Long-term results of autologous scaffold-free tissue-engineered vascular graft for hemodialysis access.

BACKGROUND: The growing size of the end stage renal disease (ESRD) population highlights the need for effective dialysis access. Exhausted native vascular access options have led to increased use of catheters and prosthetic shunts, which are both associated with high risks of access failure and infection. Emerging alternatives include tissue-engineered vascular grafts (TEVG). Here we present the endpoint results for 10 ESRD patients with the scaffold-free tissue-engineered vascular access produced from sheets of extracellular matrix produced in vitro by human cells in culture. METHODS: Grafts were implanted as arteriovenous shunts in 10 ESRD patients with a complex history of access failure. Follow-up included ultrasound control of graft morphology and function, dialysis efficiency, access failure, intervention rate, as well as immunohistochemical analysis of graft structure. RESULTS: One patient died of unrelated causes and three shunts failed to become useable access grafts during the 3-month maturation phase. The 12-month primary and secondary patency for the other six shunts was 86%. Survival of six shunts functioning as the vascular access was 22 ± 12 months with longest primary patency of 38.6 months. The dialysis event rate of 3.34 per patient-year decreased significantly with the use of this TEVG to 0.67. CONCLUSIONS: This living autologous tissue-engineered vascular graft seems to be an alternative to synthetic vascular access options, exhibiting advantages of native arteriovenous fistula.

Beneficial Effect of Successful Simultaneous Pancreas-Kidney Transplantation on Plasma Profile of Metalloproteinases in Type 1 Diabetes Mellitus Patients.

It is not fully elucidated whether the restoring of normal glucose metabolism after successful simultaneous pancreas-kidney transplantation (SPK) improves vascular wall morphology and function in type 1 diabetic (T1D) patients. Therefore, we compared arterial stiffness, assessed by pulse wave velocity (PWV), carotid intima-media thickness (IMT), and biomarkers of arterial wall calcification in T1D patients after SPK or kidney transplantation alone (KTA). In 39 SPK and 39 KTA adult patients of similar age, PWV, IMT, circulating matrix metalloproteinases (MMPs) and calcification biomarkers were assessed at median 83 months post transplantation. Additionally, carotid plaques were visualized and semi-qualitatively classified. Although PWV and IMT values were similar, the occurrence of atherosclerotic plaques (51.3 vs. 70.3%, p < 0.01) and calcified lesions (35.9 vs. 64.9%, p < 0.05) was lower in SPK patients. There were significantly lower concentrations of MMP-1, MMP-2, MMP-3, and osteocalcin in SPK subjects. Among the analyzed biomarkers, only logMMP-1, logMMP-2, and logMMP-3 concentrations were associated with log HbA1c. Multivariate stepwise backward regression analysis revealed that MMP-1 and MMP-3 variability were explained only by log HbA1c. Normal glucose metabolism achieved by SPK is followed by the favorable profile of circulating matrix metalloproteinases, which may reflect the vasoprotective effect of pancreas transplantation.

Early graft function and intrarenal resistant index after kidney transplantation using Biolasol-A new solid organ preservation fluid.

Biolasol is a newly developed preserving solution for cold organ storage prior to transplantation. To date, only animal model experiments results are available. The aim of this single-center analysis was to summarize the clinical experience concerning the early post-transplant course of kidney grafts preserved with Biolasol in comparison with other preservation solutions. Before transplantation, 173 kidney grafts were preserved using Biolasol and 240 organs with other solutions (University of Wisconsin-UW, Institute Georges Lopez-IGL-1, or StoreProtect Plus solutions). Early graft function was defined based on serum creatinine concentration at day 3 (<3 mg/dL-immediate graft function, IGF or >3 mg/dL-slow graft function, SGF) or the need of dialysis therapy during first post-operative week (delayed graft function, DGF). The analysis included intrarenal resistive indices measured by Doppler sonography early after transplantation and before discharge from the hospital. IGF was more frequent in patients with organs preserved with IGL-1 (33.5%) and StoreProtect Plus (38.8%) than Biolasol (18.5%), whereas there was no difference in the occurrence of DGF. Both initial and discharge median resistance index values were significantly higher in the Biolasol subgroup (0.77 and 0.75) than in all three other subgroups (P values for all comparisons <.001), also after 1:1 propensity score matching for baseline characteristics. Multiple logistic regression analysis based on the propensity score-matched cohort revealed that the use of Biolasol solution [OR 0.59 (0.35-0.98); P < .05] independently decreased the occurrence of IGF. In our single-center clinical experience, kidney preservation using Biolasol solution was associated with significantly higher intrarenal resistant index in comparison with other preservation fluids, as well as worse early graft function than in the IGL-1 and the StoreProtect Plus subgroups. Long-term follow-up is needed in order to assess the kidney graft and patient survival.

