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Wójciak M, Gozdowska J, Pacholczyk M, Lisik W, Kosieradzki M, Cichocki A, Tronina O, Durlik M. Liver Transplantation for a Metastatic Pancreatic Solid-Pseudopapillary Tumor (Frantz Tumor): A Case Report. Ann Transplant 2018; 23:520-523. [PMID: 30061554 PMCID: PMC6248032 DOI: 10.12659/aot.908764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Solid-pseudopapillary neoplasms (SPN) of the pancreas, first described by Frantz in 1959, are a very rare entity and account for 0.13–2.7% of all pancreatic neoplasms. They are seen predominantly in young women in their second and third decade of life. Case Report We report a case of a 51-year-old female first diagnosed with a pancreatic tumor in 2010 following a computed tomography (CT) scan of the abdomen. The lesion was originally thought to be a neuroendocrine tumor subsequently treated with chemotherapy, which delayed the appropriate treatment. The tumor was rediagnosed as a SPN only after pancreatectomy was performed. Due to the fact that the neoplasm metastasized to the liver, the patient underwent an orthotopic cadaveric liver transplantation (OLTx) in 2013. During the postoperative period lymph node metastases were identified in the abdomen. The patient received surgical treatment and palliative radiotherapy. Presently no signs of recurrence are found either in the bed of pancreatic resection or in the transplanted liver. The function of the transplant organ has demonstrated no abnormalities over the 4-year follow-up. Conclusions SPN of the pancreas is a rare disease associated with heterogeneous clinical course ranging from benign to metastatic. Choosing appropriate treatment requires individual clinical assessment of the disease’s spread. Partial living donor liver transplantation or cadaveric liver transplantation might prove an effective therapeutic option for patients with multiple SPN metastases in the liver. It ought to be remembered, however, that the experience in this area is quite limited.
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Furmańczyk-Zawiska A, Bączkowska T, Dęborska-Materkowska D, Nazarewski S, Kosieradzki M, Durlik M. Effect of Thrombophilic Factors on Renal Graft Function: A Single-Center Experience. Transplant Proc 2018; 50:1715-1719. [PMID: 30056888 DOI: 10.1016/j.transproceed.2018.02.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Optimization of immunosuppressive therapy reduced the incidence of acute rejection, and therefore vascular complications, including graft thrombosis, which have emerged as the main cause of graft loss in the early post-transplant period. A thrombophilic condition may lead to renal graft loss. The aim of the study was to assess renal graft function in thrombophilic renal recipients receiving anticoagulation treatment. METHODS This is a retrospective study including 29 renal recipients (ktx group) with a history of thrombosis and confirmed thrombophilic factor. Graft function was evaluated by median serum creatinine concentration at the third month after ktx (SCr1) and at the end of the observation (SCr2) with respect to hypercoagulability (factor V Leiden [FVL], mutation G20210A, antiphospholipid antibodies, deficiency of protein S [PS] or C [PC], factor VIII >200%). RESULTS Recipients underwent retransplantation because of graft thrombosis (P < .001). They more often underwent urgent transplantation (P = .008), received induction therapy (P = .021), underwent an indication other than protocol biopsy (P = .001), or experienced acute rejection (P = .042). Differences in graft function (SCr2) were found at the end of observation (ktx group vs controls 1.9 mg/dL vs 1.3 mg/dL, respectively, P = .014). Multivariate analysis revealed inferior thrombophilic graft function in the model with SCr1 <2 mg/dL (odds ratio 0.07, 95% confidence interval 0.01-0.57, P = .014) and in the model with SCr2 <2 mg/dL (odds ratio 0.15; 95% confidence interval 0.04-0.54, P = .004). The incidence of antiphospholipid syndrome was 31%; FVIII, 31%; FVL, 24.1%; and PC/PS, 13.8%. After anticoagulation was introduced no thromboembolic events or bleeding complications occurred. CONCLUSION Hypercoagulability is not a contraindication to ktx but may worsen graft function. Post-transplant care in thrombophilic recipients is demanding (retransplantation, immunization, protocol biopsy, anticoagulation), but is the only means by which to maintain a graft.
