Focus on Pneumonia After Organ Transplantation: Is There a Need for Specific Medical Care in the Emergency Department?

BACKGROUND

Pneumonia is a major cause of hospitalization and has a substantial impact on health care costs. Diagnosis and treatment of pneumonia in solid organ transplant (SOT) patients remain a challenge for clinicians in the emergency department. This study aimed to evaluate demographic features, clinical patterns, history of hospitalization, and diagnosis of adult patients after organ(s) transplantation (liver, kidney, pancreas) with severe pneumonia requiring hospitalization. The aim is to determine whether patients undergoing SOT receive or require specific care and whether they need to be prioritized.

METHOD

This was a single-center observational study of adult patients after SOT with severe pneumonia requiring hospitalization. The data set for the analysis included only patients with pneumonia as the main reason for hospitalization. The diagnosis of pneumonia was suspected based on the American Thoracic Society criteria.

RESULTS

The study revealed that the standard of care for patients with a history of SOT did not significantly differ from care provided to the non-SOT patients with pneumonia admitted to the same hospital during a 94-week period.

CONCLUSION

There were notable differences, such as post-transplant patients being transferred more quickly to the hospital ward, having longer hospital stays, and receiving antibiotics earlier than the non-SOT group.

Demand for Continuous and Long-Term Care in Transplant Recipients: Data From the Organ Transplantation Registry-Poltransplant Activity

BACKGROUND

This study aimed to determine the number of recipients with active transplants under the care of transplant centers in 2022 and the current volume and needs for continuous and long-term care in this group of transplant recipients. Data came from the organ transplant registry, one of the registries maintained by the Polish Transplant Coordinating Center Poltransplant. We included recipients of individual organs who, on January 1, 2022, were living with an active transplant performed in previous years and recipients who received a transplant in 2022. The number of recipients under the care of transplant centers in 2022 was 20,994 (55% of all transplants performed in Poland since the beginning of activity in 1966).

Organ Procurement From Foreigners Who Died in Poland and Organ Transplantation to Foreigners

The aim of the work was to present data concerning organ donation from and transplantation to foreigners in Poland. Data came from registries maintained by the Polish Transplant Coordinating Center POLTRANSPLANT, consisting of the national waiting list, deceased donor registry, transplant registry, and live donor registry. In Poland, the rules for organ and tissue procurement for transplantation from foreigners who died in Poland and the rules for transplanting organs to foreigners are adopted and applied. Before the outbreak of the war in Ukraine, "cross-border" cases of donations and transplants were rather sporadic. After the outbreak of the war, due to the mass influx of Ukrainian citizens, the situation changed, and the participation of foreigners (mostly Ukrainians) in transplantation procedures increased significantly and, in 2022, accounted for the total number of events: approximately 4% in the case of donation, slightly over 1% in the case of qualifications for transplantation and almost 2% in the number of transplantations performed. Despite this increase, the number of events is not high or critical and does not affect the efficiency of organ transplantation medicine in Poland.

Poltransplant Recommendations on Organ Donation and Transplantation in the COVID-19 Era

In this article, we present the standpoint and recommendations of Poltransplant on the use of organs, tissues, and cells other than hematopoietic cells for transplant in connection with SARS-CoV-2 infections (January 15, 2021).

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports

BACKGROUND The presence of fat droplets within the subarachnoid space is an uncommon finding, which is almost exclusively associated with a ruptured dermoid cyst. In a trauma setting, transthecal migration of fat droplets is an extremely rare occurrence. We present 2 case reports of intracranial transthecal migration of fatty bone marrow after sacral fractures. CASE REPORT Both patients presented to the Emergency Department (ED) after falls from a standing height. The first patient, an 84-year-old woman, suffered a stable sacral fracture extending into a large meningeal cyst within the right S2 foramen. Her initial neurological assessment and computed tomography (CT) of the head were unremarkable. As the fracture did not require surgical treatment, she was discharged home and prescribed bed rest, analgesics, and venous thromboembolism prophylaxis. Three days after the injury, she was readmitted to the ED with a mild headache, dizziness, and an episode of nausea and vomiting. A follow-up head CT revealed fat droplets in the subarachnoid space and lateral ventricles. After successful symptomatic treatment, she was discharged home in good general condition. The second patient, a 60-year-old man, underwent a head CT for a scalp hematoma, which revealed fat droplets in the 3rd ventricle and right lateral ventricle. The pelvic CT revealed a large sacral meningeal cyst with microfractures in its wall. He was discharged home on the same day and prescribed bed rest and analgesics. CONCLUSIONS The detection of intracranial intrathecal fat droplets in association with a specific trauma mechanism should initiate the search for a sacral fracture.