Metabolic acidosis in kidney transplant recipients.

Introduction Metabolic acidosis (MA) may accelerate the progression of chronic kidney disease (CKD) and is an important risk factor for increased mortality in CKD patients. The clinical value of MA in kidney transplant (KTx) recipients has not been extensively studied so far. Objectives The aim of this clinical single­­center case­­control study was to assess the prevalence of MA in KTx recipients in comparison with CKD patients and to identify pathogenic factors for MA in KTx recipients. Patients and methods Venous blood concentrations of bicarbonate (HCO3-) and blood hemoglobin concentrations were measured in 500 KTx recipients and 500 CKD patients matched for sex, age, and estimated glomerular filtration rate (eGFR). None of these patients received alkali treatment before the study. MA was diagnosed in KTx recipients with HCO3- levels lower than 22 mmol/l. Results The prevalence of MA was lower in KTx recipients than in CKD patients (12.0% vs 19.6%; P = 0.001). In both groups, the prevalence increased with progression of CKD stages (P <0.001 for trend) and was higher in patients with anemia. In a multivariable analysis, hemoglobin concentrations correlated independently with eGFR and HCO3- in KTx recipients (ß = 0.314, P <0.001 and ß = 0.274, P <0.001, respectively). Similar correlations were observed in CKD patients (ß = 0.273, P <0.001 and ß = 0.123, P = 0.006, respectively). Conclusions Our study revealed that the prevalence of MA is lower in KTx recipients than in CKD patients. Moreover, in KTx recipients, blood bicarbonate concentrations are related to kidney function and blood hemoglobin concentrations.

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

BACKGROUND Pre-procurement pancreas suitability score (P-PASS) and pancreas donor risk (PDRI) index are scoring systems believed to predict suitability of pancreatic grafts. Most European countries and the United States apply PDRI, while Poltransplant keeps using P-PASS: more than 16 points raises a red flag for graft use. Recent data discourage use of PDRI to predict pancreas graft survival. The aim of the present study was to assess PDRI and P-PASS as predictors of transplanted pancreas survival in a Polish population. MATERIAL AND METHODS From February 1998 to September 2015, 407 pancreas transplantations were performed in Poland: 370 (90.9%) simultaneous pancreas-kidney transplantation and 37 (9.1%) pancreas transplantation alone or pancreas after kidney. The endpoint was death-uncensored 12-month graft survival with satisfactory glycemic control without insulin. RESULTS Average P-PASS was 15.9±2.66 and PDRI was 0.96±0.37. Recipients who survived 12 months with good graft function had an average P-PASS score of 15.7 and PDRI of 0.95. Recipients with death-uncensored graft loss had a mean P-PASS of 16.4 and PDRI of 0.99. Univariate analysis revealed donor age, body mass index (BMI), and P-PASS to be significant risk factors for 1-year pancreas graft survival. CONCLUSIONS P-PASS, but not PDRI, is a reliable tool to predict pancreas graft survival in the Polish population.

Type 1 diabetic patients have better endothelial function after simultaneous pancreas-kidney transplantation than after kidney transplantation with continued insulin therapy.

The purpose of this study was to analyse the influence of simultaneous pancreas-kidney or kidney transplantation on endothelial function and systemic inflammation in type 1 diabetic patients with end-stage renal disease. In 39 simultaneous pancreas-kidney, 39 type 1 diabetic kidney and 52 non-diabetic kidney recipients, flow-mediated dilatation was measured. Additionally, blood glycated haemoglobin, serum creatinine and lipids, plasma nitrites [Formula: see text] and nitrates, asymmetric dimethylarginine, soluble vascular cell adhesion molecule-1, intercellular adhesion molecule-1, and E-selectin, high-sensitivity C-reactive protein, tumour necrosis factor-α, interleukin 1ß and interleukin 6 concentrations were assessed. During 58 ± 31 months follow-up period, flow-mediated dilatation and [Formula: see text] were greater in simultaneous pancreas-kidney than in type 1 diabetic kidney recipients [10.4% ± 4.7% vs 7.7% ± 4.2%, p < 0.05 and 0.94 (0.74-1.34) vs 0.24 (0.20-0.43) µmol/L, p < 0.01, respectively]. In type 1 diabetic patients after simultaneous pancreas-kidney or kidney transplantation, [Formula: see text] correlated with flow-mediated dilatation (r = 0.306, p < 0.05) and with blood glycated haemoglobin (r = -0.570, p < 0.001). The difference in [Formula: see text] was linked to blood glycated haemoglobin and estimated glomerular filtration rate, whereas the difference in flow-mediated dilatation was linked to [Formula: see text]. The levels of inflammatory markers (except soluble vascular cell adhesion molecule-1) were similar in simultaneous pancreas-kidney and type 1 diabetic kidney recipients. Improved endothelial function in type 1 diabetic patients with end-stage renal disease after simultaneous pancreas-kidney compared to kidney transplantation is associated with normalisation of glucose metabolism but not with improvement in plasma pro-inflammatory cytokines.

