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Hermanowicz M, Borczon S, Lewandowska D, Przygoda J, Podobińska I, Danielewicz R, Malanowski P, Kamiński A, Czerwiński J. Quality System of Kidney Donation for Transplantation From Living Donors in Poland. Transplant Proc 2020; 52:2033-2035. [PMID: 32409223 DOI: 10.1016/j.transproceed.2020.01.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- M Hermanowicz
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland
| | - S Borczon
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland
| | - D Lewandowska
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland; Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - J Przygoda
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland
| | - I Podobińska
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland
| | - R Danielewicz
- Department of Surgical and Transplantation Nursing and Extracorporeal Treatment, Medical University of Warsaw, Warsaw, Poland
| | - P Malanowski
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland
| | - A Kamiński
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland; Department of Transplantology and National Tissue and Cell Banking Center, Medical University of Warsaw, Warsaw, Poland
| | - J Czerwiński
- Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
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Pliszczyński J, Jasztal K, Jóźwik A, Kosieradzki M, Danielewicz R, Małkowski P, Czerwiński J. Results of Renal Transplant From Deceased Anti-hepatitis C Virus Donors, Poland 1998-2012. Transplant Proc 2018; 50:1691-1696. [PMID: 30056883 DOI: 10.1016/j.transproceed.2018.02.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- J Pliszczyński
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland.
| | - K Jasztal
- Department of Surgical and Transplant Nursing, Warsaw Medical University, Warsaw, Poland
| | - A Jóźwik
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland
| | - M Kosieradzki
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland
| | - R Danielewicz
- Department of Surgical and Transplant Nursing, Warsaw Medical University, Warsaw, Poland
| | - P Małkowski
- Department of Surgical and Transplant Nursing, Warsaw Medical University, Warsaw, Poland
| | - J Czerwiński
- Department of Emergency Medicine, Warsaw Medical University, Warsaw, Poland
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Malanowski P, Antoszkiewicz K, Jakubowska-Winecka A, Czerwiński J, Danielewicz R. Central Register of Objections for Deceased Donation in Poland 1996 to 2014: The Country With an Opting-Out System. Transplant Proc 2016; 48:1337-40. [DOI: 10.1016/j.transproceed.2016.01.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
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4
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Lewandowska D, Czerwiński J, Hermanowicz M, Przygoda J, Podobińska I, Danielewicz R. Organ Donation From Elderly Deceased Donors and Transplantation to Elderly Recipients in Poland: Numbers and Outcomes. Transplant Proc 2016; 48:1390-3. [DOI: 10.1016/j.transproceed.2016.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 01/24/2023]
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Danek T, Czerwiński J, Milaniak I, Trujnara M, Parulski A, Przybylowski P, Danielewicz R. System of Donor Hospital Transplant Coordinators Maintained and Financed By National Transplant Organization Improves Donation Rates. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ratajczak P, Nowakowska E, Kus K, Danielewicz R, Herman S, Woźniak A. Neuroleptics and enrichment environment treatment in memory disorders and other central nervous system function observed in prenatally stressed rats. Hum Exp Toxicol 2014; 34:526-37. [PMID: 25062975 DOI: 10.1177/0960327114543934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
It is believed that the most effective method of treatment in schizophrenia is pharmacotherapy, in particular, the use of atypical neuroleptics like aripiprazole (ARI) and olanzapine (OLA). Moreover, studies of many authors have shown that enriched living conditions and tobacco smoke exposure can also affect the cognitive functions that are disturbed in the course of schizophrenia. The aim of the study was to find whether tobacco smoke and enrichment living conditions have the influence on cognitive functions in the newborn offspring of prenatally stressed rats and whether drugs such as ARI (1.5 mg/kg intraperitoneally (i.p.)) and OLA (0.5 mg/kg ip) in single and chronic treatment modify those functions (Morris water maze). The study (in the same conditions) also analyses immobility time (Porsolt test) and motor activity of animals that received ARI and OLA. It has been shown that ARI and OLA as well as enriched environment reduce cognitive function disorders and modify cognitive functions in rats exposed to tobacco smoke. In turn, current research has shown that nicotine has increased cognitive function disorders compared to the previous study (animals without tobacco smoke exposure).
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Affiliation(s)
- P Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - E Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - K Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - R Danielewicz
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - S Herman
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - A Woźniak
- Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland
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Kosieradzki M, Czerwinski J, Jakubowska-Winecka A, Kubik T, Zawilinska E, Kobryn A, Bohatyrewicz R, Zieniewicz K, Nyckowski P, Becler R, Snarska J, Danielewicz R, Rowinski W. Partnership for Transplantation: A New Initiative to Increase Deceased Organ Donation in Poland. Transplant Proc 2012; 44:2176-7. [DOI: 10.1016/j.transproceed.2012.07.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Kwiatkowski A, Wszola M, Kosieradzki M, Danielewicz R, Ostrowski K, Domagala P, Lisik W, Nosek R, Fesolowicz S, Trzebicki J, Durlik M, Paczek L, Chmura A, Rowinski W. Machine perfusion preservation improves renal allograft survival. Am J Transplant 2007; 7:1942-7. [PMID: 17617857 DOI: 10.1111/j.1600-6143.2007.01877.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
UNLABELLED Machine perfusion (MP) has been used as the kidney preservation method in our center for over 10 years. The first, small (n = 74) prospective, single-blinded randomized study comparing MP and Cold Storage (CS) showed that the incidence of delayed graft function was higher after CS. There have been no reports in the literature on the effect of storage modality on long-term function of renal allografts. This paper presents an analysis of long-term results of renal transplantation in 415 patients operated on between 1994 and 1999. Of those, 227 kidneys were MP-stored prior to KTx. The control group consisted of 188 CS kidney transplants. Kidneys were not randomized to MP or to CS. Donor demographics, medical and biochemical data, cold ischemia time, HLA match and recipient data were collected. Standard triple-drug immunosuppression was administered to both groups. Mortality, graft survival and incidence of return to hemodialysis treatment were analyzed. Despite longer cold ischemia time and poorer donor hemodynamics in MP group, 5-year Kaplan-Meier graft survival was better in MP-stored than in CS-stored kidneys (68.2% vs. 54.2%, p = 0.02). CONCLUSION In this nonrandomized analysis, kidney storage by MP improved graft survival and reduced the number of patients who returned to dialysis.