Effects of the COVID-19 Pandemic on Solid Organ Transplantation During 2020 in Poland Compared with Countries in Western Europe, Asia, and North America: A Review

The coronavirus disease 2019 (COVID-19) pandemic, due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which began in March 2020, affected organ donor acceptance and rates of heart, lung, kidney, and liver transplants worldwide. According to data reported to POLTRANSPLANT, the number of solid organ transplants decreased by over 35% and the number of patients enlisted de novo for organ transplantation was reduced to 70% of its pre-COVID-19 volume in Poland. Most transplant centers in Western Europe and the USA have also drastically reduced their activity when compared to the pre-pandemic era. Areas of high SARS-CoV-2 infection incidence, like Italy, Spain, and France, were most affected. Significant decreases in organ donation and number of transplant procedures and increase in waitlist deaths have been noted due to overload of the healthcare system as well as uncertainty of donor SARS-CoV-2 status. Intensive care unit bed shortages and less intensive care resources available for donor management are major factors limiting access to organ procurement. The impact of the COVID-19 outbreak on transplant activities was not so adverse in Asia, as a result of a strategy based on experience gained during a previous SARS pandemic. This review aims to compare the effects of the COVID-19 pandemic on solid organ transplantation during 2020 in Poland with countries in Western Europe, North America, and Asia.

Quality System of Kidney Donation for Transplantation From Living Donors in Poland

OBJECTIVE

The program aims to build and develop a high-quality donation system at the hospital and national level. Thirty coordinator posts for the transplantation of kidneys from living donors (LDs) were created. The coordinators' tasks were identified as determining or excluding the possibility of LD donation for kidney transplantation for every potential kidney recipient referred to the waiting list, qualifying potential LDs, supervising health monitoring for LDs and kidney recipients, and education and promotion of transplantation from LDs.

METHODS

The coordinators' reports and verification of data in the national transplant register from June 1, 2018 to November 30, 2019 were analyzed.

ETHICS

The study was conducted according to principles of the Declaration of Helsinki, and the Declaration of Istanbul participation was on a voluntary basis.

RESULTS

Information on possible LDs was obtained from 707 (43%) of the 1630 potential recipients entered on the waiting list. In 373 cases there was no potential LD; 16 recipients did not give consent for kidney transplantation from a LD; for 318 recipients, 340 potential LDs were identified; 90 potential LDs were rejected at the initial stage for medical reasons; 60 potential donors were rejected at further stages of the qualification process; 3 persons resigned from donation; and 23 recipients were transplanted from deceased donors. Kidneys from 73 LDs were qualified and transplanted. On November 30, 2019, 91 potential donors were awaiting further qualification. As part of the program, 27 potential pairs for paired kidney exchange were reported to Poltransplant (17 pairs with positive HLA crossmatch, 10 with incompatible blood groups).

CONCLUSIONS

The creation of posts for coordinators for LD kidney transplantation in centers that qualify for LD kidney transplantation enabled systematic monitoring of donation potential, which led to an increase in the number of LD kidney transplants in 2019. Making full use of donation potential should significantly increase these numbers in the coming years.

Assessment of Organ Donation Potential From Brain-Dead Donors in Polish Hospitals Using Quality Systems: System Of Donor Hospital Transplant Coordinators and Web-Tooled System of Monitoring Intensive Care Unit Deaths

INTRODUCTION

In 2010 Poltransplant organized a national network of donor hospital transplant coordinators involved in the recruitment of potential deceased organ donors. One of the employed coordinators' tasks is monitoring donation potential at hospitals and reporting their results with the use of a tele-information tool www.koordynator.net.

BACKGROUND

The aim of our study was to evaluate the organ donation potential at hospitals in 2018 based on the analysis of reports and on the comparison of these results with organ donation indicators elaborated within the European Commission project entitled Improving the Knowledge and Practices in Organ Donation (DOPKI).

METHODS

Reports concerning deaths were applied to a retrospective analysis regarding a possibility to diagnose deaths according to neurologic criteria and to detect possible donations. In total, 1214 reports from 116 hospitals were delivered to the tele-information system during 2018. The analysis was made based on 840 full monthly reports from 70 hospitals. Numbers and indicators connected to the organ donation potential, both in the hospital and the intensive care unit (ICU) scales, have been calculated: numbers of beds and admissions, total number of deaths, deaths due to reasons frequently leading to death according to neurologic criteria, number of brain death diagnoses, and number of organ donations.