Histopathological Examination may be Useful for Assessment of Fibrosis and Lipomatosis of Pancreas Allograft Prior to Solid Organ Transplantation.

BACKGROUND: The results of pancreas transplantation depend in a large degree on appropriate pancreas allograft donor selection. Several risk factors of early surgical complications or pancreas allograft loss following transplantation have been identified, but the final decision on pancreas harvesting for transplantation belongs to the surgeon. In the present study we aimed to assess whether histopathological examination may be utilized for detection of fibrosis and lipomatosis in tissue from a potential pancreas allograft. Additionally, we aimed to test whether presence of pancreatic fibrosis and lipomatosis may be explained solely by donor age and/or body mass index (BMI). MATERIAL AND METHODS: Pancreata retrieved from 50 deceased organ donors referred to our institution and not transplanted between 2010 and 2013 were used for the present study. Tissue samples were excised from pancreata, fixed in formalin, and embedded in paraffin. Presence and intensity of pancreatic fibrosis and lipomatosis were assessed semi-quantitatively. RESULTS: Fibrosis was found in the majority of study samples (72%), but it was usually mild or moderate. Lipomatosis was present in 34% of the study cases. Presence of fibrosis was more frequent in older donors, but was still not rare in donors under 40 years old. Presence of lipomatosis did not seem to be significantly related to donor age. Neither pancreatic fibrosis nor lipomatosis was related to donor BMI. CONCLUSIONS: There is no clear relationship between histological parenchymal changes in potential pancreas allograft and donor age and BMI. Histopathological assessment of pancreatic fibrosis and/or lipomatosis can potentially facilitate decision making on pancreas allograft acceptance for solid organ transplantation.

First human use of an allogeneic tissue-engineered vascular graft for hemodialysis access.

An arteriovenous fistula is the current gold standard for chronic hemodialysis access. Tunneled catheters or synthetic grafts have poorer outcomes and much higher risks of infection. This report presents the first clinical use of a completely biological, allogeneic, nonliving, and human tissue-engineered vascular graft. Tissue-engineered vascular grafts built from allogeneic fibroblasts were implanted as shunts in three hemodialysis patients. The tissue-engineered vascular graft was stored for 9 months, without loss of mechanical strength. Implanted grafts showed no signs of degradation or dilation, with time points up to 11 months. Results of panel-reactive antibody and cross-reactivity tests showed no evidence of immune responses.

Influence of selected factors on veins' permeability for albumin in vitro.

We present the results of a study on the influence of albumin and prolactin concentrations and intravascular fluid pH on vein permeability for albumin. Permeability conditions were simulated depending on albumin concentration, pH value and prolactin concentration. In research model an in vitro method was applied using natural membrane - porcine vena cava inferior. Vein permeability was in the 0.63% to 5.69% range. In control variant permeability was ~2.54% and increased ~2 fold at decreased albumin and PRL concentrations. At increased albumin concentration permeability was decreased 4-fold. Albumin concentration significantly influences albumin permeability.

Left-hemihepatectomy as a method of treatment of locally limited Caroli disease.

The study introduces a case of a 51-year old patient with Caroli's disease of left liver lobe. In 2011 the patient was admitted to Clinic of General, Vascular and Transplantation Surgery. She was after first in her life incident of an acute pancreatitis and subsequent ERCP procedure with left hepatic biliary tract drainage. The lady was qualified to left-hemihepatoctomy, which was successfully conducted in our clinic. The only complication of the procedure was surgical site infection which was properly treated with typical antibiotics. One-year observation occurred no other complications and liver function was fine.

Comparing the effect of Biolasol® and HTK solutions on maintaining proper homeostasis, indicating the kidney storage efficiency prior to transplantation.

