Organ donation and transplantation in Poland in 2007.

In 2007 the number of effective cadaveric donors and the number of transplanted organs in Poland significantly decreased. 466 possible deceased organ donors were reported to Polish Transplant Coordinating Center POLTRANSPLANT-Health Ministry Office responsible for organization of procurement, organ allocation and providing registries. Organ recovery took place in 352 (75.5%) cases (9.2 donors/pmp).

Assessment of cadaveric livers discarded from transplantation. A correlation between clinical and histological parameters.

BACKGROUND: We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology. MATERIAL/METHODS: Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation. RESULTS: In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation. CONCLUSIONS: Results of biopsies suggested that approximately in one third of livers discarded from transplantation due to clinical donor parameters could have been harvested from histological point of view. Several donor clinical risk factors (alcohol addiction, hyperbilirubinemia, increased transaminase activity) correlate with severe histological changes rending the liver "not suitable for transplantation".

Steroid withdrawal at 3 months after kidney transplantation: a comparison of two tacrolimus-based regimens.

The 6 month prospective, randomized study compared the steroid-sparing potential of two tacrolimus-based regimens after renal transplantation. A total of 489 patients were randomized (1:1) to receive tacrolimus/mycophenolate mofetil (MMF)/steroids (n = 243; group Tac/MMF/S) or tacrolimus/azathioprine/steroids (n = 246; group Tac/Aza/S). At 3 months, steroids were tapered off in 267 (54.6%) patients free from steroid-resistant acute rejection and with serum creatinine concentrations <160 micromol/l. The incidence of biopsy-confirmed acute rejection at month 3 was lower in group Tac/MMF/S compared with group Tac/Aza/S (18.1% vs. 26.0%,P = 0.035). Moreover, more patients in the Tac/MMF/S group met the criteria for steroid withdrawal than in the Tac/Aza/S group (60.5% vs. 48.8%; P < 0.01). The incidence of acute rejection during months 4-6 was low in all groups, both for patients on steroid-free dual therapy (Tac/MMF: 2.7%, Tac/Aza: 0.8%) and for patients who continued steroid maintenance therapy (Tac/MMF/S: 3.5%, Tac/Aza/S: 7.1%). Moreover, kidney function was well preserved in steroid-free patients with month 6 median serum creatinine levels of 119.5 micromol/l (Tac/MMF), and 115.1 micromol/l (Tac/Aza). For patients who continued to receive steroids, month 6 median creatinine levels were 130.5 micromol/l (Tac/MMF/S) and 132.8 micromol/l (Tac/Aza/S). The criteria for the selection of patients to discontinue steroids were adequate. Both tacrolimus-based regimens allowed the safe discontinuation of steroids in low-risk patients at month 3. The Tac/MMF combination was superior in the prevention of acute rejections and more patients met the chosen criteria for steroid withdrawal.

Organ transplantation at the Medical University of Warsaw.

The Warsaw Transplant Center comprises 3 programs for transplantation of kidney, pancreas and liver. At the end of 2005, 3,616 kidney, 131 simultaneous pancreas kidney and 592 liver transplants had been performed. The one-year patient and graft survival rates were 92.8% and 91.1%, respectively, for 2,689 kidney transplants performed in 2001-2003 and the 5-year patient and graft survival rates were 91.4% and 77.1%, respectively, for 1,667 transplants performed in 1998-2001. The number of liver transplantations performed at the Medical University of Warsaw is growing. The gender distribution is well balanced and the most common age of the transplant recipients ranges from 41-50 years. The most common indications were post-hepatitis C and B cirrhosis and post-alcoholic cirrhosis. The average one-year mortality after liver transplantation was 9.8%. The results of liver transplantations at the Medical University of Warsaw are similar to those reported by other leading European centers. At present, 495 patients are alive with good liver function 1-8 years after transplantation.

Ethical and societal problems in organ transplantation.

Transplantation medicine, like no other medical specialty, is connected with a wide range of very difficult ethical issues. Among those are: availability of the treatment, consent for cadaveric donation, allocation of available organs, new categories of living unrelated donors and economic aspects of this method of treatment. Authors discuss sensitive aspects in societal perception of the Polish Transplantation Act, ethical issues of living donor kidney transplantation, the role of mass media and economic aspects of transplantation.