Focus on Pneumonia After Organ Transplantation: Is There a Need for Specific Medical Care in the Emergency Department?

BACKGROUND: Pneumonia is a major cause of hospitalization and has a substantial impact on health care costs. Diagnosis and treatment of pneumonia in solid organ transplant (SOT) patients remain a challenge for clinicians in the emergency department. This study aimed to evaluate demographic features, clinical patterns, history of hospitalization, and diagnosis of adult patients after organ(s) transplantation (liver, kidney, pancreas) with severe pneumonia requiring hospitalization. The aim is to determine whether patients undergoing SOT receive or require specific care and whether they need to be prioritized. METHOD: This was a single-center observational study of adult patients after SOT with severe pneumonia requiring hospitalization. The data set for the analysis included only patients with pneumonia as the main reason for hospitalization. The diagnosis of pneumonia was suspected based on the American Thoracic Society criteria. RESULTS: The study revealed that the standard of care for patients with a history of SOT did not significantly differ from care provided to the non-SOT patients with pneumonia admitted to the same hospital during a 94-week period. CONCLUSION: There were notable differences, such as post-transplant patients being transferred more quickly to the hospital ward, having longer hospital stays, and receiving antibiotics earlier than the non-SOT group.

Current Data on Organ Donation and Transplantation in Poland: Poltransplant Activity 2017 to 2022.

BACKGROUND: In this paper, we present organ donation and transplantation activities in Poland from 2017 to 2022. Data came from registries maintained by the Polish Transplant Coordinating Center Poltransplant and consisted of the national waiting list, deceased donor registry, transplant registry, and the live donor registry. Poltransplant is the Competent Authority in Organs, with tasks related to preparing assessments, analyses, information, and reports in transplantation medicine and publishing and disseminating these results in the country and abroad. Poltransplant edits the Poltransplant Bulletin on its web pages and presents its activities at Polish Transplantation Society congresses, published consecutively as professional papers.

Demand for Continuous and Long-Term Care in Transplant Recipients: Data From the Organ Transplantation Registry-Poltransplant Activity.

BACKGROUND: This study aimed to determine the number of recipients with active transplants under the care of transplant centers in 2022 and the current volume and needs for continuous and long-term care in this group of transplant recipients. Data came from the organ transplant registry, one of the registries maintained by the Polish Transplant Coordinating Center Poltransplant. We included recipients of individual organs who, on January 1, 2022, were living with an active transplant performed in previous years and recipients who received a transplant in 2022. The number of recipients under the care of transplant centers in 2022 was 20,994 (55% of all transplants performed in Poland since the beginning of activity in 1966).

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.

Change for the Better: Severe Pneumonia at the Emergency Department.

This is a single-centre observational study of adult patients with severe pneumonia requiring hospitalization conducted at the emergency department. During the observation period (94 weeks), 398 patients were diagnosed with severe pneumonia and required further treatment at the hospital. The median age of patients was 73 years. About 65% of patients had at least one chronic comorbidity. Almost 30% of patients had cardiovascular disorders, and 13% had diabetes mellitus. The average Emergency Department length of stay was 3.56 days. The average length of hospitalization was 15.8 days. Overall, 94% of patients treated for pneumonia received a beta-lactam antibiotic. The median time from ED admission to the administration of the first dose of antimicrobial agent was less than 6 h. Microbiology test samples were obtained from 48.7% patients. Gram-positive cocci were isolated most commonly (52.9%) from blood samples. Biological material from the lower respiratory tract was collected from 8.3% of patients, and from 47.2% of positive samples, fungi were cultured. The urine samples were obtained from 35.9% patients, and Gram-negative rods (76%) were isolated most commonly. Overall, 16.1% of patients died during the hospitalization. The mean age of patients who died was 79 years. This observational study is the first single-centre study conducted as part of the Polish Emergency Department Research Organization (PEDRO) project. It aims to provide up-to-date information about patients with pneumonia in order to improve medical care and develop local diagnostic and therapeutic recommendations.