RESULTS

In the scales of hospital and ICU the studied indices showed the following: 1. distinctly lower ratios related to brain death determination in the total number of beds, admissions, deaths, and deaths with selected International Classification of Diseases and Related Health Problems (ICD) codes in comparison with DOPKI results and 2. distinctly higher ratio of donations in the total number of brain deaths confirmed (69%) in comparison with DOPKI (42%).

CONCLUSIONS

Based on obtained data from respective hospitals, the analysis showed the following in comparison with data coming from international European study (DOPKI): 1. low frequency of brain death determination procedures in the total number of deaths in Polish hospitals and ICUs, probably also in cases where such mechanism of death has occurred (the discrepancy may reach 1974 cases per year) and 2. high percentage of donations in the total number of brain-dead persons (conversion index), which may be caused by successful authorization of donation and acceptance of risky donors and organs by transplant teams but (what is more probable) may be explained by the ICUs' habit that procedures of brain death protocol is implemented only in cases when donation is expected.

Spinal Cord Ischemia Because of Microvascular Thrombosis in a Patient with Necrotizing Pancreatitis. Case Report and Literature Review

Patient: Male, 37-year-old

Final Diagnosis: Acute pancreatitis • thrombotic microangiopathy

Symptoms: Epigastric pain • paresis

Medication: —

Clinical Procedure: Computed tomography • ERCP • hemodialysis • magnetic resonance imaging • omentectomy

Specialty: Critical Care Medicine • Gastroenterology and Hepatology • Radiology • Surgery

Early Complications After Kidney Transplantation in Patients Aged 60 Years and Older: A Single-Center, Paired-Kidney Analysis

OBJECTIVES

As the population ages, the number of people suffering from cardiovascular diseases (CVD) and diabetes mellitus (DM) increases. The coexistence of these diseases can affect the results of kidney transplantation (KT) in the elderly. The aim of this study was to analyze surgical and nonsurgical complications in the early period after KT and to identify the factors that influence their development in recipients aged ≥ 60 years compared to younger recipients < 60 years.

METHODS

One hundred seventy-five recipients of KT ≥ 60 years and 175 recipients of KT < 60 years who received kidneys from the same deceased donor were enrolled into the study. The incidence of surgical and nonsurgical complications, factors that may influence their development, early graft function, and patient and kidney-graft survival were analyzed during a 3-month follow-up period. Donor sources complied with the Helsinki Congress and Istanbul Declaration and organs were not procured from prisoners and individuals who were coerced or paid.

RESULTS

Older recipients were characterized by higher body mass index ± SD (26.1 ± 3.5 vs 24.7 ± 3.4 kg/m²) and suffered more often from pretransplant DM (20.6% vs 11.4%) and CVD (34.3% vs 10.3%) and less frequently underwent previous KT (6.3% vs 20.0%). There were no differences between the ≥ 60 year old and < 60 year old groups in reference to surgical (20.6% vs 24%) and nonsurgical complications (28.6% vs 27.4%), early graft function, serum creatinine, and proteinuria. Recipients (95.4% vs 97.1%) and kidney-graft survival (93.1% vs 95.4%) were similar in both groups. The recipient factors that influenced the development of infectious complications were age, dialysis duration, pretransplant DM, and CVD.

CONCLUSIONS

Despite higher co-incidence of CVD and DM, the risk of surgical and nonsurgical complications in elderly recipients is comparable to younger recipients in the early period after KT.

Evolution of Indications for Liver Transplantation (LTx) in the Years 2001-2017 in Poland

BACKGROUND Hepatitis B and C viruses have been recognized as undoubtedly carcinogenic to humans. In the Polish population, where most people are protected by HBV vaccinations, hepatocellular carcinoma (HCC) and its main cause, persistent HCV infection, significantly affect the demand for liver transplantations. MATERIAL AND METHODS The purpose of this study was to categorize the number of primary liver transplantations in Poland in the years 2001-2017 by cause and to analyze changes in LTx indications during this period. Data were sourced from POLTRANSPLANT, the Organization and Coordination Center for Transplantation in Poland. Additionally, we compared the numbers of HCC cases and hepatitis B and C cases during this period. RESULTS In the analyzed period, in Poland, 3332 primary liver transplantations were performed. Overall, 44% (1456) of LTx cases were combined with HBV and/or HCV and/or HCC. In this group, transplants in patients with only 1 specific factor - HCV - formed the largest cohort, accounting for about 40% (581) of cases. Transplants in patients who only had HBV and in those who only had HCC accounted for 12% (185) and 5% (69), respectively. CONCLUSIONS The analyzed data suggest that HCV infections are a significant public health problem in Poland, as is also reflected by the growing number of LTx performed due to HCC. To limit the numbers of HCV and HCC cases, immediate implementation of a Polish National Program against HCV should be considered.

