The Role of Pre- and Post-Transplant Hydration Status in Kidney Graft Recovery and One-Year Function.

Background and Objectives: Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) and lung ultrasonography (LUS) and to investigate the hydration status' relationship with the function of the transplanted kidney during the first year after transplantation. Materials and Methods: This observational prospective cohort study included deceased kidney recipients transplanted in the Hospital of the Lithuanian University of Health Sciences between September 2016 and January 2023. BIA and LUS were performed before transplantation, on days 3 and 7, and at discharge. Data on recipient and donor clinical characteristics were collected. Graft function was evaluated according to the serum creatinine reduction ratio and the need for dialysis. Hydration status was evaluated by calculating B-lines (BL) on LUS and the ratio of extracellular/total body water on BIA. Results: Ninety-eight kTx recipients were included in the study. Patients with immediate graft function (IGF) were compared to those with slow or delayed graft function (SGF + DGF). Recipients in the SGF + DGF group had a higher sum of BL on LUS before transplantation. After transplantation in early postoperative follow-up, both groups showed hyperhydration as determined by BIA and LUS. After one year, recipients with no BL before transplantation had better graft function than those with BL. Logistic regression analysis showed that having more than one BL in LUS was associated with a 2.5 times higher risk of SGF or DGF after transplantation. Conclusions: This study found that lung congestion detected by LUS before kTx was associated with slower graft recovery and worse kidney function after 1 year. Meanwhile, the hyperhydration status detected by BIA analysis did not correlate with the function of the transplanted kidney.

Effect of Clinical Parameters on Risk of Death from Cancer after Radical Prostatectomy in Men with Localized and Locally Advanced Prostate Cancer.

Background: The study aimed to assess predictors and to identify patients at increased risk of prostate-cancer-specific mortality (CSM) after radical prostatectomy (RP). Methods: A total of 2421 men with localized and locally advanced PCa who underwent RP in 2001−2017 were included in the study. CSM predictors were assessed using multivariate competing risk analysis. Death from other causes was considered a competing event. Cumulative CSM and other-cause mortality (OCM) were calculated in various combinations of predictors. Results: During the median 8 years (interquartile range 4.4−11.7) follow-up, 56 (2.3%) of registered deaths were due to PCa. Cumulative 10 years CSM and OCM was 3.6% (95% CI 2.7−4.7) and 15.9% (95% CI 14.2−17.9), respectively. The strongest predictors of CSM were Grade Group 5 (GG5) (hazard ratio (HR) 19.9, p < 0.0001), lymph node invasion (HR 3.4, p = 0.001), stage pT3b-4 (HR 3.1, p = 0.009), and age (HR 1.1, p = 0.0007). In groups created regarding age, stage, and GG, cumulative 10 years CSM ranged from 0.4−84.9%, whereas OCM varied from 0−43.2%. Conclusions: CSM after RP is related to GGs, pathological stage, age, and combinations of these factors, whereas other-cause mortality is only associated with age. Created CSM and OCM plots can help clinicians identify patients with the most aggressive PCa who could benefit from more intensive or novel multimodal treatment strategies.

Comparison of implant quality between loose and intra-operatively linked iodine-125 seeds in prostate cancer brachytherapy.

