Successful transplantation of kidneys from deceased donors with terminal acute kidney injury.

BACKGROUND: There are many doubts with regards to accepting deceased kidneys with acute kidney injury (AKI) for transplantation. PURPOSE: The aim of this study was to present the 5-years outcome of kidney transplantation cases where deceased donors developed AKI before organ procurement. METHODS: Two hundred twenty-six deceased renal transplants were analyzed. Data regarding donors and recipients were collected. Terminal AKI was defined as terminal serum creatinine concentration higher than 1.99 mg/dL and 66 such cases were diagnosed. All kidney transplant recipients were followed for 60 months. RESULTS: AKI group presented more episodes of delayed graft function (DGF) compared to the non-AKI group (56% vs 35%, p < .05). No differences were observed between the groups in the rate of acute rejection episodes, kidney function as well as patient and graft survival. CONCLUSIONS: Transplants with AKI present more often DGF and comparable graft survival to transplants without AKI. Kidneys with AKI can be a valuable source of organs provided attentive selection and appropriate care of deceased donors.

Obesity is associated with a decrease in expression but not with the hypermethylation of thermogenesis-related genes in adipose tissues.

BACKGROUND: Impaired thermogenesis can promote obesity. Therefore, the aim of this study was to investigate whether the expression of thermogenesis-related genes is altered in adipose tissues of obese individuals and whether excessive methylation of their promoters is involved in this phenomenon. METHODS: The expression of genes encoding ß adrenergic receptors (ADRBs), thyroid hormone receptors (THRs), 5'-iodothyronine deiodinases (DIOs), and uncoupling proteins (UCPs) was measured by real-time PCR in visceral and in subcutaneous adipose tissues of 58 obese (BMI >40 kg/m(2)) and 50 slim (BMI 20-24.9 kg/m(2)) individuals. The methylation status of these genes was studied by the methylation-sensitive digestion/real-time PCR method. RESULTS: The expression of ADRB2, ADRB3, THRA, THRB, DIO2, UCP2 was significantly lower in the adipose tissues of obese patients than in tissues of normal-weight individuals (P < 0.00001). In the obese, the expression of ADRB2, ADRB3, DIO2 was lower in visceral adipose tissue than in subcutaneous adipose tissue (P = 0.008, P = 0.002, P = 0.001, respectively). However, the mean methylation of CpG islands of these genes was similar in tissues with their high and low expression, and there was no correlation between the level of expression and the level of methylation. CONCLUSIONS: Decreased expression of thermogenesis-related genes in adipose tissues of obese patients might result in the reduced reactivity to both hormonal and adrenergic stimuli and therefore in a lower potential to activate thermogenesis.

Interleukins 6 and 15 Levels Are Higher in Subcutaneous Adipose Tissue, but Obesity Is Associated with Their Increased Content in Visceral Fat Depots.

Excess adiposity is associated with chronic inflammation, which takes part in the development of obesity-related complications. The aim of this study was to establish whether subcutaneous (SAT) or visceral (VAT) adipose tissue plays a major role in synthesis of pro-inflammatory cytokines. Concentrations of interleukins (IL): 1ß, 6, 8 and 15 were measured at the protein level by an ELISA-based method and on the mRNA level by real-time PCR in VAT and SAT samples obtained from 49 obese (BMI > 40 kg/m²) and 16 normal-weight (BMI 20-24.9 kg/m²) controls. IL-6 and IL-15 protein concentrations were higher in SAT than in VAT for both obese (p = 0.003 and p < 0.0001, respectively) and control individuals (p = 0.004 and p = 0.001, respectively), while for IL-1ß this was observed only in obese subjects (p = 0.047). What characterized obese individuals was the higher expression of IL-6 and IL-15 at the protein level in VAT compared to normal-weight controls (p = 0.047 and p = 0.016, respectively). Additionally, obese individuals with metabolic syndrome had higher IL-1ß levels in VAT than did obese individuals without this syndrome (p = 0.003). In conclusion, concentrations of some pro-inflammatory cytokines were higher in SAT than in VAT, but it was the increased pro-inflammatory activity of VAT that was associated with obesity and metabolic syndrome.

Temperament as a risk factor for obesity and affective disorders in obese patients in a Polish sample.