Analysis of Complications and Recipients' and Graft Survival in Patients 60 Years of Age and Older in the Long-Term Follow-up Period After Kidney Transplant: A Single-Center, Paired Kidney Analysis.

BACKGROUND: Long-term results of kidney transplant (KTx) in older patients may differ from younger recipients owing to increased cardiovascular comorbidities. The study aimed to analyze surgical and nonsurgical complications that develop in the long-term follow-up period after KTx, and factors that influence results of KTx in recipients aged 60 years and older (≥60) compared with younger recipients (<60). METHODS: One hundred seventy-five patients aged ≥60 years and 175 patients aged <60 years who received a kidney graft from the same deceased donor were enrolled in the study. In the long-term follow-up period (3 months to 5 years after KTx) the incidence of surgical and nonsurgical complications, as well as patient and kidney graft survival, were compared. Additionally, the influence of early complications on patients and kidney graft survival was assessed. RESULTS: There were no differences between recipients aged ≥60 years compared with recipients aged <60 years in occurrence of surgical complications (graft artery stenosis: 0.6% vs 2.3%; ureter stenosis: 3.4% vs 1.1%; lymphocele: 6.9% vs 3.4%) and nonsurgical complications (urinary tract infection: 19.4% vs 23.4%; pneumonia: 8.6% vs 8.6%; cytomegalovirus infection: 6.3% vs 8%; new-onset diabetes after transplant: 16.6% vs 17.1%; cancer incidence: 5.7% vs 4.6%; acute rejection episode: 13.1% vs 17.1%). Five-year recipient survival was lower in a group of patients aged ≥60 years (death, 15.4% vs 8%; death with functioning graft, 12% vs 5.1%). CONCLUSIONS: The incidence of surgical and nonsurgical complications, as well as kidney-graft survival, in recipients aged ≥60 years in a 5-year follow-up period is comparable to younger recipients aged <60 years.

Poltransplant Recommendations on Organ Donation and Transplantation in the COVID-19 Era.

In this article, we present the standpoint and recommendations of Poltransplant on the use of organs, tissues, and cells other than hematopoietic cells for transplant in connection with SARS-CoV-2 infections (January 15, 2021).

The Current Status of Organ Donation and Transplantation in Poland. Poltransplant Activity.

BACKGROUND: This article summarizes comprehensive information about the current status of organ donation and transplantation in Poland. MATERIAL AND METHODS: Reported statistical data of solid organs and vascularized composite allograft donation and transplantation from both deceased and living donors in Poland in 2015-2020 (presented in tables according to selected variables) are based on the national transplant registries, gathering information on donation and transplantation activity in medical centers involved in donation and transplantation programs in Poland. RESULTS: In 2020 during the COVID-19 pandemic, 529 potential deceased donors were referred to the Polish Transplant Coordinating Centre Poltransplant; 1310 solid organs from 393 actual deceased donors (10.2 per million population) were procured, mostly kidneys (758), livers (285), and hearts (157). Eighty percent were multiorgan retrievals (314). In 2020, 1231 organs procured from deceased donors and 59 organs from living donors were transplanted to 1236 recipients. CONCLUSION: This overview indicates that donation and transplantation activity from deceased donors in Poland decreased about 20% in 2020 compared with 2019, which is comparable with worldwide rates. As the unprecedented pandemic situation affected donation and transplantation procedures, there are measures that must to be taken to return to prepandemic donation and transplantation rates in both deceased and living transplant programs and then continue to improve in the years to come.

The System of Transplant Coordinators in Poland: Poltransplant Activity.

