NSGC practice guideline: prenatal screening and diagnostic testing options for chromosome aneuploidy.

The BUN and FASTER studies, two prospective multicenter trials in the United States, validated the accuracy and detection rates of first and second trimester screening previously reported abroad. These studies, coupled with the 2007 release of the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin that endorsed first trimester screening as an alternative to traditional second trimester multiple marker screening, led to an explosion of screening options available to pregnant women. ACOG also recommended that invasive diagnostic testing for chromosome aneuploidy be made available to all women regardless of maternal age. More recently, another option known as Non-invasive Prenatal Testing (NIPT) became available to screen for chromosome aneuploidy. While screening and testing options may be limited due to a variety of factors, healthcare providers need to be aware of the options in their area in order to provide their patients with accurate and reliable information. If not presented clearly, patients may feel overwhelmed at the number of choices available. The following guideline includes recommendations for healthcare providers regarding which screening or diagnostic test should be offered based on availability, insurance coverage, and timing of a patient's entry into prenatal care, as well as a triage assessment so that a general process can be adapted to unique situations.

Development of Poland's Central Bone Marrow Donor Registry Affects Donor Searches for Patients With Hematological Diseases.

In the last 10 years, numbers of donors in the case of Polish potential unrelated hematopoietic stem cells (HSC) have increased dynamically, reaching 1,900,000 in 2020 (including donors presented in World Marrow Donor Association as PL6). On the world scale, the share of Polish donors in the global registry increased from 1% in 2010 to about 5% in 2020. The level and range of typing of potential donors has also been improving steadily toward the international "gold standard." At the end of 2020, 92% of Polish resources were at least HLA-A, B, C, DR, DQ high- or intermediate-resolution typed, mostly by way of genomic typing techniques, mostly by way of genomic typing techniques. The Central Bone Marrow Donor Registry (CBMDR) also stands out in terms of the young ages of potential donors. As of 2020, 27.2% of those registered were younger than 30 years of age, and 36.3% were aged between 30 and 40 years. Sixty percent of registered donors were female. The data in question were presented at the World Marrow Donor Association Search & Match Service, ensuring their visibility and accessibility to Polish and international search units and registries. In 2020, donors in Poland were the subject of almost 18,000 search requests from 40 countries, with 271 extended typing requests and more than 7600 confirmatory typing requests. The total number of donations from Polish donors also increased. In 2020, HSC of bone marrow, peripheral blood, or lymphocytes were collected from 1391 donors, as opposed to 94 donors in 2010. The growing number of donors available in the CBMDR means a better chance of a donor being found among Polish resources, without any need to resort to international registers. Although in 2010, just 24% of Polish recipients received HSC from Polish donors, by 2019 the figure was as high as 67%, and reached 63% in 2020. The CBMDR is an example of proper strategy on registry development being implemented in Poland.

Polycylic aromatic hydrocarbons in rape seeds with relation to their growing site and thermal treatment.

A significant source of polycyclic aromatic hydrocarbons (PAH) in human diet is vegetable oils, especially those produced from plants grown in regions where the soil and the atmosphere are contaminated with these chemicals. Contamination with PAH of vegetable oils may also occur in the process of plant material drying with smoke or exhaust fumes, or in the course of extraction of that material with solvents containing trace amounts of PAH. The objective of this study was to determine the relationship between the levels of PAH present in rape seeds and the occurrence of these compounds in cultivation region and the relationship of the levels of PAH in rape seeds to thermal treatment after harvest. Rape seeds and pods from experimental fields and rape seeds subjected to thermal treatment in dryers obtained from suppliers of the raw material were examined and compared. Cleanup of extracts was performed with high-resolution size exclusion chromatography (SEC) and final determinations were by Trace Ultra/PolarisQ gas chromatography-mass spectroscopy (GC-MS). The results obtained indicated that during thermal treatment of rape seeds the concentration of PAH increased, but the levels of benzo[a]pyrene did not exceed threshold permissible levels. Data demonstrate that rapeseed cultivation in the presence of PAH results in higher levels of contaminants; however, the PAH levels still did not exceed the maximal allowable levels in Poland.

