Publications by authors named "Alicja Dębska-Ślizień"

139 Publications

The utility of cytolytic flow cytometry crossmatch before kidney transplantation.

Transpl Immunol 2021 Jun 7;68:101426. Epub 2021 Jun 7.

Department of Medical Immunology, Medical University of Gdańsk, Poland.

The donor/recipient matching in kidney transplantation is based on approved laboratory tests, which are complement-dependent cytotoxic crossmatch (CDC-XM) and flow cytometry crossmatch (FCXM). Both have some disadvantages: CDC-XM has low sensitivity, whereas FCXM does not differentiate between lytic vs. non-lytic alloantibodies. To find an improved method, we have developed a new crossmatch technique of cytolytic flow cytometry crossmatch (cFCXM), which allows for sensitive detection of clinically relevant complement-binding antibodies. The cFCXM assay detects dead cells with viability dye that ensue from the binding of allospecific lytic antibodies. In our study, 135 unsensitized kidney transplant recipients were recruited based on the CDC-XM and FCXM results and the clinical utility of cFCXM was evaluated. The 5-year follow-up for acute rejection incidents revealed that cFCXM could verify the clinical relevance of positive FCXM results as recipients with positive FCXM but negative CDC-XM had the same risk of rejection as patients with both negative CDC-XM/FCXM results. These findings suggest that cFCXM assay may provide more precise immunological risk assessment in kidney transplant recipients.
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http://dx.doi.org/10.1016/j.trim.2021.101426DOI Listing
June 2021

Extremely high mortality in COVID-19 hemodialyzed patients in before anty-SARS-CoV-2 vaccination era. The first large database from Poland.

Pol Arch Intern Med 2021 Jun 9. Epub 2021 Jun 9.

Introduction: Preliminary reports suggest a high incidence and mortality with SARS-CoV-2 infection in patients receiving kidney replacement therapy.

Objectives: To describe the incidence and outcomes of COVID-19 in hemodialyzed (HD) patients.

Patients And Methods: We conducted a cohort, retrospective, multicenter study on incidence and mortality of COVID-19 in HD patients compared to the adult general population from the beginning of the pandemic until the commencement of vaccination against SARS-CoV-2 infection. The study population included all prevalent HD patients in 14 dialysis units of the Pomeranian Voivodeship, Poland on December 31, 2019 and all new subjects starting long-term hemodialysis between January 01, 2020 and January 31, 2021, 1567 patients in total. General population data was obtained from health authorities reports.

Results: The absolute cumulative incidence of SARS-CoV-2 infection was 22.4% in HD patients and after age standardization was 3.98 times higher compared to the controls (P<0.001). The epidemic trajectory of both groups ran in parallel, but the increase and the decline in the number of new cases occurred earlier in HD patients. Fatality rate of COVID-19 was 30.4% in HD patients. It was highest among the oldest patients reaching 43.81% among subjects from the age 75 years (P=0.003). Age standardized fatality and mortality rates in HD patients were 5.5 and 10.9 times higher than in controls (both: P<0.001).

Conclusions: The results of this study show the extremely high mortality of COVID-19 in HD patients during the first and second wave of the epidemic in the Pomeranian Voivodeship before the vaccination era.
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http://dx.doi.org/10.20452/pamw.16028DOI Listing
June 2021

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Eastern and Central Europe.

Kidney Int Suppl (2011) 2021 May 12;11(2):e24-e34. Epub 2021 Apr 12.

Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey.

