Microchimerism as Post-Transplant Marker of a Chronic Rejection Process.

The risk of losing a transplanted organ is high, and non-invasive markers to warn of this phenomenon are still being sought. We investigated the impact of post-transplant microchimerism on the function of the transplanted kidney. The study included 100 kidney transplant recipients, mostly women. All transplanted organs were from opposite-sex deceased donors. Microchimerism was assessed using multiplex PCR. Male DNA was detected in all urine samples from female recipients and in 13/56 blood samples from female kidney recipients. Female DNA was found in 31/44 urine samples from male recipients, but in none of the blood samples. Microchimerism in the urine of female recipients correlated positively with blood urea (Rs = 0.45; p = 5.84 × 10-4) and K+ ions (Rs = 0.29; p = 0.03), while microchimerism in the blood of female recipients also correlated positively with blood urea (Rs = 0. 28; p = 0.04), cystatin C (Rs = 0.31; p = 0.02) and the number of incompatible HLA alleles (Rs = 0.42; p = 0.01). A history of DGF was associated with higher urinary donor DNA concentrations in female recipients.: Post-transplant microchimerism may serve as a potential marker of chronic kidney rejection.

Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients.

Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient's diet deviated from recommendations and may have contributed to metabolic disorders.

Late Recurrence of Hepatocellular Carcinoma in a Patient 10 Years after Liver Transplantation Unrelated to Transplanted Organ.

Liver transplantation (LTx) is an accepted method of hepatocellular carcinoma (HCC) treatment in cirrhotic patients; however, it has many limitations, and there is a substantial risk of recurrence. Most relapses occur within the first 2 posttransplant years. We aimed to present a late extrahepatic recurrence of HCC 10 years after LTx, and we discuss the possible risk factors and ways to improve transplantation results. A 68-year-old patient with liver cirrhosis and HCC on the background of chronic HCV and past HBV infection was transplanted urgently due to the rapid decompensation. Anti-HCV treatment before surgery was unsuccessful. Pretransplant computed tomography showed 1 focal 4.5 cm lesion consistent with HCC. Histopathology of the explanted organ showed 2 nodules outside the Milan criteria. Angioinvasion was not found. The patient achieved a sustained viral response to pegylated interferon and ribavirin 2 years post-LTx. Eight years were uneventful. CT of the abdomen performed occasionally was normal. Ten years after LTx, the patient unexpectedly presented with shortness of breath, fatigue, and weight loss. Two metastatic nodules of HCC in the lungs and pelvis were found. Although late HCC recurrence post-LTx is rare, it should be always considered, especially when risk factors such as viral infections and underestimation of tumor advancement were identified. We advocate that oncological surveillance of HCC relapse has to be continued during the whole posttransplant period. High AFP levels, the unfavorable neutrophil to lymphocyte ratio, and better estimation of primary tumor size seem to be useful in the identification of good candidates for transplantation.

Persisting bleeding from the duodenal ulcer in patients with occlusion of the celiac trunk: a case report.

INTRODUCTION: Endoscopic measures have continued to be the primary procedures in the management of ulcer bleeding. Nevertheless, in cases of failed endoscopic hemostasis and re-bleedings, endovascular techniques have gradually gained increased acceptance as an alternative to surgery, allowing to avoid surgical intervention in some cases. <br/> Case report: A case of a 42-year-old patient presenting to the authors' institution with massive bleeding from the duodenal ulcer, sprang from a pathologically enlarged gastroduodenal artery is reported. This vascular anomaly was a consequence of occlusion of the coeliac trunk (Dunbar syndrome), which was shown on an angio-CT scan. In spite of several endoscopic and endovascular measures, as well as three operations, the bleeding persistently recurred (a total of 6 episodes) and the patient eventually died. The article presents details of operative and endovascular treatments. Contemporary trends in management in cases of failed endoscopic interventions and re-bleedings form peptic ulcers are shown in the discussion.

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: A Single-Center Experience.

BACKGROUND There is a worldwide increase in use of liver transplantation (LT) for treatment of hepatocellular carcinoma (HCC). We analyzed our experience with LT for HCC to determine long-term and recurrence-free survival, accuracy of imaging diagnosis of HCC compared to the explant pathology, recurrence rate of HCC, and predictors of recurrence. MATERIAL AND METHODS The whole explant was examined by the same pathologist and compared with the baseline diagnosis established according to clinical, laboratory, and radiological data. A group of patients with pathologically confirmed HCC was characterized, with special attention to etiology, survival, recurrence, and diagnostic accuracy of imaging techniques. RESULTS Among 718 patients transplanted from 2000 to 2018 in our center, HCC was found in 166 explanted livers. In 42 cases the clinical diagnosis of HCC was not accurate, being either false positive or negative; however, the specificity and sensitivity of CT/MRI in HCC recognition was 97.87% and 88.24%, respectively. Five- and 10-year survival was 81.27% and 66.57%, respectively, and it was inferior to the overall survival. The recurrence rate was 9.6% with a median time to recurrence of 14 months and a median survival time of 9 months. Poor differentiation of HCC and HCV etiology of the baseline disease, but not previous DAA treatment, were the risk factors of HCC recurrence. CONCLUSIONS Adherence to strictly defined selection criteria for LT in HCC patients guarantees the success of LT in HCC treatment.