From 2007 to 2010, 230 patients had iodine-125 seeds implanted (loose or intra-operatively linked into seed trains with variable seed-to-seed spacing). The primary aim was to evaluate differences in implant quality by comparing the intra-operative and post-implant dosimetry in patients treated with loose and intra-operatively linked seeds. The secondary aim was to evaluate the "learning curve" for the procedure. The following parameters were compared: the radiation dose to 90% of the prostate volume (D90), the radiation dose to 30% of the urethral volume (DU30), the percentage of the prostate volume receiving 100% or 200% of the prescribed dose (V100 or V200, respectively), the percentage of the rectal volume receiving 100% of the prescribed dose (VR100), and the homogeneity index (HI). We obtained the following results for loose vs. intra-operatively linked seeds: D90 (Gy), 184.7 ± 15.0 vs. 177.9 ± 12.7 (p = 0.002); V100 (%), 95.5 ± 2.4 vs. 94.9 ± 3.2 (p = 0.206); V200 (%), 35.1 ± 7.5 vs. 24.3 plusmn; 6,9 (p < 0.001); DU30 (Gy), 218.6 ± 24.1 vs. 197.4 ± 19.5 (p = 0.001); VR100 (cm³), 0.6 ± 0.47 vs. 0.3 ± 0.3 (p < 0.001); HI (%), 31.8 ± 7.3 vs. 44.0 ± 9.8 (p < 0.001). The advantages of intra-operatively linked seed implantation over loose seed implantation are a more homogeneous prostate dose and lower urethral and rectal doses. The disadvantage is a lower post-implant D90. Sufficient experience with the loose seed implantation procedure was obtained after the first 40 patients. There was essentially no learning curve when a new implantation method using intra-operatively linked seeds was subsequently initiated.

The role of high-grade prostatic intraepithelial neoplasia for biochemical relapse of prostate carcinoma after radical prostatectomy.

UNLABELLED: The objective of the study was to evaluate the relationship between high-grade intraepithelial neoplasia diagnosed after radical retropubic prostatectomy and the clinical and pathological characteristics of prostate cancer, and to evaluate the time to biochemical relapse of the disease within the groups of high-grade prostatic intraepithelial neoplasia (HGPIN) and non-HGPIN patients. MATERIAL AND METHODS: Patients, clinically diagnosed with local prostate carcinoma at the Clinic of Urology, Kaunas University of Medicine, during 2003-2007 and treated with radical retropubic prostatectomies, were distributed into two groups according to the HGPIN detected in the postoperative material: HGPIN and non-HGPIN. The two groups were compared in terms of preoperative and postoperative characteristics. The patients who were followed up for at least 12 months were included into the study. The biochemical relapse of prostate cancer was determined if there were two consecutive rises of prostate-specific antigen (PSA) level above 0.2 ng/mL or according to the attending physician's opinion, there was a need for adjuvant treatment even with onetime rise of PSA level above 0.2 ng/mL. RESULTS: There was no significant difference between the HGPIN and non-HGPIN groups in terms of time to biochemical relapse and frequency of biochemical relapses, time before surgery, the timing of the HGPIN diagnosis, age, or PSA level. After radical prostatectomy, patients in the HGPIN group were found to have significantly more often poorer cancer cell differentiation according to the Gleason score (≥7 vs. <7; P=0.001) and higher TNM stage (T3a,b vs. T2a,b,c; P=0.001). Fewer positive resection margins were diagnosed in the HGPIN group (P=0.05). The groups did not differ in terms of the degree of differentiation according to the Gleason score or perineural invasion (P=0.811 and P=0.282, respectively). CONCLUSIONS: HGPIN was more often associated with the characteristics of the poor prognosis for relapse of prostate cancer: poorer tumor cell differentiation according to the Gleason score and more cases of higher TNM stage. HGPIN did not have any influence on biochemical relapse of the disease during the short-term follow-up.

[Review on the effectiveness of prostate cancer brachytherapy]. / Prostatos vezio brachiterapijos veiksmingumo apzvalga.

