The relationship between lower urinary tract dysfunctions and urinary leakage from ureterocystoneoanastomosis in male patients after kidney transplantation.

OBJECTIVES: The aim of this study was to investigate the association of lower urinary tract dysfunctions with urinary leakage from ureterocystoneoanastomosis (UCNA) after kidney transplantation. BACKGROUND: The UCNA leakage after kidney transplantation can be associated with various conditions while severe lower urinary tract dysfunctions could be one of them. METHODS: The analysis included all men who underwent kidney transplantation between January 2009 and December 2014. The parameters of storage and voiding functions were evaluated. All patients were monitored during their post-transplantation period for the incidence of urinary leakage from UCNA. Urodynamic parameters were compared between men with and without a documented leakage. RESULTS: The study cohort included 127 male patients, while UCNA leakage was observed in 11 (8.7 %) patients. Significant differences between both groups of patients were found for storage parameters (patients with leakage had smaller volume at first and a normal desire to void, smaller maximal cystometric capacity, and lower detrusor compliance) and voiding parameters (patients with leakage had a lower maximal flow rate, higher detrusor pressure at maximal flow rate and higher bladder outlet obstruction index). CONCLUSION: This study shows an association between lower urinary tract dysfunction and UCNA leakage in men without previous urological history (Tab. 2, Fig. 2, Ref. 24). Text in PDF www.elis.sk Keywords: urinary leakage, ureterocystoneoanastomosis, lower urinary tract dysfunctions, kidney transplantation.

The effect of induction therapy on established CMV specific T cell immunity in living donor kidney transplantation.

Cytomegalovirus (CMV) infection influences both short and long term outcomes in immunosuppressed organ transplant recipients. The aim of this study was to evaluate the effect of different induction immunosuppression regimens on CMV specific T cell response in patients with already established CMV immunity. In 24 seropositive living donor kidney recipients, the frequency of CMV specific T cells was determined by ELISPOT (Enzyme-Linked ImmunoSpot) assay prior and 6 months after transplantation. Recipients' peripheral blood mononuclear cells were stimulated with immediate-early (IE1) and phosphoprotein 65 (pp65) CMV-derived peptide pools and the number of cells producing interferon gamma (IFN-gamma) was assessed. Patients received quadruple immunosuppression based either on depletive rabbit antithymocyte globulin (rATG) or non-depletive basiliximab induction and tacrolimus/mycophenolate mofetil/steroids. Patients with rATG induction received valgancyclovir prophylaxis. No effects of different induction agents on CMV specific T cell immunity were found at sixth month after kidney transplantation. There were no associations among dialysis vintage, pretransplant CMV specific T cell immunity, and later CMV DNAemia. Similarly, no effect of CMV prophylaxis on CMV specific T cell immunity was revealed. This study shows no effect of posttransplant immunosuppression on CMV specific T cell immunity in living donor kidney transplant recipients with CMV immunity already established, regardless of lymphocyte depletion and CMV prophylaxis.

Molecular profiling in IgA nephropathy and focal and segmental glomerulosclerosis.

The aim of the study was to characterize by molecular profiling two glomerular diseases: IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) and to identify potential molecular markers of IgAN and FSGS progression. The expressions of 90 immune-related genes were compared in biopsies of patients with IgAN (n=33), FSGS (n=17) and in controls (n=11) using RT-qPCR. To identify markers of disease progression, gene expression was compared between progressors and non-progressors in 1 year follow-up. The results were verified on validation cohort of patients with IgAN (n=8) and in controls (n=6) using laser-capture microdissection, that enables to analyze gene expression separately for glomeruli and interstitium. In comparison to controls, patients with both IgAN and FSGS, had lower expression of BAX (apoptotic molecule BCL2-associated protein) and HMOX-1 (heme oxygenase 1) and higher expression of SELP (selectin P). Furthermore, in IgAN higher expression of PTPRC (protein-tyrosine phosphatase, receptor-type C) and in FSGS higher expression of BCL2L1 (regulator of apoptosis BCL2-like 1) and IL18 compared to control was observed. Validation of differentially expressed genes between IgAN and controls on another cohort using laser-capture microdissection confirmed higher expression of PTPRC in glomeruli of patients with IgAN. The risk of progression in IgAN was associated with higher expression EDN1 (endothelin 1) (AUC=0.77) and FASLG (Fas ligand) (AUC=0.82) and lower expression of VEGF (vascular endothelial growth factor) (AUC=0.8) and in FSGS with lower expression of CCL19 (chemokine (C-C motif) ligand 19) (AUC=0.86). Higher expression of EDN1 and FASLG along with lower expression of VEGF in IgAN and lower expression of CCL19 in FSGS at the time of biopsy can help to identify patients at risk of future disease progression.

Kidney transplant early venous complications managed by reperfusion and re-transplantation - salvage procedure.

We report five cases of early venous complications, all successfully rescued by graft removal, re-perfusion and re-transplantation, these kidneys would have been lost otherwise. All kidneys were from deceased donors, mean donor age was 39 years (range 29-55), with serum creatitine levels on harvesting being 81 µmol/l (65-108), glomerular filtration of 1.46 ml/s (0.82-1.83). Reasons for venous complications were following: Two cases of renal vein stenosis, another two with renal vein laceration, one renal vein thrombosis for unknown reason. All the five kidney grafts have been rescued successfully. One year's results in this group comes as mean serum creatinine level of 127 µmol/l. The described approach gives a chance to the patients with early vein thrombosis and offers the kidney graft salvage (Ref. 4).