Biocompatibility of synthetic ultraviolet radiation cross-linked polymers - Subcutaneous implantation study.

Photo-cross-linked polymers have attracted a lot of attention in the biomedical field. The main benefits of these materials are related to the fact that they are most of the time viscous liquids or pastes that adapt a custom and fixed shape on demand of the user. Present study deals specifically with the biological response upon subcutaneous implantation of four different materials in rabbits. In the study 20 rabbits were divided into four groups (each five rabbits): Groups 1-3 were implanted with tested new obtained by us macromonomers (P1838-DMA; P1838-UR; PDEGA-UR - respectively), while group 4 (control) was implanted with the mesh (PLA) routinely used for surgical treatment of a hernia. The new compounds were polarized earlier using ultraviolet radiation to obtain cross-linked networks. The polymers in the form of discs were then implanted subcutaneously in dorsal region of rabbits. After 28 days polymers were explanted and examined. Microscopic observation evaluated: thickness of the connective tissue capsule around the discs, cells of inflammatory response, disc surface erosion, spectroscopic analysis. The examined materials cause no chronic inflammation, abscesses or tissue necrosis, and the biological response is similar to observed in control group. Therefore, new synthetic materials could be considered as biocompatible and safe. Materials undergo slow degradation of ester bonds and surface erosion and degradation products could be eliminated probably by phagocytosis. On the basis on the afore mentioned knowledge, we formulated hypothesis, that the new polymers are well tolerated by the adjacent tissues. The aim of the following study was to examine reaction of the tissue on new types of prepolymerized material implanted subcutaneously. The obtained results suggest, that the new UV cross-linked polymers do not affect negatively on the connective tissue that is in the contact with the implants. Furthermore, the used materials are in the liquid form, thus they could be easily performed in in minimally invasive laparoscopic treatment of abdominal hernias. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1889-1897, 2019.

Laparoscopic live-donor nephrectomy with retroperitoneoscopic access - first case experience.

BACKGROUND: Despite observed huge progress in understanding the immunological basis of transplantation and the development of new immunosuppressive agents that have significantly improved both -- the patient and graft survival, still the kidney donation from live volunteers remains the most consistent factor which affects the long-term survival. The conventional, open method of donor nephrectomy is associated with significant surgical trauma. The laparoscopic live-donor nephrectomy (LDN) is the alternative for open approach. CASE REPORT: We present our experience of the case of laparoscopic removal of the kidney from a living donor. We applied retroperitoneoscopic access, the operation time was 210 minutes. Kidney was implanted shortly after LDN and its immediate function was observed. We have observed no serious postoperative complications either in donor or recipient. CONCLUSIONS: We hope that this successful initial case of LDN will have a positive effect on cooperation between transplantologists and urologists, and on rate of kidney donation in Poland.

Early results of a new liver transplant program in Szczecin, Poland.

New liver transplant programs have usually been associated with a significant learning curve. This learning curve, however, can be minimized or avoided if certain conditions are met. In this paper we describe the establishment of a new liver transplant program in Szczecin, Poland and present its early results. Four members of the team underwent training in clinical liver transplantation in major centers in Europe. Transplant protocols were then adopted, all the necessary facilities set up, and multidisciplinary team created. Between February 2002 and August 2003, 22 adult orthotopic liver transplantations (OLT) were performed in 21 patients (13 male; mean age 46.3 years; range 33-62), including I retransplant for early hepatic artery thrombosis. Eighteen (86%) patients are alive between 4 and 22 (median 11) months after OLT. Seventeen patients have normal liver function and 14 of them have resumed full life activity. Three patients died: one of bacterial peritonitis (day 6), one of chronic rejection with allograft failure (month 4) and one following massive stroke (month 10). Surgical complications occurred in 7 patients (33%). We believe that proper training of vital team members at established transplant centers with good results, availability of adequate equipment and all the facilities required with strict adherence to transplant protocols are all paramount for a successful start of a liver transplant program.