Provision of adequate kidney care for patients with chronic kidney disease or kidney failure (KF) is costly and requires extensive resources. There is an inequality in the global distribution of wealth and resources needed to provide this care. In this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we present data for countries in Eastern and Central Europe. In the region, the median prevalence of chronic kidney disease was 13.15% and treated KF was 764 per million population, respectively, slightly higher than the global median of 759 per million population. In most countries in the region, over 90% of dialysis patients were on hemodialysis and patients with a functioning graft represented less than one-third of total patients with treated KF. The median annual costs for maintenance hemodialysis were close to the global median, and public funding provided nearly universal coverage of the costs of kidney replacement therapy. Nephrologists were primarily responsible for KF care. All countries had the capacity to provide long-term hemodialysis, and 95% had the capacity to provide peritoneal dialysis. Home hemodialysis was generally not available. Kidney transplantation and conservative care were available across most of the region. Almost all countries had official dialysis and transplantation registries. Eastern and Central Europe is a region with a high burden of chronic kidney disease and variable capacity to deal with it. Insufficient funding and workforce shortages coupled with increasing comorbidities among aging patients and underutilization of cost-effective dialysis therapies such as peritoneal dialysis and kidney transplantation may compromise the quality of care for patients with KF. Some workforce shortages could be addressed by improving the organization of nephrological care in some countries of the region.
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http://dx.doi.org/10.1016/j.kisu.2021.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084718PMC
May 2021

Kidney graft function and arterial stiffness in renal transplant recipients.

Acta Biochim Pol 2021 May;68(2):331-339

Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin, Berlin, Germany.

Introduction: In renal transplant recipients (RTRs), cardiovascular (CV) complications are associated with non-traditional risk factors, such as a decline in graft function, immunosuppressive therapy, time of dialysis before transplantation, inflammation and anemia. Higher value of arterial stiffness is the consequence of risk factors and it can lead to CV events. The aim of this study was the assessment of the arterial stiffness in RTRs with different value of estimated glomerular filtration rate (eGFR) and its correlation with classical and non-classical CV risk factors.

Methods: 344 stable RTRs were enrolled in this study. The arterial stiffness was measured in all participants. The study population was divided in two groups based on the value of eGFR: 201 (≥45 ml/min/1,73 m2) and 143 (<45 ml/min/1,73 m2). Demographic, immunosuppression status, clinical and biochemical information were referred to a single assessment obtained from medical records in the patients' medical files. Vascular stiffness was determined by an automated oscillometric device.

Results: In the group with eGFR<45 ml/min/1.73 m2 there were more patients with cardiovascular diseases (CVD) and the participants were older, in comparison to those with eGFR≥45 ml/min/1.73 m2. Arterial stiffness was significantly higher in the group with worse graft function. The analysis showed a significant correlation between age, cardiovascular disease and all arterial stiffness parameters. In addition, a significant correlation was found between all PWV variables and pulse pressure (PP) and pulsatile stress (PS), in the total population and in groups with eGFR <45 ml/min/1.73 m2 and eGFR≥45 ml/min/1.73 m2. The multivariate analysis showed a significant correlation between age, CVD and baPWV left, baPWV right and cf PWV in the total population. Arterial stiffness did not differ depending on eGFR.

Conclusions: Significant influence of age and CVD on arterial stiffness in RTRs was confirmed and PWV did not differ depending on eGFR. Our findings suggest that PS, as a marker for arterial stiffness, represents an easy and cost-effective tool.
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http://dx.doi.org/10.18388/abp.2020_5595DOI Listing
May 2021

Associations between constipation symptoms and the sleep quality in non-dialysis chronic kidney disease patients: a cross-sectional study.

Pol Arch Intern Med 2021 Apr 27. Epub 2021 Apr 27.

Introduction: Sleep disturbances, similarly to constipation-related symptoms, are common problems in chronic kidney disease (CKD) patients and are associated with worse health-related quality of life.

Objectives: We aimed at detailing the sleep problems in conservatively-treated CKD patients, and at verifying the associations between the sleep quality and constipation in these patients.

Patients And Methods: In this cross-sectional study, 100 conservatively-treated CKD outpatients filled questionnaires that included questions addressing sleep quality (The Medical Outcomes Study 12-item Sleep Scale-Revised (MOS-Sleep-R)) and constipation-related symptoms (PAC-SYM, Rome III criteria).

Results: The T-scores of none of the assessed sleep domains differed significantly across the eGFR terciles (all P > 0.05). PAC-SYM abdominal and stool scales scores significantly correlated with all assessed sleep quality domains. In both univariable and multivariable regression models adjusted for key clinical data, functional constipation, having less than 7 bowel movements a week, abdominal discomfort and pain, as well as too small bowel movements, were independently associated with increased prevalence ratio of decreased sleep quality.