Influence of dietary peas and organic acids and probiotic supplementation on performance and caecal microbial ecology of broiler chickens.

1. The effect of dietary pea and addition of organic acid blend (OA) or probiotic (Pro) on performance and caecal microbial ecology of broiler chickens was studied. 2. A growth trial was conducted with 160 Ross 308 female broilers from d 1 to 35 of age. There were 8 treatment groups based on either control (S) or white pea (P). Both S and P were supplemented with OA (Galliacid - fumaric acid, calcium formate, calcium propionate and potassium sorbate coated with plant triglycerides, Vetagro) and or with Pro (LABYuc-Probio - lactic acid bacteria, Saccharomyces cerevisiae and Yucca schidigeri extract, Mifarmex GmbH). 3. Inclusion of peas in the diet increased feed intake and decreased gain:feed ratio in comparison to the control diet. Neither probiotic nor OA supplementations affected broiler performance. 4. The caecal microbiota was characterised in 37-d-old birds by fluorescent in situ hybridisation (FISH) and terminal-restriction fragment length polymorphism (T-RFLP). Total bacterial counts in caecal contents were slightly higher for birds fed the pea diets, but were not affected by OA or Pro supplements. 5. Neither pea nor Pro affected the Lactobacillus/Enterococcus and Streptococcus/Lactococcus counts in caecal contents, whereas OA supplementation slightly increased the Lactobacillus/Enterococcus counts. The composition of the Lactobacillus/Enterococcus population was altered by inclusion of peas as revealed by the T-RFLP patterns. 6. The DNA fingerprint further suggested that the caecal microbiota was dominated by the lactic acid bacterium Streptococcus alactolyticus. 7. In ileal contents, the concentration of short-chain fatty acids (SCFA) was decreased only by Pro supplementation. In caecal contents, the SCFA concentration was higher for birds fed on the pea diets, and increased significantly with Pro supplementation 8. In conclusion, the results indicate that the use of pea and probiotics in broiler feed may stimulate the caecal commensal microbiota (growth and/or activity) to some extent and hence prevent establishment of pathogenic and zoonotic enterobacteria in these segments of the gut.

Effect of an organic acid blend and phytase added to a rapeseed cake-containing diet on performance, intestinal morphology, caecal microflora activity and thyroid status of broiler chickens.

The experiment was carried out on 96 female broilers, allocated to eight groups of 12 birds kept in individual cages. Two basal wheat- and soyabean meal-based diets containing 150 g/kg of rapeseed expeller cake were formulated, differing in the level of P: 7.1 g/kg in diet H or 5.9 g/kg in diet L. Rapeseed cake supplied 3.15 micromol alkenyl glucosinolates per gram of diet. The eight treatments were: basal diets only, basal diets + phytase (1000 U/kg), basal diets + organic acid blend (OA, 6 g/kg), or basal diets + both additives. Diets were fed from day 8 to 28 of life. The results showed that the lower dietary P content and OA supplementation did not significantly affect feed intake or BWG, while both increased (p < 0.001) after phytase supplementation. Tibia ash content as well as tibia ultimate strength were lower (p < 0.001) in birds fed diets L compared with diets H, and increased (p < 0.01) with phytase supplementation of diet L, while OA had no influence on either parameter. Dietary P levels and OA supplementation had no influence on the pH of gut digesta, but the pH of jejunal digesta increased following phytase supplementation (p < 0.01). Morphological measurements of the small intestinal mucosa of chicks indicated that OA added to diet L depressed villi height (p < 0.001) and crypt depth (p < 0.001); both parameters increased after phytase supplementation (p < 0.01). The lower total SCFA as well as acetic, propionic and butyric acid concentrations in caecal digesta indicated lower activity of caecal microflora in birds fed diets L compared with H. OA supplementation had no influence, while phytase supplementation increased the concentration of acetic acid in caecal digesta. Supplementation of diets with either phytase or OA increased thyroid weight by 16% (p < 0.01) and 11% (p < 0.05) respectively. The increase in thyroid weight because of phytase supplementation was greater at the lower dietary P level, and the greatest when both phytase and OA were added to the diet.

Quality System of Kidney Donation for Transplantation From Living Donors in Poland.

