Organ Procurement From Foreigners Who Died in Poland and Organ Transplantation to Foreigners.

The aim of the work was to present data concerning organ donation from and transplantation to foreigners in Poland. Data came from registries maintained by the Polish Transplant Coordinating Center POLTRANSPLANT, consisting of the national waiting list, deceased donor registry, transplant registry, and live donor registry. In Poland, the rules for organ and tissue procurement for transplantation from foreigners who died in Poland and the rules for transplanting organs to foreigners are adopted and applied. Before the outbreak of the war in Ukraine, "cross-border" cases of donations and transplants were rather sporadic. After the outbreak of the war, due to the mass influx of Ukrainian citizens, the situation changed, and the participation of foreigners (mostly Ukrainians) in transplantation procedures increased significantly and, in 2022, accounted for the total number of events: approximately 4% in the case of donation, slightly over 1% in the case of qualifications for transplantation and almost 2% in the number of transplantations performed. Despite this increase, the number of events is not high or critical and does not affect the efficiency of organ transplantation medicine in Poland.

In-Depth Analysis of Anti-HLA Antibodies Using C1q Assay.

Alloantibodies are significant biomarkers of posttransplant kidney rejection. With solid-phase assays, the presence of alloantibodies and complement-binding capacities can be tested. It has been noted that complement-binding anti-HLA (C1q) correlates well with high titers of anti-HLA antibodies (single antigen bead, SAB), but we have recently shown that lower SAB titers may be associated with complement in the complement cytotoxicity test. If so, low titers of donor-specific antibodies could be stratified for complement binding and used for better donor-recipient matching. To study this, we tested 268 patients awaiting kidney transplantation for SAB and C1q and stratified them into positive (Allo+) and negative (Allo-) cohorts. Next, all assayed specificities of SAB were matched with the corresponding C1q in order to correlate mean fluorescence intensity levels. We found a strong correlation between SAB and C1q for all HLA loci apart from HLA-DP. Moreover, there was no strict cutoff for C1q prediction on SAB mean fluorescence intensity level. In addition, an unusual laboratory phenotype was found; that is, a positive C1q result without corresponding SAB specificity. We tested this phenomenon and found positive IgM SAB. CONCLUSIONS: Simultaneous C1q and SAB testing may serve as a tool for in-depth analysis of alloantibodies before transplantation.

Post-Traumatic Growth among Patients after Living and Cadaveric Donor Kidney Transplantation: The Role of Resilience and Alexithymia.

The aim of this study was to determine the role of resilience and alexithymia in the post-traumatic growth as a response to extreme stress in patients after kidney transplantation and to determine whether there are differences in the level of posttraumatic growth in patients after living and cadaveric donor kidney transplantation. The relationships between these variables were also evaluated. The questionnaire survey of 91 kidney recipients took place in 2018 and 2019. The following tools were used: authorial post-transplant questionnaire for recipients and validated questionnaires, Post Traumatic Growth Inventory (PTGI-R), Resilience Coping Scale Questionnaire, and Toronto Alexithymia Scale Questionnaire (TAS20). The results obtained showed significant differences between the group of kidney recipients from living donors and recipients from cadaveric donors, in terms of overall post-traumatic growth, as well as changes in self-perception and a greater appreciation for life. Post-traumatic growth in both groups was related to the level of resilience and the level of alexithymia. Resilience is an accurate predictor of posttraumatic growth in general and for each of the groups of recipients separately.

Efficacy of intravenous lidocaine infusions for pain relief in children undergoing laparoscopic appendectomy: a randomized controlled trial.

Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available. OBJECTIVES: To determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively. DESIGN: A single-center parallel single-masked randomized controlled study. A computer-generated blocked randomization list was used to allocate participants. The study was conducted between March 2019 and January 2020. SETTING: Pediatric teaching hospital in Poland. PARTICIPANTS: Seventy-four patients aged between 18 months and 18 years undergoing laparoscopic appendectomy. Seventy-one patients fulfilled the study requirements. INTERVENTION: Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. The infusion was discontinued before the patients' transfer to the postanesthesia care unit (PACU). PRIMARY OUTCOME MEASURE: The primary outcome measure was total nalbuphine requirement in milligrams during the first 24 h after surgery. SECONDARY OUTCOME MEASURES: The secondary outcome measures were intraoperative fentanyl consumption, intraoperative sevoflurane consumption, time to the first rescue analgesic request, incidence of postoperative nausea and vomiting during the first 24 h after surgery, frequency of side effects of lidocaine. RESULTS: Children (n = 74) aged 5-17 randomly allocated to receive intraoperative lidocaine infusion (n = 37) or no intervention (n = 37). Seventy-one were included in the analysis (35 in the study group and 36 in the control group). There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962-0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899-0.22020) mg/kg, p = 0.63]. Intraoperative fentanyl consumption was lower in the lidocaine group [median of 5.091 (IQR: 4.848-5.714) µg/kg] than in the control group [median of 5.969 (IQR: 5.000-6.748), p = 0.03]. Taking into account the additional doses administered based on clinical indications, the reduction in the requirement for fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0-0.952) vs 0.99 (IQR: 0.0-1.809) µg/kg, p = 0.01]. No difference was observed in the sevoflurane consumption between the two groups [median of 32.5 ml (IQR 25.0-43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5-46.0) in the control group, p = 0.56]. The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40-110) min in the lidocaine group vs median of 40.5 (IQR: 28-65) min in the control group, p = 0.05]. There was no difference in the frequency of PONV between the two groups (48.57% in the lidocaine group vs 61.11% in the control group, p = 0.29). No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or postoperative period. CONCLUSIONS: Intraoperative systemic lidocaine administration reduced the intraoperative requirement for opioids in children undergoing laparoscopic appendectomy. This effect was time limited, and hence did not affect opioid consumption in the first 24 h following discontinuation of lidocaine infusion. TRIAL REGISTRATION: NCT03886896 .

Immune Algorithm Optimization for Organ Transplantation in Poland.

The lack of a uniform method for determining unacceptable HLA mismatches (UAMs) for organ transplantation worldwide has resulted in many different algorithms for donor-recipient matching. Here we present our proposal for changes to the current algorithm for immune evaluation of potential kidney recipients in Poland based on the experience of various transplantation centers. The most important finding of this article is an algorithm that stratifies the pretransplant immunologic risk based on strict laboratory criteria, enabling harmonization between transplant centers in Poland. This is because of a step-by-step algorithm for alloantibody assessment using solid-phase assays (SPA) and clearly defined technical issues, as well as cutoffs for reporting UAMs. Our novel approach focuses on a laboratory testing extension in the scope of HLA typing; detection and characterization of alloantibodies before transplantation; desensitization; and post-transplant monitoring. The proposed changes will allow for the assessment of clinically relevant anti-HLA antibodies with complement binding properties; the determination of UAMs in the potential donor; the calculation of virtual panel reactive antibodies (vPRA); the calculation of the recipient's immunologic rejection risk stratification; the assessment of the donor-recipient virtual cross-match (vXM); and the determination of the final recipient's selection for the biological cross-match testing. Collectively, the optimized algorithm permit for UAM verification is based on laboratory proofed data and will firmly improve organ allocation and transplant outcomes in Poland. We hope that this novel approach also improves the individual patient's risk stratification and future personalized treatment.

Hand-assisted laparoscopic donor nephrectomy: a single centre experience.