Extended follow-up of the CYCLOFA-LUNE trial comparing two sequential induction and maintenance treatment regimens for proliferative lupus nephritis based either on cyclophosphamide or on cyclosporine A.

Objective To evaluate the extended follow-up of the CYCLOFA-LUNE trial, a randomized prospective trial comparing two sequential induction and maintenance treatment regimens for proliferative lupus nephritis based either on cyclophosphamide (CPH) or cyclosporine A (CyA). Patients and methods Data for kidney function and adverse events were collected by a cross-sectional survey for 38 of 40 patients initially randomized in the CYCLOFA-LUNE trial. Results The median follow-up time was 7.7 years (range 5.0-10.3). Rates of renal impairment and end-stage renal disease, adverse events (death, cardiovascular event, tumor, premature menopause) did not differ between the CPH and CyA group, nor did mean serum creatinine, 24 h proteinuria and SLICC damage score at last follow-up. Most patients in both groups were still treated with glucocorticoids, other immunosuppressant agents and blood pressure lowering drugs. Conclusion An immunosuppressive regimen based on CyA achieved similar clinical results to that based on CPH in the very long term.

Dynamics of fertility in patients on waiting list for kidney transplantation.

OBJECTIVES: To evaluate the presence of hormonal abnormalities and fertility disorders in patients with chronic kidney disease (CKD) awaiting renal transplantation. METHODS: From September 2009 to April 2011 all male patients with CKD awaiting kidney transplantation were investigated. The following tests were performed: semen analysis, serum concentration of testosterone, SHBG, LH, FSH and prolactin. Differences in hormone levels and sperm count parameters were statistically evaluated between the control group and the patient group. RESULTS: The group of patients consisted of 74 and the control group of 41 men. Average testosterone levels were lower in patients compared to control group. In patients significantly higher levels of SHBG, LH, FSH and PRL were found, and statistically significantly lower ejaculate volume, total sperm count, sperm concentration, total and progressive sperm motility and sperm morphology than in the control group. Within the group of patients a negative correlation between testosterone and PRL was found and a positive correlation between testosterone and total sperm motility and morphology. A negative correlation was detected between the duration of haemodialysis and testosterone, sperm concentration, total and progressive motility and sperm morphology. CONCLUSION: Significant changes in hormone levels and impaired fertility are found in haemodialyzed patients on a waiting list for kidney transplantation. The dynamics of these changes are dependent on the duration of haemodialysis (Tab. 4, Fig. 2, Ref. 15). Text in PDF www.elis.sk.

Long-term follow-up of stable kidney transplant recipients after conversion from tacrolimus twice daily immediate release to tacrolimus once-daily prolonged release: a large single-center experience.

BACKGROUND: Adult kidney transplant recipients maintained on tacrolimus twice-daily (Tac BD) were given the opportunity to convert to tacrolimus once daily (Tac QD). Conversion was based upon a 1:1 mg:mg total daily dose ratio. METHODS: Between November 2007 and September 2010, 589 patients were converted at a mean post-transplant period of 4.6 years. We retrospectively reviewed routine clinical records to assess the safety of conversion to Tac QD for up to 12 months post-conversion. RESULTS: Tac QD mean dose barely changed from preconversion values. Mean exposure (tacrolimus trough blood level [Cmin]) remained within the target window but was reduced by 12% (P = NS) with a trend toward less interpatient variability. Renal function at 12 months remained stable within 2.5% of the preconversion mean value. There were 14 (2.4%) cases of biopsy-proven acute rejection: 6 (1.0%) borderline and 8 (1.4%) Banff grade ≥ IA. Actuarial first year post-conversion graft survival was 96.3% and patient survival 99.0%. Twenty-eight patients (4.8%) discontinued Tac QD and were switched to sirolimus: 19 for malignancy, 6 for thrombotic microangiopathy, and 3 with severe vascular changes; 3 patients were reconverted to Tac BD. CONCLUSIONS: Conversion from Tac BD to Tac QD in renal recipients was accompanied by stable renal function, a low risk of acute rejection, and less interpatient variability in drug exposure.

[Acute humoral rejection of renal transplant]. / Akutní humorální rejekce transplantované ledviny.

Acute humoral rejection (AHR) is a rare complication which often results in the loss of kidney graft. The objective of this retrospective monocentric study was to evaluate two different approaches to AHR. Documentation of 730 patients was analysed, who underwent renal transplantation between 2002 and 2005. From 2002 to 2003, patients with AHR were treated with 5 plasmaphereses (PF group, n = 13), and from 2004 to 2005 with a combination of 5 PF and intravenous immunoglobulins (PF + IVIG, 0.5 g/kg, n = 8). Data for the period of one year post-transplant was analysed. AHR occurred in 21 out of 730 patients (2.9%). Survival of grafts in the 6th month and in the 1st year was significantly higher for the PF + IVIG group than for the PF group only (p < 0.05). Patient survival was similar in both groups. The incidence of infectious complications was similar in both groups. There was a higher incidence of acute cellular rejections in the PF group (46.2 vs. 14.3%) in control rebiopsies (performed due to deteriorated graft function or in order to check the efficiency of the treatment). It can be concluded that acute humoral rejection of transplanted kidney is a rare complication which can be treated by the combination of plasmaphereses and intravenous immunoglobulins.