BACKGROUND: Maintaining proper homeostasis involving normal physiological level of extra- and intracellular solutions is one of the factors that determine restoring the life functions of a transplanted organ. The aim of this study was to demonstrate the effectiveness of the newly developed Biolasol(®) solution in kidney storage and to compare its protective effect to the standard HTK solution. MATERIAL/METHODS: Isolated porcine kidneys were perfused, preserved (24 and 48 h) and reperfused with Biolasol(®) and HTK solutions. The perfusate samples were used to analyze pH; the amount of released indicator enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH); and the concentration of sodium, potassium and magnesium. RESULTS: Kidney storage in the HTK liquid may cause metabolic acidosis after 24 and 48 hour preservation (pH drop below 6.8). pH of perfusates sampled after perfusion and reperfusion with Biolasol(®) solution was within the range 6.8-7.7. The content of sodium ions during perfusion and reperfusion was the closest to the reference values while using the Biolasol(®) solution. Only Biolasol(®) ensured normal homeostasis of Mg2+ ions. In the presence of the HTK solution their level was significantly (more than 1000%) higher than the normal physiological value. For both solutions, ALT and AST activities were within the normal range or differed only slightly. CONCLUSIONS: Biolasol(®) and HTK solutions protect kidneys against ischemic damage. Still, Biolasol(®) offers better homeostasis maintenance, which may suggest it more effectively preserves kidneys prior to transplantation.

[Composed angioplasty of the multilevel right common and internal carotid artery stenoses with implantation stents with used of proximal and distal protection system]. / Zlozona angioplastyka prawej tetnicy szyjnej wewnetrznej i wspólnej z implantacja stentów z zastosowaniem równoczesnej protekcji proksymalnej i dystalnej.

We present a case of a 73 year-old man with, long-segment thigh stenosis in the right common and internal carotid artery with occlusion left common carotid artery. Complex angioplasty with modification proximal and distal system protection was successful performed. There were no procedure-related complications. We concluded that in very complex, multilevel lesions in carotid artery, there is a place for safe double system protection. This maneuver can increase safe of the carotid artery stenting and minimise potential complications.

Apoptosis of tubular epithelial cells in preimplantation biopsies of kidney grafts with immediate, slow and delayed function.

BACKGROUND: Apoptosis is a form of cell death observed in kidney grafts as a result of ischemia/reperfusion injury. The aim of our prospective study was to analyze the intensity of apoptosis in kidney tubules after cold storage in respect to early and 12-month post-transplant graft function. MATERIAL/METHODS: The intensity of renal tubular apoptosis was estimated by TUNEL method in proximal and distal tubules in 72 pre-implantation kidney biopsies. Sixteen patients with biopsies that did not fulfill Banff 97 classification, with early acute rejection or early graft loss, were excluded. Early graft function was defined as IGF (N=17) when serum creatinine (sCr) was <264 µmol/l at 3(rd) postoperative day (POD); as SGF (N=20) when sCr >264 µmol/l and not more than 1 dialysis was performed; and as DGF (N=19) when more than 1 dialysis was done. RESULTS: The percentage of apoptotic cells was markedly higher in distal than in proximal tubules in all 3 groups. The percentage of apoptotic cells in distal tubules found was: 3.02% (1.03-5.00%) in IGF, 1.66% (0.92-2.39%) in SGF, and 1.76% (0.84-2.68%) in DGF; these differences were not significant. In the IGF group the mean percentage of apoptotic cells in distal tubule was higher than in the other groups (not statistically significant). The subgroups of patients with higher and lower than median (1.35%) apoptotic cell range in distal tubules had similar graft function at the 12-month follow-up. CONCLUSIONS: The enhancement of tubular epithelial cells apoptosis in kidney grafts after cold storage does not determine its early and later excretory function.

Intra-abdominal infections after simultaneous pancreas - kidney transplantation.

