Paired Analysis of Outcomes After Kidney Transplantation in Peritoneal and Hemodialysis Patients.

BACKGROUND: The impact of dialysis modality before kidney transplantation (hemodialysis or peritoneal dialysis) on outcomes is not clear. In this study we retrospectively analyzed the impact of dialysis modality on posttransplant follow-up. METHODS: To minimize donor bias, a paired kidney analysis was applied. One hundred thirty-three pairs of peritoneal dialysis (PD) and hemodialysis (HD) patients were transplanted at our center between 1994 and 2016. Those who received kidneys from the same donor were included in the study. HD patients were significantly older (44 vs 48 years), but the Charlson Comorbidity Index was similar (3.12 vs 3.46) in both groups. The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.96 vs 2.95). RESULTS: One-year patient (98% vs 96%) and graft (90% vs 93%) survival was similar in the PD and HD patient groups. The Kaplan-Meier curves of the patients and graft survival did not differ significantly. Delayed graft function (DGF) and acute rejection (AR) occurred significantly more often in the HD recipients. Graft vessel thrombosis resulting in graft loss occurred in 9 PD (6.7%) and 4 HD (3%) patients (P > .05). Serum creatinine concentration and estimated glomerular filtration rate (using the Modification of Diet in Renal Disease guidelines) showed no difference at 1 month, 1 year, and at final visit. On multivariate analysis, factors significantly associated with graft loss were graft vessel thrombosis, DGF, and graft function 1 month after transplantation. On univariate analysis, age, coronary heart disease, and graft loss were associated with death. Among these factors, only coronary heart disease (model 1) and graft loss were significant predictors of death on multivariate analysis. CONCLUSION: The long-term outcome for renal transplantation is similar in patients with PD and HD. These groups differ in some aspects, however, such as susceptibility to vascular thrombosis in PD patients, and to DGF and AR in HD patients.

Evaluation of Pretransplant Donor-Specific Alloantibodies With Different Crossmatch Techniques.

Donor-recipient crossmatching for kidney transplantation is an obligatory step for the transplant work-up process. Attention is currently put on single bead assay (SBA) that enables virtual crossmatching. In contrast, methods developed for complement binding capacity are still not routinely established. We compared modified, cytolytic flow cytometry crossmatch (cFC-XM) with complement-dependent serological crossmatch (CDC-XM), SBA, and flow cytometry crossmatch (FC-XM) to verify whether newly developed techniques may be beneficial for transplant immunological matching. Also, the cutoff value for donor-specific alloantibodies levels currently used for virtual crossmatch was verified. Serum from 22 sensitized patients was crossmatched with surrogate donors by CDC-XM, FC-XM, and cFC-XM, while anti-HLA antibodies were measured by SBA. In all cases, virtual crossmatch was positive at 5000 mean fluorescence intensity cutoff. Among 22 tested sera with donor-specific alloantibodies above 5000 mean fluorescence intensity, the positive CDC-XM result was noted only in 41% of patients (n = 9), but positive FC-XM was noted in 86% (n = 19), and further lytic antibodies (cFC-XM) were confirmed in 27% of cases (n = 6). Our results suggest that donor-recipient immunological matching for kidney transplantation requires different methods to verify the importance of alloantibodies, and improvement in laboratory investigation is needed. This is especially important for immunized patients that have many types of alloantibodies and virtual crossmatching used as a tool for deceased donor allocation should balance between the likelihood of transplantation and risk of positive crossmatch result.

Management of Renin-Angiotensin-Aldosterone System Blockade in Kidney Transplant Recipients.

Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are the cornerstone treatment in chronic kidney disease patients. Despite facilitating a reduction in blood pressure and albuminuria, there are insufficient data in kidney transplant recipients (KTRs). They are often administered for hypertension and polycythemia treatment. The aim of this study was to investigate the frequency and route of administration of ACEIs and ARBs and their early clinical effects in the KTR population. In a cross-sectional, retrospective study we analyzed 874 medical records of all KTRs treated in our unit in 2014. A total of 391 KTRs (44.7%) using ARBs or ACEIs were qualified for the study. The primary reasons for renin-angiotensin-aldosterone system antagonist administration were hypertension (59.1%), polycythemia (19.2%), and proteinuria (18.2%). Among the studied KTRs, 86.7% of patients were treated with ACEIs and 12.2% were treated with ARBs. The majority of patients treated with ACEIs and ARBs received these agents in a dose range below 25% and between 25% and 49% of their maximal dose, respectively. Both the mean serum creatinine level and estimated glomerular filtration rate (chronic kidney disease epidemiology collaboration) remained fairly stable and urine protein excretion (g/24 hours) was significantly reduced after 3 months of ACEI and ARB therapy. The serum potassium level increased significantly, while hemoglobin concentration dropped significantly. In KTRs, renin-angiotensin-aldosterone system antagonists were applied mainly due to hypertension, proteinuria, and polycythemia. ACEIs and ARBs were effective in the reduction of proteinuria and hemoglobin, but graft function was stable and the increase of serum potassium was not of clinical significance.

Solid Organ Cancer and Melanoma in Kidney Transplant Recipients: TumorTx Base Preliminary Results.

BACKGROUND: Incidence of malignancy in transplant recipients is higher than in the general population. Malignancy is a major cause of mortality following solid organ transplantation and a major barrier to long-term survival for the kidney. The aim of this study was to estimate the incidence of solid organ malignancy (SOM) and melanoma in renal transplant recipients (RTR) transplanted at 2 representative transplant centers in Poland based on data from the Polish Tumor Registry. MATERIAL AND METHODS: We analyzed the medical data of 3069 patients who underwent kidney transplantation (KTx) between 1995 and 2015. RESULTS: In our study 112 SOM (3.6%) were diagnosed. The majority of patients were male (n = 71; 63.4%; P < .01). The mean age at KTx was 48.0 ± 13.1 years and the mean age at the time of cancer diagnosis was 55.9 ± 12.7 years. The average time of malignancy occurrence was 5.9 ± 5.0 years after KTx. SOM was the cause of death in 60 patients (53%). The most common were malignancies of gastrointestinal tract (25%), urinary tract tumors (23.2%), lung cancer (n = 18; 16%), and lymphoma (13.4%). We found an increase in the percentage of chronic glomerular nephropathy in the group of SOM (n = 56; 50%) compared with renal insufficiency of other etiologies. CONCLUSIONS: RTR in Poland are at a significant risk of malignancy development in a variety of organs, primarily urinary tract tumors and lymphoma. Cancers most frequently occurring in the general population such as lung and colorectal cancer are common in our RTR. On this basis an appropriate tumor screening schedule can be developed in individual countries.

Improvement of Blood Pressure Control in Renal Transplant Recipients-Retrospective Longitudinal Study.

BACKGROUND: Hypertension is a very common complication in renal transplant recipients (RTRs). It has been identified as a potent cardiovascular risk factor associated with impaired patient and graft survival. METHODS: A longitudinal retrospective analysis was performed to evaluate adherence to recommended blood pressure (BP) targets and to estimate the tendency in the management of hypertension from 2001 to 2015. A total of 96 RTRs (55 male, 41 female; overall mean age (2001), 41.66 ± 11.08 years; mean serum creatinine level, 1.45 ± 0.3 mg/dL; 41.2 ± 34.9 months after kidney transplantation) with diagnoses of hypertension and monitored continuously in the unit from 2001 to 2015 were included in the study. RESULTS: The average diastolic BP decreased (P < .01) and the average systolic BP did not change in this period. The target values of BP (ie, <140/90 mm Hg) were accomplished by 45.8% (2001) and 53.1% (2015) of patients. When the target BP was corrected by age (<150/90 mm Hg for people >65 years old) the adherence improved to 57.29% in 2015. The average number of antihypertensive agents used per patient increased significantly (P < .001): 2.03 ± 1.0 (2001) versus 2.69 ± 1.26 (2015). The most commonly used antihypertensive agents were beta-blockers: 69% and 74% in 2001 and 2015, respectively. There was a significant increase in the percentage of RTRs treated with the use of alpha-blockers (P < .01), angiotensin-converting enzyme inhibitors (P < .001), and angiotensin II receptor blockers (P < .05). CONCLUSIONS: The study showed modest improvement of the hypertension control rate from 2001 to 2015 in RTRs. Greater efforts are needed to implement the guidelines, which would further improve patient and graft outcomes.