OBJECTIVE: The program aims to build and develop a high-quality donation system at the hospital and national level. Thirty coordinator posts for the transplantation of kidneys from living donors (LDs) were created. The coordinators' tasks were identified as determining or excluding the possibility of LD donation for kidney transplantation for every potential kidney recipient referred to the waiting list, qualifying potential LDs, supervising health monitoring for LDs and kidney recipients, and education and promotion of transplantation from LDs. METHODS: The coordinators' reports and verification of data in the national transplant register from June 1, 2018 to November 30, 2019 were analyzed. ETHICS: The study was conducted according to principles of the Declaration of Helsinki, and the Declaration of Istanbul participation was on a voluntary basis. RESULTS: Information on possible LDs was obtained from 707 (43%) of the 1630 potential recipients entered on the waiting list. In 373 cases there was no potential LD; 16 recipients did not give consent for kidney transplantation from a LD; for 318 recipients, 340 potential LDs were identified; 90 potential LDs were rejected at the initial stage for medical reasons; 60 potential donors were rejected at further stages of the qualification process; 3 persons resigned from donation; and 23 recipients were transplanted from deceased donors. Kidneys from 73 LDs were qualified and transplanted. On November 30, 2019, 91 potential donors were awaiting further qualification. As part of the program, 27 potential pairs for paired kidney exchange were reported to Poltransplant (17 pairs with positive HLA crossmatch, 10 with incompatible blood groups). CONCLUSIONS: The creation of posts for coordinators for LD kidney transplantation in centers that qualify for LD kidney transplantation enabled systematic monitoring of donation potential, which led to an increase in the number of LD kidney transplants in 2019. Making full use of donation potential should significantly increase these numbers in the coming years.

Hospital Profiling and Hospital Stratification System as a Step for Assessment the Potential of Organ Donation From Deceased Donors.

AIM: To be able to calculate the potential of organ donation from deceased donors in a single hospital, region, and country, it is necessary to develop a useful stratification system for all hospitals taking into account their characteristics in having or not having departments crucial for donor identification and recruitment, such as an intensive care unit (ICU or neurology and neurosurgery departments), number of beds, and patient profiles (pediatric vs adult). MATERIALS AND METHODS: There are 1032 hospitals in Poland, and 388 have facilities and tools to confirm death according to neurological criteria. These hospitals with the potential of deceased donation were characterized accordingly to the criteria presented above. RESULTS: The largest group of institutions were first-degree referral hospitals having ICUs only for adults (161 hospitals), followed by hospitals with ICU and stroke departments for adults (76), then hospitals for adults with ICU and neurological department with no stroke beds (25), and hospitals for adults with second-degree referral and with ICU, stroke departments, and neurosurgery. In the case of pediatric patients and possible pediatric organ donation, the largest group consisted of 5 hospitals with pediatric ICU, pediatric neurology, and pediatric neurosurgery units. The remaining hospitals were unique in the country range. An exemplary analysis of 1 of the 40 stratified groups (19 out of 388 hospitals) showed that differences in actual activity in the donation process between similar hospitals are significant (from 0 to 62 donations in a 3-year period). CONCLUSION: We believe the results of this study are fundamental for the calculation of potential donation in the country. Our thesis is that hospitals from the same group should have the same potential and should be active in donation process on the same level. Formal comparative analysis of historical data on donor referral from active and nonactive hospitals will allow us to estimate the lost numbers of possible donations and will help focus efforts to improve transplantation systems.

Transplant Coordinators' Opinions Regarding the Decreasing Indicator of Organ Donation From Deceased Donors in Poland.