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Affiliation(s)
- A Kwiatkowski
- Department of General and Transplantation Surgery, Warsaw Medical University, Poland
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9
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Michalak G, Kwiatkowski A, Czerwinski J, Chmura A, Wszola M, Nosek R, Ostrowski K, Danielewicz R, Lisik W, Adadynski L, Małkowski P, Fesolowicz S, Bieniasz M, Kasprzyk T, Durlik M, Walaszewski J, Rowinski W. Surgical complications of simultaneous pancreas-kidney transplantation: a 16-year-experience at one center. Transplant Proc 2006; 37:3555-7. [PMID: 16298659 DOI: 10.1016/j.transproceed.2005.09.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fifty-one simultaneous pancreas-kidney transplants (SPKT) were performed between 1988 and 2004 in patients of mean age 34 years and 23 years duration of diabetes treatment. All kidney and pancreas recipients were on maintenance hemodialysis therapy prior to SPKT. The pancreas with duodenal segment and the kidneys were harvested from cadaveric heart-beating donors. Cold ischemia time in UW solution varied from 4 to 14 hours (mean, 9 hours 35 minutes). Twenty patients had the duodenal segment sutured to the urinary bladder, and the remaining 31 grafts were drained to an isolated ileal loop. Quadruple immunosuppression was administered as well as an anticoagulant and antibiotic prophylaxis. Forty-nine patients (49/51, 96%) regained insulin independence in the immediate postoperative period; 44 (86%) displayed immediate graft function. The remaining patients experienced postoperative ATN, the longest duration was 18 days. Of 51 patients, 38 (14.5%) are alive (follow-up, 6 to 180 months), 26 (68.5%) have good pancreatic function, and 34 (89%), good kidney function. Nineteen (50%) patients regard their quality of life as improved compared to their pretransplant status, which is mainly attributed to being dialysis and insulin free. Of 19 patients, 14 (74%) reported measuring glycemia regularly due to fear of losing the pancreas graft. Of 19 persons, seven (37%) returned to work after transplantation. Four (8.3%) lost their kidney graft secondary to vascular complications (n = 2) or rejection (n = 2). Four pancreas grafts with bladder drainage required conversion to enteric drainage owing to persistent urinary infections or urinary fistulae. Fifteen (29%) patients lost their pancreatic grafts within 1 year of transplantation due to the following: vascular complications (n = 12), septic complications (n = 1), or rejection (n = 2). Thirteen patients died within 1 year after transplantation, 5 of septic complications, 5 of neuroinfection, 1 of pulmonary embolism, and 2 of myocardial infarction. In conclusion, SPKT is a successful treatment for diabetic nephropathy, burdened by the possibility of serious complications.
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Affiliation(s)
- G Michalak
- Department of General and Transplantation Surgery, Warsaw Medical University, Poland
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10
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Wszola M, Kwiatkowski A, Nosek R, Podsiadly E, Meszaros J, Danielewicz R, Lisik W, Ostrowski K, Chmura A, Adadyński L, Paczek L, Durlik M, Tylewska-Wierzbanowska S, Rowiński W. Chlamydia Pneumoniae Infection and Ischemic Heart Disease in Hemodialysis Patients. Transplant Proc 2006; 38:31-4. [PMID: 16504656 DOI: 10.1016/j.transproceed.2005.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ischemic heart disease and other atherosclerotic complications are the prominent causes of death among hemodialyzed end-stage renal disease (ESRD) patients and renal transplant recipients. Numerous articles in recent years have raised the possibility of an infective factor, especially Chlamydia pneumoniae, in the development of atherosclerosis and its complications. The aim of this study was to assess the incidence of chronic C pneumoniae infection and its association with ischemic heart disease and atherosclerosis in a population of patients with ESRD awaiting renal transplantation. MATERIAL AND METHODS The studied group consisted of 164 subjects: 99 ESRD patients (heart disease [HD] group) who were hospitalized for vascular access creation (27), pretransplantation nephrectomy (47), or kidney transplantation (25), and a control group of 65 subjects consisting of 50 healthy blood donors and 15 multiorgan donors. C pneumoniae was detected in vascular wall fragments, kidney biopsy specimens and peripheral blood monocytes using real time polymerase chain reaction (PCR). Serum immunoglobulin IgG and IgA anti-C pneumoniae antibodies were detected using Enzyme-linked immunosorbent assay (ELISA) and a lipid profile (cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides [TG]) was obtained. Data on cardiovascular disease events, smoking history, diabetes, hypertension, cause, and length of renal failure were collected and analyzed. The existence of atherosclerotic lesions was detected using ultrasound (US) Doppler examination of aortic bifurcation. Chronic C pneumoniae infection was diagnosed on the basis of detection of both IgA and IgG antibodies and/or the detection of C pneumoniae DNA in vascular wall fragments or peripheral blood monocytes. After a follow-up of 32 months, data on cardiovascular events and patient history were collected again. RESULTS Chronic C pneumoniae infection affected 46.5% (46/99) of HD patients and 9% (6/65) of controls (P < .05). Among HD patients, 26.3% (26/99) had ischemic heart disease (IHD) versus 6% in the control group. Among C pneumoniae-infected HD patients, IHD was more frequent (39.1%) than in noninfected HD patients (15%; P < .05). Within the 32-month observation period of the HD group, cardiac pain was observed in 11 (24%; 11/46) infected patients versus 3 (5.7%; 3/53) patients without C pneumoniae infection (P < .05). Exacerbation of previously diagnosed IHD was observed in 8 (44%; 8/18) cases in the C pneumoniae-infected group versus 0 (0%; 0/8) in the uninfected patients (P < .05). CONCLUSIONS Chronic C pneumoniae infection affects hemodialysis patients more frequently than healthy subjects. Hemodialysis patients with C pneumoniae infection are at the greater risk of exacerbation of existing IHD.