INTRODUCTION: The advantages of a minimally invasive nephrectomy are a faster recovery and better quality of life for the donors. Until recently, the majority of donor nephrectomies in Poland were done by open surgery. AIM: To present a single centre experience in hand-assisted laparoscopic donor nephrectomy (HALDN). MATERIAL AND METHODS: The first videoscopic left donor nephrectomy in Poland was performed in our department in 2003 using a hand-assisted retroperitoneal approach. From 2011, we changed the method to a transperitoneal approach and started to harvest also right kidneys. Since then, it has become the method of choice for donor nephrectomy and has been performed in 59 cases. Preoperatively, kidneys were assessed by scintigraphy and by angio-computed tomography. We harvested 32 left and 27 right kidneys. There were double renal arteries in 2 cases and triple renal arteries in 1 case. The warm ischaemia time (WIT) was 80-420 s (average 176.13 s); operative time was 85-210 min (average 140 min). RESULTS: All procedures were uncomplicated, and all donors were discharged after 2-8 days with normal creatinine levels. The average follow-up period lasted 23 months (1-51 months). Out of all of the cases, 1 case had two minor complications, while all others were uneventful. None of the donors were lost to follow-up. All of the kidneys were transplanted. There were 2 cases of delayed graft function (DGF) and 2 cases of ureter necrosis. One of those kidneys was lost in the third postoperative week. CONCLUSIONS: Our limited experience shows that HALDN is a safe method and should be used routinely instead of open surgery.

Identification of patients with increased immunological risk among potential kidney recipients in the Polish population.

Pretransplant identification of allosensitized patients is possible thanks to new technologies, which allow for accurate detection of clinically relevant alloantibodies. Implementation of these methods in the screening of patients awaiting transplantation increased their chance for successful donor-recipient matching. Here, 1460 patients reported to the Polish National Waiting List were screened with the Luminex Screen (LS) solid phase test for anti-HLA antibodies. The patients with detected anti-HLA antibodies were assayed with the Luminex Single Antigen (LSA) tests in order to establish defined antigen specificity of the alloantibodies. The results were compared with data on the immunization assessed with the routine complement-dependent-cytotoxicity panel-reactive-antibody assay (PRA CDC). The study showed significantly higher sensitivity of the LS method when compared with PRA CDC. It has been shown that LSA test is a useful technique identifying the specificities of alloantibodies. In particular, LSA allowed to assess donor specific antibodies (DSA) to previous mismatches (MM) and to determine acceptable HLA mismatches of the potential donors. The introduction of solid phase tests in routine pretransplant diagnostics allowed for faster and more accurate assessment of the immunological risk of the recipients and optimal donor-recipient matching. Hence, the presented algorithm of solid phase assays has become a new standard for the identification of allosensitized patients awaiting kidney transplantation in Poland.

Prevalence of the coronary artery disease risk factors and 10-year risk of cardiovascular mortality based on HeartScore in people qualified for kidney donation.

BACKGROUND: The living kidney donor is exposed to the renal function impairment as a result of kidney donation, which may increase the risk of cardiovascular diseases. It seems justified to identify cardiovascular risk factors prior to kidney donation. MATERIAL AND METHODS: We analyzed data of 50 consecutive potential kidney donors. All individuals underwent clinical examination and lipid profile. For each subject we calculated atherogenic index. To calculate the 10-year risk of cardiovascular death, the HeartScore calculator was used. RESULTS: The most frequent risk factors were obesity, lipid disorders, and smoking. In 72% of subjects, at least 1 of the risk factors was detected. Atherogenic index values considered to indicate high risk of atherosclerosis were found in 16% of subjects. More than 40% of subjects had more than 1 coronary risk factor, and most had 2. In 58% of subjects, the calculated HeartScore risk value was consistent with risk estimated for age, and in 26% it exceeded this value by 1-9% (mean, 3.1%). CONCLUSIONS: The prevalence of coronary risk factors is high in potential kidney donors. HeartScore seems to be a useful method to evaluate the risk of cardiovascular mortality in these individuals, and is a simple tool to use in controlling the influence of the modification of risk factors on the global risk in follow-up. Comparison with the value of risk acceptable according to age and sex may oblige the physician to take action to reduce it.

Placebo-controlled trial of cytisine for smoking cessation.