Ultrasound-guided transperineal prostate brachytherapy is now widely used modality in the treatment of prostate cancer. The overall prostate-specific antigen (PSA) progression-free survival at 10 years is 80-90% for low-risk patients. The results of long-term follow-up have showed better biochemical disease-free survival after I-125 and Pd-103 brachytherapy than after conventional external-beam radiotherapy and similar survival after radical prostatectomy. The most commonly reported dosimetric quantifiers include D90 (the dose that covers 90% of the prostate volume outlined on postimplant computed tomography images) and V100 (the fractional volume of the prostate that receives 100% of prescription dose). The biochemical disease-free survival correlates with the dose. In low-risk patients, achieving a D90 dose of 140-160 Gy might be adequate for prostate-specific antigen control. However, high-risk disease might require a D90 dose higher than 200 Gy. In the immediate posttreatment period, the most common complication is acute urinary retention. Urinary symptoms such as frequency, nocturia, and dysuria occur commonly and are documented in about 80% of patients complaining of symptoms 2-3 months after treatment. Late urinary complications of brachytherapy include urethral stricture and incontinence. Incontinence is rare and mainly occurs in patients who had transurethral resection of the prostate either prior or after brachytherapy. Rectal complications (proctitis, rectal bleeding) are rare after prostate brachytherapy. Brachytherapy like external-beam radiotherapy but unlike surgery preserves ejaculation; potency rates also appear to be relatively high after brachytherapy, at 50-85%, and most patients' sexual quality and function are preserved. Since July 2007, the real-time I-125 prostate brachytherapy has been started in Lithuania and Baltic countries at the Hospital of Kaunas University of Medicine. A total of 150 low-risk patients (< or =T2a, Gleason < or =6, PSA < or =10) were treated by this method. Permanent prostate brachytherapy is an appropriate method for standard treatment of localized prostate cancer.

[Reactivation of cytomegalovirus infection after kidney transplantation in Kaunas University of Medicine Hospital during the period of 2000-2006]. / Citomegalovirusines infekcijos reaktyvavimasis po inkstu persodinimo Kauno medicinos universiteto klinikose (2000-2006).

Cytomegalovirus infection has been associated with increased morbidity and mortality after transplantation and with diminished graft survival. After transplantation, more than 75% of solid organ transplant patients are newly infected with cytomegalovirus, or latent cytomegalovirus infection may be reactivated. The objective of our study was to evaluate reactivation rate of cytomegalovirus infection after kidney transplantation in Kaunas University of Medicine Hospital and its relation to anticytomegalovirus prophylaxis. A retrospective review of all kidney transplants performed between May 2000 and December 2006 was conducted. We analyzed the prevalence of cytomegalovirus in the groups of donors and recipients, and risk categories were defined for cytomegalovirus infection/disease in transplant patients. During this period, a total of 93 transplantations were performed in 56 men (60.2%) and 37 women (39.8%). The mean age of recipients was 41.04+/-12.74 years. There were 33 (68.7%) men and 15 (31.3%) women in the group of donors; their mean age was 39.49+/-14.81 years. Patients at high risk for the development of cytomegalovirus infection/disease were defined as those who had donor-positive/recipient-negative serostatus (D+/R-), and they made up 5.4% of all patients. Intermediate-risk patients with cytomegalovirus infection (D+/R+ and D-/R+) accounted for 73.1% and 15.1% of all recipients, respectively; 6.4% of patients were at low risk (D-/R-). Anti-cytomegalovirus prophylaxis with i/v ganciclovir was given during the period of hospitalization in all cases, except when there was a D-/R- combination, or when the transplant was removed in the early period after transplantation. The reactivation of cytomegalovirus infection was observed in 23 patients (24.7%). We have observed 41 episodes of cytomegalovirus infection, but during this period, no patient developed cytomegalovirus disease that might cause lethal outcome.

[Importance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients]. / Pakartotiniu krastiniu sekstantiniu prostatos biopsiju reiksme nustatant prostatos vezi padidejusios rizikos pacientams.

