Arterial hypertension after liver transplantation.

One of the most prevalent influenceable risk factors for poor cardiovascular outcome is arterial hypertension.This is a prospective analysis of liver transplant recipients in which 24-hour blood pressure (BP) measurement was performed. The primary aim was to identify post-LT (liver transplantation) patients without a history of arterial hypertension who meet the criteria for arterial hypertension using 24-hour BP monitoring. Secondary objectives were to determine how many patients with known treated arterial hypertension had suboptimal BP control. The group included 88 patients (men, 52.3%, history of arterial hypertension group: n=56, no history of arterial hypertension group: n=32) with an average age at the time of measurement of 62.4 years±11. The average time since LT at the time of measurement was 45.2 months. De novo arterial hypertension using 24-hour BP monitoring was diagnosed in 28%. Hypertonic changes in the fundus oculi were confirmed as predictor for suboptimally controlled hypertension [OR 5,1265, p=0.0279]. On the other hand, male sex [OR 3.1840, p=0.0311], together with age [OR 1.3347, p=0.0153] and waist circumference [OR 4.3490, p=0.0418] predicted the need of intensification of antihypertensive treatment. Male sex, age and waist circumference should increase the index of suspicion and lead to zoom-in on a possibility of poorly controlled blood pressure. Where automated blood pressure monitoring is unavailable, regular examination of the fundus could serve as an available surrogate marker of suboptimally controlled arterial hypertension (Tab.6, Fig. 1, Ref. 36). Text in PDF www.elis.sk Keywords: liver transplantation, arterial hypertension, automated blood pressure monitoring.

Effect of Different Induction Immunosuppression on the Incidence of Infectious Complications after Kidney Transplantation-Single Center Study.

Background/Objectives: Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim of our analysis was to find whether there were higher incidences of infectious complications after kidney transplantation (KT) in groups with different induction immunosuppressive treatment and also to find independent risk factors for recurrent infections. Materials: We retrospectively evaluated all patients with induction treatment with basiliximab after kidney transplantation from 2014 to 2019 at our center relative to age- and sex-matched controls of patients with thymoglobulin induction immunosuppression. Results: Our study consisted of two groups: basiliximab (39) and thymoglobulin (39). In the thymoglobulin group we observed an increased incidence of recurrent infection in every observed interval; however, acute rejection was seen more often in the basiliximab group. A history of respiratory diseases and thrombocytopenia were identified as independent risk factors for recurrent bacterial infections from the first to sixth month after KT. Decreased eGFR from the first month, infections caused by multi-drug-resistant bacteria, and severe infections (reflected by the need for hospitalization) were identified as independent risk factors for recurrent bacterial infections from the first to the twelfth month after KT. Conclusions: We found that in the group of patients with thymoglobulin induction immunosuppressive treatment, infectious complications occurred significantly more often during the entire monitored period with decreased incidence of acute humoral and cellular rejection occurred more often.

Molecular Microscope Diagnostic System in Patients after Kidney Transplantation-First Experience.

BACKGROUND: The diagnosis of graft rejection relies on the identification of donor-specific antibodies along with histological findings. Borderline changes are particularly challenging, representing non-rejection findings in up to 70% of cases. The analysis aimed to compare the results of histopathological conclusions with the findings from examination using a molecular microscope, which assesses gene expression (whole-genome microarray chip technology). METHODS: Molecular microscope examination (MMDx) was applied to twelve patients (six men and six women) who underwent either indication or protocol graft biopsy. RESULTS: The average age of patients was 46.6 years ± 4.2 (average follow-up from kidney transplantation was 6.1 months ± 1.2). MMDx examination was performed during indication biopsy in 11 patients and protocol biopsy in 1 patient. A total of 33% of the findings matched and 50% did not. Finally, we present a case of a patient with acute cellular rejection findings without clinical and laboratory correlation, where the use of MMDx significantly altered the treatment strategy. CONCLUSIONS: MMDx examination is suitable for complementing patients with ambiguous histological findings and a clinical picture not corresponding to biopsy results. The limitations of MMDx include cost and its inability to evaluate the potential recurrence of the underlying kidney disease in the graft.

Effect of regular physical activity and lifestyle changes on insulin resistance in patients after kidney transplantation.

Insulin resistance (IR) is the most significant risk factor for post-transplant diabetes mellitus (PTDM). This study aimed to determine the effects of regular physical activity on IR and PTDM in patients after kidney transplantation (KT). The study group (n = 22) participated in aerobic or combined sports (aerobic and anaerobic). Monitoring was provided by a sports tracker (Xiaomi Mi Band 4, compatible with the Mi Fit mobile application). Waist circumference was significantly lower (p = 0.0437, p = 0.0372), graft function was better (p = 0.0036, p = 0.0137), fasting blood glucose was lower (p = 0.0016, p = 0.0003), C-peptide level was lower (p = 0.0447, p = 0014) in the 3rd and 6th months of monitoring, and low-density lipoprotein was lower at 6 months (p = 0.0444) in the observed group than in the control group. IR was significantly lower at 6 months (p = 0.0202), and fasting blood glucose was significantly lower at 3 and 6 months (p = 0.0227) in the observed group. We confirmed the significant effect of regular physical activity on preventing the development of IR and impaired fasting glucose levels in patients after KT (Tab. 1, Fig. 4, Ref. 27). Text in PDF www.elis.sk Keywords: kidney transplantation, insulin resistance, physical activity.

The role of hyperleptinaemia and low values of interleukin 10 in de novo DSA production after kidney transplantation.

BACKGROUND: White adipose tissue secretes a number of peptide hormones. The aim of this paper was to determine the role of leptin, adiponectin and interleukin-10 and interleukin-6 on the development of graft rejection in protocol biopsy after kidney transplantation. METHODS: In a prospective analysis (n = 104), we monitored the values of leptin, adiponectin, IL-6, and IL-10 prior to the transplantation and in the 3rd month after the transplantation. The protocol biopsy of the graft was performed in the 3rd month after the transplantation. The group was divided into the following according to the biopsy result: negative result, IFTA 1, borderline, and DSA positive. RESULTS: After adjusting for the differences in the baseline recipient and donor characteristics, we identified the hyperleptinaemia baseline (HR = 2.0444, P = 0.0341) and month 3 (HR = 49.8043, P < 0.0001) as independent risk factors for borderline changes in the protocol biopsy. The hyperleptinaemia baseline (HR = 7.4979, P = 0.0071) and month 3 (HR = 9.7432, P = 0.0057) are independent risk factors for de novo DSA positivity. A low value of IL-10 month 3 is a risk factor for de novo DSA positivity (HR = 3.0746, P = 0.0388). CONCLUSIONS: Higher leptin levels and low values of IL-10 might play a role in rejection and de novo DSA production.

Complications of Liver Resection in Geriatric Patients

Abstract: Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. Material and methods. We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). Results. In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older tan 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). Conclusion. In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.