BACKGROUND: Cytisine, a partial agonist that binds with high affinity to the α(4)ß(2) nicotinic acetylcholine receptor, is a low-cost treatment that may be effective in aiding smoking cessation. This study assessed the efficacy and safety of cytisine as compared with placebo. METHODS: We conducted a single-center, randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive cytisine or matching placebo for 25 days; participants in both groups received a minimal amount of counseling during the study. The primary outcome measure was sustained, biochemically verified smoking abstinence for 12 months after the end of treatment. Of 1542 adult smokers screened, 740 were enrolled and 370 were randomly assigned to each study group. RESULTS: The rate of sustained 12-month abstinence was 8.4% (31 participants) in the cytisine group as compared with 2.4% (9 participants) in the placebo group (difference, 6.0 percentage points; 95% confidence interval [CI], 2.7 to 9.2; P=0.001). The 7-day point prevalence for abstinence at the 12-month follow-up was 13.2% in the cytisine group versus 7.3% in the placebo group (P=0.01). Gastrointestinal adverse events were reported more frequently in the cytisine group (difference, 5.7 percentage points; 95% CI, 1.2 to 10.2). CONCLUSIONS: In this single-center study, cytisine was more effective than placebo for smoking cessation. The lower price of cytisine as compared with that of other pharmacotherapies for smoking cessation may make it an affordable treatment to advance smoking cessation globally.

[Neonatal behavioural assessment of pre-term and full-term infants as experienced by parents].

AIM: The analysis of similarities and differences of parental experience of observing preterm versus full term babies assessed with the Neonatal Behavioural Assessment Scale (NBAS). MATERIAL AND METHOD: 95 pairs of parents participated in the study, including 33 mothers and fathers of babies born before 29th gestational week, 31 - between 29th and 34th week and 31 - at term. All infants were assessed with the NBAS in the first month of life (or corrected age) in the presence of both parents. Semi-structured clinical interviews were conducted with each parental pair and the qualitative analysis of the obtained co-constructed narratives was carried out. RESULTS: Seven common categories of parental experience related to the NBAS were empirically discerned in all groups of parents. There were also two categories of experience related to the NBAS that were different in the group of parents of preterm versus full term babies. Apart from that, three specific categories characteristic of the parental narratives in the two preterm groups were identified: parental tendency to compare NBAS assessment with medical examination, hope for having the child's health confirmed and parental tendency to compare preterm with full term babies. CONCLUSIONS: Mothers and fathers of preterm vs full term babies experience the observation of NBAS assessment differently. Parents of preterm babies are extremely sensitive to any information regarding their child. Therefore specialists should pay a special attention to the process of communicating with the family. Effective support of any family in the perinatal period requires special appreciation of the individual parental needs.

The efficacy and safety of ciclosporin (Equoral®) capsules after renal transplantation: A multicentre, open-label, phase IV clinical trial.

BACKGROUND: The use of bioequivalent generic ciclosporin is a cost-effective alternative to non-generic ciclosporin in renal transplant patients. This study aims to explore the efficacy, safety and tolerability of Equoral®, a generic ciclosporin, in adult de novo renal transplant patients. MATERIAL/METHODS: This was a multicentre, open label, phase IV clinical study consisting of a 6-month treatment and 3-month follow-up periods. Patients underwent renal transplantation supported by an immunosupressive regimen of azathioprine (or mofetil mycophenylate [MMF]), prednisolone and Equoral® (10 mg/kg/day, given 12 hours before patients' surgical procedure, and a maintenance ciclosporin dose of 4-6 mg/kg/day thereafter). The primary endpoint was the rate of occurrence of acute graft rejection over the 6-month period after renal transplantation. RESULTS: A total of 54 patients were enrolled and constituted the intention-to-treat/safety population, while 52 patients forming the per-protocol population were assessed for efficacy. There were 13 episodes of acute graft rejection reported in 12 patients, and two of these episodes resulted in withdrawal from the study. The probability of acute rejection in patients was less then 24% for the duration of the study including the observation period which is within the usual range. There were no deaths and one graft loss during the study, and the safety and tolerability profile reported was typical of that of ciclosporin in use in de-novo renal transplant patients. CONCLUSIONS: The use of the generic ciclosporin Equoral® is effective and is associated with the usual safety and tolerability profile of ciclosporin when used as the calcineurin-inhibitor component of an immunosuppressive regimen in de novo renal transplant patients.