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Surowiecka-Pastewka A, Matejak-Górska M, Frączek M, Durlik M. Duplicated Ureters in Transplantation-A Single-center, Retrospective Study. Transplant Proc 2018; 50:1662-1668. [PMID: 30056878 DOI: 10.1016/j.transproceed.2018.02.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney transplantation remains the best therapeutic option for chronic renal failure. The objective of the study was to evaluate the impact of ureteral duplication in donor kidneys on transplantation outcome. METHODS In this study we performed a retrospective analysis of 75 patients who had undergone renal transplantation. The evaluated parameters included frequency of occurrence and risk of reoperation and graftectomy, mortality, as well as dependency of early and long-term graft function on pyelocaliceal system duplication. RESULTS Ureteral duplication was associated with more frequent double J stent catheter implantation (P < .05). There was no relationship detected between ureteral duplication, number of operations performed, and risk of graftectomy (P > .05). Early graft function with 2 ureters was similar to that of grafts with a single pyelocaliceal system. The long-term results were also comparable. CONCLUSION Ureteral duplication should not be considered a contraindication for renal transplantation.
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Pazik J, Lewandowski Z, Nowacka Cieciura E, Ołdak M, Podgórska M, Sadowska A, Dęborska Materkowska D, Durlik M. Malnutrition Risk in Kidney Recipients Treated With Mycophenolate Mofetil Is Associated With IMPDH1 rs2278294 Polymorphism. Transplant Proc 2018; 50:1794-1797. [DOI: 10.1016/j.transproceed.2018.02.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
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Jędrzejko K, Kieszek R, Kwapisz M, Nita M, Durlik M, Kwiatkowski A. Comparison of Kidney Transplantation Results From the Same Deceased Donor Between Patients With the First Transplantation and Retransplanted Patients. Transplant Proc 2018; 50:1726-1729. [DOI: 10.1016/j.transproceed.2017.12.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 10/17/2022]
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Franczyk S, Skrabaka D, Jędrusik E, Ziaja J, Kolonko A, Świder R, Sekta S, Czerwiński J, Owczarek A, Durlik M, Więcek A, Cierpka L, Król R. Results of Transplantation of Kidneys Procured From Donors After Brain Death Aged 60 Years and Older. Transplant Proc 2018; 50:1674-1679. [DOI: 10.1016/j.transproceed.2018.02.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/06/2018] [Indexed: 12/17/2022]
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Zieniewicz K, Durlik M, Pączek L, Przybyłowski P. Preface. Transplant Proc 2018; 50:1589. [DOI: 10.1016/j.transproceed.2018.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Czarnecka P, Czarnecka K, Tronina O, Durlik M. Cytomegalovirus Disease After Liver Transplant-A Description of a Treatment-Resistant Case: A Case Report and Literature Review. Transplant Proc 2018; 50:4015-4022. [PMID: 30577306 DOI: 10.1016/j.transproceed.2018.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/23/2018] [Indexed: 12/18/2022]
Abstract
Cytomegalovirus (CMV) infection is a common complication in solid organ transplant recipients. In patients receiving immunosuppressive treatment, CMV may lead to life-threatening organ complications or graft loss. We describe a case of 31-year-old CMV-seronegative patient who underwent liver transplant from a CMV-seropositive donor with an early acute resistant rejection of the transplanted organ followed by primary CMV infection, despite prophylaxis, and its severe organ complications. Routine treatment of acute allograft rejection through increasing the base immunosuppression and then administering methylprednisolone infusions did not yield significant therapeutic effect. This resulted in anti-thymocyte globulin and ultimately proteasome inhibitor introduction. The cholestasis remitted and liver parameters improved. But 4 weeks later the patient was admitted again due to incorrect liver function tests. Blood tests revealed high CMV viral load, and primary CMV infection was diagnosed. On diagnosis the patient was treated with ganciclovir (GCV) intravenously. As GCV resistance was suspected based on clinical premises, foscarnet (FOS) and leflunomide (LFM) were implemented with concomitant cautious immunosuppression reduction due to the history of recent graft rejection. Despite aggressive treatment introduction, viral clearance was not obtained. Ultimately the patient died due to respiratory distress resulting from lung fibrosis, most probably owing to CMV diseases with Pneumocystis jiroveci coinfection. The presented case proves the importance of strictly following the rules of prophylaxis, especially in patients with a high risk factor of CMV infection development. A quick diagnosis, implementation of appropriate treatment, and fast reaction to the lack of satisfying therapeutic effect can be the key to a successful treatment.