Despite the good overall condition of Polish transplantation medicine there is a shortage of organs for transplantation. Health care is also in a stage of development with problems including insufficient funding and lack of personnel. In 2015 the number of deceased organ donors in Poland was 526, which was distinctly lower than in 2014 when it reached 594. The aim of this paper was to collect, elaborate on, and summarize the opinions of transplant coordinators regarding the decrease of donation indicators in Poland. MATERIALS AND METHODS: The opinions of the transplant coordinators were collected during training meetings and questionnaires performed in 2016. The questionnaires targeted coordinators of active hospitals (above 5 retrievals a year) and less active donor hospitals. RESULTS AND DISCUSSION: Transplant coordinators indicated a number of factors that influence donor hospital activity, such as changing roles of intensive care units, changes in hospital flow of patients in critical condition, lack of nurses and anesthesiologists resulting in work overload, changes in forms of doctors' employment, low basic income of health professionals, difficulties in determination of brain death, decrease in engagement of transplant centers in cooperation with donors' hospitals, inadequate in-hospital training meetings, undermining of authority of doctors and medical personnel, change of attitude towards transplantation medicine (treated as profitable, regular specialty), insufficient funding of hospitals and personnel for deceased donor recruitment, and disobeying the rules of personnel remuneration for their engagement in donation and retrieval. CONCLUSIONS: Analyzing the opinions of the coordinators, we can state the following: 1. support of the hospital or hospital unit management is crucial for effective donation programs, 2. there is a need to build and implement a hospital quality systems covering each stage of donor recruitment as well as hospital trainings, 3. there should be a transplant coordination team rather than a single coordinator, 4. transplantation centers should maintain good cooperation with donor hospitals, and 5. intensive care unit personnel identification with their own hospital, which is less likely in the case of "locum" employment, is one of the major factors supporting donation programs.

Kidney Transplant Recipients With Rheumatic Diseases: Epidemiological Data From the Polish Transplant Registries 1998-2015.

Chronic kidney disease (CKD) is a common complication of rheumatic disorders. We analyzed the incidence of different rheumatic conditions as a primary diagnosis of end-stage renal disease (ESRD) in kidney transplant recipients in Poland. Data were received from the national waiting list for organ transplantation (Poltransplant) registries. Primary diagnosis leading to ESRD were analyzed in 15,984 patients who received kidney transplants between 1998 and 2015. There was no information about primary diagnosis in 4981 cases (31%) and in 1482 cases (9%) the diagnosis was described as unknown. Rheumatic diseases were specified in 566 (5.14%) kidney transplant recipients: lupus erythematosus, (systemic lupus erythematous nephritis) in 211 (1.92%), vasculitis in 176 (1.60%), amyloidosis AA in 82 (0.75%), hemolytic uremic syndrome in 59 (0.54%), secondary glomerulonephritis in 24 (0.22%), scleroderma in 9 (0.08%), rheumatoid arthritis in 4 (0.04%) and Sjögren syndrome in 1 (0.01%). Graft survival at 1 and 5 years were significantly better in the nonrheumatic versus rheumatic group (90 vs 87% and 76 vs 72% respectively, P = .04). Recipient survival at 5 years was significantly better in the nonrheumatic versus the rheumatic group (88 vs 84%, P = .02). Our study showed that systemic lupus erythematosus and systemic vasculitides are the major rheumatic causes of ESRD in the Polish population. Long-term graft and recipient survival were significantly better in the nonrheumatic versus the rheumatic group in the Poltransplant cohort.

Results of Renal Transplant From Deceased Anti-hepatitis C Virus Donors, Poland 1998-2012.

Kidney transplant (KTx) is the best method of renal insufficiency treatment. In dialyzed patients, mortality rises with the time on dialysis. There is a continuing shortage of organs for transplantation, hence a propensity to expand the donor pool with expanded-criteria donors, anti-hepatitis C virus-positive included. In the above case a transmission of hepatitis C virus (HCV) genotype to recipient is present. It has been proven that contamination with more than 1 HCV genotype did not worsen KTx outcomes. There are 2.6% anti-HCV(+) donors in Poland. Use is only possible in cases of anti-HCV(+) and anti-HCV RNA(+) recipients. METHODS: Retrospective analysis covered 8675 deceased donors (1998-2012 Polish data from Poltransplant). The early (after 12 months) and late (after 60 months) graft and patient survival was assessed in KTx recipients, with documented recipient and donor data spanning at least 1 year after KTx. In comprehensive analysis, 7016 KTx recipients with known anti-HCV status were included according to anti-HCV profile of recipient and donor. The results are in absolute and percentage values and P < .05 assessed with χ2 test. RESULTS: Twelve-month survival: recipient (R) (95%), graft (G) (89%), total; R (95% vs 89%, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(+/-) vs HCV(+) to HCV(+); R (95 vs 94, P = .2), G (88 vs 83, P < .001), HCV(-) to HCV(-) vs HCV(-) to HCV(+); R (93 vs 95, P = .004), G (82 vs 89, P < .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (95 vs 89, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(-) vs HCV(+) vs HCV (+). Sixty-month survival: R (86%), G (75%), total; R (84 vs 88, P = .01), G (63 vs 71, P = .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (88 vs 80, P = .003) in HCV(-) to HCV(-) vs HCV(+) to HCV(+). CONCLUSIONS: The worst anti-HCV serological profile was HCV(+) to HCV(+), although transplanting HCV(+) to HCV(+) did not worsen outcomes in that group. Worse KTx outcomes of HCV(+) over HCV(-) donors can be attributed to HCV(+) status of the recipient.

