Evaluation of renal graft function based on standard mathematical formulas.

BACKGROUND: Creatinine is a standard marker for estimation of the transplanted kidney function. Concentration values are used in mathematical equations for GFR (glomerular filtration rate) calculation, with MDRD (modification diet in renal disease) being most commonly used. Cystatin C is an alternative marker for changes in glomerular filtration, which is also used in eGFR (estimated GFR) formulas. The aim of this study was to reveal eGFR <60 ml/min/1.72 m(2) in a population of patients after renal transplant, with stable graft function, using different formulas. MatERIAL AND METHODS: A group of 100 patients (56 females and 44 males) aged 20-78 years, took part in this study. Renal transplantation was conducted from 10 years to 10 months prior to the study. Estimated GFR was calculated with 4 formulas: MDRD, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), CKD-EPI cys (using cystatin C), and CKD-EPI mix (using creatinine and cystatin C). We used electronic calculators available on the National Kidney Foundation and the Nephron Information Center websites. RESULTS: The occurrence of eGFR values <60 ml/min/1.73 m(2) was 28% according to MDRD formula, 23% according to CKD-EPI, 25% according to CDK-EPI cys, and 26%according to CDK-EPI mix. CONCLUSIONS: Occurrence of GFR <60 ml/min/0.73 m(2) was the highest when calculated by MDRD formula, and the lowest when calculation was done with CDK-EPI. The significant discrepancy with different eGFR formula testing suggests the need for further research to find the best marker and/or formula for graft function estimation.

Role of platelets in the modulation of kidney allograft recipients' immune systems.

BACKGROUND: Renal transplantation is the most effective method of treatment in end-stage renal disease. Chronic allograft rejection still remains a challenge for transplant physicians. Despite a growing amount of data regarding the role of platelets (PLT) in immunological processes, few reports have correlated number of platelets with transplanted kidney function. We aimed to evaluate the correlation between number of circulating platelets and number of immune system cells, including lymphocytes CD 4+, CD8+, lymphocytes B, monocytes, NK cells, and lymphocytes T reg in kidney transplant recipients with stable graft function. MATERIAL AND METHODS: We enrolled 100 kidney transplant recipients (ages 20-78 years) 10 month to 10 years after transplantation. The numbers of platelets (using standard procedure) and immune blood cells were evaluated using flow cytometry. Statistical analysis was performed with Spearman rank correlation. RESULTS: We found a negative correlation between number of platelets and number of lymphocytes T reg, and a positive correlation between platelet count and number of other examined immunocompetent cells. CONCLUSIONS: The number of PLT correlates with number of cells responsible for induction and effector mechanisms of acquired cellular response.

Program of laparoscopic living-donor nephrectomy with retroperitoneoscopic access - a Polish single-center experience - success or disappointment?

BACKGROUND: Laparoscopic living-donor nephrectomy (LLDN) is an attractive alternative to open approach and is a widely accepted method of kidney retrieval for transplantation. Here, we present the first Polish series of LLDN performed at a single center. MATERIAL AND METHODS: Between April 2008 and May 2012, we performed 8 LLDN with an immediate renal transplantation using classical surgical approach and technique. Four men and 4 women were operated on. In all cases of LLDN, left kidneys were retrieved and retroperitoneal approach with 3 trocars was used according to the technique we described previously. RESULTS: No intra- or postoperative complications were observed. The average "skin-to-skin" time of surgery was 138 minutes (min. 80; max. 210). The blood loss ranged from 0 to 280 ml (average, 80). Warm ischemia time did not exceed 3 minutes in any case. All organs were immediately implanted in the second operating room. Postoperative course was uneventful in all donors and recipients. CONCLUSIONS: Similar to many authors, at the beginning of our program we hoped that introduction of LLDN would increase the donor pool in Poland. Unfortunately, so far, these expectations have not been realized. However, we consider our program as a success regarding multidisciplinary cooperation and feasibility of LLDN in our country.