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Kuczera P, Kwiecień K, Adamczak M, Bączkowska T, Gozdowska J, Madziarska K, Augustyniak-Bartosik H, Klinger M, Durlik M, Ritz E, Wiecek A. Different Relevance of Peripheral, Central or Nighttime Blood Pressure Measurements in the Prediction of Chronic Kidney Disease Progression in Patients with Mild or No-Proteinuria. Kidney Blood Press Res 2018; 43:735-743. [PMID: 29763910 DOI: 10.1159/000489749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/03/2018] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND/AIMS Arterial hypertension is one of the leading factors aggravating the course of chronic kidney disease (CKD). It seems that the novel parameters used in the assessment of the blood pressure (BP) load (i.e. central blood pressure, nighttime blood pressure) may be more precise in predicting the cardiovascular risk and the progression of CKD in comparison with the traditional peripheral blood pressure measurements in the office conditions. The aim of the study was to assess the impact of the central, or nighttime blood pressure on the progression of CKD in patients with mild or no-proteinuria (autosomal, dominant polycystic kidney disease or IgA nephropathy). METHODS In each of the enrolled 46 patients with CKD stage 3 or 4, serum creatinine concentration was assessed, eGFR (MDRD) was calculated, also central blood pressure and pulse wave velocity (PWV) was assessed and the 24-hour ambulatory blood pressure monitoring (ABPM) was conducted at the beginning of the study and then repeated after one-year observation period. RESULTS During the observation period mean eGFR decreased from 44.1 (33.2-50.6) mL/min to 36.7 (29.7-46.3) mL/min. No significant differences were observed in the peripheral blood pressure or central blood pressure parameters. After one-year observation period the values of diastolic blood pressure dipping during the night significantly decreased from 16 (13-19) mmHg to 12 (10-15) mmHg; p< 0.05. The values of systolic dipping during the night or the mean BP values recorded in ABPM did not change significantly. Additionally, no significant differences in the PWV values were found. In the multivariate regression model the change of serum creatinine concentration was explained by the initial diastolic dipping values. CONCLUSION 1. In patients with CKD stages 3 or 4 and mild or no- proteinuria, peripheral and central blood pressure did not change significantly during a one-year observation period despite the significant decline of eGFR and seems not to participate in the CKD progression. 2. Reduced magnitude of the diastolic dipping, which reflects the increase of diastolic blood pressure load during the nighttime, may play an important role in the pathogenesis of deterioration of kidney function in these patients.
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Czerwinska M, Gniewkiewicz M, Gozdowska J, Czerwińska K, Sadowska A, Perkowska-Ptasińska A, Kosieradzki M, Durlik M. Urine levels of CCL2 and CXCL10 chemokines as potential biomarkers of kidney allograft function: a pilot study. THE JOURNAL OF IMMUNOLOGY 2018. [DOI: 10.4049/jimmunol.200.supp.55.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Introduction
Early prognostic markers that identify high-risk patients could lead to increased surveillance, personalized immunosuppression, and improved outcomes. The vigilance and rapid detection of allograft injury is what would result in the identification of patients who will require more intensive monitoring to ensure that their new allografts function well for the longest possible time.
The aim of the study was to assess whether urine levels of CCL2 and CXCL10 can be valuable, noninvasive source of information about inflammation, tubular injury, progression of fibrosis and other damage features in the kidney allograft.
Materials and methods
In this prospective study 40 patients who underwent a protocolar biopsy within 1 year post kidney transplant were included. The levels of chemokines CCL2 and CXCL10 with reference to creatinine in urine were assayed in all patients. Based on biopsy results research group (N=25) with diagnosis of BKV nephropathy, IFTA II–III, peritubular capillaritisis, C4d or rejection was selected. Patients with normal biopsy results were included as control group (N=15).
Results
Median urinary CCL2-to-creatinine (Cr) ratio [ng/mmol] was significantly elevated in research group compared to control group (21.76 ± 18.57 vs 8.99 ±5.12, p=0.003). There was no statistical difference between groups regarding CXCL10/Cr ratio (7.96 ± 9.08 vs 5.58 ±5.7 p=0.32). Patients with BKV nephropathy (N=3) had much higher level of CCL2 [ng/l] than control group but the difference did not reach statistical significance (429.69 ± 166.49 vs 78.04 ±53.61, p=0.06).