BACKGROUND: Intra-abdominal infections (IAI) are among the most common causes of pancreatic graft loss and recipient death in the early period after simultaneous pancreas - kidney transplantation (SPK). The aim of the study was to analyze risk factors and clinical consequences of IAI in SPK patients. MATERIAL/METHODS: Forty-six consecutive SPK performed from 2004 to 2010 were subjected to analysis. RESULTS: IAI developed in 10 recipients (21.7%). The group of recipients with IAI had a higher rate of patients that required transfusion of more than 2 blood units (90% vs. 47%, p=0.028) or relaparotomy (80% vs. 14%, p<0.001), in comparison with patients without IAI. Additionally, in patients with IAI, both delayed kidney graft function or primary kidney graft nonfunction (40% vs. 11%, p=0.001) and recipient death (40% vs. 3%, p=0.006) were more frequently observed. Logistic regression analysis revealed an increased risk of IAI development in patients who required early relaparotomy (OR=24.8, p<0.001), transfusion of more than 2 blood units (OR=12.6, p=0.02), or postoperative dialysis therapy (OR=14.1, p=0.003). CONCLUSIONS: Perioperative blood loss requiring transfusion and necessity of relaparotomy increase the risk of IAI after SPK. Development of IAI after SPK may result in impaired kidney graft function and increases patient mortality in the early postoperative period.

Prolactin (PRL) reduces the release of transaminases from the isolated pig liver.

BACKGROUND: This study investigated methods of increasing the effectiveness of preservation solutions. Recently, it has been reported that solution effectiveness can be improved by the addition of prolactin (PRL). This study determines the effect of prolactin (PRL) on the amount and release rate of alanine aminotransferase (ALAT) and aspartate aminotransferase (AST) from liver during its 24-hour preservation period. MATERIAL/METHODS: Isolated porcine liver was kept in the HTK (histidine-tryptophan-ketoglutaric acid) solution with and without PRL. Once infusion and the 24-hour preservation period had been finished, samples of the preservation solution were taken and the amounts of released indicator enzymes were determined. RESULTS: Aminotransferases were released from hepatocytes to the preservation solution at various rates. ALT was released much faster into the solution without PRL (k=-0.1230 [U/l/h-1]) and slower with PRL (k=-0.0895 [U/l/h-1]). The enzyme was released into the solution with PRL at a 27% slower rate. Similar results were obtained when the release rate of AST was analyzed. AST was more quickly released into the solution without PRL (k=-0.0642 [U/l/h-1]), and more slowly with PRL (k=-0.0205 [U/l/h-1]). The enzyme was released into the PRL-containing solution at a 68% slower rate. CONCLUSIONS: The obtained results indicate that the addition of PRL significantly lowers the amount of aminotransferases released from hepatocytes and also lessens their release rate, as it significantly affects the time of efficient in vitro storage of the liver.

[Percutaneous angioplasty of the left renal artery in a patient with acute infarction of the left kidney with persistent occlusion of the right renal artery treated with angiotensin converting enzyme inhibitor]. / Przezskórna angioplastyka lewej tetnicynerkowej w przebiegu zawalu lewej nerkiu chorej z przewlekla okluzja prawej tetnicynerkowej w trakcie terapii inhibitoremkonwertazy angiotensyny.

A case of a 67 year-old woman with acute renal syndrome during treatment of angiotensin converting enzyme is presented. In angiography was affirmed acute occlusion left renal artery (LRA) with chronic occlusion right renal artery. Percutaneous angioplasty with implantation stent of the LRA were performed with optimal effect. In this article, the clinical management of patients with angiographically documented acute occlusion renal artery is discussed.

New biological solutions for hemodialysis access.

Since Scribner described the first prosthetic chronic dialysis shunt in 1961, the surgical techniques and strategies to maintain vascular access have improved dramatically. Today, hundreds of thousands of patients worldwide are treated with some combination of native vein fistula, synthetic vascular graft, or synthetic semipermanent catheter. Despite significantly lower efficacy compared with autologous fistulae, the basic materials used for synthetic shunts and catheters have evolved surprisingly slowly. The disparity between efficacy rates and concomitant maintenance costs has driven a strong campaign to decrease the use of synthetic grafts and catheters in favor of native fistulae. Whether arguing the benefits of Fistula First or "Catheter Last," the fact that clinicians are in need of an alternative to expanded polytetrafluoroethylene (ePTFE) is irrefutable. The poor performance of synthetic materials has a significant economic impact as well. End-stage renal disease (ESRD) accounts for approximately 6% of Medicare's overall budget, despite a prevalence of about 0.17%. Of that, 15%-25% is spent on access maintenance, making hemodialysis access a critical priority for Medicare. This clinical and economic situation has spawned an aggressive effort to improve clinical care strategies to reduce overall cost and complications. While the bulk of this effort has historically focused on developing new synthetic biomaterials, more recently, investigators have developed a variety of cell-based strategies to create tissue-engineered vascular grafts. In this article, we review the evolution of the field of cardiovascular tissue engineering. We also present an update on the Lifeline™ vascular graft, an autologous, biological, and tissue-engineered vascular graft, which was the first tissue-engineered graft to be used clinically in dialysis patients.