AIMS: The main purpose of the study was to investigate temperament traits postulated in the Regulative Theory of Temperament that may contribute as risk factors to obesity and, potentially, to affective disorders in obese patients. METHOD: A cross-sectional design was applied in this study. The study was conducted on a group of 163 obese patients (BMI > 35) that included 59 men and 104 women compared with a control group that included 89 men and 113 women who were non-obese. Temperament was assessed using the formal characteristics of behaviour-temperament inventory (FCB-TI). RESULTS: Obese patients compared with a control group scored lower in briskness, endurance and activity, and higher in perseveration. When compared with obese men, obese women had higher levels of perseveration and emotional reactivity, and showed lower levels of activity. CONCLUSIONS: Temperament traits, including low levels of briskness, endurance and activity, may serve as risk factors for the development of obesity. Low levels of these traits with accompanying high levels of perseveration may potentially contribute as risk factors for affective disorders in obese patients. The findings suggest that obese women are at somewhat greater risk than obese men for the development of affective disorders.

Preservation of kidneys by machine perfusion influences gene expression and may limit ischemia/reperfusion injury.

CONTEXT: Machine perfusion improves graft survival. Histopathologic analysis reveals a lower incidence of chronic rejection and interstitial fibrosis in kidneys preserved with machine perfusion. Ischemic/reperfusion injury may help to explain these findings. OBJECTIVE: To assess the activation of genes correlated with ischemic/reperfusion injury in kidneys preserved under different conditions before transplant. DESIGN/PATIENTS: Between 2005 and 2006, 69 kidney biopsy specimens were collected and patients were followed up for 5 years after that.Intervention-Before transplant, kidneys were preserved with machine perfusion or cold storage. Donors from the machine perfusion and cold storage groups did not differ with regard to age, sex, or hemodynamic status. Recipients were divided into 5 groups: expanded criteria donor-machine perfusion (n = 16), standard criteria donor-machine perfusion (n = 10), expanded criteria donor-cold storage (n = 9), and standard criteria donor-cold storage (n = 27); 7 kidneys were retrieved from living related donors. MAIN OUTCOME MEASURES: Biopsies were done 30 minutes after reperfusion. Interleukin-1ß, vascular endothelial growth factor, heme oxygenase-1, and hypoxia-inducible factor-1 gene expression levels were analyzed. RESULTS: Mean expression levels of hypoxia-inducible factor-1α were significantly higher in the cold storage groups, and lower in the machine perfusion and living-related donor groups. Five-year graft survival was significantly (P< .05) lower in the expanded criteria donor-cold storage group (66%) than in the standard criteria donor-machine perfusion group (90%). Machine perfusion influences gene expression related to hypoxia during reperfusion and may improve the long-term results of kidney transplant.

Cardiac status of persons qualified for living kidney donation--single-center experience.

UNLABELLED: Some of living kidney donors have medical conditions associated with future risk of cardiovascular diseases. It seems justified to identify risk factors and cardiological disorders prior to the donation. AIM: To determine the cardiological status of persons qualified as a living kidney donor. MATERIAL AND METHODS: We analyzed the data of 109 potential living kidney donors, aged 25-70 (mean 45.7 ± 10.9) years. They underwent clinical and biochemical examination. In some of them extended diagnostics was performed. The presence of risk factors of coronary artery disease were registered. RESULTS: Only 46 (42%) persons were qualified for kidney donation. As many as 40 of them had 21 risk factor. In 75 (68.8%) patients without hypertension, 24-hours ambulatory blood pressure monitoring was done. The masked hypertension was found in 6 persons. In 22 candidates aged > 50 years the exercise test was performed (positive or inconclusive in 3 persons). Coronarography was done in 5 individuals (in no any significant atherosclerotic lesions were found). 63 (58%) person were disqualified. In 15 (23.8%) person the reasons were cardiological. In 2 patient the abdominal aneurysms were found. Both men smoked and had severe dyslipidaemias. In 3rd patient we observed persistent atrial fibrillation. The next 2 men had the peripheral occlusive arterial disease. In 9 patients ≥ 2 risk factors and in the last one morbid obesity were present. CONCLUSION: In Poland candidates for living kidney donation have very often risk factors of cardiovascular disease. Among the persons proceeded for kidney donation cardiovascular problems are an important cause of disqualification.

