One-year follow-up of kidney transplant recipients with increased expression of mRNA for granzyme B in urinary cells.

BACKGROUND: Measurement of mRNA encoding cytotoxic proteins in urinary cells is recognized as a potential noninvasive means to diagnose acute rejection in kidney allograft recipients. We sought to evaluate kidney graft function after 1 year follow-up without therapeutic intervention among patients with increased urinary expression of mRNA for granzyme B, albeit with stable graft function at the time of measurements. PATIENTS AND METHODS: The 29 randomly selected patients were at a median of 39 months (range, 10-156) after transplantation with stable graft function over the previous 3 months. The reference housekeeping gene GAPDH was used for expression measurement in a TaqMan Gene Expression Assay with the target granzyme B gene. Delta delta ct relative gene expression analysis compared results with reference samples from 10 healthy individuals. Kidney graft function was reassessed after 1 year follow-up; immunosuppression was not changed during this period. RESULTS: mRNA granzyme B expression was significantly higher among the group of randomly assessed out-clinic patients with stable graft function than among healthy volunteers (mean ± standard error of the mean, 6.18 ± 1.27; P < .01). Despite no therapeutic intervention, no significant changes were observed in delta glomerular filtration rate or quantitative proteinuria between groups with mRNA expression > 5× versus <2× higher than the healthy controls at 1 year of follow-up. CONCLUSION: Increased mRNA expression for granzyme B in urinary cells over the medium to long term among kidney transplant recipients did not predict changes in renal allograft function after 1 year follow-up.

Hyperacute rejection of living related kidney grafts caused by endothelial cell-specific antibodies: case reports.

We describe two cases of hyperacute humoral rejection of living related kidney grafts despite negative pretransplantation T- and B-lymphocyte flow cytometric crossmatches and blood group identity. Retrospectively, antiendothelial IgG antibodies were detected on a panel of umbilical cord cells in the first case, and IgM antibodies against donor endothelial precursor cells were detected using a new endothelial cell crossmatch kit in the second case. Standard crossmatch methods using donor lymphocytes failed to detect these pathogenic antibodies and did not predict the danger of hyperacute rejection.

The effects of occlusive techniques on the short-term prognosis after liver resections.

BACKGROUND/AIMS: Anatomic liver resection can be performed without vascular occlusion, but controlling blood loss during liver parenchyma dissection by compression or clamping of vessels in the liver hilus is almost the rule. The aim of this study is to assess the negative consequences of different types of occlusion techniques used during liver parenchyma dissection. METHODOLOGY: From 2001 to 2003, 43 anatomical liver resections were performed in patients with primary and metastatic tumors. Patients were divided into three groups according to the duration and the type of occlusion of incoming blood vessels in the hepatoduodenal ligament (continuous over 20 min, continuous under 20 min, or interrupted blood-vessel occlusion for 5 min after every 20 min of occlusion). Blood level of bilirubin, ALT, AST and prothrombin time were evaluated in the postoperative period. RESULTS: Within the continuous occlusion group that lasted longer than 20 minutes (37 +/- 14 min) increase in levels of bilirubin and liver enzymes and decrease of prothrombin time were noted as compared to the group with occlusion shorter than 20 minutes and to the group with intermittent occlusion over 20 minutes (34 +/- 5 min). CONCLUSIONS: From results issued, it can be seen that using intermittent occlusion during liver parenchyma dissection lasting longer than 20 minutes causes less ischemic-reperfusion injury in the remaining liver parenchyma than by using continual occlusion.

[Kidney transplantation from living donors]. / Transplantácie obliciek od zijúcich darcov.

From Jan. 1, 1994 till August 31, 1999 in the Transplantation Centre of the F. D. Roosevelt Hospital and Policlinic 202 transplantations of the kidneys were made, incl. 11 from live donors. The survival of patients and renal grafts in our group is 100%, i.e. all transplanted kidneys are so far functional. In transplantations of kidneys from dead donors the one-year survival of grafts was 85% and the 5-year survival only 70%. During removal of kidneys from live donors we had only one minor complication--a surface infection of the surgical wound. The authors describe their own experience with assessing the indication criteria, criteria for selection of the most suitable donor-recipient pair. Consistently with work of authors from abroad, they consider transplantations of the kidneys from live donors as one of the best alternatives how to increase the number and quality of renal transplantations and to prevent thus an increase of the number of patients on the waiting list.

[The reflex sympathetic dystrophy syndrome of the lower extremities in patients after kidney transplantation--another complication of cyclosporin A therapy?]. / Syndróm reflexnej sympatikovej dystrofie dolných koncatín u pacientov po transplantácii oblicky--d'alsia komplikácia liecby cyklosporínom A?

The authors describe a new complication observed in patients after transplantation of the kidneys, characterized by intensive periarticular pain of the joints of the lower extremities, mostly with a symmetrical affection of the heels and knees, associated with vasomotor changes in the affected area, X-ray evidence of patchy osteoporosis and an increased periarticular activity of radionuclide on bone scans. The symptoms develop shortly after transplantation and recede within several months. The clinical findings, X-ray and scintigraphic changes are typical for the syndrome of reflex sympathetic dystrophy. The etiology of the syndrome remains obscure, the symptomatology recedes parallel with reduction of the dosage and levels of cyclosporin A.

Reflex sympathetic dystrophy of the lower limbs after kidney transplantation.

Reflex sympathetic dystrophy syndrome (RSDS) is a rarely described complication after different types of organ transplants. Three out of 147 kidney recipients treated at our center during the last 6 years developed severe bilateral symmetrical pain in the ankles and knees, with great difficulties in walking 2-3 months after kidney transplantation. Clinical examination revealed periarticular soft tissue swelling and vasomotor changes with no effusion. Patchy osteoporotic patterns were seen radiographically in clinically affected areas. Scintigraphy showed increased epiphyseal uptake of 99mTc with a periarticular distribution. Clinical symptoms, radiographic, and scintigraphic signs were compatible with so-called RSDS. The exact cause of the syndrome remained obscure. All patients received standard immunosuppression with cyclosporine A (CyA), azathioprine, and prednisone. Symptoms of RSDS improved when doses of CyA were reduced and blood levels declined; patients were treated with calcitonin and calcium channel blockers simultaneously. Non-steroidal antiinflammatory drugs were not effective in symptom relief. In all three cases, most probably spontaneous complete recovery was achieved over the course of 2-8 months; no one patient progressed to aseptic osteonecrosis.