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Affiliation(s)
- M Wszola
- Department of General and Transplantation Surgery, Warsaw Medical University, ul. Nowogrodzka 59, 02-006 Warsaw, Poland.
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Kwiatkowski A, Wszola M, Nosek R, Podsiadly E, Meszaros J, Ostrowski K, Lisik W, Michalak G, Chmura A, Kosieradzki M, Danielewicz R, Fesolowicz S, Kasprzyk T, Paczek L, Durlik M, Persson K, Tylewska-Wierzbanowska S, Rowinski W. Chlamydia Pneumoniae Infection: An Additional Factor for Chronic Allograft Rejection. Transplant Proc 2006; 38:108-11. [PMID: 16504677 DOI: 10.1016/j.transproceed.2005.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Chronic rejection (CHR) of organ allografts, one of the most significant problems in modern transplantation, is not fully understood. This study sought to evaluate the influence of selected parameters on late kidney transplant function. PATIENTS AND METHOD The studied group consisted of eighty-six patients who received allogeneic transplants between 1988 and 1999 for leukocyte Chlamydia pneumoniae-DNA, immunoglobulin (Ig)A/IgG anti-C pneumoniae, blood lipids, ischemic damage in the donor and during organ preservation, HLA mismatch, and acute rejection episodes. RESULTS Eighty-six patients were segregated as 26 patients (30%) with histologically proven chronic graft rejection (CHR[+]) and 59 patients (70%) without (CHR[-]). The presence of C pneumoniae-DNA in peripheral blood leukocytes was significantly more frequent in CHR(+) than CHR(-) group (46% vs 20%). Patients with leukocytes positive for C pneumoniae-DNA more frequently (50%) had CHR than patients negative for C pneumoniae-DNA (22%). CHR(+) patients showed significantly lower HDL levels (47 mg/dL vs 58 mg/dL) and higher triglyceride levels (193 mg/dL vs 148 mg/dL). To study the cumulative effect of differences between the CHR(+) and CHR(-) groups, we applied a multiple binary logistic regression analysis. An econometric model enabled us to calculate the probability of CHR for a given patient taking into account covariates chosen by means of stepwise selection: the presence of C pneumoniae-DNA in blood leukocytes, the use of continuous pulsatile perfusion in hypothermia, myocardial infarction occurrence, and triglyceride concentrations. CONCLUSION The presence of C pneumoniae-DNA in peripheral blood leukocytes increased the risk of CHR, which may be predicted by a multifactor analysis of chosen parameters.
