monitoring and management, as required of EU Member States by Directive 2010/53/EU. A management system was implemented in Poland using modern network technologies through the following steps: 1) the development of a catalogue of events and reactions, 2) the preparation and implementation of the network module, 3) the operational procedures, 4) the evaluation system. The catalogue consists of reactions and events in recipients and living donors related to organ procurement. A referral system was introduced as a module of a web tool www.rejestry.net (400 participated institutions). Notification includes information regarding the location, type, description, analysis, and measures taken to resolve and prevent problems. During the period 2012-2013, 17 serious adverse events and 112 reactions were documented among 3223 transplanted organs (events in 0.5% and reactions in 3.4% of the cases). The major cases included: transplantation from a donor with neoplasia, early recipient death, early graft loss, and transmission of severe infection. Evaluation revealed underestimated number of notifications of "death of recipient within 30 post-transplant days", which reported 74 of the 92 reactions (80%) occurring in reality. The system is a platform for self-assessment and the dissemination of information regarding the potential dangers, including alarms in cases in which an event/reaction in one center is accessible to others. However, the system is not punitive, because the fear of disclosing failures in the transplant centers plays an important role in the monitoring process.

Profiles of all 550 procurements and transplantations of kidneys from living donors in Poland, 1967-2012

INTRODUCTION

Nationwide live organ donor registry is mandatory to ensure the quality and safety of kidney procurement from living donors and for donor protection. In Poland, this concept is achieved with the use of an Internet tool (www.rejestry.net); donation centers are obligated to collect donors' data (demographic characteristics, including pre-, peri-, and post-donation and long-term follow-up). The registry currently handles data from 2008 but is incomplete in the collection of historical procurements. The goal of the research was to collect in one database all information regarding cases of kidney procurements and transplantations from living donors in Poland starting from the first such transplant in 1967.

MATERIALS AND METHODS

Data were gathered from several existing but incomplete records stored by transplant centers.

RESULTS

A total of 550 kidney procurements and transplantations from living donors were made in the years 1967 to 2012. We collected 100% of information on the date and donation centers and 100% of information regarding the recipients but only 65% of information regarding the donor and 80% regarding donor-recipient relations. According to the data, women accounted for 60% of living donors and men for 40% of living donors. The mean age of a donor was 45 years, and the mean age of a recipient was 28 years. Among related donors, parents constituted the majority (59%), siblings accounted for 21%, and spouses accounted for 12%.

CONCLUSIONS

Although the collected data are incomplete, our research provided the Polish live-donor registry a solid starting point (eg, all dates, center procurements, records of transplantations) to enter remaining data and to build a serviceable tool for full assessment of all live-donor kidney donations in the country.

Biobank concept in Poland

Possible adverse events and reactions associated with organ procurement and transplantation from deceased donors require compliance with quality and safety standards. Shortage of organs for transplantation makes it necessary to obtain organs from nonstandard (expanded-criteria) donors. This increases the risk of disease transmission with the graft which is difficult or impossible to identify before transplantation. The long-term access to biologic material of organ donors and recipients proffers the possibility to evaluate serious adverse reactions as well as to improve the quality and safety in transplantation medicine. Implementation of the above-mentioned tasks requires a Biobank whose aims are: to gather and long-term storage sera, lymph nodes, and other tissues of deceased organ donors for analysis of their biologic properties; to gather and store organ recipient sera; to determine methods to store biologic material in a manner enabling identification of the donor, organ, and recipients; and to provide electronic record keeping. Tactical tasks of a Biobank are: to carry out new or verify results of previously performed testing of deceased donors and recipients as controls to evaluate transmission of infection; to perform genetic material testing (NAT) to verify and confirm serologic tests, eg, determination of HIV RNA/DNA in donors at risk of infections; to discover rare diseases in donors and recipients whose detection before transplantation is difficult because of the time constraints related to organ storage or the lack of available methods (eg, sponge encephalopathies); to perform biochemical or genetic tests to evaluate neoplasia transfer from donor to recipient; and to reexamine HLA typing in cases of immunologic complications.