One-year results of a prospective, randomized trial comparing two machine perfusion devices used for kidney preservation.

Studies have shown beneficial effects of machine perfusion (MP) on early kidney function and long-term graft survival. The aim of this study was to investigate whether the type of perfusion device could affect outcome of transplantation of deceased donor kidneys. A total of 50 kidneys retrieved from 25 donors were randomized to machine perfusion using a flow-driven (FD) device (RM3; Waters Medical Inc) or a pressure-driven (PD) device (LifePort; Organ Recovery Systems), 24 of these kidneys (n = 12 pairs; 48%) were procured from expanded criteria donors (ECD). The primary endpoints were kidney function after transplantation defined using the incidence of delayed graft function (DGF), the number of hemodialysis sessions required, graft function at 12 months, and analyses of biopsy. DGF was similar in both groups (32%; 8/25). Patients with DGF in the FD group required a mean of 4.66 hemodialysis sessions versus 2.65 in the PD group (P = 0.005). Overall, 1-year graft survival was 80% (20/25) vs. 96% (24/25) in the FD and PD groups. One-year graft survival of ECD kidneys was 66% (8/12) in the FD group versus 92% (11/12) in the PD group. Interstitial fibrosis and tubular atrophy were significantly more common in the FD group - 45% (5/11) vs. 0% (0/9) (P = 0.03) in PD group. There were no differences in creatinine levels between the groups. Machine perfusion using a pressure-driven device generating lower pulse stress is superior to a flow-driven device with higher pulse stress for preserving kidney function.

[Islet transplantation as a treatment for complications of type I diabetes]. / Przeszczepienie wysp trzustkowych jako metoda leczenia powiklan cukrzycy typu I.

Reduced physical activity and high calories up-take along with carbohydrates based diet are considered to be a leading cause of diabetes mellitus rise in western countries. Together with rise in DM morbidity, increase of complicated diabetes is also observed. Pancreas transplantation occurred to be a milestone in diabetic patient management. Guine pig pancreatic islets isolation performed for the first time by Moskalewski in 1965 and updates of his method have given an opportunity to introduce allogenic isolated islets transplantation to clinical usage. For the first time in Poland clinical allotransplantation of isolated pancreatic islets took place in Department of General Surgery and Transplantology of Medical University of Warsaw in 12's June 2008. Unfortunately, unsatisfying results of islet transplantation, specially short period of insulin independence after successful transplantation related with multifactor islet function lost, reduce clinical indications. In this publication we have analyzed known and potential factors of islet lost and we have tried to find way to prevent them, with a long period insulin-independence after transplantation as a main goal.

Successful outcome of transplant of kidneys recovered from a brain-dead liver transplant recipient: case report.

Few reports describing the use of organs donated by transplant recipients have been published. In this case report, kidneys procured from a brain-dead liver recipient were transplanted successfully. A 21-year-old man was referred for liver transplant after an overdose of acetaminophen. The patient's kidney function was initially normal, with proper urine production and normal kidney laboratory parameters. On the third day after admission, the patient's kidney laboratory parameters became elevated and hepatic encephalopathy requiring mechanical ventilation developed. An orthotopic liver transplant was performed the next day. The patient did not recover consciousness, and brain death was diagnosed on the third day after the liver transplant surgery. The maximum serum concentration of creatinine was 5.8 mg/dL (513 µmol/L) before kidney recovery, and urine production was normal. The kidneys were recovered with organ-perfusion support and were preserved by using machine perfusion. The kidneys were transplanted into 2 male recipients. Twelve months after transplant, the recipients remained in good health with satisfactory kidney function. This case demonstrates that transplanting kidneys recovered from liver transplant recipients is possible and beneficial, thus expanding the pool of potential donors.

Electrocardiographic criteria of left ventricular hypertrophy in patients with morbid obesity.