BACKGROUND: One of the important tasks of a modern hospital, in addition to treatment, prevention, and education, is the activity in the field of donating organs from deceased and living donors. In July 2010, the Polish Transplantation Coordination Center Poltransplant (the national transplantation organization and the authority responsible for organ donation and transplantation), thanks to the funds of the Ministry of Health, under the National Program for the Development of Transplant Medicine, initiated the project of building a network of coordinators by employing hospital transplantation coordinators in selected hospitals, where it is possible to identify potential deceased donors, perform the brain death diagnostic procedure, and where the conditions are met and it is possible to collect organs (they have an intensive care unit and operating theater in their structures). In Poland, these conditions are met by 388 hospitals with a donation potential. AIM: The aim of the work is to present the functioning of the system of transplant coordinators in Poland. RESULTS: The work presents the system of employment and tasks of transplant coordinators at various levels: hospital coordinators for donating organs from deceased donors, living donation and transplant coordinators, coordinators of hematopoietic cell collection and transplantation, central coordinators of Poltransplant, and organ procurement and transplant coordinators associated with transplant centers.

National Organ Transplant Registry in Poland. Poltransplant Activity.

BACKGROUND: In 2006 the National Transplants Registry administered by national transplant organization was introduced in Poland to monitor the results of organ transplantations. Statistical analysis is published yearly in the Poltransplant Bulletin, publicly available on the website and reported to European institutions. The transplant registry cooperates with other registers functioning online, based on the tool https://rejestrytx.gov.pl/. We present the formal analysis of data collected for the years 1996-2019. MATERIALS AND METHODS: Analysis covered the total number of organ transplantations in every transplant center; outcomes are related to recipients living with a functioning graft 1, 5, and 10 years after transplantation; results presented are real, not extrapolated. RESULTS: The total number of deceased-donor kidney transplantations was 20,606, the 1-year survival rate of recipients with a functioning graft was 90% (data completeness of 97%), and the 10-year survival rate was 59% (data completeness of 99%). The total number of deceased-donor liver transplantations was 4790; the 1-year survival rate of recipients with a functioning graft was 59% (data completeness of 98%). SUMMARY: The National Transplant Registry is an important tool for quality and safety systems in the transplantation field on the national level. The registry efficiently and effectively fulfills its tasks related to collecting records of all transplantations performed. Monitoring function for graft and recipient survival is also satisfied. The data provide an important and unique source of information to be used by transplant institutions and referred to in the literature.

Non-Donor Registry in Poland: Poltransplant Activity.

BACKGROUND: Organ, tissue and cell procurement from deceased donors for transplantation requires consent and authorization, documented donor's positive acceptance, or lack of objection to donation expressed while alive. It also requires the fulfillment of other legal conditions required by the law, such as person's legal abilities to act in this field or to obtain approval for donation. Consent to and authorization of donation from deceased donors requires regulations on national level. Poland developed an opting-out policy since 1996, when The Central Register of Objections (CRO) was introduced. The purpose of this article is a formal analysis of all submitted objections and objection withdrawals managed by the CRO since the introduction of the registry until the end of 2020. METHODS: All data collected by the CRO during 25 years of service was subject of analysis. The objections and withdrawals of objections are summarized in the tables, along with the age, sex and place of residence of registered person. RESULTS: By December 2020, a total 37,728 records were registered, including 37,392 registered objections and 336 registered withdrawals of objections; this means that 0.09% of the country's population expressed objection to deceased donation. CONCLUSIONS: The CRO is an indispensable option in a country with opt-out system as a part of deceased donation authorization protocol. Number of registered objections is extremely low, in practice, this leads to a situation where the will of the deceased most often is obtained from the family.

Hematopoietic Stem-Cell Transplant Registry in Poland: 2020 Summaries.

In the pandemic year 2020, 634 allogeneic hematopoietic stem-cell (HSC) transplants were performed in Poland, including fully matched and haploidentical family donors (n = 248) as well as unrelated donors transplantation (n = 386). In 48 recipients (7.6%) for allogeneic transplantation, hematopoietic bone marrow cells were transplanted, and in 586 recipients (92.4%), peripheral blood hematopoietic cells. The effect of the pandemic was noticeable but not disastrous-the number of HSC transplants from unrelated donors was lower by 9% compared to 2019 and the use of haploidentical donors slightly increased compared to 2019. Out of all 386 unrelated HSC transplants, the material for 143 transplants (37%) came from international donors, whereas for 243 transplants (63%) material collected from domestic donors was used. Along with the increase in the number of potential bone marrow donors in the national resources, the share of transplants from Polish donors in the total number of transplants increased noticeably from 2006 to 2020. The total number of allogeneic transplants performed in 18 Polish transplant centers between 2006 and 2020 is 7426. Total transplant rates (cumulative number of all allogeneic HSC transplants performed from 2006 to 2020 per 1 million inhabitants) differs between regions and for regions with nonzero number of transplants varies from 520 in Mazowieckie Voivodship to 14 in Lodzkie Voivodship.