Influence of dietary peas and organic acids and probiotic supplementation on performance and caecal microbial ecology of broiler chickens

1. The effect of dietary pea and addition of organic acid blend (OA) or probiotic (Pro) on performance and caecal microbial ecology of broiler chickens was studied. 2. A growth trial was conducted with 160 Ross 308 female broilers from d 1 to 35 of age. There were 8 treatment groups based on either control (S) or white pea (P). Both S and P were supplemented with OA (Galliacid - fumaric acid, calcium formate, calcium propionate and potassium sorbate coated with plant triglycerides, Vetagro) and or with Pro (LABYuc-Probio - lactic acid bacteria, Saccharomyces cerevisiae and Yucca schidigeri extract, Mifarmex GmbH). 3. Inclusion of peas in the diet increased feed intake and decreased gain:feed ratio in comparison to the control diet. Neither probiotic nor OA supplementations affected broiler performance. 4. The caecal microbiota was characterised in 37-d-old birds by fluorescent in situ hybridisation (FISH) and terminal-restriction fragment length polymorphism (T-RFLP). Total bacterial counts in caecal contents were slightly higher for birds fed the pea diets, but were not affected by OA or Pro supplements. 5. Neither pea nor Pro affected the Lactobacillus/Enterococcus and Streptococcus/Lactococcus counts in caecal contents, whereas OA supplementation slightly increased the Lactobacillus/Enterococcus counts. The composition of the Lactobacillus/Enterococcus population was altered by inclusion of peas as revealed by the T-RFLP patterns. 6. The DNA fingerprint further suggested that the caecal microbiota was dominated by the lactic acid bacterium Streptococcus alactolyticus. 7. In ileal contents, the concentration of short-chain fatty acids (SCFA) was decreased only by Pro supplementation. In caecal contents, the SCFA concentration was higher for birds fed on the pea diets, and increased significantly with Pro supplementation 8. In conclusion, the results indicate that the use of pea and probiotics in broiler feed may stimulate the caecal commensal microbiota (growth and/or activity) to some extent and hence prevent establishment of pathogenic and zoonotic enterobacteria in these segments of the gut.

Polycylic aromatic hydrocarbons in rape seeds with relation to their growing site and thermal treatment

A significant source of polycyclic aromatic hydrocarbons (PAH) in human diet is vegetable oils, especially those produced from plants grown in regions where the soil and the atmosphere are contaminated with these chemicals. Contamination with PAH of vegetable oils may also occur in the process of plant material drying with smoke or exhaust fumes, or in the course of extraction of that material with solvents containing trace amounts of PAH. The objective of this study was to determine the relationship between the levels of PAH present in rape seeds and the occurrence of these compounds in cultivation region and the relationship of the levels of PAH in rape seeds to thermal treatment after harvest. Rape seeds and pods from experimental fields and rape seeds subjected to thermal treatment in dryers obtained from suppliers of the raw material were examined and compared. Cleanup of extracts was performed with high-resolution size exclusion chromatography (SEC) and final determinations were by Trace Ultra/PolarisQ gas chromatography-mass spectroscopy (GC-MS). The results obtained indicated that during thermal treatment of rape seeds the concentration of PAH increased, but the levels of benzo[a]pyrene did not exceed threshold permissible levels. Data demonstrate that rapeseed cultivation in the presence of PAH results in higher levels of contaminants; however, the PAH levels still did not exceed the maximal allowable levels in Poland.

Effect of an organic acid blend and phytase added to a rapeseed cake-containing diet on performance, intestinal morphology, caecal microflora activity and thyroid status of broiler chickens

The experiment was carried out on 96 female broilers, allocated to eight groups of 12 birds kept in individual cages. Two basal wheat- and soyabean meal-based diets containing 150 g/kg of rapeseed expeller cake were formulated, differing in the level of P: 7.1 g/kg in diet H or 5.9 g/kg in diet L. Rapeseed cake supplied 3.15 micromol alkenyl glucosinolates per gram of diet. The eight treatments were: basal diets only, basal diets + phytase (1000 U/kg), basal diets + organic acid blend (OA, 6 g/kg), or basal diets + both additives. Diets were fed from day 8 to 28 of life. The results showed that the lower dietary P content and OA supplementation did not significantly affect feed intake or BWG, while both increased (p < 0.001) after phytase supplementation. Tibia ash content as well as tibia ultimate strength were lower (p < 0.001) in birds fed diets L compared with diets H, and increased (p < 0.01) with phytase supplementation of diet L, while OA had no influence on either parameter. Dietary P levels and OA supplementation had no influence on the pH of gut digesta, but the pH of jejunal digesta increased following phytase supplementation (p < 0.01). Morphological measurements of the small intestinal mucosa of chicks indicated that OA added to diet L depressed villi height (p < 0.001) and crypt depth (p < 0.001); both parameters increased after phytase supplementation (p < 0.01). The lower total SCFA as well as acetic, propionic and butyric acid concentrations in caecal digesta indicated lower activity of caecal microflora in birds fed diets L compared with H. OA supplementation had no influence, while phytase supplementation increased the concentration of acetic acid in caecal digesta. Supplementation of diets with either phytase or OA increased thyroid weight by 16% (p < 0.01) and 11% (p < 0.05) respectively. The increase in thyroid weight because of phytase supplementation was greater at the lower dietary P level, and the greatest when both phytase and OA were added to the diet.

