Current Data on Organ Donation and Transplantation in Poland: Poltransplant Activity 2017 to 2022.

BACKGROUND: In this paper, we present organ donation and transplantation activities in Poland from 2017 to 2022. Data came from registries maintained by the Polish Transplant Coordinating Center Poltransplant and consisted of the national waiting list, deceased donor registry, transplant registry, and the live donor registry. Poltransplant is the Competent Authority in Organs, with tasks related to preparing assessments, analyses, information, and reports in transplantation medicine and publishing and disseminating these results in the country and abroad. Poltransplant edits the Poltransplant Bulletin on its web pages and presents its activities at Polish Transplantation Society congresses, published consecutively as professional papers.

Non-Donor Registry in Poland: Poltransplant Activity.

BACKGROUND: Organ, tissue and cell procurement from deceased donors for transplantation requires consent and authorization, documented donor's positive acceptance, or lack of objection to donation expressed while alive. It also requires the fulfillment of other legal conditions required by the law, such as person's legal abilities to act in this field or to obtain approval for donation. Consent to and authorization of donation from deceased donors requires regulations on national level. Poland developed an opting-out policy since 1996, when The Central Register of Objections (CRO) was introduced. The purpose of this article is a formal analysis of all submitted objections and objection withdrawals managed by the CRO since the introduction of the registry until the end of 2020. METHODS: All data collected by the CRO during 25 years of service was subject of analysis. The objections and withdrawals of objections are summarized in the tables, along with the age, sex and place of residence of registered person. RESULTS: By December 2020, a total 37,728 records were registered, including 37,392 registered objections and 336 registered withdrawals of objections; this means that 0.09% of the country's population expressed objection to deceased donation. CONCLUSIONS: The CRO is an indispensable option in a country with opt-out system as a part of deceased donation authorization protocol. Number of registered objections is extremely low, in practice, this leads to a situation where the will of the deceased most often is obtained from the family.

Results of Kidney Transplants From Deceased Donors Discarded From Transplantation by a Regional Transplant Center but Accepted and Transplanted by Another Center.

BACKGROUND: Kidney allocation policy in Poland is strictly patient oriented. Kidneys are transplanted by the same center that made procurement. Sometimes kidneys are transferred for transplantation to another center due to medical or logistic reasons or according to allocation rules. AIM: The aim of the study was to compare early graft and recipient survival rates in cases of kidneys exported for transplantation to another center and in cases of kidneys transplanted typically. METHODS: Data came from national transplant registry. Kidney transplants from the years 2008 to 2017 were divided into several groups. One-year graft and patient survival rates were calculated for each group, and statistical differences were cross-calculated between groups. RESULTS: Groups were compared by using the χ2 test. Statistical analysis showed significantly lower graft and recipient survival rates: in the group of kidney transplantations performed in another transplant centers vs group of kidneys not transferred, where kidney transplantations were performed in a regional transplant center (P = .005 and = .02); and in the group of kidneys transferred due to logistic reason and allocation rules vs group of kidneys not transferred, where kidney transplantations were performed in regional transplant center (P = .01 and = .04). CONCLUSION: Early results of kidneys procured and transplanted by the same regional transplant center are significantly better than kidneys that have been transferred for transplantation to another center, but this result concerns only the subgroup of kidneys shifted due to logistic or allocation reasons. Early results of kidneys discarded by a regional team due to medical reasons and transplanted by another team are not different from results of transplantations performed by the same center that made the procurement.

Organization and Development of Bone Marrow Donation and Transplantation in Poland.

This paper describes bone marrow donation and transplantation in Poland in terms of its history, current state, and information on the quality control system. Based on data gathered from the informatics systems of the Polish Central Unrelated Potential Bone Marrow Donor and Cord Blood Registry and the Polish transplant registries, as well as World Marrow Donor Association statistics, we performed an overview study to collect and compare numbers on hematopoietic stem cells donations and transplantations in Poland in the years 2010-2014. In the last 5 years, the number of registered potential hematopoietic stem cells donors in Poland increased by more than 4 times, from about 146,000 to over 750,000. During the same period, the number of patients qualified to hematopoietic stem cells transplantation from unrelated donor increased from 557 in 2010 to 817 in 2014. We observed a striking change in the percentage of transplantations performed in Polish centers using material collected from national donors--from 24% to 60%. This shift was also evident in the number of search procedures closed with acceptation of Polish donors--from 27% in 2010 to 58% in 2014. Another consequence of Polish registry growth is the increasing number of donations from Polish donors for international patients. Between 2010 and 2014, the percent of donation for non-national patient increased from 33% to 76%, placing Poland in 6th place in the ranking of the HSC "exporters" worldwide. Growth of transplantation rates involves standardization process, which is a natural way of development for national organizations in the field of HSCT because of its international character.

An approach to predicting hematopoietic stem cell transplantation outcome using HLA-mismatch information mapped on protein structure data.

In hematopoietic stem cell transplantation (HSCT), the outcome is predicted using HLA-matching procedures, which are very time-consuming. There exists substantial evidence of the importance of early donor acceptance in HSCT outcome. In cases when the donor cannot be perfectly matched, it often is unclear which mismatch is less harmful and thus has a greater likelihood of acceptance. We modeled and analyzed interactions between the protein products of different HLA alleles of the transplant recipient and natural killer and T lymphocyte cell receptors of the donor's immune system. Reactions between these 2 systems often lead to graft-versus-host disease (GVHD). Sequence polymorphisms that define HLA I and II alleles predict not only GVHD, but also host-versus-graft and graft-versus-leukemia effects, all of which influence the overall transplantation outcome. Although complete high-resolution HLA matching of the donor-recipient pair seems to be associated with optimal post-HSCT survival, recent reports suggest that not every HLA disparity is functionally relevant. We performed interaction energy calculations for selected pairs of donor-recipient HLA alleles. Based on the results, we conclude that the energy of contact between the T lymphocyte cell receptor (TCR) and HLA residues can help predict the future development of an immune reaction and, consequently, the outcome of allogeneic HSCT.

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).

[Expression of mRNA for growth factors and cytokines in the renal artery wall of chronically rejected renal allograft]. / Ekspresja mRNA czynników wzrostu i cytokin w scianie tetnicy nerkowej przeszczepionej nerki w okresie przewleklego odrzucania.

The vascular hallmark of chronic rejection (CR), as well as of atherosclerosis, is initial hyperplasia. It results from migration and proliferation of vascular smooth muscle cell and increased deposition of extracellular matrix proteins. A possible mechanism responsible for formation of neointima is the release of growth factors and cytokines, such as: transforming growth factor beta (TGF-beta), tumour necrosis factor alfa (TNF-alpha), interleukin 1 (IL-1) and interleukin 6 (IL-6). The expression of these factors in the renal artery wall of chronically rejected allografts was quantified. The renal artery samples were obtained from patients with chronic renal allograft rejection, undergoing graftectomy (n = 11) and patients with autosomal dominant polycystic kidney disease (ADPKD), undergoing nephrectomy (n = 4). Total RNA was isolated and the expression of mRNA for TGF-beta, TNF-alpha, IL-1 and IL-6 was measured using a real time PCR. In patients with CR the expression levels of TGF-beta, TNF-alpha and IL-1 mRNA were higher than in control group. No difference between groups was detected for IL-6. In both groups a correlation was detected between age and TGF-beta expression. The increased expression of TGF-beta, TNF-alpha and IL-1 may be a key factor in the neointimal formation and pathogenesis of CR. The increase in the TGF-b expression with age might be a protective mechanism in atherosclerosis.