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports.

BACKGROUND The presence of fat droplets within the subarachnoid space is an uncommon finding, which is almost exclusively associated with a ruptured dermoid cyst. In a trauma setting, transthecal migration of fat droplets is an extremely rare occurrence. We present 2 case reports of intracranial transthecal migration of fatty bone marrow after sacral fractures. CASE REPORT Both patients presented to the Emergency Department (ED) after falls from a standing height. The first patient, an 84-year-old woman, suffered a stable sacral fracture extending into a large meningeal cyst within the right S2 foramen. Her initial neurological assessment and computed tomography (CT) of the head were unremarkable. As the fracture did not require surgical treatment, she was discharged home and prescribed bed rest, analgesics, and venous thromboembolism prophylaxis. Three days after the injury, she was readmitted to the ED with a mild headache, dizziness, and an episode of nausea and vomiting. A follow-up head CT revealed fat droplets in the subarachnoid space and lateral ventricles. After successful symptomatic treatment, she was discharged home in good general condition. The second patient, a 60-year-old man, underwent a head CT for a scalp hematoma, which revealed fat droplets in the 3rd ventricle and right lateral ventricle. The pelvic CT revealed a large sacral meningeal cyst with microfractures in its wall. He was discharged home on the same day and prescribed bed rest and analgesics. CONCLUSIONS The detection of intracranial intrathecal fat droplets in association with a specific trauma mechanism should initiate the search for a sacral fracture.

Effects of the COVID-19 Pandemic on Solid Organ Transplantation During 2020 in Poland Compared with Countries in Western Europe, Asia, and North America: A Review.

The coronavirus disease 2019 (COVID-19) pandemic, due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which began in March 2020, affected organ donor acceptance and rates of heart, lung, kidney, and liver transplants worldwide. According to data reported to POLTRANSPLANT, the number of solid organ transplants decreased by over 35% and the number of patients enlisted de novo for organ transplantation was reduced to 70% of its pre-COVID-19 volume in Poland. Most transplant centers in Western Europe and the USA have also drastically reduced their activity when compared to the pre-pandemic era. Areas of high SARS-CoV-2 infection incidence, like Italy, Spain, and France, were most affected. Significant decreases in organ donation and number of transplant procedures and increase in waitlist deaths have been noted due to overload of the healthcare system as well as uncertainty of donor SARS-CoV-2 status. Intensive care unit bed shortages and less intensive care resources available for donor management are major factors limiting access to organ procurement. The impact of the COVID-19 outbreak on transplant activities was not so adverse in Asia, as a result of a strategy based on experience gained during a previous SARS pandemic. This review aims to compare the effects of the COVID-19 pandemic on solid organ transplantation during 2020 in Poland with countries in Western Europe, North America, and Asia.

Central Unrelated Potential Bone Marrow and Cord Blood Registry in Poland: Structure and Numbers.

Poland's Central Unrelated Potential Bone Marrow Donor and Cord Blood Registry (CBMDR Poltransplant) was established in 2011. Affiliated with the World Marrow Donor Association (WMDA) as PL5, the CBMDR is an internationally recognized hematopoietic stem cell donor registry with a large, high-quality donor database. Overall, Polish resources in this domain are the second largest in Europe and the fourth largest in the world, accounting for 4.8% of the WMDA Register of over 33.5 million records. In the last 10 years, the number of potential hematopoietic stem cell donors registered in Poland has increased more than 10-fold, from about 146,000 to 1,579,809 at the end of 2018. Such a growing number of donors in the CBMDR is contributing to an increase in overall numbers of donor searches in Polish databases, as well as in donations from Polish donors.