Effects of build orientation and element partitioning on microstructure and mechanical properties of biomedical Ti-6Al-4V alloy produced by laser sintering.

Direct Metal Laser Sintering (DMLS) technology was used to produce tensile and flexural samples based on the Ti-6Al-4V biomedical composition. Tensile samples were produced in three different orientations in order to investigate the effect of building direction on the mechanical behavior. On the other hand, flexural samples were submitted to thermal treatments to simulate the firing cycle commonly used to veneer metallic devices with ceramics in dental applications. Roughness and hardness measurements as well as tensile and flexural mechanical tests were performed to study the mechanical response of the alloy while X-ray diffraction (XRD), electron microscopy (SEM, TEM, STEM) techniques and microanalysis (EDX) were used to investigate sample microstructure. Results evidenced a difference in the mechanical response of tensile samples built in orthogonal directions. In terms of microstructure, samples not submitted to the firing cycle show a single phase acicular α' (hcp) structure typical of metal parts subject to high cooling rates. After the firing cycle, samples show a reduction of hardness and strength due to the formation of laths of the ß (bcc) phase at the boundaries of the primary formed α' plates as well as to lattice parameters variation of the hcp phase. Element partitioning during the firing cycle gives rise to high concentration of V atoms (up to 20wt%) at the plate boundaries where the ß phase preferentially forms.

Dietary Intake of Vitamins in Different Options of Treatment in Chronic Kidney Disease: Is There a Deficiency?

BACKGROUND: The importance of diet in the management of kidney transplantation (KT), as well as other treatment options of chronic kidney disease (CKD), is generally acknowledged. However, data regarding vitamin intake are very limited. Vitamins are essential in maintaining good nutritional status and preventing many chronic complications. It is still not clear which treatment modality imposes the highest risk of dietary vitamin deficiency and whether successful KT reverses such a threat. METHODS: We performed this observational study to assess dietary intake of vitamins in CKD patients: after successful KT, not yet dialyzed (ND), treated with hemodialysis (HD), and with peritoneal dialysis (PD). A total of 202 patients were recruited (45 KT, 50 ND, 45 HD, and 62 PD). Vitamin intakes were evaluated through the use of a 24-hour dietary recall and processed with the use of a computerized database. Each record was evaluated by a skilled dietitian. In general, vitamin intakes in all study groups were comparable, with KT and ND groups manifesting lower risk of deficiency than HD and PD groups. RESULTS: The content of fat-soluble vitamins in diet was insufficient, with remarkably high prevalence of vitamin D deficiency. Mean intakes of water-soluble vitamins were close to recommended, with the exception of folic acid, which was profoundly deficient in all groups. CONCLUSIONS: CKD patients are at risk of inadequate vitamin intake. Vitamin D and folic acid are universally deficient in diet. KT patients have the most satisfactory content of vitamins in their diet, whereas HD individuals are at highest risk of deficiency.

Influence of Body Mass on Kidney Graft Function in Patients After Kidney Transplantation.

