Quality System of Kidney Donation for Transplantation From Living Donors in Poland.

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.

Organ Donation From Elderly Deceased Donors and Transplantation to Elderly Recipients in Poland: Numbers and Outcomes.

The age of a donor and recipient is one medical criterion in the kidney allocation system. The number of elderly donors and recipients is steadily growing. The aim of the study was to retrospectively evaluate the 5-year results of kidney transplantation from donors over 65 years of age to recipients over 60 years of age. In the years 1998 to 2010, 8526 potential deceased donation after brain death organ donors and 8206 people (81%), who had been treated with transplantation of kidneys were referred to the Poltransplant. The actual number of deceased donors >65 years was 358 and <65 years was 7207. The actual 5-year survival of a kidney transplant from donors >65 years was 59.2% (55.3% of recipients >60 years and 60.7% of recipients <60 years of age; P < .0001) and from donors <65 years was 75.1% (67.5% of recipients >60 years and 75.7% of recipients <60 years; P < .0001). The actual 5-year survival of kidney recipients from all donors >65 years was 75.6% (79.5% younger recipients vs 65.9% elderly recipients; P < .0001). The 5-year survival of kidney recipients from all donors <65 years was 88.1% (P < .0001); 89% younger recipients and 74.3% elderly recipients (P < .0001). The above analysis of the material from the Polish registry displayed significantly worse results of kidney transplantation from donors >65 years, regardless of the age group of recipients.

[Histocompatibility class I antigens loci A and B in familial sarcoidosis in Poland]. / Antygeny zgodnosci tkankowej klasy I loci A i B w sarkoidozie rodzinnej w Polsce.

Thirty three affected members from 17 Polish sarcoidosis families and their healthy relatives (61 subjects) have been typed for HLA class I (A and B). Controls consisted of 101 healthy Polish subjects. The HLA typing was performed by the serological method using the standard microcytotoxicity test. No significant differences were observed between group 1 (33 affected family members), group 2 (61 healthy relatives) and group 3 (healthy controls) considering the HLA class I locus A antigens. The frequencies of HLA B8, HLA B16 and HLA B40 were significantly higher in affected sarcoidosis families members compared to control subjects (p < 0.05). When comparing all families members (affected and non-affected as a one group) to the control group we found a significant overrepresentation of HLA B12 and B35 in the control group. We concluded that HLA antigens locus B: B12 and B35 may have a protective function against the disease; the role of HLA class I antigens in the pathogenesis of sarcoidosis needs further evaluation.

[Transplantation of the cornea from the donor selected on the basis of HLA compatibility in high risk leukoma]. / Przeszczepianie rogówki od dawcy dobranego pod wzgledem czesciowej zgodnosci czynnika HLA w bielmach wysokiego ryzyka.

Fifteen corneal grafts were performed in 15 men with high risk leukoma (5+) in the period October 1988--November 1990. The age of the patients oscillated between 11 and 76 years. In 5 patients the grafting was done in only eye. The period of observation after surgery amounted 4-29 months. The favourable results (transparent and ++semi-transparent grafts) were obtained in 9 eyes (60 p.c.) and partly opacified grafts in 6 (40 p.c.). Neither of the grafts opacified. In the preceding years--without taking into account the antigenic selection of the donor--favourable results in similar leukoma cases were achieved in ca. 42 p.c. of cases.

[Personal experiences with transplantation of antigenically compatible cornea. Preliminary report]. / Doswiadczenia wlasne w przeszczepianiu rogówki dobranej antygenowo. Doniesienie wstepne.

Ten corneae from donors selected in respect of partial compatibility of the HLA antigens were transplanted in the period October 1988--October 1989. The grafting was performed in 10 patients with leukomas included in the group of maximal risk (5+). In 9 patients the leukomas were due to ocular burns (chemical in 8 patients and thermal in 1 patient). In 1 patient, a 74 years old man the grafting was performed in the single eye with Salzman's corneal dystrophy with a simultaneous cataract extraction. During observation, which lasted 2 to 12 months 6 grafts remained transparent, 1--partly opacified. Not any transplant did totally opacify.

HLA antigens and intracranial aneurysms.

The frequencies of the HLA-A, -B and -DR were determined in a group of 59 transplant donors who died from subarachnoid haemorrhage within three days following the rupture of intracranial aneurysm (the SAH group) and compared with those of a control group consisting of 389 donors who died from other causes. The only significant difference was in the increased frequency in the SAH group of non-typed ("empty")-DR loci in association with the DR7 phenotype. The most probable explanation of this finding is that in the SAH group the frequency of DR7 homozygotes is several times higher than in the general population, and that bearing the DR7 allele in homozygotic form is associated with a very high risk of developing potentially fatal intracranial aneurysmal haemorrhage.

Identification of HLA antigens in familial and non-familial epidermodysplasia verruciformis.

The distribution of HLA specificities was studied in 7 non-familial cases of epidermodysplasia verruciformis (EV) and in 5 cases from one family. In the non-familial cases, six antigens of locus A (2, 3, 9, 10, 24, 26) and eight antigens of locus B (7, 15, 27, 35, 37, 38, 40, 41) were found. All 5 cases of familial EV possessed 26,5 haplotype, however, 6 of the remaining 12 healthy family members inherited the same haplotype. There is no association of EV with HLA-A and B antigens. However, the defect of cell-mediated immunity, present in all EV cases, may indicate the association of the disease with other major histocompatibility products (i.e. loci on immune response genes).

The effect of ampicillin on the response of human lymphocytes to PHA.

The effect of ampicillin on the sensitivity of human lymphocytes to PHA was examined by measuring the following parameters: temperature-stable E rosette formation: leukocyte migration inhibition: DNA synthesis. It was found, that ampicillin present in the culture medium at a concentration of 50 microgram/ml does not change E rosette formation, intensifies the inhibition of leukocyte migration and modulates the proliferative response to PHA. The magnitude and direction of this last effect depended upon the preparation of PHA used and on its dose. Ampicillin enhanced DNA synthesis in cultures stimulated by submitogenic, as well as supraoptimal doses of PHA-Wellcome and suppressed the DNA synthesis in cultures containing optimal mitogenic doses of PHA-Difco.

Lymphocyte dependent antibody (LDA) test in renal transplanted patients.

Using LDA test the presence of antibodies in patients prior to and post renal transplantation was studied. The relationship between the results of LDA test and graft rejection episodes, the treatment with large doses of prednisolone and CDC test performed simultaneously were analized. No correlation between results of LDA test prior to transplantation or its response to prednisolone treatment and acute rejection crises was found. The value of LDA test in predicting rejection episodes was not confirmed. LDA test detects antibodies 10 times more frequently than CDC test. The presence of cytotoxic antibodies CDC was not always connected with the presence of LDA and vice versa.