Results of Kidney Transplants From Deceased Donors Discarded From Transplantation by a Regional Transplant Center but Accepted and Transplanted by Another Center.

BACKGROUND: Kidney allocation policy in Poland is strictly patient oriented. Kidneys are transplanted by the same center that made procurement. Sometimes kidneys are transferred for transplantation to another center due to medical or logistic reasons or according to allocation rules. AIM: The aim of the study was to compare early graft and recipient survival rates in cases of kidneys exported for transplantation to another center and in cases of kidneys transplanted typically. METHODS: Data came from national transplant registry. Kidney transplants from the years 2008 to 2017 were divided into several groups. One-year graft and patient survival rates were calculated for each group, and statistical differences were cross-calculated between groups. RESULTS: Groups were compared by using the χ2 test. Statistical analysis showed significantly lower graft and recipient survival rates: in the group of kidney transplantations performed in another transplant centers vs group of kidneys not transferred, where kidney transplantations were performed in a regional transplant center (P = .005 and = .02); and in the group of kidneys transferred due to logistic reason and allocation rules vs group of kidneys not transferred, where kidney transplantations were performed in regional transplant center (P = .01 and = .04). CONCLUSION: Early results of kidneys procured and transplanted by the same regional transplant center are significantly better than kidneys that have been transferred for transplantation to another center, but this result concerns only the subgroup of kidneys shifted due to logistic or allocation reasons. Early results of kidneys discarded by a regional team due to medical reasons and transplanted by another team are not different from results of transplantations performed by the same center that made the procurement.

Assessment of Organ Donation Potential From Brain-Dead Donors in Polish Hospitals Using Quality Systems: System Of Donor Hospital Transplant Coordinators and Web-Tooled System of Monitoring Intensive Care Unit Deaths.

INTRODUCTION: In 2010 Poltransplant organized a national network of donor hospital transplant coordinators involved in the recruitment of potential deceased organ donors. One of the employed coordinators' tasks is monitoring donation potential at hospitals and reporting their results with the use of a tele-information tool www.koordynator.net. BACKGROUND: The aim of our study was to evaluate the organ donation potential at hospitals in 2018 based on the analysis of reports and on the comparison of these results with organ donation indicators elaborated within the European Commission project entitled Improving the Knowledge and Practices in Organ Donation (DOPKI). METHODS: Reports concerning deaths were applied to a retrospective analysis regarding a possibility to diagnose deaths according to neurologic criteria and to detect possible donations. In total, 1214 reports from 116 hospitals were delivered to the tele-information system during 2018. The analysis was made based on 840 full monthly reports from 70 hospitals. Numbers and indicators connected to the organ donation potential, both in the hospital and the intensive care unit (ICU) scales, have been calculated: numbers of beds and admissions, total number of deaths, deaths due to reasons frequently leading to death according to neurologic criteria, number of brain death diagnoses, and number of organ donations. RESULTS: In the scales of hospital and ICU the studied indices showed the following: 1. distinctly lower ratios related to brain death determination in the total number of beds, admissions, deaths, and deaths with selected International Classification of Diseases and Related Health Problems (ICD) codes in comparison with DOPKI results and 2. distinctly higher ratio of donations in the total number of brain deaths confirmed (69%) in comparison with DOPKI (42%). CONCLUSIONS: Based on obtained data from respective hospitals, the analysis showed the following in comparison with data coming from international European study (DOPKI): 1. low frequency of brain death determination procedures in the total number of deaths in Polish hospitals and ICUs, probably also in cases where such mechanism of death has occurred (the discrepancy may reach 1974 cases per year) and 2. high percentage of donations in the total number of brain-dead persons (conversion index), which may be caused by successful authorization of donation and acceptance of risky donors and organs by transplant teams but (what is more probable) may be explained by the ICUs' habit that procedures of brain death protocol is implemented only in cases when donation is expected.