BACKGROUND: Obesity is frequently accompanied by systemic hypertension complicated by left ventricular hypertrophy (LVH). Standard electrocardiography (ECG) is generally accepted screening tool for LVH in systemic hypertension. The aim was to assess currently used ECG criteria in the diagnosis of LVH in morbidly obese patients. METHODS: Ninety-five patients (80 women, 15 men) with body mass index ≥ 40 kg/m(2) , prior to scheduled bariatric surgery were included into the study. All patients underwent standard ECG and transthoracic ECG for LVH assessment. RESULTS: Echocardiographically LVH (>110 g/m(2) in women, and >132 g/m(2) in men) was diagnosed in 54 patients (56.8%). None of the ECG criteria showed satisfactory performance in the diagnosing echocardiographically confirmed LVH. Although, Receiving operating curves (ROC) analysis showed that only Romilht-Estes score and Cornell index × QRS complex duration were characterized by area under curve >0.6 (0.662; 0.612, respectively),currently recommended values of both tests (Romilht-Estes score and Cornell index × QRS duration 2436 mm · ms) showed very low sensitivity in morbidly obese patients (0% and 2%, respectively). CONCLUSIONS: Our study showed that none of voltage-based ECG criteria are of value for LVH diagnosis in severely obese patients. Only Romhilt-Estes scale and Cornell indices could be helpful for the identification of LVH in the group of patients with morbid obesity, but their value is far from being satisfactory.

[Actinomycosis associated with perforation of jejunum in patient after cholecystectomy--a case report]. / Perforacja jelita cienkiego w przebiegu promienicy u chorego po cholecystektomii--opis przypadku.

Actinomyces is endogenic infection with rare abdominal manifestations. Diagnosis is very difficult and not always taken into account in differential diagnosis. Disease is recurrent and treatment is mostly pharmacologic and takes a long time. The aim of the paper was to present a case of patient operated on acute cholecystitis with intraabdominal actinomycosis. The 66 years old patient 28 days after cholecystectomy appeared to have jejunal perforation in the course of actinomycosis. Patient regarded two interventions due to intraabdominal abscesses. Since last discharge, a year ago, we do not observe recurrence. Intraabdominal actinomycosis is often recurrent and should be considered in patients with purulent complications after surgical procedures.

[Current trends in the treatment of incisional hernia in patients after kidney transplantation]. / Aktualne trendy w leczeniu przepukliny pooperacyjnej po przeszczepieniu nerki.

The incidence of incisional hernia following abdominal surgery varies between 2 and 13%, the rate of incisional hernia after renal transplantation varies between 1.1 and 3.8%. There are no evidence based guidelines regarding the treatment of incisional hernias in renal transplant recipients. The aim of this study was to compare results of surgical repair of incisional hernia in patients after renal transplantation depending on the treatment method. A Pubmed was searched for articles related to the treatment of patients with incisional hernia after renal transplantation. Finally five articles were used for review. The analyzed papers report a total of 5606 patients in a time period between 1965-2004. Hernia mesh repairs were similar - primary approximation of the fascial borders and polypropylene mesh reinforcement, mainly by on lay technique or by suturing the mesh to fascial edges. Hernia repairs without mesh were diverse: simple closure, component separation technique, tensor fascia late grafts, split thickness skin grafting. Although all authors are concerned about prosthetic mesh use for hernia repair in transplant patients, four of them advise this method. Surprisingly, the incidence of incisional hernia in transplant recipients (1.83%) is no higher than in normal population (2-13%). Hernia recurrence in the analyzed group was 2% for prosthetic mesh repair, and 25% for no mesh repair. Prosthetic mesh repair of incisional hernias after kidney transplantation is a safe technique and starting to displace other methods of treatment.

Bacterial infections in the early period after liver transplantation: etiological agents and their susceptibility.