Organ and Tissue Procurement From Non-residents Deceased in Poland: Guidelines for Transplant Coordinators.

Due to increasing global mobility, the number of non-residents who are potential deceased organ donors is likely to increase as well. Since 2014, 14 deceased foreigners have been referred as potential organ donors in Poland. There are, however, no precise international agreements between Poland and other countries regulating this issue. The aim of this paper is to provide guidelines on this subject for transplant coordinators. While there are no differences in the algorithms of potential donor identification, death diagnosis, donor management, organ procurement and preservation, allocation, transportation and transplantation, and the medical evaluation of a foreigner as a potential organ donor may differ. In certain cases, the risk of tropical or endemic infections should be evaluated. The authorization of the procurement may differ as well-foreigners who are not listed in the Polish Electronic System for Registration of Population cannot be registered in Polish Central Registry of Objection. They may have also not expressed refusal or consent for donation due to different legal solutions in their home countries. The donor's family and the proper diplomatic representative must be involved in donation process in order to obtain authorization for organ donation, to acquire essential medical information about the donor, and to ensure the transparency of the process. The procurement of organs, tissues and cells from foreigners deceased in Poland may be performed provided that a proper donor qualification process is conducted, the deceased had not objected to donation, there is no objection on the part of the donor's family or the prosecutor (if required), and the donation and procurement are properly described in medical documentation.

Results of Transplantation of Kidneys Procured From Donors After Brain Death Aged 60 Years and Older.

OBJECTIVE: To analyze results of transplantation of kidneys procured from donors after brain death aged 60 years and older (hereafter denoted by "≥60") compared to kidneys procured from donors after brain death aged 40-59 years (hereafter denoted by "40-59") in medium-term follow-up period, and to assess factors that affect recipient and kidney graft survival. MATERIAL AND METHODS: 92 transplant recipients of kidneys procured from donors after brain death ≥60 were enrolled into the study. The control group were 363 recipients of kidneys procured from donors after brain death 40-59. RESULTS: Mean values of serum creatinine were higher in recipients of kidneys procured from donors after brain death ≥60 compared to control after 3 years: 168.2 ± 57.5 (n = 59) vs 147.9 ± 65.7 (n = 294), P < .05; and after 5 years: 196.2 ± 95.3 (n = 38) vs 157.3 ± 80.0 µmol/L (n = 211), P < .01. Restricted mean recipient survival time was 56.4 (95% confidence interval: 55.0-57.8) and 52.0 (48.0-56.1) months, P < .05; and kidney graft survival time was 51.6 (49.6-53.5) and 43.9 (39.0-48.9) months, P < .01 in recipients who received kidneys from donors after brain death 40-59 and from donors after brain death ≥60 respectively. In Cox regression, donor death due to cardiovascular disease proved to be the factor increasing risk of kidney graft loss (hazard ratio 1.553, P < .001). CONCLUSIONS: The survival and function of kidneys procured from donors after brain death ≥60 at medium-term follow-up remain worse compared to kidneys procured from donors after brain death 40-59, and the donor dependent risk factor of kidney graft loss is cardiovascular disease, which caused donor death.

Viral hepatitis B and C markers in the population of deceased donors in Poland.