BACKGROUND: Increasing evidence shows that body mass may play a role in complications after kidney transplantation and influence graft and patient survival. The aim of this study was to analyze the association between graft function and both the body mass and adipokines (leptin, visfatin, adiponectin) in kidney transplant recipients. METHODS: We studied 183 kidney transplant recipients from the Department of Nephrology, Transplantology and Internal Disease, Medical University of Gdansk. Anthropometry and body composition examinations were performed using an electronic scale, hand grip dynamometer, and BCM - Body Composition Monitor (Fresenius, Germany). Obesity, overweight, and underweight were defined according to body mass index (BMI) classification. Blood urea nitrogen, creatinine, blood morphology, lipidogram, albumin, and C-reactive protein were measured. Estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration formula. Leptin, visfatin, and adiponectin were measured by ELISA methods. RESULTS: Underweight was found in 16 (8.7%) KTR, overweight and obesity were observed in 68 (37.1%) and 26 (14.2%) patients, respectively. No relation between BMI and eGFR in all groups was noted, but in the early period after transplantation a correlation between BMI and creatinine and eGFR was observed. In all studied patients (also patients in the early posttransplantation period), eGFR significantly correlated with leptin and visfatin. Multiple regression analysis confirmed an association between eGFR and leptin and visfatin in all studied populations and between eGFR and BMI in the group examined shortly after transplantation. CONCLUSIONS: Sarcopenic overweight and obesity prevail in KTR. In the short-term but not long-term period after transplantation, worse graft function was associated with high BMI. An association between graft function and leptin and visfatin was noted.

Impact of Obesity on Renal Graft Function-Analysis of Kidney Grafts From the Same Donor.

BACKGROUND: The epidemic of obesity has led to dilemmas facing all nephrologists who care for patients with chronic kidney disease and who must make decisions regarding whether or not the patient can undergo transplantation. The aim of the study was to assess the outcome of transplantation among obese compared to nonobese recipients. To minimize donor variability and bias, paired kidney analysis was applied. MATERIALS AND METHODS: Patients with a body mass index >30 who received transplants in our unit between January 2000 and December 2010 were selected. For the analysis, only obese transplant recipients (OTR) and their kidney donor pairs with a body mass index <30 (nonobese transplant recipients [NOTR]) were selected. A total of 37 pairs of patients were evaluated in terms of the graft function, patient and graft survival, and number of complications. RESULTS: Groups did not differ with respect to sex and comorbidities. OTR were older than NOTR (53.1 vs 46.02 years old, P < .05). One-year patient and graft survivals were similar (100% vs 97.29% and 100% vs 94.59% in OTR and NOTR, respectively). There were no significant differences between OTR and NOTR with respect to incidence of acute rejection (29.7% vs 18.9%), delayed graft function (35.13% vs 29.72%), and mean serum creatinine and estimated glomerular filtration rate (four-variable Modification of Diet in Renal Disease formula) assessed at discharge and after 3, 6, and 12 months, respectively. OTR had a significantly longer hospitalization time (25.56 vs 20.66 days; P < .05), and more often experienced wound breakdown (32.43% vs 8.1%; P < .05) and new-onset diabetes after transplantation (57.14% vs 6.25%; P < .05). CONCLUSIONS: Obesity did not negatively influence patient and graft survival. Transplantation in obese patients should not be postponed.

Outcomes in Renal Transplant Recipients With Lupus Nephritis-A Single-Center Experience and Review of the Literature.

BACKGROUND: Renal transplantation is the renal replacement therapy of choice in patients with end-stage lupus nephritis (LN). The aim of this study was to evaluate the early and late outcomes of renal transplantation in LN patients in a single transplant center. PATIENTS AND METHODS: This study analyzed the clinical data of patients who received a renal transplant (RTx) at Gdansk Transplantation Centre between January 1999 and December 2014. RESULTS: There were 1296 RTx performed between January 1999 and December 2014, including 21 RTx in 19 LN patients (mean age 40 ± 10 years, 89% female). During the follow-up period (between 1 month and 10.5 years), 1 patient died of urosepsis and 1 of pneumonia. Three RTx recipients with antiphospholipid syndrome lost 5 kidney allografts, including 3 due to acute rejection (AR) during the first posttransplantation month. Kidney allograft survival median was 64 months. Delayed graft function (DGF) and AR were observed in 48% and 33% vs 31% and 21% of LN patients and other RTx patients, respectively (P = .1 and P = .16 for DGF and AR, respectively). The most common early posttransplantation complications were AR (31%) and perirenal hematomas (29%), and late complications were urinary tract infections (75%). Recurrence of LN in renal allograft was observed in 1 patient and was successfully treated by increasing the basic immunosuppression. CONCLUSIONS: Secondary antiphospholipid syndrome has a major influence on the outcomes of RTx in LN patients. Recurrence of LN has no clinical significance.

