The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation.

Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months post-transplantation (M3). However, many adverse events occurring earlier might be missed, and stratification at 1 month post-transplantation (M1) has not been investigated. We retrospectively analyzed case data from 589 patients who had undergone kidney transplantation between 2011 and 2021 at three German transplant centers. Tacrolimus metabolism was estimated by use of the C/D ratio at M1, M3, M6, and M12. C/D ratios increased substantially during the year, particularly between M1 and M3. Many viral infections and most graft rejections occurred before M3. Neither at M1 nor at M3 was a low C/D ratio associated with susceptibility to BKV viremia or BKV nephritis. A low C/D ratio at M1 could not predict acute graft rejections or impaired kidney function, whereas at M3 it was significantly associated with subsequent rejections and impairment of kidney function. In summary, most rejections occur before M3, but a low C/D ratio at M1 does not identify patients at risk, limiting the predictive utility of this stratification approach.

An Unusual Complication of Pericarditis.

Background According to current guidelines, acute pericarditis is an inflammatory pericardial syndrome with or without pericardial effusion. Case Description We report on a patient who was treated for purulent pericarditis and developed a fistula from the ascending aorta to the right ventricle (RV), leading to cardiac decompensation. Operative closure of the aortic and RV perforation solved the problem. Conclusion Bacterial pericarditis may lead to life-threatening complications. Early diagnosis and immediate therapy are essential for a successful outcome.

Rescue allocation and recipient oriented extended allocation in kidney transplantation-influence of the EUROTRANSPLANT allocation system on recipient selection and graft survival for initially nonaccepted organs.

Nonaccepted kidneys grafts enter the rescue allocation (RA) process to avoid discards. In December 2013, recipient oriented extended allocation (REAL) was introduced to improve transparency. The aim of this study was to evaluate the influence of REAL on recipients' selection and graft function compared to the formerly existing RA as well as to identify factors that influence graft outcome. Therefore, a multicenter study of 10 transplant centers in the same region in Germany was performed. All transplantations after RA or REAL from December 1, 2012, until December 31, 2014, with a follow-up time until December 31, 2015 were analyzed. 113 of 941 kidney transplantations were performed after RA or REAL (12%). With REAL, the number of refusals before transplantation had increased (12 ± 7.1 vs. 8.6 ± 8.6, P = 0.036), and cold ischemia time has decreased (13.6 ± 3.6 vs. 17.2 ± 4.8 h, P = 0.019). Recipients after REAL needed significantly more allocation points compared to RA to receive a kidney. One-year graft survival was comparable. If kidneys from the same donor were transplanted to two recipients at one center, the greater the difference in recipient age, the greater the difference in serum creatinine after 12 months (-0.019 mg/dl per year, P = 0.011) was, that is older recipients showed lower creatinine. REAL influences selection of the recipients compared to the former RA era for successful organ receipt. Graft function is comparable and seems to be influenced by recipient age.

Electroanalytical measurements without electrolytes: conducting polymers as probes for redox titration in non-conductive organic media.

Electroanalytical methods have been applied only in conducting media. An application of conducting polymers allows to overcome this limitation. If such material is in electrochemical equilibrium with dissolved redox active species, its electrical conductivity depends on the redox potential of these species. Therefore, conductometric measurements with conducting polymers can provide about the same information as classical redox electrodes. The approach was applied for redox titration. Equivalent points obtained by this titration in aqueous and organic electrolytes were identical. Then the approach was applied for determination of bromine number by redox titration in non-conducting organic phase.

Chemiresistors based on conducting polymers: a review on measurement techniques.

This review covers the development of measurement configurations for chemiresistors based on conducting polymers. The simplest chemiresistors are based on application of a two-electrode technique. Artifacts caused by contact resistance can be overcome by application of a four-electrode technique. Simultaneous application of the two- and four-electrode measurement configurations provides an internal control of sensor integrity. An incorporation of two additional electrodes controlling the redox state of chemosensitive polymers and connecting to the measurement electrodes through liquid or (quasi)solid electrolyte results in a six-electrode technique; an electrically driven regeneration of such sensors allows one to perform fast and completely reversible measurements.

Integrated electrochemical transistor as a fast recoverable gas sensor.

A new design of conductometric chemical sensors based on conducting polymers as chemosensitive elements was suggested. The sensor includes six electrodes. Four inner electrodes coated by chemosensitive polymer are used for simultaneous two- and four-point resistance measurements thus providing information on the bulk polymer resistance and on the resistance of the polymer/electrode contacts. Two outer electrodes wired to inner electrodes by polymeric electrolyte are used for electrical control of redox state of the chemosensitive polymer. The outer electrodes are connected to potentiostat as reference and counter electrodes. It allows us to control redox state of the inner (working) electrodes. This new measurement configuration, resembling chemosensitive electrochemical transistors, provides an internal test of the sensor integrity and an electrically driven sensor regeneration. It was tested as a sensor for the detection of nitrogen dioxide. Polythiophene or polyaniline was used as receptors. Cyclic voltammograms of these polymers on the sensor surface measured in air atmosphere were very similar to that measured in aqueous electrolyte. A control of conductivity of these chemosensitive polymers by electrical potential applied vs. incorporated reference electrode was demonstrated. This effect was used for the regeneration of the chemosensitive material after exposure to nitrogen dioxide: in comparison to usual chemiresistors displaying an irreversible behavior in such test even in the time scale of hours, a completely reversible sensor regeneration within few minutes was observed.

Conducting polymers in chemical sensors and arrays.

The review covers main applications of conducting polymers in chemical sensors and biosensors. The first part is focused on intrinsic and induced receptor properties of conducting polymers, such as pH sensitivity, sensitivity to inorganic ions and organic molecules as well as sensitivity to gases. Induced receptor properties can be also formed by molecularly imprinted polymerization or by immobilization of biological receptors. Immobilization strategies are reviewed in the second part. The third part is focused on applications of conducting polymers as transducers and includes usual optical (fluorescence, SPR, etc.) and electrical (conductometric, amperometric, potentiometric, etc.) transducing techniques as well as organic chemosensitive semiconductor devices. An assembly of stable sensing structures requires strong binding of conducting polymers to solid supports. These aspects are discussed in the next part. Finally, an application of combinatorial synthesis and high-throughput analysis to the development and optimization of sensing materials is described.