Usefulness of Pancreas Donor Risk Index and Pre-Procurement Pancreas Allocation Suitability Score: Results of the Polish National Study

Background

Pre-procurement pancreas suitability score (P-PASS) and pancreas donor risk (PDRI) index are scoring systems believed to predict suitability of pancreatic grafts. Most European countries and the United States apply PDRI, while Poltransplant keeps using P-PASS: more than 16 points raises a red flag for graft use. Recent data discourage use of PDRI to predict pancreas graft survival. The aim of the present study was to assess PDRI and P-PASS as predictors of transplanted pancreas survival in a Polish population.

Material/Methods

From February 1998 to September 2015, 407 pancreas transplantations were performed in Poland: 370 (90.9%) simultaneous pancreas-kidney transplantation and 37 (9.1%) pancreas transplantation alone or pancreas after kidney. The endpoint was death-uncensored 12-month graft survival with satisfactory glycemic control without insulin.

Results

Average P-PASS was 15.9±2.66 and PDRI was 0.96±0.37. Recipients who survived 12 months with good graft function had an average P-PASS score of 15.7 and PDRI of 0.95. Recipients with death-uncensored graft loss had a mean P-PASS of 16.4 and PDRI of 0.99. Univariate analysis revealed donor age, body mass index (BMI), and P-PASS to be significant risk factors for 1-year pancreas graft survival.

Conclusions

P-PASS, but not PDRI, is a reliable tool to predict pancreas graft survival in the Polish population.

Simultaneous Pancreas-Kidney Transplantation in a Patient with Heparin-Induced Thrombocytopenia on Dabigatran Therapy

Background

New oral anticoagulants like direct thrombin inhibitors are an attractive alternative to vitamin K antagonists as anticoagulation therapy and can be used in heparin-induced thrombocytopenia. They are convenient in low-risk surgery, as there is no need for bridging with heparins. Patients who need urgent major surgery are at similar risk as on warfarin therapy, which, however, is much higher than in elective procedures. Due to their elimination profiles, these drugs are generally contraindicated in patients with severe renal insufficiency. On the other hand, pancreas transplantation is associated with high risk of bleeding and substantial risk of graft thrombosis. There are no recommendations on anticoagulation therapy in high-risk patients on kidney-pancreas waiting lists who cannot be given heparins.

Case Report

We describe a case of simultaneous pancreas-kidney transplantation in a patient with heparin-induced thrombocytopenia on dabigatran treatment.

Conclusions

We conclude that, despite the high risk, pancreas transplantation in a patient with HIT can be safely done while on NOAC therapy, but an access to idarucizumab should be assured.

Results of Renal Transplant From Deceased Anti-hepatitis C Virus Donors, Poland 1998-2012

Kidney transplant (KTx) is the best method of renal insufficiency treatment. In dialyzed patients, mortality rises with the time on dialysis. There is a continuing shortage of organs for transplantation, hence a propensity to expand the donor pool with expanded-criteria donors, anti-hepatitis C virus-positive included. In the above case a transmission of hepatitis C virus (HCV) genotype to recipient is present. It has been proven that contamination with more than 1 HCV genotype did not worsen KTx outcomes. There are 2.6% anti-HCV(+) donors in Poland. Use is only possible in cases of anti-HCV(+) and anti-HCV RNA(+) recipients.

METHODS

Retrospective analysis covered 8675 deceased donors (1998-2012 Polish data from Poltransplant). The early (after 12 months) and late (after 60 months) graft and patient survival was assessed in KTx recipients, with documented recipient and donor data spanning at least 1 year after KTx. In comprehensive analysis, 7016 KTx recipients with known anti-HCV status were included according to anti-HCV profile of recipient and donor. The results are in absolute and percentage values and P < .05 assessed with χ² test.