Psychological Well-Being in Patients After Preemptive Kidney Transplantation.

BACKGROUND: Preemptive kidney transplantation (PKT) is associated with improved patient and graft survival as compared with transplantation in previously dialyzed patients. Complications related to dialysis are avoided in preemptively transplanted patients. Psychological functioning of those patients is still under investigation. The aim of the study was to evaluate the acceptance of illness, satisfaction of life, and anxiety in patients preemptively transplanted (PET) and transplanted after dialysis (PTD). METHODS: The present study compares 23 pairs of PET and PTD patients after kidney transplantation from the same donor. Each patient completed a set of psychological questionnaires: Acceptance of Illness Scale, Satisfaction With Life Scale, and State-Trait Anxiety Inventory. Pairs were examined in the same moment, from 7 days to 5 years after transplantation. The PET and PTD groups did not differ significantly in respect to sex, underlying renal diseases, incidence of acute rejection, surgical complications, and graft function. More PTD patients had delayed graft function (P < .05). RESULTS: The statistical analysis revealed a significant lower acceptance of illness as well as satisfaction with life in PET recipients (P < .05). The groups differed significantly in the trait of anxiety but not in the state of anxiety. CONCLUSIONS: Although the medical benefits of PKT are widely known, numerous psychological problems may occur in patients who do not have difficulties of dialysis and who after transplantation are faced with unexpected discomfort, which influences psychological well-being. Further effort should focus on providing psychological support during qualification to the transplantation and in follow-up after surgery.

Impact of Skin Cancer Awareness on Prophylactic Behavior Among Renal Transplant Recipients.

BACKGROUND: Renal transplant recipients (RTRs) have a risk for skin cancer. The most important risk factor, and the only one that depends on patient behavior, is the exposure to ultraviolet light. The aim of this study was to assess the level of skin cancer awareness and its impact on preventative behavior among RTRs. METHODS: Questionnaires were applied to assess the awareness of increased risk of skin cancer and its influence on preventative behavior among RTRs. RESULTS: Of the RTRs, 51.6% considered themselves as a group of patients with a high risk of skin cancer. Only 11.5% (group A) were able to fully explain the whole reason of the need for sun protection usage. A partial explanation was provided by 40.1% of the patients (group B). The other 48.5% of the patients (group C) provided no explanation. Among the patients, 53.9% of surveyed RTRs never applied any sunscreen. Of RTRs, 22.5% claimed to always avoid direct exposure to sunlight. Most of the patients admitted to having outdoor hobbies (81% of group A, 60.3% of group B, 58% of group C). In addition, 36.2% of RTRs thought that they were more attractive if they were tanned. CONCLUSIONS: The awareness of being in a group of increased risk of skin cancer is still poor among RTRs. Skin cancer awareness does not correlate with usage of different forms of sun prevention. There is a great need for active education of Polish RTRs.

Tissue Doppler Imaging and Intima-Media Thickness as Noninvasive Methods of Cardiovascular Risk Stratification in Patients After Kidney Transplantation.

BACKGROUND: Cardiovascular complications, including coronary artery disease and chronic heart failure, are the leading causes of death in patients with chronic kidney disease. New echocardiographic techniques, such as tissue Doppler imaging (TDI) with strain and strain rate, are noninvasive, easy-to-perform methods of the estimation of left ventricular (LV) systolic and diastolic function. The aim of the study was to analyze the utility of new noninvasive methods of cardiovascular risk stratification in patients after kidney transplantation. METHODS: We included 43 consecutive kidney transplant (KT) recipients, with 30 healthy subjects constituting the control group in the study. We evaluated LV morphology and LV systolic and diastolic function by means of echocardiography with TDI and intima-media thickness by ultrasonography of the carotid arteries. RESULTS: LV mass index was significantly higher in transplanted patients, and both mitral inflow E/A and Em/Am ratios from pulsed myocardial imaging were significantly lower in the KT group as compared with the control group. The systolic wave of TDI at the basal segments was much lower in KT patients than in the control patients (P < .05). The mean value of strain rate was reduced in KT recipients as compared with the control patients. IMT was significantly higher in KT recipients. CONCLUSIONS: Echocardiography with TDI provided more accurate information about systolic and diastolic LV function. KT recipients showed significant alterations in LV longitudinal myocardial function parameters estimated by strain and strain rate. Strain and strain rate are noninvasive methods, easy to repeat, and valuable for detecting myocardial LV dysfunction in asymptomatic KT recipients.