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Affiliation(s)
- A Kwiatkowski
- Department of General and Transplantation Surgery, Warsaw Medical University, ul. Nowogrodzka 59, 02-006 Warsaw, Poland
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12
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Michalak G, Kwiatkowski A, Bieniasz M, Meszaros J, Czerwinski J, Wszola M, Nosek R, Ostrowski K, Chmura A, Danielewicz R, Lisik W, Adadynski L, Fesołowicz S, Dobrowolska A, Durlik M, Rowiñski W. Infectious Complications After Simultaneous Pancreas–Kidney Transplantation. Transplant Proc 2005; 37:3560-3. [PMID: 16298661 DOI: 10.1016/j.transproceed.2005.09.078] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Simultaneous pancreas-kidney transplantation (SPKT) improves long-term survival of insulin-dependent diabetes mellitus patients with diabetic nephropathy. The increasing success of SPKT is a result of improved surgical technique, better organ preservation, potent antirejection therapy, and effective use of antibiotics to prevent and treat infectious complications. However, morbidity and mortality following SPKT remain high mainly owing to infection. From 1988 to 2004, the 51 patients who underwent SPKT were 32 women and 19 men of mean age 34 +/- 4 years old with diabetes and end-stage renal disease. The mean duration of diabetes mellitus was 23 +/- 4 years. The incidence of HCV and HBV infections were 19.6% and 13.7%, respectively. Preoperative work-up included identification and elimination prior to surgery of potential sources of infection. All patients prior to SPKTx had been treated by dialysis (26 +/- 20 months). The kidneys were always placed into the left retroperitoneal space first; at the same time the pancreatic grafts were prepared on the back table. The reconstruction of the superior mesenteric and the splenic arteries was performed using a Y graft of donor iliac artery to the common or external donor's iliac artery. The pancreas was transplanted intraperitoneally to the right iliac vessels. The portal vein was sutured to the common or external iliac vein and the arterial conduit of donor iliac artery. In 20 of the patients, bladder drainage and in 31, enteric drainage was used for the pancreatic juice exterioration. Patients received immunosuppression with a calcineurin inhibitor (tacrolimus or cyclosporin), mycophenolic acid or azathioprine, and steroids. Antibody induction (alternatively anti-IL-2 monoclonal antibody or ATG) was used in last 38 patients. Antibacterial (tazobactam) and antifungal (fluconazole) as well as antiviral (gancyclovir) prophylactic treatment was given to all patients for 7 to 10 days after transplantation. Thirty-eight recipients are alive, 26 with function of both grafts; 8 with functioning kidney grafts; and 4 with nonfunctioning grafts on dialysis treatment from 1 to 14 years after transplantation. Thirteen patients (24.5%) died during the first year after transplantation. Infectious complications were the main cause of death. Systemic infections accounted for the death of five patients and CNS infection for death of another five patients. Three patients died with functioning grafts due to cardiopulmonary disorders (myocardial infarction, pulmonary embolus) early in the postoperative period. A total of 102 infections were diagnosed in 51 patients during the posttransplant course. Twenty-one episodes of CMV infection (systemic 20, duodenal site 1), 73 bacterial infections (systemic 13, pulmonary 13, urinary tract 15, intestinal 8, wound 23), and 8 fungal infections (central nervous system 5, gastrointestinal tract 3). Some patients had more than one type of infection. Overall mortality in the investigated group was 24.5%. Infectious complications were the main cause of death (77%), including systemic infection (38.5%) and CNS infection (38.5%). The predominant etiology of the systemic infections was bacterial. The etiology of CNS infections was fungal. In conclusion, infectious complications are the main cause of morbidity and mortality following SPKT. The early diagnosis of infection, particularly fungal complications, is necessary. The administration of broad-spectrum prophylactic antibiotics, antifungal, and antiviral agents is recommended.
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Affiliation(s)
- G Michalak
- Department of General and Transplantation Surgery, Warsaw Medical University, Ul. Nowogrodzksa 59, 02-006 Warsaw, Poland
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Kwiatkowski A, Michalak G, Czerwinski J, Wszola M, Nosek R, Ostrowski K, Chmura A, Danielewicz R, Lisik W, Adadynski L, Malkowski P, Fesolowicz S, Bieniasz M, Kasprzyk T, Bernas M, Szczeklik-Kumala K, Glowania A, Durlik M, Walaszewski J, Tatoń J, Rowinski W. Quality of Life After Simultaneous Pancreas–Kidney Transplantation. Transplant Proc 2005; 37:3558-9. [PMID: 16298660 DOI: 10.1016/j.transproceed.2005.09.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients' psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality of life. Results showed excellent endocrine pancreatic function in 17 patients. In most recipients, insulin activity and C-peptide levels were elevated owing to systemic venous drainage. Opthalmological examination revealed blindness in 7 patients (in 4 cases with onset following SPKTx) and retinopathy in 13 patients (in 5 cases it appeared after SPKTx). Assessment of the cardiovascular system revealed satisfactory cardiac function in 16 of 19 patients; 4 patients underwent amputation of a lower limb following SPKTx. All 19 recipients admitted to a great benefit of transplantation; most patients declared ability to organize their life activity and social functions and 4 had regular employment. Conversely, most patients were afraid of graft loss, and half were often sad and even depressed.
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Affiliation(s)
- A Kwiatkowski
- Department of General and Transplantation Surgery, Warsaw Medical University, Ul. Nowogrodzksa 59, 02-006 Warsaw, Poland
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Baczkowska T, Perkowska-Ptasińska A, Sadowska A, Lewandowski Z, Nowacka-Cieciura E, Cieciura T, Pazik J, Lewandowska D, Mroz A, Urbanowicz A, Nazarewski S, Danielewicz R. Serum TGF-beta1 correlates with chronic histopathological lesions in protocol biopsies of kidney allograft recipients. Transplant Proc 2005; 37:773-5. [PMID: 15848527 DOI: 10.1016/j.transproceed.2005.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Transforming growth factor-beta (TGF-beta) is a well-known profibrotic factor playing a role in chronic kidney allograft nephropathy. Cyclosporine (CsA)-sparing immunosuppressive regimens may improve long-term graft function. Our aim was to study the influence of immunosuppressive treatment with versus without calcineurin inhibitors on serum TGF-beta levels and histological changes in protocol biopsies of kidney allograft recipients. PATIENTS AND METHODS In this prospective, randomized study of 42 low-rejection risk patients we randomized two groups: group A: mycophenolate mofetil (MMF), prednisone, daclizumab, and reduced CsA dose for 7 months (5 mg per kg per day) followed by complete withdrawal (n = 21); and group B: normal CsA dose (10 mg per kg per day adjusted according to C2 levels), MMF, prednisone, and no daclizumab (n = 21). METHODS In both groups we performed histological assessments (Banff 97) and measured serum TFG-beta levels before as well as, at 3 and 12 months after transplantation. RESULTS We found a relationship between immunosuppressive regimen and the TGF-beta concentration over 1 year of observation. Before transplant the TGF-beta1 levels did not differ between the groups (P = .29); at 3 months they were 33 +/- 9 vs 49 +/- 15 pg per mL, respectively, in groups A and B (P = .08), and at 12 months they were 39.5 +/- 4 versus 55.5 +/- 11 pg per mL, respectively, in groups A and B (P = .03). Protocol biopsies at 12 months in group B showed chronic tubular lesions more pronounced than in group A. TGF-beta1 concentrations were significantly higher among group B than A. We conclude that TGF-beta1 concentration may predict the development of kidney graft fibrosis; early CsA withdrawal may achieve a reduction in chronic tubular and interstitial injury of cadaveric kidney allografts.