Case study: first implantation of a frozen, devitalized tissue-engineered vascular graft for urgent hemodialysis access.

Previously we reported on the mid- to long-term follow-up in the first clinical trial to use a completely autologous tissue-engineered graft in the high pressure circulation. In these early studies, living grafts were built from autologous fibroblasts and endothelial cells obtained from small skin and vein biopsies. The graft was assembled using a technique called tissue-engineering by self-assembly (TESA), where robust conduits were grown without support from exogenous biomaterials or synthetic scaffolding. One limitation with this earlier work was the long lead times required to build the completely autologous vascular graft. Here we report the first implant of a frozen, devitalized, completely autologous Lifeline™ vascular graft. In a departure from previous studies, the entire fibroblast layer, which provides the mechanical backbone of the graft, was air-dried then stored at -80°C until shortly before implant. Five days prior to implant, the devitalized conduit was rehydrated, and its lumen was seeded with living autologous endothelial cells to provide an antithrombogenic lining. The graft was implanted as an arteriovenous shunt between the brachial artery and the axillary vein in a patient who was dependent upon a semipermanent dialysis catheter placed in the femoral vein. Eight weeks postoperatively, the graft functions without complication. This strategy of preemptive skin and vein biopsy and cold-preserving autologous tissue allows the immediate availability of an autologous arteriovenous fistula, and is an important step forward in our strategy to provide allogeneic tissue-engineered grafts available "off-the-shelf".

Germinal mutations of RET, SDHB, SDHD, and VHL genes in patients with apparently sporadic pheochromocytomas and paragangliomas.

INTRODUCTION: Pheochromocytomas and paragangliomas are derived from neural crest cells and are localized mainly in adrenal medulla and sympathetic or parasympathetic ganglia. They can be inherited (25%) and be part of multi-endocrine syndromes such as MEN2 syndrome, von Hippel-Lindau syndrome, pheochromocytoma/paraganglioma syndrome, neurofibromatosis type 1, and Sturge-Weber syndrome. Clinical presentation can sometimes be atypical and does not always allow proper diagnosis. In such situations, DNA analysis can be helpful, especially when the pheochromocytoma is the first and only symptom. MATERIAL AND METHODS: We analyzed DNA from 60 patients diagnosed and treated in the Centre of Oncology with a diagnosis of pheochromocytoma or paraganglioma. DNA analysis was carried out for RET (exons 10, 11, 13, and 16), SDHB, SDHD, and VHL genes. Techniques used for the analysis were direct sequence analysis, MSSCP, and RFLP. RESULTS: Germinal mutations were found in 16 patients (26,7%). Most frequent were mutations in RET proto-oncogene, followed by VHL gene, one mutation in SDHB, and one in SDHD genes. A comparison of some of the clinical features of both groups (with and without mutation) showed statistically significant differences. CONCLUSIONS: The results of our study show that genetic predisposition is frequent in chromaffin tissue tumours, which indicates that DNA analysis is necessary in every case, also because of possible atypical clinical presentation. (Pol J Endocrinol 2010; 61 (1): 43-48).

Factors determining changes in concentrations of pro-inflammatory markers in blood serum in the initial period after kidney transplantation from dead donor.

BACKGROUND: The main aim of this paper is to determine scope of changes in concentration of selected pro-inflammatory factors in blood serum in the initial period after the kidney transplantation from the brain death donor and attempt of establishing which of them are connected with delayed function of the organ, initial condition of both the donor and the recipient. MATERIAL/METHODS: The prospective examination carried out in group of 20 patients that underwent kidney transplantation from 10 donors diagnosed brain death. Blood samples were drawn before the transplantation procedure, 4 hours after procedure and in 4(th) day after the procedure. The blood serum analysis included: interleukin-6 (IL-6), tumor necrosis factor-alpha, interleukin-1beta (IL-1b) and C-reactive protein (CRP). RESULTS: In perioperative period the dynamic changes of all observed markers were noticed, especially in 4 th hour after the transplantation procedure. Generally, apart from TNFalpha, their concentration in blood serum was raising (the most significantly for IL-6) and then in 4(th) day reached the level equal to or lower than before transplantation. CONCLUSIONS: The delayed graft function is accompanied by high CRP level in donors before grafting and sustaining rise of IL-1b content in blood serum in 4(th) day after the transplantation procedure. The IL-6 content in this period revealed similar tendency in recipients' pairs that have been given the kidney from one donor, reflecting the condition of an organ that has been transplanted.