[Evaluation of the interdependence between homocystein and folic acid levels in patients after kidney transplantation during a 2 year observation period]. / Ocena zaleznosci homocysteinemii i kwasu foliowego u chorych po przeszczepieniu nerki w róznych okresach od momentu wykonania zabiegu w trakcie dwuletniej obserwacji.

UNLABELLED: Patients on maintenance dialysis have increased heomocystein (Hcy) serum levels. The aim of the study was to evaluate the interdependence between Hcy and folic acid (FA) levels in renal transplant patients (pts) at various time periods during a two year observation period after kidney transplantation (Ktx). PATIENTS AND METHODS: The study included 51 pts (17 F, 34 M) aged 15-62 years (median 38.1) after deceased donors Ktx. Before Ktx, 46 pts were treated with maintenance hemodialysis (HD), while 5 by peritoneal dialysis (PD). The mean observation period equaled 21.2 months (6-24 months); while total observation period was 90 person/years. Hcy level was measured using high performance liquid chromatography (HPLC). FA level was measured using chemiluminesence method (standard methods) using the Immulite 2000 analyzer. Patients blood was drawn before Ktx and 3, 6, 9, 12, 15, 18, 21 and 24 months after procedure. RESULTS: An increased Hcy level (>15 micromol/l) - mean 28.5 +/- 17.8 micromol/l (range from 10.2 micromol/l to 116.8 micromol/I) was noted in the blood of 44 pts before Ktx (86.3% of the examined population). In 31 pts after Ktx (60.8% of the examined population), mean Hcy level remained increased above 15 micromol/I (mean Hcy - 19.2 +/- 5.8 micromol/I). A negative correlation was found between the levels of Hcy and FA directly before Ktx (R= -0.28, p<0.05). A statistically significant drop of FA level of 72.6% (mean 220.5 +/- 395.1 ng/ml to 60.3 +/- 129.8 ng/ mi) was noted 3 months after Ktx in the examined group (p<0.001 in the Wilcoxon test). However, in the following period time after Ktx, FA levels did not differ statistically (ANOVA Friedmana p=NS). Mean concentrations of Hcy after Ktx did not correlate significantly with levels of FA (R = -0.12, p = NS). No significant differences between mean levels of FA after Ktx in pts with normal and increased mean levels of Hcy were found; but one must note that presence of hiperhomocysteinemia (HHcy) was associated with a 42% lower concentration of FA in relation to patients who had Hcy >15 micromol/l (36.4 ng/ml vs. 62.5 ng/ml). CONCLUSIONS: Statistically significant decrease of Hcy concentration was observed after Ktx as compare with values before procedure, however not reached normal values. Significant decrease of FA concentration after Ktx is most likely associated with the discontinuation of FA supplementation, as well as due to the restoration of the erythropoietic line.

Different technical possibilities of post-therapeutic tandem 90Y/ /177Lu-DOTATATE imaging.

BACKGROUND: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms derived from endocrine stem cells.These tumors are characterized by overexpression of somatostatin receptors (SSTR), which is utilized for imaging using SSTR analogs. Peptide receptor radionuclide therapy (PRRT) somatostatin analogs labeled with 90Y and 177Lu in neuroendocrine tumors (NETs) results in symptomatic improvement, prolonged survival,and enhanced quality of life. The post-therapeutic imaging leadsto possibility of biodistribution of therapy. The aim of our study was to describe different possibilities of post-therapeutic imaging in patients underwent tandem therapy 90Y/177Lu-DOTATATE with preliminary results of 90Y PET imaging. MATERIAL AND METHODS: Thirty patients (11 men, 19 women; the mean age 55 ± 10.9 y) with histological confirmation of metastatic neuroendocrine tumors (G1 and G2) were treated with tandem therapy 90Y/177Lu-DOTATATE. WHBA scan and SPECT acquisition of the abdomen were performed 24 hours post therapy injection, on the dual-head Varicam camera (ELSCINT) using 177Lu photopeak and 90Y bremsstrahlung. PET imaging of 90Y component was done on Siemens Biograph Truepoint PET/CT (window 511 keV ± 15%)4 hours after 90Y/177Lu-DOTATATE. Additionally phantom studies were performer to analyze the spatial resolution of different protocols. RESULTS: Out of all the patients, median OS was 49.8 months and median EFS time 24.3 months. Spatial resolution achieved for 90Y, 177 Lu and PET imaging of 90Y component measured using the phantom of the torso filled up with water was 20 mm, 8 mm and 4-5 mm FWHM, respectively. Spatial resolution in human body in our study was about 30 mm for 90Y, 15 mm for 177Lu and 25-30 mm for PET imaging of 90Y component. CONCLUSIONS: The theoretically best spatial resolution offers PET scanner, however it is important to keep in mind that 90Y-imaging PET is not used for diagnosis purposes (small activities)but rather to present new possibility of post-therapeutic imaging (substantially higher activities). For post-therapeutic imaging after intravenous radiopharmaceutical administration the best spatial resolution offers standard scintigraphic camera for 90Y/177Lu DOTATATE imaging, with using 177Lu photopeaks. The worst spatial resolution offers standard scintigraphic camera for 90Y/177Lu DOTATATE imaging, with using 90Y bremsstrahlung gammas.

[Influence of elevated homocystein level and selected lipid parameters in kidney transplant patients on the progression of atherosclerotic changes assessed by intima-media thickness index (CCA-IMT)]. / Ocena wplywu hiperhomocysteinemii i wybranych parametrów lipidowych u chorych po przeszczepieniu nerki na rozwój zmian miazdzycowych ocenianych wskaznikiem intima-media (CCA-IMT).