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Cieciura T, Urbanowicz A, Perkowska-Ptasinska A, Nowacka-Cieciura E, Tronina O, Majchrzak J, Baczkowska T, Matlosz B, Danielewicz R, Nazarewski S, Durlik M. Tubular and Glomerular Proteinuria in Diagnosing Chronic Allograft Nephropathy With Relevance to the Degree of Urinary Albumin Excretion. Transplant Proc 2005; 37:987-90. [PMID: 15848599 DOI: 10.1016/j.transproceed.2005.01.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The diagnosis of chronic allograft nephropathy (CAN) is based on pathological examination according to Banff 97 schema. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria for noninvasive recognition of CAN. One hundred and thirty renal allograft recipients (at least 90 days after transplantation) who had undergone diagnostic allograft biopsy were included in the study. Beta2-microglobulin, alpha1-microglobulin, albumin, immunoglobulin G, total protein, and creatinine concentrations were obtained from the second morning urine specimen. Raw data and values calculated per 1 g of creatinine excreted in urine along with time after transplantation, serum creatinine, and its change over a period of 2 months prior to biopsy were taken for analysis. Urine proteins were measured using a nephelometric method. Statistical calculations were performed using MANOVA and stepwise discriminant analysis (SDA). Statistical diagnosis and staging of CAN matched the pathological method in 68% of a preliminary SDA. Therefore patients were divided into normoalbuminuric, microalbuminuric, and macroalbuminuric groups. There was no significant differences between protein excretion, except alpha1-microglobulinuria (CAN 0 vs 2, P = .018; CAN 1 vs 2, P = .041), beta2-microglobulinuria (CAN 0 vs 2, P = .026; CAN 1 vs 2, P = .0033), and total proteinuria (CAN 0 vs 2, P = .042) in the normoalbuminuric group. Nevertheless, diagnoses obtained using SDA were 89%, 91%, and 92% identical to the results of pathological examinations, for normoalbuminuric, microalbuminuric, and macroalbuminuric groups, respectively. In conclusion, tubular and glomerular proteinuria measurements may be useful for a noninvasive CAN diagnosis and staging only with regard to degree of urinary albumin excretion.
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Affiliation(s)
- T Cieciura
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
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16
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Michalak G, Czerwiński J, Kwiatkowski A, Danielewicz R, Kosieradzki M, Lisik W, Chmura A, Lao M, Durlik M, Wałaszewski J, Rowiński W. Surgical complications observed in simultaneous pancreas-kidney transplantation: thirteen years of experience of one center. Transplant Proc 2002; 34:661-2. [PMID: 12009657 DOI: 10.1016/s0041-1345(01)02880-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Grzegorz Michalak
- Department of General and Transplantation Surgery, Medical University of Warsaw, 59 Nowogrodzka Street, 02-006 Warsaw, Poland
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17
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Kosieradzki M, Danielewicz R, Kwiatkowski A, Polak WP, Wszola M, Fesołowicz S, Michalak G, Lisik W, Wegrowicz-Rebandel I, Paczek L, Wałaszewski JE, Rowiński WA. Early function of kidneys stored by continuous hypothermic pulsatile perfusion can be predicted using a new "viability index". Transplant Proc 2002; 34:541-3. [PMID: 12009616 DOI: 10.1016/s0041-1345(01)02838-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M Kosieradzki
- Department of General and Transplantation Surgery, Transplantation Institute, Medical University of Warsaw, 59 Nowogrodska Street, 02-006 Warsaw, Poland
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18
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Kwiatkowski A, Danielewicz R, Kosieradzki M, Polak WP, Wszola M, Fesolowicz S, Michalak G, Lisik W, Malanowski P, Lao M, Paczek L, Walaszewski JE, Rowiński WA. Six-year experience in continuous hypothermic pulsatile perfusion kidney preservation. Transplant Proc 2001; 33:913-5. [PMID: 11267127 DOI: 10.1016/s0041-1345(00)02267-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Kwiatkowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
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19
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Danielewicz R, Kwiatkowski A, Wszola M, Fesolowicz S, Polak W, Kosieradzki M, Michalak G, Malanowski P, Durlik M, Sankowska M, Patrzalek D, Walaszewski J, Rowiński W. Transplantation of kidneys from Anti-HCV positive donors. Transplant Proc 2001; 33:1789-90. [PMID: 11267513 DOI: 10.1016/s0041-1345(00)02681-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- R Danielewicz
- Department of General and Transplantation Surgery, Transplantation Institute, Medical University of Warsaw, Poland
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20