Gastrointestinal Pathologies in Patients After Successful Renal Transplantation-A Pilot Study.

BACKGROUND: The beneficial effect of kidney transplantation in patients requiring continuous renal replacement therapy owing to chronic kidney disease is well known and accepted. Kidney transplantation protects the patient from complications that may develop during chronic dialysis. Unfortunately, there is also evidence that kidney transplant patients are more prone to developing cancer than healthy persons. The aim of this study was to evaluate the prevalence of gastrointestinal pathologies in patients after kidney transplantation. METHODS: Adult patients after kidney transplantation, who are under the care of the Outpatient Department of Nephrology in Gdansk, received alarm symptom questionnaires and referral for testing for the presence of fecal occult blood. Then, in 45 selected patients (29 men and 16 women) endoscopic examination was performed. Mean age was 57.6 ± 10.1 (range, 35-83) years. RESULTS: Out of ∼940 patients after kidney transplantation, resting under supervision of outpatient department, 181 patients completed the questionnaire and 100 gave a stool sample for testing: 32 results were positive. After analyzing the questionnaires and stool results, 88 patients were qualified for further investigation. The endoscopic examination had been performed so far in 45 patients and revealed gastritis and/or duodenitis in 33 patients, diverticular colon disease in 18, esophagitis in 8, colon polyps in 14, stomach polyps in 3, inflammatory bowel disease in 7, and cancers in 3. CONCLUSIONS: The preliminary results indicate that patients after kidney transplantation have significant risk of gastrointestinal pathologies and require detailed diagnostic endoscopy.

Association Between HLA Type and Skin Cancer in Kidney Transplant Recipients.

BACKGROUND: Organ transplant recipients (OTRs) are more susceptible to various diseases, among them cancers. Nonmelanoma skin cancers (NMSC) represent the most common malignancies in OTRs in Europe. Due to the significantly higher morbidity, aggressive and rapid progression, and poor prognosis of NMSC in the OTR population, these patients require a special oncological approach. Intensive attention should therefore be paid to factors predisposing OTRs to the development of cancer. The aim of this study was to establish the role of genetic factors in the pathogenesis of skin cancer in kidney transplant recipients (KTRs). METHODS: This single-center study was performed in 39 KTRs with posttransplant NMSC. The frequency of particular types of HLA Class I (HLA-A and HLA-B) and Class II (HLA-DR) in each group were compared to establish the association between the HLA type and risk of skin cancer after renal transplantation. RESULTS: HLA-DR15 were more commonly detected in patients with MNSC than in the control group of KTRs (P = .014) There was also a positive correlation between HLA-B18 and skin squamous cell carcinoma. The antigen was more often recorded in KTRs with squamous cell carcinoma than in KTRs without NMSC (P = .03) and in the general population (P = .002). CONCLUSIONS: Patients who are positive for HLA-BR15 and HLA-B18 should be under special dermatologic surveillance due to the potentially high risk of skin cancer.

Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience.

BACKGROUND: Lymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg edema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment. In this report, we present the incidence of symptomatic lymphocele requiring treatment (LRT), demographic and surgical factors that influenced lymphocele formation, its clinical presentation, and 2 types of treatment: open and laparoscopic intraperitoneal drainage in the experience of our center. MATERIAL AND METHODS: We retrospectively analyzed all kidney transplantations performed between January 2007 and December 2014 in Gdansk Transplantation Center (n = 740) and selected patients with LRT. LRT occurred in 59 cases (8%). All other patients transplanted during the same time (n = 681) were treated as a control group in the univariate and multivariate analysis of risk factors of the lymphocele formation. RESULTS: Surgical intraperitoneal drainage was performed in an open method in 53 cases and laparoscopically in 6 patients. We observed recurrence of lymphocele in 11 cases (18.6%). Acute rejection episodes (ARE) and delayed graft function (DGF) were more frequent in patients with LRT. ARE and age were independent risk factors for LRT in multivariate analysis. The mean estimated glomerular filtration rate by the Modification of Diet in Renal Disease method at 1 month after the fenestration was higher than before the operation (51.7 and 43.6 mL/min, respectively). CONCLUSIONS: Fenestration is a safe and effective method of treatment of symptomatic lymphocele. ARE, DGF, and older age were associated with a greater risk of LRT.

