Pregnancy in Liver and Kidney Female Recipient: A Case Report.

Deterioration of kidney function after orthotopic liver transplantation is a common complication that may occur after perioperative acute kidney injury (AKI) and preexisting or developing chronic kidney disease (CKD). AKI is described in the early postoperative period in more than half of recipients, whereas the main cause of CKD is pharmacotherapy. When end-stage renal failure occurs, patients may be qualified for additional transplantations. We present a rare case of a 27-year-old woman who, as a teenager, underwent 2 liver transplantations due to Wilson's disease. Surgeries were complicated by systemic infection and multiple organ failure. The kidneys did not regain their function, and therefore, after 6 months of dialysis, the organ was transplanted. Three organ transplantations were performed. Due to the patient's willingness and good graft functions, the patient started trying to conceive. Three months before successful conception, immunosuppressive therapy was changed to tacrolimus and azathioprine. Pregnancy was complicated by pregnancy-induced hypertension, and its course was closely monitored. Organ functions and immunosuppressive therapy were regularly assessed. Due to the pre-eclampsia developed in the 35th week of gestation, a Cesarean delivery was performed, and she gave birth to a daughter weighing 2350 g (Apgar 7-7-8). The patient decided to breastfeed. There were no obstetric complications or graft function deterioration in the early postpartum period. Mother and daughter left home after 7 days of hospitalization. The presented clinical situation proves that multiorgan transplantation recipients can have a successful pregnancy without impairing graft functions. Therefore, the pregnancy requires adequate preparation and increased care.

Unexpectedly High Efficacy of SARS-CoV-2 BNT162b2 Vaccine in Liver versus Kidney Transplant Recipients-Is It Related to Immunosuppression Only?

The BNT162b2 vaccine is reportedly effective in preventing severe disease in more than 90% of the general population, but its efficacy in transplant recipients remains controversial. We aimed to determine the immune response to the BNT162b2 vaccine in kidney (KTRs) and liver transplant recipients (LTRs). In this retrospective cohort study, we included randomly 65 KTRs and 65 LTRs, who received two 30 µg doses of BNT162b2 vaccine in 3-to6-week intervals. We analyzed the anti-SARS-CoV-2 spike protein IgG antibody (anti-S1 Ab) titer, biochemical liver and renal tests, immunosuppressive drug trough level, and clinical follow up 4-6 weeks after the first dose and 4-8 weeks after the second dose. The level of protective antibodies was 57.1% in KTRs and 88.9% in LTRs after the second dose. The anti-S1 Ab response was significantly associated with sex, age, and history of COVID-19. A tacrolimus dose at vaccination but not its trough level was significantly correlated with the increase in anti-S1 Ab titer after the second vaccine dose in LTRs. Rejection episodes did not occur after vaccination. Our results showed a higher than previously reported humoral response to the BNT162b2 vaccine in KTRs and LTRs, which was dependent upon age, type of transplanted organ, and immunosuppression.

Assessment of Volumetric Hemodynamic Parameters and Body Composition in Stable Renal Transplant Recipients.

BACKGROUND Cardiovascular disease (CVD) has been associated with decreased graft survival and increased complications in renal transplant recipients (RTRs). The objectives of this study were to explore the relationship between body composition and hemodynamic parameters (cardiac index [CI] and systemic vascular resistance index [SVRI]) in RTRs. MATERIAL AND METHODS The study included 80 RTRs (mean age: 51±8 yrs) who had been admitted to our Nephrology and Transplantology Clinic at 0.5 to 28 years after KTx. The control groups consisted of the 40 patients receiving hemodialysis and 20 health-care professionals. A Cardioscreen 1000 monitor (Messtechnik, Ilmenau, Germany) was used to perform non-invasive hemodynamic measurements. Body composition was studied using a Tanita BC 418 body composition analyzer (Tanita Corp., Tokyo, Japan). Clinical and laboratory data were also analyzed. RESULTS One-way ANOVA confirmed statistically significant differences between RTRs, HD patients, and the control group in CI (2.8±0.3 vs. 3.1±0.7 vs. 3.5±0.6 L/min/m2, P<0.001, respectively) and SVRI (2619±492 vs. 2307±701 vs. 2012±452 d·s/cm-5/m², P<0.001, respectively). In RTRs with functioning AVF, our study revealed significantly higher CI (2.9±0.3 vs. 2.7±0.4 L/min/m², P=0.004) and significantly lower SVRI (2497±286 vs. 2729±605 d·s/cm-5/m², P=0.035). CONCLUSIONS In conclusion, our data indicate that cardiovascular manifestations in the RTRs group are mainly related to decreased CI and HR in addition to increased SVRI with high arterial blood pressure.

Structure of Post-Transplant Care in a Single Transplant Center.