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Polak WP, Kosieradzki M, Kwiatkowski A, Danielewicz R, Lisik W, Michalak G, Paczek L, Lao M, Wałaszewski J, Rowiński WA. Activity of glutathione S-transferases in the urine of kidney transplant recipients during the first week after transplantation. Ann Transplant 2000; 4:42-5. [PMID: 10850600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
UNLABELLED Glutathione S-Tranferases (GST) are the enzymes which are strictly specific for epithelial cells of the proximal and distal tubules in the kidney. These enzymes are detected in the urine when some tubular damage process is found. In healthy people urine GST is hardly detected. The goal of this study was to evaluate the release of two isoenzymes -- alpha and pi GST in the urine of kidney graft recipients during the first week after kidney transplantation, aiming to differentiate the cause of the delayed function (DF) of transplanted kidney. MATERIAL AND METHODS 50 cadaveric kidneys were procured using standard technique with "in situ" cooling using UW solution. All kidneys were machine perfused. After preservation kidneys were transplanted to 50 ERSD patients. Standard triple drug immunosuppression was applied (steroids, CsA, Cell-Cept or Aza.). Graft function and the release of alpha and pi GST in the urine were measured 1, 3 and 7 days after transplantation. RESULTS immediate function (IF) was found in 72% (36pts), DF in 28% (14pts). 5 of DF patients had ATN, 4 had acute rejection (REJ) and the remaining 5 had ATN and acute rejection (see table below). CONCLUSIONS High alpha and pi GST concentrations were found in pts with DF graft function during the first 7 days after Tx. Elevated pi GST and low alpha GST in the urine indicates acute rejection. High alpha and pi GST in pts with DF should raise suspicion of graft rejection.
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Affiliation(s)
- W P Polak
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
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21
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Polak W, Danielewicz R, Kwiatkowski A, Kosieradzki M, Michalak G, Wegrowicz-Rebandel I, Wałaszewski J, Rowiński W. Pretransplant evaluation of renal viability by glutathione S-transferase in machine perfusate. Transplant Proc 2000; 32:171-2. [PMID: 10701010 DOI: 10.1016/s0041-1345(99)00921-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- W Polak
- Department of General & Transplantation Surgery, Medical University of Warsaw, Poland
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22
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Rowinski W, Chmura A, Kosieradzki M, Danielewicz R, Kwiatkowski A, Lagiewska B, Pacholczyk M, Polak W, Paczek L, Lao M, Wałaszewski J. Delayed kidney function risk score: donor factors versus ischemia/reperfusion injury. Transplant Proc 1999; 31:2077-8. [PMID: 10455975 DOI: 10.1016/s0041-1345(99)00268-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- W Rowinski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
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23
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Kosieradzki M, Danielewicz R, Kwiatkowski A, Polak W, Wegrowicz-Rebandel I, Wałaszewski J, Gaciong Z, Lao M, Rowiński W. Rejection rate and incidence of acute tubular necrosis after pulsatile perfusion preservation. Transplant Proc 1999; 31:278-9. [PMID: 10083107 DOI: 10.1016/s0041-1345(98)01626-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- M Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
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24
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Dabrowska A, Pietkiewicz J, Dabrowska K, Czapińska E, Danielewicz R. Interaction of M1 and M2 isozymes pyruvate kinase from human tissues with phospholipids. Biochim Biophys Acta 1998; 1383:123-9. [PMID: 9546053 DOI: 10.1016/s0167-4838(97)00192-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The effect of pH and the presence of FBP on the interaction of skeletal muscle (PK-M1) and kidney or tumor meningioma (PK-M2) pyruvate kinase with the phospholipids liposomes were investigated by ultracentrifugation and steady-state kinetics and were compared with those results obtained using the bovine heart (PK-M1) isoenzyme which we previously studied. Pyruvate kinase specific activity increases upon the interaction with liposomes. The activation is specifically sensitive to presence of phosphatidylserine (PS) in liposomes. Liposomes made of phosphatidylcholine + phosphatidylserine mixture are good adsorptive systems for both human and bovine of M-type isozymes at low ionic strength. Interaction of PK-M1 with PS liposomes results in the change of Vmax and K(m) values for PEP without marked effect on Hill coefficients. Addition of PS liposomes to PK-M2 induces hyperbolic saturation curves for PEP.