Conclusion
CCL2/Cr may be used as a non-ivasive tool useful for monitoring graft condition and predicting recipients with high risk of transplant kidney loss.
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Kuczera P, Kwiecien K, Adamczak M, Baczkowska T, Gozdowska J, Madziarska K, Augustyniak-Bartosik H, Klinger M, Durlik M, Wiecek A. SP280CENTRAL BLOOD PRESSURE AND NIGHTTIME BLOOD PRESSURE AND THE PROGRESSION OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH MILD, OR NO- PROTEINURIA. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bieniasz M, Kieszek R, Jakubowska-Winecka A, Zatorski M, Kwapisz M, Jędrzejko K, Nita M, Durlik M, Pączek L, Kwiatkowski A. Psychological Aspects of Living Kidney Donation in Poland: Experience of One Center. Transplant Proc 2018; 50:1637-1639. [PMID: 30056874 DOI: 10.1016/j.transproceed.2018.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/08/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Living kidney transplantation is the optimal treatment of end-stage renal disease. The benefits for recipients are obvious. The psychological consequences for living kidney donors in Poland are not known. OBJECTIVE The objective of the study was to evaluate the psychological aspects of living kidney donation in Poland. PATIENTS AND METHODS A total of 66 living donor open nephrectomies were performed in our institution between 1995 and 2005. The psychological aspects were assessed in 40 donors after nephrectomy. The study applied the Satisfaction With Life Scale (SWLS), the Situation Assessment Questionnaire, the Health Behaviors Survey, and our own questionnaire. The mean observation period was 65.6 months. RESULTS There was a trend toward better life satisfaction in living kidney donors compared to Polish adults. Donor life satisfaction was significantly lower when the recipient was dead than when the recipient was alive. Most donors perceived the kidney donation as a challenge in cognitive judgment. The mean score of the Health Behaviors Survey was not significantly different than in the general population in Poland. The mean pain score after donation was 3.2 in a 5-item scale (1 = severe pain, 5 = mild pain). The mean time of return to work was 3.5 months. No donors regretted their decisions about kidney donation. CONCLUSION Living kidney donation in Poland has a positive impact on donors' quality of life. Among living kidney donors, the sense of danger concerning the risk of donation depends on the degree of the relationship with the recipient.
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Gniewkiewicz M, Czerwińska M, Gozdowska J, Czerwińska K, Sadowska A, Dęborska-Materkowska D, Perkowska-Ptasińska A, Kosieradzki M, Durlik M. SP714URINE LEVELS OF CCL2 AND CXCL10 CHEMOKINES AS POTENTIAL BIOMARKERS OF KIDNEY ALLOGRAFT FUNCTION: A PILOT STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ważna E, Pazik J, Perkowska-Ptasińska A, Durlik M. SP722HISTOPATHOLOGY OF IMPLANTED KIDNEY ACCORDING TO BANFF’07 AND PREDICTION OF LONG TERM TRANSPLANTATION OUTCOME. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Szymanek-Majchrzak K, Mlynarczyk A, Bilinska M, Rownicki M, Majchrzak K, Chmura A, Kwiatkowski A, Durlik M, Deborska-Materkowska D, Paczek L, Mlynarczyk G. Effect of Selective Antibiotic Pressure on the MLS-B Phenotype in Methicillin-Resistant Staphylococcus aureus Strains Originating From Patients From Transplantation Wards: 24 Years of Observations. Transplant Proc 2018; 50:2164-2169. [PMID: 29801965 DOI: 10.1016/j.transproceed.2018.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Staphylococcus aureus infection, and health care-associated-methicillin resistant S aureus (HA-MRSA) in particular, is a serious risk for patients treated with organ transplantation. The frequent combined resistance of these bacteria to macrolides, lincosamides, and streptogramin-B (MLS-B) limits the use of these drugs in therapy. AIM Evaluation of the mechanism of MLS-B resistance among HA-MRSA strains derived from patients treated in surgical-transplantation wards, over a 24-year period, and assessment of correlation of clindamycin use and resistance phenotype. MATERIALS AND METHODS One hundred and twelve HA-MRSA strains from patients in surgical-transplantation wards (clinical hospital, Warsaw), hospitalized in the period from 1991 to 2014. Methicillin-resistance was determined using phenotypic and genetic methods by detecting the mecA gene. Erythromycin/clindamycin resistance was determined by E-test, the iMLS-B (inductive) and cMLS-B (constitutive) phenotypes by the D-test method. The number of defined daily doses (DDD), statistically per 1000 person-days, was calculated in accordance with the WHO guidelines. RESULTS Resistance to erythromycin/clindamycin in MRSA strains increased from 1991 to 2004-2007 from 64.7/11.8% to 100/76.9%, respectively. The frequency of the cMLS-B phenotype in the years 1991/2010-2011/2012 was 5.9%/76.9%/69.7%, respectively, and correlated with the increased use of clindamycin in the examined wards. In 2012, the percentage of MLS-B-sensitive isolates increased from 3.9 to 21.7%, while constitutive resistance decreased to 69.7%, which correlated with a decrease in the use of clindamycin. CONCLUSIONS The proportion of cMLS-B to iMLS-B phenotypes in HA-MRSA is related to the amount of clindamycin used in hospital wards. Limiting the selection pressure of antibiotics can lead to complete loss of resistance or return to the inductive mechanism of its regulation.