Clinical Utility of QuantiFERON-Cytomegalovirus Test in Management of Kidney Transplant Recipients.

Immune monitoring of cytomegalovirus (CMV) - specific T-cells responses has become an additional tool in the CMV risk assessment of kidney transplant recipients (KTRs). Some data demonstrated a potential use of QuantiFERON-CMV assay (QF-CMV) in stratifying CMV risk before transplantation, at the end of prophylaxis and during pre-emptive strategy. High risk for CMV disease was also reported in KTRs with indeterminate QF-CMV results in which both mitogen and CMV antigen responses were absent. Twenty-five KTRs in the first year after kidney transplantation (KT), including 17 KTRs after CMV infection treatment (CMV-KTR), were studied by QF-CMV assay. Positive QF assay (QF+) was present in 16 of 25 (64%) of KTRs, negative (QF-) in 5 of 25 (20%), and indeterminate (QF0) in 4 of 25 (16%). The QF0 patients, in comparison to the combined group of QF+ and QF-, presented an increased incidence of CMV disease (4 of 4 [100%] vs. 7 of 21 [33.3%]; P < .05) and severe infectious complications such as sepsis, and systemic mycosis (4 of 4 [100%] vs. 6 of 21 [29%]; P < .02). Of 17 CMV-KTRs, 11 of 17 (64.7%) were QF+, 2 of 17 (11.8%) were QF-, and 4 of 17 (23.5%) were QF0. The incidence of CMV disease and severe infectious complications was not different among these groups. CMV-KTRs with interferon-γ <3.5 IU/mL vs. >3.5 IU/mL in mitogen tube, irrespective of QF-CMV status, showed an increased incidence of CMV disease (8 of 9 [88.9%] vs. 3 of 8 [37.5%]; P < .05) and severe infectious complications (8 of 9 [88.9%] vs. 2 of 8 [25%]; P < .02). In conclusion, indeterminate result of QF-CMV or interferon-γ <3.5 IU/mL in mitogen tube seems to be related to impaired immunity. The QF-CMV assay appears to be a useful tool in clinical practice, identifying the group of KTRs with increased risk of infectious complications who may benefit from immunosuppression reduction and maintenance of antiviral prophylaxis.

Associations of Selected Cytokines Levels in Organ Transplant Recipients Without and With Malignant Skin Neoplasms.

INTRODUCTION: Skin malignancies are the most prevalent neoplasms seen in organ transplant recipients (OTRs). Immunosuppressive treatment has been attributed to play a causative role in malignancy development. The aim of the study was to assess cytokine concentrations involved in cytotoxic and regulatory responses in patients after organ transplantation (Tx). We compared two OTR subgroups: those with malignant skin tumors and those without any known changes developed after Tx. MATERIALS AND METHODS: We enrolled 102 patients, 63: 3-360 (median: min-max) months after Tx, aged 54.3 ± 9.9 (mean ± SD) years (38.2% females). Seventeen patients were diagnosed with malignant skin neoplasms. The most frequent treatment schemes were cyclosporine A - mycophenolate mofetil - glucocorticosteroids (GS) (37.4%), mycophenolate mofetil-tacrolimus - GS (15.2%), and azathioprine-cyclosporine A-GS (14.1%). A 5-mL sample of venous blood was obtained from participants of two subgroups: those with malignant skin tumors and those without any known changes. The blood was tested for interleukin 2 (IL-2), interferon gamma, IL-10, and transforming growth factor beta concentrations (Multicytokine Flex Set, ELISA). The Kruskal-Wallis test was used to compare variables; P < .05 was considered valid. RESULTS: Age, gender distribution, and time from transplantation did not differ across the two subgroups. We found significantly lower blood concentrations of IL-2 and IL-10 in patients with post-transplantation skin cancers versus patients without any known skin changes (0 pgmL(-1) vs. 21.22 pgmL(-1), and 4.93 pgmL(-1) vs. 7.36 pgmL(-1), respectively). The differences between interferon gamma and transforming growth factor beta levels were insignificant across studied groups. CONCLUSIONS: Our findings suggest that immunosuppressive response assessed by cytokine IL-2 and IL-10 levels may be used in the risk stratification for the development of skin cancer in organ recipient patients.