BACKGROUND: The number of transplant surgeries across the globe has markedly increased in recent decades and is associated with improvement in outcomes. Factors that could improve the organization of post-transplant care are sought. The aim of our study was to evaluate the changes in post-transplant care in the largest Polish transplant center from 2010 to 2014. MATERIAL AND METHODS: Analysis was performed in all transplant recipients followed up at our center. The following factors were evaluated: changes in patient inflow and outflow, changes in the number of ambulatory visits, causes of loss to follow-up of the patients, and changes in National Health Fund financing. All factors were measured in 5-year period from 2010 to 2014. RESULTS: Stable year-to-year patient inflow increased by 31% in the total number of patients under follow-up within 5 years. In the same time, the total NHF spending increased by 32%, but spending per patient increased by only 11%. As a consequence, after the initial growth in the years 2010-2012, the number of ambulatory visits per patient per year tended to decline. CONCLUSIONS: Our study revealed that the real challenge in long-term post-transplant care is the increasing number of patients and the increasing length of their follow-up. Potential risks related to financial expenditure discrepancy between short-term and long-term transplantation procedures were also found.

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw.

UNLABELLED: Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). MATERIAL AND METHODS: Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. RESULTS: Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). CONCLUSIONS: Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.

Comparative analysis of hypertension and its causes among renal replacement therapy patients.

BACKGROUND: In renal replacement therapy (RRT) patients, the target values of blood pressure (BP) are being continuously modified and excessive fat tissue may even have a protective impact on the risk of mortality due to cardiovascular causes - the "obesity paradox". The purpose of the study was to compare the occurrence of hypertension (HTN) and its underlying causes in patients in the first year after kidney transplantation (KTx), and hemodialysis (HD) or peritoneal dialysis (PD) patients. MATERIAL/METHODS: A group of 120 RRT patients (PD, n=30; HD, n=40; KTx, n=50) was analyzed. The following research tools were used: (1) 24- or 44-h ambulatory blood pressure monitoring (ABPM); (2) bioelectrical impedance analysis (BIA); (3) traditional method - office BP; (4) Morisky-Green test; and (5) disease history. The significance level was p<0.05. RESULTS: The analysis revealed (HTN) (on the basis of ABPM values and anti-hypertensive treatment) in 90% of PD patients, 83% of HD patients in the first 24 h after hemodialysis, and in 95% of HD patients in the second 24 h after hemodialysis. In patients in the 12(th) month after KTx, BP values went up along with increased creatinine and hemoglobin concentration and urine protein presence (r=0.38; r=0.31; r=0.38; p<0.05). HD had a statistically significant impact of fat tissue growth on reducing BP (r=-0.34; p<0.05). CONCLUSIONS: Fat tissues play a cardioprotective role in the development of hypertension in HD patients. This shows the possibility of early noninvasive identification of patients exposed to development of chronic allograft nephropathy.

Assessment of health-related quality of life of patients after kidney transplantation in comparison with hemodialysis and peritoneal dialysis.

BACKGROUND: The quality of life may determine the efficacy of renal replacement therapy (RRT). The purpose of the study was to compare the health-related quality of life (HRQOL) of end-stage renal disease (ESRD) patients depending on RRT method. MATERIAL/METHODS: The studies were conducted on 120 patients divided into 3 groups depending on RRT method: 30 peritoneal dialysis (PD) patients, 40 hemodialysis (HD) patients, and 47 post-kidney transplantation (KTx) patients. The following research tools were used: (1) Medical Outcomes Study 36 - the Short Form (SF-36 v.1); (2) Kidney Disease Quality of Life Short Form (KDQOL-SF™ v.1.3); and (3) disease history. The relevance level was p<0.05. RESULTS: The evaluation of PCS by HD and PD patients is poorer compared to patients in the 3rd and 12th month after KTx (34.7 ± 7.4 vs. 37.51 ± 10.63 vs. 45.01 ± 9.43 vs. 45.55 ± 8.62; p<0.05; respectively). PCS statistically significantly correlated with the following: SBP (r=-0.54; p<0.05), DBP (r=-0.58; p<0.05), and creatinine concentration (r=0.46; p<0.05) in the 12(th) month after KTx. CONCLUSIONS: HRQOL of ESRD patients differed depending on the RRT method: top values were shown by post-KTx patients, lower by PD patients, and the bottom ones by HD patients. Along with patient age, increased BP, and BMI, a drop in value of HRQOL in post-Tx or PD patients was observed. When choosing RTT method, patients may use the results of the evaluation of quality of life. A preferred lifestyle, and predominantly the work status and quality of social interaction, should decide the choice of treatment.

Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection.