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Deborska-Materkowska D, Perkowska-Ptasinska A, Sadowska A, Gozdowska J, Ciszek M, Serwanska-Swietek M, Domagala P, Miszewska-Szyszkowska D, Sitarek E, Jozwik A, Kwiatkowski A, Durlik M. Diagnostic utility of monitoring cytomegalovirus-specific immunity by QuantiFERON-cytomegalovirus assay in kidney transplant recipients. BMC Infect Dis 2018; 18:179. [PMID: 29661141 PMCID: PMC5902940 DOI: 10.1186/s12879-018-3075-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/03/2018] [Indexed: 12/18/2022] Open
Abstract
Background Despite universal prophylaxis, late cytomegalovirus (CMV) infection occurs in a high proportion of kidney transplant recipients. We evaluated whether a specific viral T-cell response allows for the better identification of recipients who are at high risk of CMV infection after prophylaxis withdrawal. Methods We conducted a prospective study in 19 pretransplant anti-CMV seronegative kidney graft recipients R- (18 from seropositive donors [D+] and one from a seronegative donor [D-]) and 67 seropositive recipients R(+) (59 from seropositive donors and eight from seronegative donors) who received antiviral prophylaxis with valganciclovir. The QuantiFERON-CMV (QF-CMV) assay was performed within the first and third months after transplantation. Blood samples were monitored for CMV DNAemia using a commercial quantitative nucleic acid amplification test (QNAT) that was calibrated to the World Health Organization International Standard. Results Twenty-one of the 86 patients (24%) developed CMV viremia after prophylaxis withdrawal within 12 months posttransplantation. In the CMV R(+) group, the QF-CMV assay yielded reactive results (QF-CMV[+]) in 51 of 67 patients (76%) compared with 7 of 19 patients (37%) in the CMV R(−) group (p = 0.001). In the CMV R(+) group, infection occurred in seven of 16 recipients (44%) who were QF-CMV(−) and eight of 51 recipients (16%) who were QF-CMV(+). In the CMV R(−) group, infection evolved in five of 12 recipients (42%) who were QF-CMV(−) and one of 7 recipients (14%) who were QF-CMV(+). No difference was found in the incidence of CMV infection stratified according to the QF-CMV results with regard to the recipients’ pretransplant CMV IgG serology (p = 0.985). Cytomegalovirus infection occurred in 15 of 36 patients (42%) with hypogammaglobulinemia (HGG) 90 days posttransplantation compared with two of 34 patients (6%) without HGG (p = 0.0004). Cytomegalovirus infection occurred in seven of 13 patients (54%) with lymphocytopenia compared with 14 of 70 patients (20%) without lymphocytopenia (p = 0.015). The multivariate analysis revealed that the nonreactive QuantiFERON-CMV assay was an independent risk factor for postprophylaxis CMV infection. Conclusions In kidney transplant recipients who received posttransplantation prophylaxis, negative QF-CMV results better defined the risk of CMV infection than initial CMV IgG status after prophylaxis withdrawal. Hypogammaglobulinemia and lymphocytopenia were risk factors for CMV infection.