BACKGROUND: The study comprises an analysis of bacterial infections in the early period after liver transplantation (LT) in adults. MATERIAL/METHODS: Eighty-three patients were followed for four weeks after LT. Samples comprised mainly blood, urine, surgical-site specimens, sputum, and stool. Culture and identification of the isolated microorganisms was done in accordance with standard microbiological procedures. Susceptibility testing was carried out using CLSI guidelines. Statistical analysis was done with Medi-Stat. RESULTS: In total, 913 samples from LT recipients were cultured. Of the 469 isolated strains, 331 (70.6%) were Gram-positive bacteria, 133 (28.4%) were Gram-negative bacteria, and 5 (1.0%) were yeast-like fungal strains. Of the 284 surgical-site isolates, 222 (78%) were Gram-positive and 61 (21.5%) were Gram-negative bacteria. Of the 99 blood culture isolates, 75 (75.8%) were Gram-positive and 22 (22.2%) of Gram-negative bacterial strains. Of the 73 urine samples, 46 (63.0%) were strains of Gram-negative, 25 (34.0%) of Gram-positive bacteria, and 2 (3.0%) fungal strains. In the 13 respiratory tract samples were 9 (69.0%) Gram-positive and 4 (31.0%) Gram-negative strains. In the 54 stool samples, 63.0% and 16.7% were C. difficile toxin- and culture-positive, respectively. In total, 138 strains of MRCNS, 10 of MRSA, 80 of HLAR, and 19 ESBL(+) were detected. CONCLUSIONS: The isolation of MDR bacterial strains such as MRSA (52.6%), MRCNS (81.7%), HLAR (86.0%), and ESBL(+) Gram-negative rods (12.5%) from patients after LT indicates the need for strict adherence to infection control procedures.

Long term medical and economical benefit of machine perfusion (MP) kidney storage in comparison to cold storage (CS).

BACKGROUND: Despite documented positive effect of MachinePerfusion (MP) on long-term kidneys-graft function its wide use is restricted due to higher costs. The aim of this study was to analyze the difference in costs of kidney transplantation in patients who received organ stored in ColdStorage (CS) vs those who received kidneys stored with MP.
MATERIAL/METHODS: Analysis was done on kidney transplantations performed between 1994-1999 in 415 patients.. Kidneys were not randomized to MP or to CS: 188 kidneys were stored in CS, 227-in MP. Recipients didn't differ in regard to the age, sex, PRA, HLA mismatch, and immunosupression.The costs of organ procurement,transportation,surgical and anesthetic procedures, episodes of acute rejection were similar for both group of patients and were not included into the analysis. Costs of first month post-transplantation included: the cost of MP, post-transplantation hemodialysis, costs of hospitalization.Analysis of costs difference in between two groups of patients during follow-up included the costs of immunosupression and the monthly cost of dialysis. Statistical analysis was done using linear regression model.
RESULTS: Long graft survival was 68,2% in MP group vs.54,2% in CS group (p=0.02) Return to dialysis treatment was 20% in MP group vs.36% in CS group (p=0.01).Since 2 month post-transplant, mean cost of treatment for one patient was higher of 59,7 USD in CS group vs. MP group (p<0.001)in each month. Costs of investments on MP were equalized in 16 month post-transplantation.
CONCLUSIONS: Despite higher costs of MP use in the first month post transplantation, it is money-saving method of kidneys preservation and its cost of use, are equalized after 16 months post transplantation.

The early and long term function and survival of kidney allografts stored before transplantation by hypothermic pulsatile perfusion. A prospective randomized study.

BACKGROUND: A prospective evaluation of the influence of methods of kidney storage prior to transplantation on long-term graft function has not been shown so far. A retrospective study undertaken in 415 patients in our department showed the benefit of machine perfusion (MP) on long-term results. The aim of the present study was to assess prospectively the long term function and survival of paired kidney allografts retrieved from the same donor, comparing the influence of cold storage (CS) and MP. MATERIAL/METHODS: 74 recipients included in the study received kidneys from 37 cadaveric donors. Kidneys were randomized to storage by CS or MP. There were no significant differences between the groups as to age, gender, duration of ESRD treatment, PRA titres, HLA compatibility and immunosuppressive regimens. RESULTS: At 10 years follow-up recipients of CS-stored kidneys returned to dialysis treatment twice as frequently as recipients of MP-stored kidneys (50% vs. 25%, p=0.02). CONCLUSIONS: Kidney storage by MP improves graft survival and reduces the number of patients who return to dialysis treatment at long-term post-transplant.

Influence of preservation method on histopathological lesions of kidney allografts.