Spinal Cord Ischemia Because of Microvascular Thrombosis in a Patient with Necrotizing Pancreatitis. Case Report and Literature Review.

BACKGROUND Central nervous system ischemia in acute pancreatitis is rare with only a handful of cases reported in the literature. We report a case of spinal cord ischemia due to microvascular thrombosis complicating acute on chronic pancreatitis. CASE REPORT A 37-year-old male was transferred to a university hospital intensive care unit with a diagnosis of acute onset chronic pancreatitis, paraplegia, and multi-organ failure. Laboratory studies showed elevated serum amylase activity and leukocytosis. The patient deteriorated quickly and anemia with thrombocytopenia and coagulation abnormalities developed. Computed tomography showed large pancreatic pseudocyst and ischemic lesions in abdominal organs. Symptoms of paraplegia preceded by the bilateral paresis were noted 7 days from the onset of his disease and magnetic resonance imaging showed ischemia involving the central part of the medullary cone resulting from microvascular thrombosis. The patient underwent endoscopic retrograde cholangiopancreatography and repeated surgery with a number of complications but 2 months later was discharged to rehabilitation center due to persistent neurologic deficit. CONCLUSIONS Patients with severe pancreatitis and multiorgan failure requiring intensive care should undergo routine neurological examination to identify and treat deficits early.

Early Complications After Kidney Transplantation in Patients Aged 60 Years and Older: A Single-Center, Paired-Kidney Analysis.

OBJECTIVES: As the population ages, the number of people suffering from cardiovascular diseases (CVD) and diabetes mellitus (DM) increases. The coexistence of these diseases can affect the results of kidney transplantation (KT) in the elderly. The aim of this study was to analyze surgical and nonsurgical complications in the early period after KT and to identify the factors that influence their development in recipients aged ≥ 60 years compared to younger recipients < 60 years. METHODS: One hundred seventy-five recipients of KT ≥ 60 years and 175 recipients of KT < 60 years who received kidneys from the same deceased donor were enrolled into the study. The incidence of surgical and nonsurgical complications, factors that may influence their development, early graft function, and patient and kidney-graft survival were analyzed during a 3-month follow-up period. Donor sources complied with the Helsinki Congress and Istanbul Declaration and organs were not procured from prisoners and individuals who were coerced or paid. RESULTS: Older recipients were characterized by higher body mass index ± SD (26.1 ± 3.5 vs 24.7 ± 3.4 kg/m2) and suffered more often from pretransplant DM (20.6% vs 11.4%) and CVD (34.3% vs 10.3%) and less frequently underwent previous KT (6.3% vs 20.0%). There were no differences between the ≥ 60 year old and < 60 year old groups in reference to surgical (20.6% vs 24%) and nonsurgical complications (28.6% vs 27.4%), early graft function, serum creatinine, and proteinuria. Recipients (95.4% vs 97.1%) and kidney-graft survival (93.1% vs 95.4%) were similar in both groups. The recipient factors that influenced the development of infectious complications were age, dialysis duration, pretransplant DM, and CVD. CONCLUSIONS: Despite higher co-incidence of CVD and DM, the risk of surgical and nonsurgical complications in elderly recipients is comparable to younger recipients in the early period after KT.

High-resolution allele frequencies for NGS based HLA-A, B, C, DQB1 and DRB1 typing of 23,595 bone marrow donors recruited for the Polish central potential unrelated bone marrow donor registry.

Next-generation sequencing (NGS)-based typings of HLA-A, B, C, DQB1 and DRB1 loci were performed from 2018 to 2019 in 23 595 newly recruited or re-typed adult potential bone marrow donors registered in Poltransplant Registry to characterize allele and haplotype frequencies of HLA system for loci important for hematopoietic stem cell transplantation. The donors were recruited for registry and not for any other purpose including controls in a disease association study. The population sample was collected in various regions of Poland including all voivodships. The data regarding the degree of relatedness among individuals in the sample were not collected. Typings were supported by public funds as a part of the Polish National Program for Transplant Medicine Development. HLA frequency data are available in the Allele Frequencies Net Database.