In the years 2001 to 2005 in Poland, 3146 potential deceased donors were referred with 2583 (82%) organs procured and 57 (2%) donors not used due to positive viral markers. According to Polish rules, in every case of possible organ harvest from a deceased donor we test viral markers of anti-HIV I/II, HBsAg, and anti-HCV. Organs from HBsAg-positive donors (the rule accepted in Poland a few years ago) are not transplanted; kidneys from anti-HCV(+) donors are transplanted into matched recipients. According to donor hospital capabilities, other viral tests are performed: anti-HBs, anti-HBc, HBeAg, and anti-HBe. We calculate the frequency of positive serological tests for viral markers among the population of deceased donors, for HBsAg it was 1.1% (from these donors 10 kidneys and 1 liver were transplanted); and for anti-HCV it was 2.6% (from these donors 78 kidneys were used). Anti-HBc-positive deceased donors, particularly liver donors (due to the high risk of viral transmission and de novo infection), are a major problem in transplantation, which reduced the number of used organs. Only 17 of 86 (20%) of the HBc-positive donors became liver donors compared with 257 of 524 (49%) donors from the HBc-negative group. But anti-HBc was checked only in 24% of potential donors (positive in 16.6% of cases), which means that 506 of 780 transplanted livers (65%) were obtained from donors of unknown anti-HBc status, 257 (33%) from anti-HBc-negative subjects and 17 (2%) from anti-HBc-positive subjects.

Long-term results of kidney transplantation from HCV-positive donors.

BACKGROUND: Due to the shortage of organs for transplantation, procurement of kidneys from marginal donors is inevitable. Not infrequently, these donors are infected with hepatitis C virus (HCV). AIM: We sought to determine the effect of transplanting kidneys from anti-HCV-positive donors to anti-HCV-positive recipients. PATIENTS AND METHODS: Among 765 procedures between 1994 and 2006, 259 kidney recipients were anti-HCV-positive, including 60 who received kidneys from anti-HCV-positive donors (HCV(+)/HCV(+) group) and the others, from seronegative donors (HCV(-)/HCV(+) group). The control group of 506 seronegative recipients received kidneys from seronegative donors (HCV(-)/HCV(-) group). All kidneys from anti-HCV-positive donors were preserved with machine perfusion. We investigated recipient liver function tests (LFTs; alanine aminotrasferase, aspartate aminotransferase; alkaline phosphatase, and bilirubin), graft survival, and patient survival. RESULTS: No significant difference was observed between the groups among the biochemistry results (LFTs, creatinine at 5 years). No significant differences, were observed in patient survival, graft survival, or number of patients returning to dialysis. CONCLUSION: Transplantation of kidneys from HCV-positive donors to HCV-positive recipients did not influence long-term liver function, or long-term renal allograft function. This strategy enhances the availability of transplantation as means of end-stage renal disease treatment.

Organ donation in Poland 2006.

Organ transplantation program has been slowly developing over last 30 years. The number of DD (deceased donors) stabilized on the level of approximately 13/million of population. Multiorgan donation has been 45%, due to some problems with donor management. Polish Transplant Coordinating Center POLTRANSPLANT which is responsible for organization of procurement, organ allocation and providing several registries (registry of objections, registry of transplantation, waiting lists of potential organ recipients etc). National data on organ donation and transplantation are each year submitted to the Ministry of Health and the National Transplantation Council which is the Advisory Committee to the Minister.

Questionnaire regarding the knowledge of the rules of organ procurement from cadaveric donors for transplantation directed to the directors of medical institutions in Poland.

We assessed the level of knowledge of organ procurement regulations among the directors of medical institutions in Poland. We also sought to promote the objection form, and the activity of the Central Register of Objections. A questionnaire consisting of 10 questions was sent to 381 random medical health care institution directors countrywide. In 89% of surveyed institutions, the written text of the organ procurement regulations was available and 94% of directors knew the forms of objection, but in 26% of institutions the form was not available and in 14% it was never obtainable. In the medical institutions directors' opinions, the estimated number of objections is 13% of the population in Poland. Organ transplantation is a form of treatment most medical institutions are familiar with, but the matter of donation is not as well known as transplantation, as observed in 48% of questioned institutions.