Parental tobacco smoking is associated with augmented IL-13 secretion in children with allergic asthma.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has been shown to increase symptoms of allergic bronchial asthma, but direct effects on the expression of inflammatory markers have not been demonstrated thus far. OBJECTIVE: The aim of this study was to assess the correlation of ETS exposure with the expression of proinflammatory mediators in airway secretions, including IFN-gamma and IL-12, as well as IL-5 and IL-13, in allergic asthmatic schoolchildren and healthy control subjects. METHODS: By using the nasopharyngeal aspiration technique, airway secretions were collected from 24 atopic children with asthma (age, 6-16 years) and 26 healthy control subjects, and the concentration of cytokines was measured with immunoenzymatic methods. RESULTS: IL-13 levels were highly increased in patients with asthma (P < .005), and parental tobacco smoke resulted in a significant increase in airway IL-13 secretion in these children compared with that seen in nonexposed children and healthy control subjects (median, 860 pg/mL vs 242 pg/mL and 125 pg/mL, respectively). Furthermore, a positive correlation between IL-13 levels and serum IgE concentrations (r(s) = 0.55) was found in children with allergic asthma. CONCLUSIONS: These results indicate that ETS augments the expression and secretion of IL-13 in allergic asthma and that nasopharyngeal aspiration is a suitable method to assess cytokine measurements in airways in children. Measurements of IL-13 in secretions might be taken into account as a noninvasive marker of airway inflammation and to assess the detrimental effects of ETS.

Lamivudine therapy for chronic hepatitis B in renal transplant recipients.

Chronic liver disease due to hepatitis B virus (HBV) infection remains a significant cause of morbidity and mortality after renal transplantation. Administration of immunosuppressive drugs facilitates viral replication and may lead to increased frequency of progressive chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic HBV infection adversely affects both patient and graft survival. Because of increased risk of death HBV-seropositive renal graft recipients require prophylaxis and treatment of hepatitis B. Interferon due to its immunomodulating effects, risk of activation of rejection is not recommended for transplant recipients. Lamivudine seems to be efficacious and useful for treating hepatitis B in renal transplant recipients. The main disadvantages of lamivudine are relapse after withdrawal of the agent and emergence of lamivudine resistant strains due to mutations in the YMDD locus of the HBV polymerase gene during prolonged lamivudine therapy. Optimal lamivudine treatment regimen for HBsAg-positive renal transplant recipients should be defined. It seems better to initiate lamivudine therapy before or immediately after transplantation to prevent viral replication. The clinical course of hepatitis in most patients with lamivudine resistant HBV mutants seems relatively benign and long-term resistance was well tolerated. Discontinuation of lamivudine in order to minimize the emergence of drug resistant HBV mutants is safe in selected groups of patients. Lamivudine therapy has become the treatment of choice in HBV positive renal transplant recipients and improves prognosis and outcome of infected patients.

[The influence of lamivudine therapy on the course of chronic hepatitis B in renal allograft recipients]. / Wplyw leczenia lamiwudyna na przebieg przewleklego wirusowego zapalenia watroby typu B u biorców nerki allogenicznej.

The aim of this study was to evaluate efficacy and safety of lamivudine therapy in renal allograft recipients with chronic hepatitis B infection. Twenty-four patients with chronic hepatitis B after renal transplantation were observed. We obtained HBV replication blockage in 95% of patients, in half of them also ALT normalisation was observed. Delayed HBV replication blockage was observed in patients with prolonged duration of haemodialysotherapy or HBV infection and HCV coinfection, although listed parameters did not influence overall treatment efficacy. After lamivudine discontinuation HBV replication relapsed, in part of patients with ALT activity elevation. We did not observed any serious adverse reactions under lamivudine therapy.

Day/night food consumption in mice is strain and age-dependent.

Food consumption was measured during the day (lights on) and the night (lights off) and compared between one outbred and 9 inbred strains of mice (CBA/Kw, C3H, DBA2, KP, BALB/c, C57BL, B10.Amst, B10.BR, B10.BR Y-del) in age groups 30-60, 60-90, 90-120, and more than 120 days. Outbred mice and animals from B10 sublines ate significantly more during nocturnal darkness. Day and night food consumption was similar in KP animals. In mice from the remaining strains there was an apparent age-related shift from nocturnal towards diurnal eating habits.