UNLABELLED: The aim of the study was to evaluate the influence of elevated homocystein (Hcy) level and selected lipid parameters on the progression of atherosclerotic changes in patients after kidney transplantation (KTx). PATIENTS AND METHODS: The study included 51 pts (17 F, 34 M) aged 15-62 years (median 38.1) after cadaver KTx. The mean observation period equaled 21.2 months (6-24 months); while total observation period was 90 patients/ years. Hcy levels was measured using HPLC, Lp(a) and Apo-B levels using the nephelometric method and total cholesterol with its' HDL and LDL fractions, triglycerides and creatinine based on the Hitachi 917 analyzer. Patients' blood was drawn before renal transplantation and 3, 6, 9, 12, 15, 18, 21 and 24 months after KTx. Common carotid artery intima media thickness (CCA-IMT) was evaluated by ultrasound on 14 days, 12 and 24 months after KTx. RESULTS: CCA-IMT correlated significantly with Hcy levels after 12 months (R=0.53; p=0.0009) and 24 months (R=0.38; p=0.0356) after KTx. Significant differences were found 12 and 24 months after KTx in CCA-IMT between patients with normal (<15 micromol/l) and increased (>15 micromol/ l) mean Hcy concentrations: p=0.0035 and p= 0.015, respectively. Analyzing changes in CCA-IMT, significant differences were noted when comparing the CCA-IMT increment after 12 and 24 months post KTx in patients with normal (< or =15 micromol/l) and increased (>15 micromol/l) homocystein concentrations: p=0.049 and p=0.0039, respectively. Increment of CCA-IMT 12 months after KTx, significantly correlated with mean total cholesterol level (R=0.35; p=0.0333), whereas 24 months after procedure correlated significantly with 0.0315). CONCLUSIONS: Hcy level is an independent risk factor for atherosclerosis development in patients after KTx. Elevated Hcy level as well as increased cholesterol and Lp(a) levels enhance the progression of atherosclerotic changes evaluated by CCA-IMT in KTx patients.

[Evaluation of immunosuppressive treatment on homocystein levels in patients after kidney transplantation during a 2 year observation period]. / Ocena wplywu rodzaju stosowanego leczenia immunosupresyjnego na stezenia homocysteiny u pacjentów po przeszczepieniu nerki w trakcie dwurocznej obserwacji.

UNLABELLED: The aim of the study was to evaluate the influence of the type of prescribed immunosuppression: cyclosporine A (CsA) vs. tacrolimus (Tac) on remote homocystein levels in patients (pts) after kidney transplantation (Ktx). PATIENTS AND METHODS: The study included 51 pts (17 F, 34 M) aged 15 to 62 years (mean 38.1) after cadaver Ktx. The mean observation period equaled 21.2 months (6 -24); while total observation period was 90 personlyears. Before Ktx, 46 pts were treated with maintenance hemodialysis (HD), while 5 by peritoneal dialysis (PD). After Ktx, patients had immunosuppression prescribed according to the following schemes: prednisone (P) + CsA + azathioprine (AZA) - 12 pts; P + CsA + mycophenolate mofetil (MMF) -26 pts; P + Tac + MMF - 11 pts; and P + Tac + AZA - 2 pts. Hcy level was measured using high performance liquid chromatography (HPLC). Serum creatinine level was measured by standard method using the Hitachi 917 analyzer. Creatinine clearance was calculated based on the Cockcroft-Gault formula. Patient's blood was drawn before Ktx and 3, 6, 9, 12,15, 18, 21 and 24 months post procedure. RESULTS: Delayed graft function (DGF) after Ktx was diagnosed in 29 pts (56.9%) and this group required from 4 to 28 HD sessions (mean 14 sessions). Hcy level did not significantly differ between pts requiring (29 pts) and not requiring (22 pts) HD treatment after Ktx. It was also noted that the number of performed HD sessions did not significantly correlate with Hcy levels 24 months after Ktx (R =0.04, p=0.81). No relationship was found (non-parametric Spearman test) between the drop in Hcy level 3 months after Ktx as compare with value before Ktx and ischemia time (R=0.09, p=0.49), number of compatible HLA A and B (R=0.07, p=0.63), and DR antigens (R=0.09, p=0.51). Decrease in Hcy level (before Ktx and 24 months after Ktx) did not significantly correlate with the above parameters, respectively: R=-0.14, p=0.40; R=0.06, p=0.73; R=0.12, p=0.45; R=0.11, p=0.50. Decrease in Hcy level (before Ktx and 3 months after) did not differ significantly when compared to pts receiving immunosuppressive therapy CsA vs. Tac (p=0.18). Even though notable differences were observed in the drop in Hcy level (immunosuppressive treatment scheme CsA vs. Tac) in measurements before Ktx and 24 months post (respectively: 27% and 57.6%), no statistical significance was noted (p=0.13). Using the Mann-Whitneys' Test, no statistical significance was noted (p=0.13) when comparing differences in creatinine clearance between the group of pts receiving CsA and Tac 24 months after Ktx. Patients treated with Tac achieved a higher creatinine clearance by 16.5% when compared with those receiving CsA. No significant differences were observed between these two groups (p=0.65) when serum creatinine levels were evaluated. CONCLUSIONS: Incidence of DGF, as well as prescribed immunosuppressive therapy does not have an influence on remote Hey levels in pts after Ktx. Graft function seems to be the main predictor that influences Hcy levels after Ktx in this group of pts.