[Can urinary neutrophil gelatinase-associated lipocalin predict acute rejection following deceased donor kidney transplantation?]. / Alkalmas-e a vizelet neutrofil gelatináz asszociálta lipokalin meghatározása a rejekció elorejelzésére veseátültetés után?

INTRODUCTION: Delayed graft function and acute rejection have negative impact on graft survival. AIM: To asses the predictive value of urinary neutrophil gelatinase-associated lipocalin, which has been found to be a promising biomarker for the diagnosis of acute kidney injury. METHOD: In this prospective study urinary neutrophil gelatinase-associated lipocalin levels of 27 kidney recipients were measured. RESULTS: Patients were grouped as follows: group 1, no complication; group 2, rejection; group 3, delayed graft function requiring dialysis; group 4, rejection plus delayed graft function. There were no significant differences between groups 1 and 2, and between groups 3 and 4. Patients in groups 3 and 4 had significantly higher urinary neutrophil gelatinase-associated lipocalin levels as compared to those in groups 3 and 4. There was a paralIel change in urinary neutrophil gelatinase-associated lipocalin levels in groups 1 and 2. CONCLUSIONS: In these patients urinary neutrophil gelatinase-associated lipocalin levels failed to provide useful information in both cases of normal and impaired function.

Experimental results and clinical impact of using autologous rectus fascia sheath for vascular replacement.

Vascular complications are major causes of graft failure in liver transplantation. The use of different vascular grafts is common but the results are controversial. The aim of this study was to create an 'ideal' arterial interponate for vascular replacements in the clinical field. An autologous, tubular graft prepared from the posterior rectus fascia sheath was used for iliac artery replacement in dogs for 1, 3, 6 and 12 months. Forty-one grafts were implanted and immunosuppression was used in separate groups. The patency rate was followed by Doppler ultrasound. Thirty-seven grafts remained patent, 2 cases with thrombosis and 2 cases with stenosis occurred. There was no evidence of necrosis or aneurysmatic formation. The histological analysis included conventional light microscopic and immunohistochemical examinations for CD34 and factor VIII. The explanted grafts showed signs of arterialisation, appearance of elastin fibres, and smooth muscle cells after 6 months. Electron microscopy showed intact mitochondrial structures without signs of hypoxia. In conclusion, the autologous graft presents acceptable long-term patency rate. It is easy to handle and the concept of beneficial presence of the anti-clot mesothelium until endothelialisation seems to work. The first clinical use was already reported by our group with more than 2 years survival.

[The role of oxidative stress and arterial blood supply in the transplanted liver function]. / Az oxidatív stressz és az artériás vérellátás szerepe a transzplantált májgraft múködésében.

INTRODUCTION: Reperfusion injury and hepatic artery thrombosis are major causes of graft failure after liver transplantation. The magnitude of oxidative stress increases after reperfusion and the appearance of an arterial thrombosis presents a higher risk for the graft and patient survival. AIM OF THE STUDY: The aim of the study was to detect the level of oxidative stress in the perioperative period of transplantation. METHODS: Clinical documentations of 32 patients were investigated and the level of myeloperoxidase (MPO) was measured for the monitoring of the oxidative stress. RESULTS: The mean age of the patients was 43 years and hepatitis C cirrhosis was the most common indication (14 cases, 43%). Two retransplantations were done. In 24 cases (75%) the primary graft functions and patient survival were good. Eight patients died, in two cases because of acute liver failure, in two cases due to primary non function and in four cases due to late complications. The incidence of hepatic artery thrombosis was 11% (4 cases) and the incidence of acute rejection was 35% (12 cases). The level of MPO was higher (65 ng/ml) in all patients before operation. After the first 48 hours this level increased significantly (p < 0.0001) up to the mean level of 123 ng/ml and decreased after one week. In the cases with acute liver failure and hepatic artery thrombosis high levels of MPO were measured. CONCLUSION: This study provides evidence of increased oxidative stress before liver transplantation. The magnitude of these changes increased after operation, mostly in cases with acute liver failure and hepatic artery thrombosis. Reducing the reperfusion injury and performing an "ideal" arterial supply for the liver-graft present better survival.