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Tronina O, Ślubowska K, Mikołajczyk-Korniak N, Komuda-Leszek E, Wieczorek-Godlewska R, Łągiewska B, Pacholczyk M, Lisik W, Kosieradzki M, Durlik M. Fibrosing Cholestatic Hepatitis C After Liver Transplantation: Therapeutic Options Before and After Introduction of Direct-Acting Antivirals: Our Experience and Literature Review. Transplant Proc 2018; 49:1409-1418. [PMID: 28736015 DOI: 10.1016/j.transproceed.2017.01.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cirrhosis caused by hepatitis C is the most common indication for liver transplantation. The most aggressive form of hepatitis C virus (HCV) relapse after liver transplantation is fibrosing cholestatic hepatitis C, which can be observed in 2% to 15% of recipients. METHODS Double therapy with peg-interferon and ribavirin was characterized by low antiviral response, rapid fibrosis, and frequent graft failure within 1 year after surgery. RESULTS Introduction of direct-acting antivirals for HCV treatment allows for more efficient therapy with less adverse reactions, including patients with fibrosing cholestatic hepatitis C. CONCLUSIONS We present 4 (2.5%) cases of cholestatic viral hepatitis C recurrence in patients undergoing transplantation between 2006 and 2015 at the Transplantation Institute of Warsaw; during this period, 158 liver transplants were performed in patients with cirrhosis caused by HCV infection.
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Wazna E, Pazik J, Perkowska-Ptasinska A, Durlik M. Does Histopathology of Implanted Kidney According to Banff 07 Help Predict Long-term Transplantation Outcome? Transplant Proc 2018; 50:1765-1768. [PMID: 30056897 DOI: 10.1016/j.transproceed.2018.02.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/19/2018] [Indexed: 11/27/2022]
Abstract
Analyses of peritransplant biopsies of deceased-donor kidneys show high incidence of chronic abnormalities. The question arises whether chronic abnormalities present at implantation determine engrafted kidney fate regardless of other concomitant variables. The aim of this study was to identify risk factors of graft loss considering histopathological changes present at implantation scored according to Banff 07 criteria. PATIENTS AND METHODS Inclusion criteria (n = 300) was engraftment between years 2000 and 2008 and availability of implantation biopsy. Analyzed abnormalities present in donor biopsy were arteriolar hyalinization, interstitial fibrosis, intimal sclerotization, tubular atrophy, total inflammation, and percentage of sclerotic glomeruli (Banff classification). Allograft function was estimated by abbreviated Modification of Diet in Renal Disease formula and proteinuria semi-quantitatively by standard dip-stick test. Kaplan-Meier estimate was used to assess graft survival. Searching for independent risk factors of graft survival was performed by means of Cox proportional hazards models (SAS System, SAS Institute Inc, Cary, NC, United States). RESULTS In one-factor analyses, predictors of kidney allograft loss were donor age, donor history of diabetes, kidney allograft dysfunction within first posttransplant year, and recipient chronic hepatitis C. In terms of chronic abnormalities, arteriolar hyalinization of any intensity nearly doubled the risk of allograft loss. Independent risk factors of kidney allograft loss in multivariate analysis were donor age, posttransplant diabetes mellitus, proteinuria after engraftment, and recipient hepatitis C. CONCLUSION The effect of arteriolar hyalinization on renal transplant survival is probably interwoven with other predictors of graft loss. Recognizing the negative impact of recipient chronic hepatitis C on graft survival, hepatitis C virus treatment should be provided to patients with advanced chronic kidney disease, patients on wait lists, or patients already transplanted.