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Affiliation(s)
- A Dabrowska
- Department of Biochemistry, Wrocław University of Medicine, Poland
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25
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Danielewicz R, Kwiatkowski A, Polak W, Kosieradzki M, Michalak G, Wegrowicz I, Gaciong Z, Walaszewski J, Rowiński W. An assessment of ischemic injury of the kidney for transplantation during machine pulsatile preservation. Transplant Proc 1997; 29:3580-1. [PMID: 9414845 DOI: 10.1016/s0041-1345(97)01032-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Danielewicz
- Department of General and Transplantation Surgery, Warsaw Medical School, Poland
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26
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Nawrocki G, Grieb P, Górski A, Danielewicz R, Rowiński W. Prolongation of cardiac allograft survival in rats following combination treatment with 2-chloro-2'-deoxyadenosine and cyclosporine: a novel immunosuppressive strategy. Transplant Proc 1996; 28:3538-9. [PMID: 8962374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G Nawrocki
- Maria Sklodowska-Curie Memorial Cancer Center, Warsaw Medical School, Poland
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27
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Szostek M, Pacholczyk M, Łαgiewska B, Danielewicz R, Wałaszwski J, Rowiński W. Effective surface cooling of the kidney during vascular anastomosis decreases the risk of delayed kidney function after transplantation. Transpl Int 1996. [DOI: 10.1111/j.1432-2277.1996.tb01694.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Kwiatkowski A, Danielewicz R, Polak W, Michalak G, Paczek L, Wałaszewski J, Rowiński W. Storage by continuous hypothermic perfusion for kidney harvested from hemodynamically unstable donors. Transplant Proc 1996; 28:306-7. [PMID: 8644234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A Kwiatkowski
- Department of General and Transplantation Surgery, Warsaw Medical School, Poland
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29
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Michalak G, Danielewicz R, Ostrowski K, Barcikowska B, Wałaszewski JE, Rowiński WA. Is the decreased number of renal transplants in Warsaw caused by a shortage of potential organ donors?: an analysis of hospital deaths in Warsaw in 1993. Transplant Proc 1996; 28:270-1. [PMID: 8644218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G Michalak
- Department of General and Transplantation Surgery, Warsaw Medical School, Poland
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30
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Abstract
In liver transplantation, the quality of the liver is determined by a number of factors including donor nutritional status. Livers from fasted donors appear to tolerate long-term preservation better than livers from fed donors. In this study we repeated earlier results and obtained 31% (4/13) survival after 40-hr preservation of livers from fed donor Brown Norway rats and 67% (8/12) survivors with donor livers from 4-day-fasted rats (P = 0.154). The explanation for this improvement is not known but may be due to inactivation of Kupffer cells due to nutritional depletion of the liver. Kupffer cell activation has been one explanation advanced to explain how cold storage injuries livers during reperfusion (transplantation). In this study, we have measured how donor fasting affects Kupffer cell function (phagocytosis of colloidal carbon) after preservation of the rat liver. In addition, we measured how enhancing liver glycogen by feeding glucose to the rat donors affected outcome and liver functions tested by isolated perfusion after 24- and 40-hr cold storage of the liver. Preservation did not cause inactivation or activation of Kupffer cell phagocytosis of colloidal carbon. In livers with 0-hr preservation, colloidal carbon uptake was 3.1 +/- 0.2 mg/g/hr, after 40-hr preservation uptake was 3.8 mg/g/hr (P < 0.05 vs. 0 hr) (fed) and 2.7 +/- 0.3 mg/g/hr (fasted, P, 0.05 vs. 0-hr and 40-hr-fed). Thus, the improved survival obtained with livers from fasted donors does not appear related to inactivation of Kupffer cell phagocytosis. Although livers from fasted donors showed improved survival, there was extensive hepatocellular injury as indicated by large LDH release from the livers after 40-hr cold storage as tested by isolated perfusion. LDH released into the perfusate increased from 35.8 +/- 10.1 U/L (fed, 40-hr CS) to 301 +/- 65 U/L (fasted, 40-hr CS) after 1-hr reperfusion. AST release showed a similar pattern and bile production was suppressed more in livers from fasted donors than fed donors. Feeding rats glucose elevated liver glycogen and significantly reduced hepatocellular injury as measured by LDH release and AST release in the isolated perfused liver after 40-hr cold storage. Feeding rats glucose (40% in drinking water for 4 days) also improved survival: fed+glucose = 85% survival versus 31% survival with no glucose and fasted+glucose = 92% survival versus 67% survival with no glucose. These results show that both extensive donor fasting and glucose feeding enhanced outcome in orthotopic liver transplantation. This dilemma (both fasting and feeding improved survival) are discussed in terms of how the interactions between Kupffer cells and hepatocytes affect liver viability. Donor fasting is probably impractical clinically as a method to improve the donor liver, but elevating liver glycogen by glucose supplementation is possible and may lead to improved preservation and outcome in liver transplantation.
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Affiliation(s)
- S L Lindell
- Department of Surgery, University of Wisconsin, Madison, 53792, USA
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31
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Szostek M, Pacholczyk M, Lagiewska B, Danielewicz R, Wałaszwski J, Rowiński W. Effective surface cooling of the kidney during vascular anastomosis decreases the risk of delayed kidney function after transplantation. Transpl Int 1996; 9 Suppl 1:S84-5. [PMID: 8959798 DOI: 10.1007/978-3-662-00818-8_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the prospective study was to assess the exact kidney temperature and the effect of surface cooling of the kidney during the time of vascular anastomosis. Twenty-two renal graft recipients were incorporated into our study. We used an electronic temperature measurer provided with a needle-shaped probe pierced into the body of the kidney. The temperature was recorded every 5 min. The mean temperature of the kidney at the beginning of anastomosis (T0) was 8.87 +/- 3.97 degrees C and 17.95 +/- 5.1 degrees C at the end (Tend). The striking finding of this study was that the mean Tend delayed kidney function-negative in [ATN(-)] recipients was significantly lower than in the ATN(+) group; respectively, 14.86 +/- 3.6 degrees C and 19.71 +/- 5.07 degrees C. Therefore, we have divided all recipients according to Tend (< 15 degrees C and > 15 degrees C) in an attempt to assess the direct influence of kidney temperature on early graft function. In nine cases, a temperature below 15 degrees C was recorded and in 13 cases it exceeded 15 degrees C at the end of anastomosis. The mean cold ischemia time and anastomosis time were not different in these recipients. Delayed graft function occurred in 14 recipients; in 3 of 9 (33.3%) recipients from group Tend < 15 degrees C; and in 11 of 13 (85%) from group Tend > 15 degrees C. One case of primary non-function was observed (Tend > 15 degrees C). This study documents the value of effective cooling of the kidney during the time of vascular anastomosis. Since in most clinical reports the significance of the second warm ischemia was assessed only by the duration of the anastomosis, without measurement of the actual organ temperature, this may explain the different findings in our studies.