INTRODUCTION: Cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is the most frequent indication for liver transplantation worldwide. Progress in prophylaxis of posttransplant HBV recurrence has led to major improvements in long-term outcomes of patients after liver transplantation. Conversely, impaired posttransplant survival of patients with HCV infection was reported in several studies, mainly due to recurrence of viral infection. The purpose of this study was to compare long-term results of liver transplantation between patients with HBV monoinfection, HCV monoinfection and HBV/HCV coinfection. MATERIAL AND METHODS: A total of 1090 liver transplantations were performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw between December 1994 and May 2012. After exclusion of patients with cirrhosis of non-viral etiology, patients with malignant tumors, and patients with acute liver failure, the final study cohort comprised 209 patients with HBV (HBV+/HCV- subgroup; n = 56) or HCV (HBV-/HCV+ subgroup; n = 119) monoinfection or HBV/HCV coinfection (HBV+/HCV+; n = 34). These subgroups of patients were compared in terms of long-term results of transplantations, defined by 5-year patient and 5-year graft survival estimates. RESULTS: Overall and graft survival rates after 5-years for the whole study cohort were 74.5% and 72.6%, respectively. Five-year overall survival was 70.4% for patients within the HBV+/HCV- subgroup, 77.8% for patients within the HBV-/HCV+ subgroup, and 68.5% for patients within the HBV+/HCV+ subgroup. The corresponding rates of graft survival were 67.0%, 76.3%, and 68.5% for patients within the HBV+/HCV-, HBV-/ HCV+, and HBV+/HCV+ subgroups, respectively. Observed differences were non-significant, both in terms of overall (p = 0.472) and graft (p = 0.461) survival rates. CONCLUSIONS: Both overall and graft survival rates after liver transplantations performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw in patients with HBV and HCV infection are comparable to those reported by other European and American centers. In contrast to other studies, obtained results do not confirm the negative impact of HCV infection on long-term outcomes of patients.

1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw--analysis of indications and results.

THE AIM OF THE STUDY: was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw. MATERIAL AND METHODS: Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival. RESULTS: The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations. CONCLUSIONS: Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Renal function, efficacy and safety postconversion from twice- to once-daily tacrolimus in stable liver recipients: an open-label multicenter study.

This multicenter, open-label, phase III study assessed renal function, safety, and efficacy in stable adult liver transplant recipients converted from tacrolimus twice-daily (BID) to once-daily (QD). Patients received tacrolimus BID for 6weeks before conversion to tacrolimus QD (1:1 [mg:mg] total daily dose basis) for 12weeks. Primary endpoint: change in steady state creatinine clearance (CrCl) between treatment phases. Of 112 patients enrolled, 98 were converted to QD dosing (full analysis set [FAS]). Mean (SD) tacrolimus dose was 3.7 (1.7) mg/day during BID and at conversion, and 3.9 (1.8) mg/day at Week 12. 74.5% of patients required no dose adjustment on conversion (FAS). Mean tacrolimus whole blood trough levels were at the lower end of the recommended range during tacrolimus BID and QD; the difference between mean steady-state trough levels was statistically significant (7.5ng/ml vs. 6.5ng/ml; P<0.0001). Following conversion, mean tacrolimus trough levels were reduced by 15% (about 1ng/ml) without any cases of acute rejection, remained stable during the remainder of the study, and were more consistent, showing reduced between- and within-patient variability in trough levels. Renal function remained stable, demonstrating noninferiority of tacrolimus QD versus BID (relative difference in mean calculated CrCl -0.1% [±6.3%]). Patient and graft survival were 100%. Adverse events incidence was low during both treatment phases.

A retrospective study of steroid elimination in simultaneous pancreas and preemptive kidney transplant (Sppre-Ktx) recipients.

OBJECTIVES: The feasibility and timing of corticosteroid elimination and its impact on lipid metabolism in simultaneous pancreas and preemptive kidney transplantation were examined. MATERIAL AND METHODS: A retrospective study was conducted on 14 recipients of pancreas and preemptive kidney grafts transplanted form April 2003 to March 2004. All recipients received ATG induction. Tacrolimus (Tac) was administered according to trough concentration 8-15 ng/ml. Mycophenolate mofetil (MMF) was administered at doses of 2 g per day with subsequent dosage adjustment based on tolerability. All recipients received corticosteroids with subsequent dose tapering. Total cholesterol and triglyceride levels before transplantation and after steroid withdrawal were assessed. RESULTS: One year recipient survival rate was 100%. Cumulative one year panaceas and kidney survival rates were: 85% and 100%, respectively. After transplantation of fasting glycemia and HbAIC were normalized. Serum creatinine decreased from 4.35 +/- 1.61 mg/dl before transplantation to 1.1 + 0.25 mg/dl after surgery (p < 0.05). Corticosteroids were eliminated between the 2nd and 16th month (mean 6 months) after transplantation. Cholesterol and triglyceride levels were wiyhin normal range, in addition significantly decreased after transplantation and steroid withdrawal, from 194.5 +/- 35.6 mg/dl to 162.4 +/- 36.8 mg/dl and 142.5 +/- 65 94.8 +/- 42.5 mg/dl, respectively (p < 0.05). CONCLUSIONS: It is possible to eliminate steroids 6 months after transplantation using immunossupression based on MMF and Tac. Withdrawal of steroids could be partially contributed to the normalization of lipid metabolism.