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Durlik M. History of kidney transplantation in Poland. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2018; 35:84-86. [PMID: 29482280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Perkowska-Ptasinska A, Bartczak A, Wagrowska-Danilewicz M, Halon A, Okon K, Wozniak A, Danilewicz M, Karkoszka H, Marszalek A, Kowalewska J, Mroz A, Korolczuk A, Oko A, Debska-Slizien A, Naumnik B, Hruby Z, Klinger M, Ciechanowski K, Myslak M, Sulowicz W, Rydzewski A, Wiecek A, Manitius J, Gregorczyk T, Niemczyk S, Nowicki M, Gellert R, Stompor T, Wieliczko M, Marczewski K, Paczek L, Rostkowska O, Deborska-Materkowska D, Bogdanowicz G, Milkowski A, Durlik M. Clinicopathologic correlations of renal pathology in the adult population of Poland. Nephrol Dial Transplant 2017; 32:ii209-ii218. [PMID: 28339709 DOI: 10.1093/ndt/gfw365] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/13/2016] [Indexed: 01/28/2023] Open
Abstract
Background This is the first report on the epidemiology of biopsy-proven kidney diseases in Poland. Methods The Polish Registry of Renal Biopsies has collected information on all (n = 9394) native renal biopsies performed in Poland from 2009 to 2014. Patients' clinical data collected at the time of biopsy, and histopathological diagnoses were used for epidemiological and clinicopathologic analysis. Results There was a gradual increase in the number of native renal biopsies performed per million people (PMP) per year in Poland in 2009-14, starting from 36 PMP in 2009 to 44 PMP in 2014. A considerable variability between provinces in the mean number of biopsies performed in the period covered was found, ranging from 5 to 77 PMP/year. The most common renal biopsy diagnoses in adults were immunoglobulin A nephropathy (IgAN) (20%), focal segmental glomerulosclerosis (FSGS) (15%) and membranous glomerulonephritis (MGN) (11%), whereas in children, minimal change disease (22%), IgAN (20%) and FSGS (10%) were dominant. Due to insufficient data on the paediatric population, the clinicopathologic analysis was limited to patients ≥18 years of age. At the time of renal biopsy, the majority of adult patients presented nephrotic-range proteinuria (45.2%), followed by urinary abnormalities (38.3%), nephritic syndrome (13.8%) and isolated haematuria (1.7%). Among nephrotic patients, primary glomerulopathies dominated (67.6% in those 18-64 years of age and 62.4% in elderly patients) with leading diagnoses being MGN (17.1%), FSGS (16.2%) and IgAN (13.0%) in the younger cohort and MGN (23.5%), amyloidosis (18.8%) and FSGS (16.8%) in the elderly cohort. Among nephritic patients 18-64 years of age, the majority (55.9%) suffered from primary glomerulopathies, with a predominance of IgAN (31.3%), FSGS (12.7%) and crescentic GN (CGN) (11.1%). Among elderly nephritic patients, primary and secondary glomerulopathies were equally common (41.9% each) and pauci-immune GN (24.7%), CGN (20.4%) and IgAN (14.0%) were predominant. In both adult cohorts, urinary abnormalities were mostly related to primary glomerulopathies (66.8% in younger and 50% in elderly patients) and the leading diagnoses were IgAN (31.4%), FSGS (15.9%), lupus nephritis (10.7%) and FSGS (19.2%), MGN (15.1%) and pauci-immune GN (12.3%), respectively. There were significant differences in clinical characteristics and renal biopsy findings between male and female adult patients. Conclusions The registry data focused new light on the epidemiology of kidney diseases in Poland. These data should be used in future follow-up and prospective studies.
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Sajjad EA, Radkowski M, Perkowska-Ptasińska A, Pacholczyk M, Durlik M, Fedorowicz M, Pietrzak R, Ziarkiewicz-Wróblewska B, Włodarski P, Malejczyk J. Negative Correlation Between Hepatitis C Virus (HCV) and Let-7 MicroRNA Family in Transplanted Livers: The Role of rs868 Single-Nucleotide Polymorphism. Ann Transplant 2017; 22:638-645. [PMID: 29061957 PMCID: PMC6248281 DOI: 10.12659/aot.905540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Genetic alterations of TGF-β pathway members, including its transmembrane receptor, TGFBR1, may influence the course of HCV infection. Rs868 is a single-nucleotide polymorphism of the 3′UTR region of TGFBR1, located in a binding site for the conserved let-7/miR98 microRNA family. Previously, we demonstrated a favorable course of hepatitis C recurrence after liver transplantation in rs868 AG genotype of the transplanted liver when compared to rs868 AA. The aim of the present study was to confirm the biological effect of rs868. Material/Methods HepG2 cell line was transfected with luciferase vectors cloned with 3′UTR of TGFBR1 gene encompassing different rs868 alleles. Post-transplant liver biopsies from 61 patients with HCV-related end-stage liver disease were evaluated histopathologically and analyzed for the expression of TGFBR1 mRNA, let-7/miR98 microRNAs, HCV RNA load, and rs868 genotype. Results Luciferase expression was significantly lower in the A allele-containing vector. TGFBR1 mRNA and HCV RNA load were correlated negatively with let-7/miR98 microRNAs and this correlation was significantly stronger for rs868 AG compared to AA genotype. A strong positive correlation was demonstrated between TGFBR1 and HCV in both genotypes. In AG heterozygotes, let-7/miR98 microRNAs showed a strong negative correlation with periportal or periseptal interface hepatitis (Ishak A score). Conclusions There is a negative correlation between let-7/miR98 microRNAs and HCV viral load and TGFBR1 mRNA after liver transplantation. In the rs868 AG heterozygotes, this correlation was stronger and there was a negative correlation between let-7/miR98 and Ishak A score, which is in concordance with the previously demonstrated protective role of this genotype in post-transplant hepatitis C recurrence.