RESULTS

Twelve-month survival: recipient (R) (95%), graft (G) (89%), total; R (95% vs 89%, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(+/-) vs HCV(+) to HCV(+); R (95 vs 94, P = .2), G (88 vs 83, P < .001), HCV(-) to HCV(-) vs HCV(-) to HCV(+); R (93 vs 95, P = .004), G (82 vs 89, P < .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (95 vs 89, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(-) vs HCV(+) vs HCV (+). Sixty-month survival: R (86%), G (75%), total; R (84 vs 88, P = .01), G (63 vs 71, P = .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (88 vs 80, P = .003) in HCV(-) to HCV(-) vs HCV(+) to HCV(+).

CONCLUSIONS

The worst anti-HCV serological profile was HCV(+) to HCV(+), although transplanting HCV(+) to HCV(+) did not worsen outcomes in that group. Worse KTx outcomes of HCV(+) over HCV(-) donors can be attributed to HCV(+) status of the recipient.

Relationships Between Social Attitudes Toward Deceased Organ Donation and the Donation Rates in Poland, a Country With an Opting-out System

BACKGROUND

Monitoring of attitudes toward deceased donation gives the general view of the acceptance of this treatment but does not allow for precise prediction of single person's behavior. Consistency of actions and attitudes has many determinants, personal and situational. The idea of this study was to assess and compare relationships between behaviors and attitudes toward postmortem organ donation in single districts and between larger regions of the country (west and east).

METHODS

Indicators calculated for the years 1996-2014 included the number of potential deceased donors (per million population [pmp]/y), the number of objections registered in the refusal registry (pmp), and the number and percentage of family refusals to donation. To assess relationships between variables, statistical and descriptive analyses were used.

RESULTS

There were 10,731 potential donor referrals: 10 times more in the most active than in the least active province. Potential donor referrals from the western region were almost twice as high (18.3 pmp/y) as from the east (10.1). In 1,045 cases (9.7%), organs were not used owing to objections of the relatives; this index differed in each province up to 7-fold, but was almost the same in western and eastern regions. Total number of objections listed in the Refusal Registry was 28,725 (748 pmp). This index was different in each district up to 4-fold, but was not distinctly different in west and east regions. No distinct correlation (Pearson test) was found among the 3 assessed variables.

CONCLUSIONS

Donation in Poland has much geographic differences. There is no common pattern of behavior and attitude toward donation and no correlation between these variables.

The Model of Postgraduate Studies for Transplant Coordinators in Poland: 500 Graduates in the Years 2007-2015

BACKGROUND

Since 2007, the Medical University of Warsaw has been organizing the Transplant Coordinators Postgraduate Studies, which are funded by the National Programme for the Development of Transplantation Medicine. The aim of the studies is to recruit medical professionals for every hospital with the potential of deceased donations. The goal of the present study was to formally evaluate the previous 16 editions of Transplant Coordinators Postgraduate Studies by assessing graduate profiles and analyzing the efficiency and sustainability of their education.

METHODS

Graduate profiles were determined by gathering sociodemographic information contained in student records. Training efficiency and sustainability were defined by assessing the actual performance of the coordinators' functions in the hospital after taking the course.

RESULTS

As of May 2015, the number of Transplant Coordinators Postgraduate Studies graduates totals 501. Approximately one half of the graduates (n = 248) had nursing degrees; training was also finished by 199 physicians, and 54 individuals had other medical education. The number of graduates per million population across the whole country totals 13. A total of 226 of the graduates (45%) were employed in the years 2007-2015 in hospitals as transplant coordinators; physicians (93 graduates), nurses (107 graduates) and other medical proffessionals (26 graduates).

CONCLUSIONS

The academic formula of the Transplant Coordinators Postgraduate Studies funded by public sources makes it possible to educate practicing staff (physicians and nurses alike) for a nationwide system of donor hospital transplant coordinators posted in >200 hospitals and maintained by a national transplant organization.

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.

Assessment of cadaveric livers discarded from transplantation. A correlation between clinical and histological parameters

BACKGROUND

We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology.

MATERIAL/METHODS

Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation.

RESULTS

In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation.

CONCLUSIONS

Results of biopsies suggested that approximately in one third of livers discarded from transplantation due to clinical donor parameters could have been harvested from histological point of view. Several donor clinical risk factors (alcohol addiction, hyperbilirubinemia, increased transaminase activity) correlate with severe histological changes rending the liver "not suitable for transplantation".