Benign Cutaneous Disease Among Polish Renal Transplant Recipients.

BACKGROUND: Organ transplant recipients are an at-risk group for skin cancers and benign cutaneous diseases. Immunosuppression type, dosage, and treatment length dictates the frequency of benign lesions. MATERIAL AND METHODS: Two hundred twenty-three consecutive adult renal transplant recipients (RTRs) were enrolled and screened for benign skin lesions. During examination, swabs, skin scrapings, and nail clippings were collected from any suspected areas infection and any cutaneous lesions marked for quality and quantity on a special questionnaire. The aim was to examine the prevalence of benign cutaneous disease and risk factors. RESULTS: Fungal infections were the most common infections found (60%), most commonly in the oral cavity (40.8%). Viral warts occurred in 18.4%, being significantly more common in those transplanted over 5 years (P = .002). Hypertrichosis was the most common pilosebaceous disorder found (P ≤ .001). Other iatrogenic cutaneous effects included purpura (50.2%), xerosis (41.2%), and gingival hyperplasia (28.2%), the latter strongly associated with cyclosporine (P = .0005). Seborrhoeic warts (23.8%) were most common in patients older than 50 years (P < .001). One-third of subjects had skin tags (31%). DISCUSSION: This is the largest study of the prevalence and type of non-malignant cutaneous diseases in Polish RTRs. We see increasing numbers of patients with long-term side effects from immunosuppressive therapy, and treatment, gender, age, and time since transplantation should be considered with new skin lesions in everyday practice with RTRs. CONCLUSIONS: The study group had a high prevalence of benign cutaneous diseases and these should not be overlooked as they can cause aesthetic problems and reduced quality of life.

Kaposi Sarcoma in the Genital Area in a Kidney Transplant Patient: A Case Report and Literature Review.

BACKGROUND: Kaposi sarcoma (KS) is a cancer with an incidence in patients after transplantation (Tx) that is 500 times greater than that in the healthy population. The risk of KS increases significantly during therapy, especially when immunosuppressive therapy with cyclosporine A (CsA) is used. Most cases of KS develop during the first 2 years after transplantation. After a KS diagnosis, it is recommended to reduce the doses of immunosuppressive medications. Conversion of immunosuppressive treatment into mammalian target of rapamycin (m-TOR) inhibitors is strongly suggested. PATIENTS AND METHODS: We present the case of a 65-year-old man with end-stage renal disease (ESRD) of unknown etiology, who had kidney transplantation in 2008. Immunosuppressive protocol was based on CsA, mycophenolate mofetil (MMF) and prednisolone (PRE). In 2011, during the dermatological consultation, on the penis glans a purple stain of uneven surface was noted. Histology study revealed the presence of KS. The treatment was modified. The patient was converted from CsA to everolimus. Before converting, the creatinine concentration was 1.79 mg/dl and proteinuria less than 0.3 g/day. RESULTS: The change in the scheme of immunosuppresion from CsA to everolimus was performed to treat the Kaposi sarcoma. Gradually, within a year, the KS was cured. However, the graft function deteriorated, and the graft was lost in one-years' time. CONCLUSION: We present the first documented case of KS in the genital area of a kidney patient. The reduction in the strength of immunosuppression, and the introduction of an m-TOR inhibitor, may have contributed to the deterioration of kidney function, however it was substantial in the treatment of KS.