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Affiliation(s)
- M Szostek
- Warsaw Medical School, Department of General and Transplantation Surgery, Poland
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32
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Szostek M, Danielewicz R, Lagiewska B, Pacholczyk M, Rybicki Z, Michalak G, Adadyński L, Wałaszewski J, Rowiński W. Successful transplantation of kidneys harvested from cadaver donors at 71 to 259 minutes following cardiac arrest. Transplant Proc 1995; 27:2901-2. [PMID: 7482960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Szostek
- Department of General and Transplantation Surgery, Warsaw Medical School, Poland
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Stubenitsky BM, Ametani M, Danielewicz R, Southard JH, Belzer FO. Regeneration of ATP in kidney slices after warm ischemia and hypothermic preservation. Transpl Int 1995; 8:293-7. [PMID: 7546152 DOI: 10.1007/bf00346883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current shortage of cadaveric kidneys may be alleviated to some degree by increasing our capabilities to use less than ideal donor kidneys, such as those from non-heart-beating donors. These kidneys are often exposed to no flow (ischemia) for varying lengths of time. Full utilization of these kidneys may require better methods of organ preservation that could reverse existing ischemic injury. This may conceivably require that, during preservation, energy stores (ATP) lost during warm ischemia be recharged. This would required continuous perfusion. Using a kidney slice model, we investigated the effects of simulated hypothermic machine perfusion with the UW gluconate perfusate on the capability of rabbit kidneys exposed to warm ischemia to regenerate ATP. After 30 min of warm ischemia, ATP content was low (0.2 mumol/g wet weight) but increased to 0.7-0.9 mumol/g wet weight after 24 h of simulated machine perfusion at 4 degrees C. After an additional 2 h of rewarming (37 degrees C in oxygenated Krebs Henseleit buffer), the slice ATP content increased to about 1.0 mumol/g wet weight (similar to kidneys not exposed to warm ischemia) when the antioxidants desferrioxamine and N-2-(mercaptopropionyl) glycine were included in the preservation media. Significantly less ATP was present without the antioxidants. After 60 min of warm ischemia, less ATP was regenerated after 24 h of simulated machine perfusion (about 0.4 mumol/g wet weight) than after 30 min of warm ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B M Stubenitsky
- Department of Surgery, University of Wisconsin, Madison 53792-3236, USA
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34
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Stubenitsky B, Ametani M, Danielewicz R, Southard J, Belzer F. Regeneration of ATP in kidney slices after warm ischemia and hypothermic preservation. Transpl Int 1995. [DOI: 10.1111/j.1432-2277.1995.tb01524.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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35
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Saunder A, Danielewicz R, Ametani M, Southard JH, Belzer FO. L-arginine in 5-day perfusion of canine kidneys. Transplant Proc 1993; 25:3004-5. [PMID: 7505497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A Saunder
- Department of Surgery, University of Wisconsin, Madison
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36
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Danielewicz R, Southard JH, Belzer FO. UW solution decreases Kupffer cell function in rat livers. Transplant Proc 1993; 25:3218-9. [PMID: 8266520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R Danielewicz
- Department of Surgery, University of Wisconsin Hospital, Madison 53792
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37
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Marcinkowska A, Danielewicz R, Wolny M. The effect of temperature on catalytic function of glyceraldehyde-3-phosphate dehydrogenase from muscle of pig and carp Cyprinus carpio. Comp Biochem Physiol B 1990; 97:49-54. [PMID: 2253480 DOI: 10.1016/0305-0491(90)90176-t] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. The temperature dependence of the kinetics of glyceraldehyde-3-phosphate dehydrogenase from white muscle of carp and skeletal muscle of pig was examined. 2. The Km values of carp muscle enzyme were stable over the temperature range 5-35 degrees C, but increased for pig muscle enzyme with increasing temperature. 3. The Arrhenius plot for pig muscle enzyme is linear but non-linear for carp muscle enzyme. 4. The differences indicate that glyceraldehyde-3-phosphate dehydrogenase from white carp muscle may contribute to the adaptive mechanism of carp to varied temperature conditions.
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Affiliation(s)
- A Marcinkowska
- Department of Biochemistry, Medical School, Wrocław, Poland
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Walaszewski J, Rowinski W, Chmura A, Cajzner S, Kowalczyk J, Danielewicz R, Michalak G, Nawrocki G, Lazowski T, Zawadzki A. Decreased incidence of acute tubular necrosis after cadaveric donor transplantation due to lidocaine donor pretreatment and low-dose dopamine infusion in the recipient. Transplant Proc 1988; 20:913. [PMID: 3055532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Fiedor P, Rezulski J, Wierzbicki Z, Michalak G, Danielewicz R, Wałaszewski J, Rowiński W, Nowak M. [Study of arterial vascularization of the pancreas taken for transplantation]. Pol Arch Med Wewn 1988; 80:76-82. [PMID: 3271316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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