[The post of transplant coordinator in Polish law regulations]

The aim of this report is to present the review of Polish legislative acts concerning the post of Transplant Coordinator. The coordination of organs retrieval and transplantation is specified in the Ministry of Health Regulation 2007 as an postgraduate accomplishment in the field of medicine. Furthermore, the requirements regarding basic education, adequate length of work and experience in the field of organs, tissues and cells retrieval and transplantation for transplant coordinator and senior transplant coordinator as well as continuous education and salary are specified by law. Transplant centres are present in 11/16 Polish regions. Official duties of the regional transplant coordinators are performed in Poland by 15 professionals. They are employed mostly in kidney transplantation centres (60%) and additionally as a part-time workers (86%) in Polish Transplant Coordinating Centre "Poltransplant'. Nevertheless, the key role is played by local transplant coordinators employed in donor hospitals. They are responsible for donors detection and organs procurement coordination in cooperation with regional transplant coordinator.

Organ donation and transplantation in Poland in 2007

In 2007 the number of effective cadaveric donors and the number of transplanted organs in Poland significantly decreased. 466 possible deceased organ donors were reported to Polish Transplant Coordinating Center POLTRANSPLANT-Health Ministry Office responsible for organization of procurement, organ allocation and providing registries. Organ recovery took place in 352 (75.5%) cases (9.2 donors/pmp).

Quality of life after liver transplantation--preliminary report

BACKGROUND

Liver transplantation (OLTx) is an optimal method of treatment of end-stage liver failure. It gives a chance to get back to an active life. 80-90% of patients survive over 1 year after liver transplantation with a perspective of a long life.Recently more attention is being paid to health related quality of life (QoL). It is considered as a combination of physical and mental condition, social and economical state and somatic experience. The aim of the study was to analyze patient's QoL after OLTx compared to the condition before OLTx.

MATERIAL/METHODS

123 patients 1-12 years after transplantation were included in the study. The study was conducted in Outpatients Clinic of Immunology, Transplantology and Internal Medicine Department and Transplantation Medicine and Nephrology Department of Warsaw Medical University between October 2007 and January 2008. Original questionnaire was used, consisting of 8 general questions and 44 detailed questions concerning pre- and posttransplant period. Information about physical condition (health, mobility, basic functions, drug side effects), mental condition (anxiety, happiness, cognition disorders), social function (family, friends, work) and economic status were gathered. "Never, sometimes, often, very often" score was used.

RESULTS

Majority of subjects de fi ned their quality of life and physical condition before transplantation as poor, and post transplantation - as good. The respondent's mental condition didn't differ much before and after transplantation. Level of satisfaction was higher after transplantation. Health condition in some cases affected patients' family life, however it often devastated their social life before OLTx. Most patients were on disability pension and after transplantation they indicated the influence of health on their financial condition.

CONCLUSIONS

The quality of life after liver transplantation gets better and it's de fi ned as good or very good. During the analysis of QoL a difference between conditions before and after LTX wasn't observed.

Long-term survival after kidney transplantation from homozygotic twin--a case report

Grafts from genetically related living donors have better survival rates than ones from deceased donors. Immunological match is one of the beneficial factors involved. The aim of this paper is to discuss a case of a 55-year old patient living for 33 years with transplanted kidney, weaned off immunosuppressive therapy for 20 years. Perfect match between donor and recipient, homozygotic siblings, was vital for such long-term graft survival.