Assessment of an Interferon-gamma release assay for the diagnosis of latent tuberculosis infection in haemodialysis patient.

BACKGROUND: The accurate diagnosis of latent tuberculosis infection (LTBI) in haemodialysis patients remains elusive. Impaired immune function associated with chronic kidney failure causes a high number of anergic tuberculin skin tests (TST). Interferon-gamma (INF-gamma) release assays (IGRAs) measuring the INF-gamma secretion of tuberculosis specific T-cells have several advantages over the TST but their significance in dialysis patients is currently uncertain. METHODS: This study examines the test-performances of the QuantiFERON Gold InTube (QFT-GIT) in a cohort of 39 haemodialysis (HD) patients and 52 healthy individuals. RESULTS: INF-gamma secretion in HD patients was significantly lower than in healthy controls, however, mitogen-anergic QFT-GIT results were only found in 2.5% of HD-patients. INF-gamma secretion was independent of duration of HD treatment, dialysis quality and nutritional status. The QFT-GIT showed a closer association with TB risk factors as a proxy for past exposure to TB than the TST. CONCLUSIONS: We conclude that the QFT-GIT is a valid alternative to the TST. Together with the survey of TB risk factors, it may help to diagnose LTBI more accurately in HD-patients.

[The Swiss Organ Living Donor Health Registry (SOL-DHR)]. / Das Schweizer Lebendspender-Gesundheitsregister (SOL-DHR).

The Swiss Organ Living Donor Health Registry (SOL-DHR) started in April 1993. The purpose was the prospective and sequential follow up of donors long-term health. Between 1993 and January 2005 737 Living Kidney donations were registered and followed. Two thirds of donors were female and two thirds of recipients male. The three most common relations were life-partners, parents and siblings (approximately 30% each). 10% of donors could not be followed since living far abroad and 5% were lost due to missing current address after moving. 9 donors died (4 malignancies, 2 traffic accidents, 1 myocardial infarction, 1 stroke and 1 suicide), non due to kidney donation. Perioperative complications were age dependent, ranging from 17% in donors below the age of 40 year and 46% in donors older than 70 years. The longterm complications were divided in surgical, medical and psychological ones. The most common surgical long-term complications were pain (cicatrice, back, abdomen) and hernias. The major medical complications were hypertension (35% at seven years after donation) and rising rate of Albuminuria (9% at seven years). Although hypertension was not higher than in an age matched Swiss control population, untreated hypertension was regarded as the higher risk for development of glomerulosclerosis than in people with two kidneys. No donor went into end stage renal failure. Using the SF-8-Test to quantify the psychological well-being the mean MCS (mental component summary) was 54.3 +/- 7.8 as compared to 52.9 +/- 7.7 in the age matched control population. MCS was low (< 40) in 6.2% and very low (< 25) in 2.2% of donors. 94.4 % of donors would donate again, while 4.3% would not (mostly women). The reasons not to donate again was mainly related to poor outcome of the kidney recipient, or long-lasting major pain or disappointment about medical handling before (not enough information, wrong advice) and after organ donation. The association of Swiss Living Organ Donors, where only kidney or liver donors can become a member, are organising self-help-groups for pain, psychological and financial problems (with health insurances). The organisation and financial support of SOL-DHR is briefly described. The waste majority of living kidney donors are very satisfied about the free care given by SOL-DHR.

Gender imbalance in living kidney donation in Switzerland.

Gender characteristics were analyzed in 631 living kidney donors followed by the Swiss Organ Living Donor Health Registry (SOL-DHR) from 1993 to 2003; 65% of kidney donors were women and 64% of recipients were men. The proportion remained stable over the years and in different donor age classes from 25 to 74 years. The observed rate of female life partners giving their kidneys to male life partners was significantly higher than expected (P < .005). After exclusion of spousal pairs, the observed rate of gender pairing in all 4 possible directions differed significantly from the expected rate (P < .0001). Men were always behind the expected rate for kidney donation and women ahead. The main 3 reasons for gender imbalance in living kidney donors in Switzerland are the higher risk of men to acquire end-stage renal failure, financial risks for main breadwinners and the traditional female role in family life. Measures are proposed to narrow the gap between expected and observed gender balance in living organ donation.

Sodium balance-neutral sodium profiling does not improve dialysis tolerance.

BACKGROUND: Modern haemodialysis monitors offer computerised ultrafiltration and sodium concentration profiles which promise better dialysis tolerance. This presumption was tested in chronic haemodialysis patients. METHODS: Using Fresenius MC 4008S monitors a group of nine patients were dialysed with a given ultrafiltration profile comparing sessions with decreasing sodium concentration (145 to 133 mmol/L) to sessions with constant sodium concentration (138 mmol/L) in random order. The built-in blood volume monitor recorded changes in haematocrit and blood volume during each dialysis. The analyses included dialytic weight loss, interdialytic weight gain and adverse symptoms (hypotensive episodes and muscle cramps). RESULTS: 321 dialysis sessions, 160 with and 161 without sodium profile, were available for analysis. No significant differences could be detected regarding changes in haematocrit, blood volume and weight in relation to sodium profiling. No significant difference in the incidence of hypotension or muscle cramping was observed with 55 symptomatic dialyses of 160 with sodium profile, compared to 52 symptomatic dialyses of 161 without sodium profile. Interdialytic weight gain and consequent weight loss during dialysis was higher in symptomatic dialyses both with sodium profile or without sodium profile. The same was true of increase in haematocrit and decrease in blood volume, which were greater for symptomatic versus symptom-free dialyses irrespective of sodium profiling. CONCLUSIONS: Sodium balance-neutral sodium profiling failed to improve dialysis tolerance in a group of stable chronic haemodialysis patients. This may be explained by the fact that vascular refilling as deduced from changes in haematocrit was uninfluenced by sodium profiling.

Blood eosinophilia in tacrolimus-treated patients: an indicator of Pneumocystis carinii pneumonia.

BACKGROUND: Pneumocystis carinii pneumonia (PcP) in immunocompromised patients is suggested if the following symptoms develop: dyspnea, fever, and interstitial infiltrates on chest x-ray. We observed a significant blood eosinophilia in kidney recipients with PcP under immunosuppressive treatment with tacrolimus. METHODS: Blood eosinophil counts of kidney recipients under immunosuppression with tacrolimus suffering from PcP were compared to eosinophil counts of patients without evidence of PcP and to patients showing PcP under immunosuppression with cyclosporine. RESULTS: PcP-positive patients treated with tacrolimus showed a significantly higher blood eosinophil count compared to PcP-positive patients treated with cyclosporine (P=0.01), and to patients under immunosuppression with tacrolimus without PcP, respectively (P=0.006). Eosinophilia preceded the time of a definitive PcP diagnosis by bronchoalveolar lavage and decreased after successful treatment. CONCLUSIONS: An increasing blood eosinophil count can be an indicator of P. carinii pneumonia in patients under immunosuppressive therapy with tacrolimus.