Fever, human herpesvirus-6 (HHV-6) seroconversion, and acute rejection episodes as a function of the initial seroprevalence for HHV-6 in renal transplant recipients.

Human herpesvirus-6 (HHV-6) is an opportunistic viral pathogen of emerging clinical significance in immunocompromised patients. We performed a seroepidemiological survey to test the relation between seroprevalence among donors and recipients for HHV-6 at three endpoints. Before transplantation sera obtained from cadaveric donors and from potential recipients were tested for IgG antibodies against HHV-6 using an enzyme-linked immunoassay. The group of recipient sera, including samples obtained before as well as 2, 4, 12, and 48 weeks after transplantation, were tested for anti-HHV-6 IgM antibodies using an indirect immunofluorescence assay. The statistical analysis was performed with the Cox proportional hazards models. The HHV-6 seronegative group (n = 11) compared with the HHV-6 seropositive group (n = 109) showed twice the risk of HHV-6 IgM seroconversion (RR = 2.24; P < .04), with a greater risk of fever, namely 3.8, which was on the verge of statistical significance. The opposite trend toward an association with acute rejection episodes was observed among HHV-6 seronegative patients (RR = 1.81). The presence of IgG antibody in the sera of donors to IgG seropositive recipients had no association with the occurrence of IgM seroconversion. In contrast, IgM antibodies to HHV-6 appeared in four of five seronegative patients who received allografts from IgG seropositive donors. These preliminary data suggest that the effects seem to be the consequence of HHV-6 transmission through a renal allograft.

Geography of the referred potential liver recipients and donors in Poland in 2004.

Our aim was to assess the accessibility of potential liver recipients to cadaveric organs and the ability of transplant teams to realize recipients needs in Poland in 2004. Our calculations revealed that in Poland the number of cadaveric liver transplants was two to three times lower than in other countries and is insufficient to meet the needs, also the number of referred potential liver recipients is two to three times lower than expected.

Effective Application of a Quality System in the Donation Process at Hospital Level.

This article describes the application of a quality system at the hospital level at the Multidisciplinary Hospital in Warsaw-Miedzylesie in Poland. A quality system of hospital procedures (in accordance with the ISO system 9001:2008) regarding the donation process, from the identification of a possible donor to the retrieval of organs, was applied there in 2014. Seven independent documents about hospital procedures, were designed to cover the entire process of donation. The number of donors identified increased after the application of the quality system. The reason for this increase is, above all, the cooperation of the well-trained team of specialists who have been engaged in the process of donation for many years, but formal procedures certainly organize the process and make it easier.

Liver Donation and Transplantation in Poland: Numbers, Indicators, and Trends.

We aim to provide a panorama of liver donation and transplantation in Poland, where each year around 300 liver transplantations from deceased donors and 20 liver fragment transplantations from living donors are performed. This means about 9 transplantations per population of 1 million. Each year, the number of deceased donors reaches more than 500. In more than 50% of cases, livers are used. The law allows liver procurement from living donors. Until the end of 2013, liver fragments were recovered from 236 living donors and transplanted mainly to pediatric recipients (n = 232). A living-donor registry was created to monitor and assess the health condition of donors. The range of the national waiting list and allocation is nationwide. It is managed with the use of the Web tool www.rejestry.net. There are 2 modes of recipient referral: "urgent" and "elective." Allocation is either patient oriented and center oriented. Disease groups, which comprise the most frequent indications for transplantation in adults, include the cirrhosis group (48%), in which the highest number of procedures was performed for patients with hepatitis C virus (24%); alcohol-induced cirrhosis (14%); alcohol-induced hepatitis (8%), and hepatitis B virus cirrhosis (7%). Among pediatric recipients, the most frequent indications were congenital cholestatic diseases, which made up 38% of all transplantation indications. The results of liver transplantations are collected in the national transplant register. The 1-year graft and recipient survival with deceased donor transplantation are 81% and 84% and with living donor transplantation 86% and 89%. The 5-year graft and recipient survival in deceased donor transplantation are 69% and 73%, and in living donor transplantation are 80% and 83%.