BACKGROUND: Cold storage (CS) of cadaveric kidneys procured from hemodynamically stable donors for less than 24 hours is a safe procedure. Some papers indicate that continuous pulsatile machine perfusion (MP) allows for extension of preservation times, permits a wider use of kidneys damaged by preagonal ischemia, results in superior immediate function rate as compared to CS and improves long-term graft survival. The aim of the study was to evaluate the influence of kidney preservation method prior to transplantation on the characteristics of histopathological lesions of allografts at long-term post transplantation. MATERIAL/METHODS: The study group consisted of 274 patients who received a cadaveric kidney allograft between 1994 and 1999. Altogether 553 biopsy specimens were obtained from this group of patients between 1994 and 2004 and graded according to Banff 2005 criteria.Two groups were identified: CS - recipients of kidneys stored in simple hypothermia (n=114) and MP - recipients of kidneys stored by machine perfusion (n=160). There were 161 cadaveric donors, 92 in the Mp group and 69 in the CS group. The 553 biopsy specimens obtained revealed the following: interstitial fibrosis and tubular atrophy - 189, chronic rejection - 19, acute rejection - 64, arteriosclerosis - 117, calcineurin inhibitor toxicity - 25, microangiopathy - 44, focal glomerulosclerosis - 82, arteriole hyalinization - 85, ATN - 241. RESULTS: In the CS group histopathological lesions consistent with interstitial fibrosis and tubular atrophy were more frequently encountered than in the MP group (90% vs 64%, p<0.05) Also, chronic rejection was more frequent in the CS group (9% vs 3%, p<0.05). The remaining lesions encountered in biopsies did not differ significantly between the groups. CONCLUSIONS: Kidneys preserved by cold storage are more frequently affected by chronic rejection and interstitial fibrosis.

TransEndoscopic Gastric SubMucosa Islet Transplantation (eGSM-ITx) in pigs with streptozotocine induced diabetes - technical aspects of the procedure - preliminary report.

BACKGROUND: Islets and pancreas transplantation have become standard treatments of patients with diabetic complications. However pancreas transplantation is associated with high incidence of complications and the long-term results of islet transplantation are still unsatisfactory. Loss of pancreatic islets grafts is caused not only by immunological reactions but also due to the site of grafting and IBMIR. Gastric submucosal space could be an alternative site for transplantation. The aim of this study was to assess the possibility of endoscopic islets transplantation into the gastric submucosa-its efficacy and potential complications.
MATERIAL/METHOD: 20 Landrace pigs weighing 19-24 kg were obtained for the study. Seven animals were controls (C-group) and 13 formed the transplantation group (TX group). In both groups diabetes was induced by streptozotocine (stz) infusion at a dose of 200 mg/kg. At 7 days post stz infusion pigs of both groups underwent endoscopy-in group C to assess the feasibility of gastroscopic examination under general anaesthesia in pigs with diabetes and to study the influence of basiliximab infusion on pigs, in the Tx-group to perform endoscopic submucosal islet transplantation (eGSM-ITx). Immunosuppression consisted of tacrolimus 0.2 mg/kg and sirolimus 6 mg/m(2). At 7 days post transplantation, control gastroscopy was performed to assess the gastric mucosa and to obtain biopsies for histopathology. 10 to 30 days after eGSM-ITx, magnetic resonance (MRI) scan was performed. Stomach and pancreas were obtained at autopsy for histopathology. Glycemia was assessed twice daily during the experiment. For 10 days after diabetes induction (up to three days after eGSM-ITx) in both groups, insulin was given to reach glycemia between 150-200 mg/dl, after that period insulin was given only when glycemia exceeded 600 mg/dl.
RESULTS: There were no differences in insulin requirement and glycemia up to the day of eGSM-ITx between the groups. Tx-group animals received a mean of 6000+/-3170 IEQ/kg. Tx-group animals had a significantly lower insulin requirement and significantly lower mean glycemia since the first day post transplantation. C-group animals all required insulin once daily to keep glycemia below 600 mg/dl. There were no signs of perforation, ulceration or bleeding after eGSM-ITx on gastroscopy and histopathological examination. MRI scans revealed unspecific thickening of gastric wall at sites of islet deposition.
CONCLUSIONS: Transendoscopic islets transplantation into gastric submucosa is feasible and a safe procedure in an experimental animal setting. Its potential for clinical application in human subjects needs further studies.

Do We Need Insulin Independence After Islet Transplantation?