UNLABELLED: Our purpose was to evaluate the relevance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients. MATERIAL AND METHODS: Our study included 195 men at high risk for prostate cancer (elevated prostate-specific antigen level and/or abnormal prostate detected by digital rectal examination). We consulted the patients in outpatient department of Kaunas University of Medicine Hospital during 2003-2007. We performed transrectal ultrasound-guided laterally directed sextant prostate biopsy in every patient. For the patients with benign histological findings and increased risk of prostate cancer, laterally directed sextant biopsies were repeated. RESULTS: Prostate cancer was detected in 30.3% of patients (59/195) on the first prostate biopsy, in 13.1% (11/84) on the second prostate biopsy, in 10.3% (4/39) on the third, and in 7.7% (1/13) on the forth biopsy. After all biopsies, prostate cancer was detected in 38.5% (75/195) of patients, and it differed significantly from the percentage of prostate cancer cases detected on the first biopsy (30.3%, P=0.04). We detected 78.7% (59/75) of all prostate cancer cases by the first laterally directed sextant prostate biopsy. The rest 21.3% (16/75) of cases we detected by repeat biopsies. The second laterally directed sextant prostate biopsy revealed additional 14.6% (n=11) of prostate cancer cases and increased the detection of prostate cancer to 93.3% (70/75). At the time of the first prostate biopsy, prostate cancer was diagnosed most frequently when patients had both risk factors: elevated prostate-specific antigen level and abnormal digital prostate examination; prostate cancer was diagnosed in 45.3% of these patients. The odds ratio to detect prostate cancer by the first biopsy in patients with elevated prostate-specific antigen level and abnormal digital prostate examination was 3.7, and odds ratio to detect prostate cancer by repeat biopsies was 4.7. CONCLUSIONS: Repeat ultrasound-guided laterally directed sextant prostate biopsies reveal more cases of prostate cancer as compared to the first prostate biopsy. The majority of prostate cancer cases (93.3%) are detected by the first and second laterally directed sextant prostate biopsies. After the first negative prostate biopsy, we recommend to repeat prostate biopsy in high-risk patients.

[Importance of prostate volume for detection of prostate cancer by first sextant biopsy in high-risk patients]. / Prostatos turio reiksme nustatant prostatos vezi pirmaja sekstantine biopsija dideles rizikos pacientams.

UNLABELLED: The aim of this study was to evaluate the relevance of prostate gland volume, transitional zone volume, and transitional zone index for the detection of prostate cancer by the first sextant biopsy. MATERIAL AND METHODS: A total of 121 men with high risk of prostate cancer were included in our study (prostate-specific antigen level higher than 4 ng/mL and/or pathological digital rectal examination). We consulted the patients in Outpatient Department of Kaunas University of Medicine Hospital during 2003-2006. Total prostate volume and transition zone volume were measured, and all patients underwent transrectal ultrasound-guided sextant biopsy of the prostate. According to histological results of prostate biopsy, patients were divided into two groups: benign group (benign prostate hyperplasia and high-grade intraepithelial neoplasia) and prostate cancer group. Statistical analysis was made by SPSS (Statistical Package for Social Sciences) 12.0.1 for Windows. RESULTS: After histological examination, prostate cancer was detected in 20.7% of patients (n=25). Prostate cancer was found in 24.6% of patients with a total prostate volume of less than 60 cm3 and only in 8.2% of patients with a total prostate volume greater than 60 cm3 (P=0.026). Prostate cancer was found in 27.1% of patients with transition zone volume smaller than 30 cm3 and only in 7.5% of patients with transition zone volume greater than 30 cm3 (P=0.007). A statistically significant difference was found when patients were divided into the groups according to transition zone index: when transition zone index was lower than 0.45, prostate cancer was detected in 37.1% of patients, and when transition zone index was higher than 0.45, prostate cancer was observed in 9.1% of patients (P=0.001). The possibility to detect prostate cancer was 5.9 times higher in patients with transition zone index lower than 0.45. CONCLUSIONS: Prostate cancer detection rate by first sextant prostate biopsy in patients with elevated prostate-specific antigen level and/or pathological digital rectal examination was higher when total prostate volume was less than 60 cm3, transition zone was less than 30 cm3, and transition zone index was less than 0.45.