Conclusions: In non-dialysis CKD patients, sleep disorders can possess common etiological factors with constipation-related symptoms.
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http://dx.doi.org/10.20452/pamw.15974DOI Listing
April 2021

Analysis of Serum Fatty Acids Profile in Kidney Transplant Recipients.

Nutrients 2021 Feb 28;13(3). Epub 2021 Feb 28.

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland.

Patients with end-stage kidney disease, treated with renal transplantation, are at increased risk of cardio-vascular disease (CVD) and cardio-vascular mortality. They are also characterized by an atherogenic dyslipidemia. Alterations of the fatty acids (FA) profile contribute to increased cardio-vascular risk in the general population. In the current study, we test the hypothesis that kidney transplantation is associated with ab-normalities in FA profile. The FA profile was analyzed by gas chromatography-mass spectrometry in 198 renal transplant recipients, and 48 control subjects. The most profound differences between renal transplant patients and controls were related to the content of branched chain FA, monounsaturated FA, and n-6 polyunsaturated FA, respectively. The FA profile significantly separated the patients from the controls in the principal component analysis (PCA). The abnormalities of FA profile showed a tendency for normalization in long-term kidney recipients, as compared to patients with recent transplants. The n-3 PUFA content demonstrated a strong inverse association with the presence of inflammation. Most profound alterations of the FA profile were observed in patients with impaired graft function (glomerular filtration rate < 45 mL/min). The study demonstrated significant disorders of the FA profile in kidney transplant recipients, which might contribute to cardio-vascular risk in this vulnerable patient population.
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http://dx.doi.org/10.3390/nu13030805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001777PMC
February 2021

Non-HDL-C/TG ratio indicates significant underestimation of calculated low-density lipoprotein cholesterol (LDL-C) better than TG level: a study on the reliability of mathematical formulas used for LDL-C estimation.

Clin Chem Lab Med 2021 Apr 24;59(5):857-867. Epub 2020 Dec 24.

Department of Clinical Chemistry, Medical University of Gdańsk, Gdańsk, Poland.

Objectives: Low-density lipoprotein cholesterol (LDL-C) is the main laboratory parameter used for the management of cardiovascular disease. The aim of this study was to compare measured LDL-C with LDL-C as calculated by the Friedewald, Martin/Hopkins, Vujovic, and Sampson formulas with regard to triglyceride (TG), LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C)/TG ratio.

Methods: The 1,209 calculated LDL-C results were compared with LDL-C measured using ultracentrifugation-precipitation (first study) and direct (second study) methods. The Passing-Bablok regression was applied to compare the methods. The percentage difference between calculated and measured LDL-C (total error) and the number of results exceeding the total error goal of 12% were established.

Results: There was good correlation between the measurement and calculation methods (r 0.962-0.985). The median total error ranged from -2.7%/+1.4% (first/second study) for Vujovic formula to -6.7%/-4.3% for Friedewald formula. The numbers of underestimated results exceeding the total error goal of 12% were 67 (Vujovic), 134 (Martin/Hopkins), 157 (Samspon), and 239 (Friedewald). Less than 7% of those results were obtained for samples with TG >4.5 mmol/L. From 57% (Martin/Hopkins) to 81% (Vujovic) of underestimated results were obtained for samples with a non-HDL-C/TG ratio of <2.4.

Conclusions: The Martin/Hopkins, Vujovic and Sampson formulas appear to be more accurate than the Friedewald formula. To minimize the number of significantly underestimated LDL-C results, we propose the implementation of risk categories according to non-HDL-C/TG ratio and suggest that for samples with a non-HDL-C/TG ratio of <1.2, the LDL-C level should not be calculated but measured independently from TG level.
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http://dx.doi.org/10.1515/cclm-2020-1366DOI Listing
April 2021

The renin-angiotensin-aldosterone system blockade and arterial stiffness in renal transplant recipients - a cross-sectional prospective observational clinical study.

Acta Biochim Pol 2020 Dec;67(4):613-622

Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin, Germany.