INTRODUCTION: Most life-threatening diabetes-related complications involve the kidneys, eyes, cardiovascular system, and autonomic nervous system. Clinical islet transplantation (CITx) may be a therapeutic option for some patients. In this study, we analyzed the progression of diabetic complications after CITx and in patients waiting for islet transplantation. METHODS: From 2008 to 2015, 67 patients were listed for pancreatic or islet transplantation. We compared beta scores, islet scores, and secondary complications between patients who underwent islet allotransplantation (CITx group, n = 6) and the patients awaiting islet transplantation (wait group, n = 19) at baseline and during the 1-year follow-up. RESULTS: In the CITx group, good islet function was observed in 80% of patients 1 month post-transplantation and 40% of patients 1 year post-transplantation; however, no patient achieved insulin independence. One patient who underwent simultaneous islet-kidney transplantation died on day 8 because of severe bleeding in the retroperitoneal space. In 1 case, islet primary nonfunction was observed. Mean islet score in the CITx group 1 year post-transplantation was significantly higher than the pretransplant score and wait group scores at enrollment and 1 year later (P < .01). Increased albuminuria was observed in 3 of 11 (27%) patients in the wait group and 0 patients in the CITx group (P = .08). One patient (9%) in the wait group developed chronic renal failure requiring hemodialysis. Ophthalmologic procedures were required by 47% of patients in the wait group and 0 patients in the CITx group in the first year after transplantation (P < .01). CONCLUSION: Successful islet transplantation slows the progression of diabetic complications.

Time of Cold Storage Prior to Start of Hypothermic Machine Perfusion and Its Influence on Graft Survival.

BACKGROUND: Hypothermic machine perfusion (HMP) has become a standard method of preservation for kidneys procured from expanded-criteria donors and donors after cardiac death. There are different systems and approaches to the HMP preservation period, with cold storage prior to HMP sometimes taking several hours. This study evaluated whether the time at which kidneys receive HMP had any influence on the outcomes of kidney transplantation. METHODS: In this analysis, patient and graft survival were evaluated over a 1-year post-transplantation period. Patients who received HMP kidneys (n = 379) were divided into 2 groups: those who received kidneys with a cold ischemia time (CIT) prior to HMP <295 minutes (group G1; n = 254) and those who received kidneys with CIT prior to HMP >295 minutes (group G2; n = 125). RESULTS: Delayed graft function was observed in 31.8% (81/254) of patients in group G1 vs 46.4% (58/125) of patients in group G2 (P = .007). One-year graft survival was statistically higher in the group G1 (93.2%; 233/254) vs group G2 (86.5%; 105/125, P = .029). Mean 1-year estimated glomerular filtration rate was significantly better in the group G1. CONCLUSIONS: In conclusion, introduction of HMP up to 295 minutes from procurement led to better early and 1-year graft results. Kidneys should receive HMP as soon as possible after retrieval, preferably during procurement.

Islet Autotransplantation in Diabetic Patients.

INTRODUCTION: Painful chronic pancreatitis (CP) is the main indication for analgesic pancreatectomy with simultaneous islet autotransplantation to prevent postoperative diabetes mellitus (DM). However, advanced CP may lead to insulin secretion disorders and DM. There are doubts as to whether islet autotransplantation in such cases is an appropriate procedure. The aim of this study was to analyze the results of islet autotransplantation in patients with CP with already diagnosed with DM. METHOD: Between 2008 and 2015, at the Department of General and Transplantation Surgery, patients with CP and unsatisfying pain treatment with positive fasting C-peptide ( > 0.3 ng/mL) level were qualified for simultaneous pancreatectomy and islet autotransplantation. Eight procedures were performed. In 5 cases patients had DM diagnosed prior to the procedure (DM group n = 5). Three patients without DM diagnosed prior to surgery were the control group (n = 3). RESULT: There were no cases of procedure-related deaths in either group. Pain relief without analgesics was reported by all patients. Good islet function was observed in 80% (4/5) of the DM group vs 100% (3/3) in the control group (P = ns). Brittle diabetes was diagnosed in 1 patient in the DM group as a result of islet primary non-function. CONCLUSION: Patients with CP-related severe pain and DM patients with positive C-peptides should be considered for pancreatectomy and islet autotransplantation.