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Grenda R, Durlik M. Eculizumab in Renal Transplantation: A 2017 Update. Ann Transplant 2017; 22:550-554. [DOI: 10.12659/aot.905917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Diuwe P, Domagala P, Durlik M, Trzebicki J, Chmura A, Kwiatkowski A. The effect of the use of a TNF-alpha inhibitor in hypothermic machine perfusion on kidney function after transplantation. Contemp Clin Trials 2017; 59:44-50. [DOI: 10.1016/j.cct.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 01/08/2023]
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Perkowska-Ptasinska A, Deborska-Materkowska D, Durlik M. The current management of kidney disease in the elderly. Minerva Med 2017; 109:41-52. [PMID: 28750501 DOI: 10.23736/s0026-4806.17.05351-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic kidney disease (CKD), diabetes and cardiovascular disease constitute three interrelated conditions of strong public health relevance. Elderly individuals account for the largest and the most rapidly growing age segment of the end-stage renal disease population. The elderly are affected by the same types of kidney diseases as younger individuals, but aging itself is associated with a gradual reduction in estimated glomerular filtration rate, which leads to the diminishment of the functional reserve and makes an individual more vulnerable to injurious effects of hypertension, cardiovascular disease, diabetes, and drugs' toxicity. Although the spectrum of diseases affecting people aged ≥65 is the same as in younger population, there are some distinct differences in the frequency of certain nephropathies between these two age groups. The superimposition of aging-related lesions on other kidney diseases evolving in the elderly population makes the clinical picture more complex and reaching diagnosis more challenging. In elderly CKD patients the high prevalence of comorbidities and the often aberrant metabolism of medications have to be considered in individually tailored treatment strategies.
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Forns X, Berenguer M, Herzer K, Sterneck M, Donato MF, Andreone P, Fagiuoli S, Cieciura T, Durlik M, Calleja JL, Mariño Z, Shukla U, Verbinnen T, Lenz O, Ouwerkerk-Mahadevan S, Peeters M, Janssen K, Kalmeijer R, Jessner W. Efficacy, safety, and pharmacokinetics of simeprevir, daclatasvir, and ribavirin in patients with recurrent hepatitis C virus genotype 1b infection after orthotopic liver transplantation: The Phase II SATURN study. Transpl Infect Dis 2017; 19. [PMID: 28295849 DOI: 10.1111/tid.12696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/13/2016] [Accepted: 12/30/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recurrent hepatitis C virus (HCV) infection following liver transplantation is associated with accelerated progression to graft failure and reduced patient survival. METHODS The Phase II, open-label SATURN study (NCT01938625) investigated the combination of simeprevir (SMV), daclatasvir (DCV), and ribavirin (RBV) administered for 24 weeks in 35 patients with recurrent HCV genotype (GT) 1b infection after orthotopic liver transplantation (OLT). RESULTS High rates of both on-treatment and sustained virologic response 12 weeks after end of treatment (SVR12) were achieved in patients who were either treatment-naïve or had failed post-OLT treatment with peginterferon and RBV. Overall, 91% of patients (32/35) achieved SVR12. The combination was generally well tolerated, with an adverse event profile consistent with that observed in previous clinical trials of SMV or DCV separately. Co-administration of SMV with cyclosporine resulted in significantly increased SMV plasma exposures, which was not the case with the co-administration of SMV with tacrolimus. Therefore, the concomitant use of SMV with cyclosporine is not recommended. CONCLUSION The interferon-free combination of SMV, DCV, and RBV administered for 24 weeks was shown to be effective and well tolerated in the treatment of post-OLT HCV GT1b-infected patients.
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