Introduction: Arterial stiffness parameters can be used as a predictor of cardiovascular events in the general population and renal transplant recipients (RTRs). Additionally, the renin-angiotensin-aldosterone-system (RAAS) blockade mitigates arterial stiffness in the general population. There are no sufficient data concerning the role of the RAAS blockade in reducing arterial stiffness among patients after kidney transplantation. The aim of this study is to assess the influence of the above blockade on arterial stiffness in RTRs.

Methods: 344 stable RTRs were enrolled in the study. 204 (59.3%) of them received RAAS blockers (angiotensin convertase inhibitors - ACEIs or angiotensin receptor blockers - ARBs): group RAAS (+), and 140 (40.7%) were not treated with such agents: group RAAS (-).

Results: In the RAAS (+) group, 55.9% of the patients used ARBs and 44.1% ACEIs. Cardiovascular disease (coronary artery disease and/or peripheral obliterans artery disease) (27.9% vs 14.3%, p<0.05), and heart failure (27.4% vs 24.3%, p<0.05) were significantly more often diagnosed in the RAAS (+) group when compared to the RAAS (-) group. Systolic blood pressure, diastolic blood pressure and all arterial stiffness parameters (baPWV, cfPWV, pulse pressure) did not differ significantly between the RAAS (+) and RAAS (-) groups. The results revealed that cardiovascular disease in patients was associated with a significant increase in both, the PWV and pulse pressure. No difference between the arterial stiffness parameters was observed in patients with a cardiovascular disease, diabetes and heart failure in the RAAS (+) and RAAS (-) groups. Moreover, beta-blockers and diuretics ameliorated the arterial stiffness parameters.

Conclusions: This study showed the indication bias of the RAAS prescription, and no conclusion on the influence of RAAS on arterial stiffness can be drawn. The results indicated diuretics and beta-blockers as agents lowering the arterial stiffness in RTRs.
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http://dx.doi.org/10.18388/abp.2020_5490DOI Listing
December 2020

KDIGO Controversies Conference on onco-nephrology: kidney disease in hematological malignancies and the burden of cancer after kidney transplantation.

Kidney Int 2020 12;98(6):1407-1418

Department of Internal Medicine and Therapeutics, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy. Electronic address:

The bidirectional relationship between cancer and chronic kidney disease (CKD) is complex. Patients with cancer, particularly those with hematological malignancies such as multiple myeloma and lymphoma, are at increased risk of developing acute kidney injury and CKD. On the other hand, emerging evidence from large observational registry analyses have consistently shown that cancer risk is increased by at least 2- to 3-fold in kidney transplant recipients, and the observed increased risk occurs not only in those who have received kidney transplants but also in those on dialysis and with mild- to moderate-stage CKD. The interactions between cancer and CKD have raised major therapeutic and clinical challenges in the management of these patients. Given the magnitude of the problem and uncertainties, and current controversies within the existing evidence, Kidney Disease: Improving Global Outcomes (KDIGO) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology to identify key management issues in nephrology relevant to patients with malignancy. This report covers the discussed controversies in kidney disease in hematological malignancies, as well as cancer after kidney transplantation. An overview of future research priorities is also discussed.
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http://dx.doi.org/10.1016/j.kint.2020.07.012DOI Listing
December 2020

Constipation and the Quality of Life in Conservatively Treated Chronic Kidney Disease Patients: A Cross-sectional Study.

Int J Med Sci 2020 18;17(18):2954-2963. Epub 2020 Oct 18.

Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Constipation is a common gastrointestinal disorder that in general population is associated with worse health-related quality of life (HRQoL). The epidemiology of constipation has not been reliably determined in conservatively-treated CKD patients. We aimed to determine the prevalence of constipation and constipation-related symptoms in conservatively-treated CKD patients, to find factors associated with their altered prevalence ratio (PR), and to verify the associations between constipation and HRQoL. In this cross-sectional study, 111 conservatively-treated CKD outpatients fulfilled questionnaires that included questions addressing HRQoL (SF-36v2®), constipation-related symptoms (The Patient Assessment of Constipation-Symptoms questionnaire), the Bristol stool form scale (BSFS), Rome III criteria of functional constipation (FC), and frequency of bowel movement (BM). Depending on the used definition, the prevalence of constipation was 6.6-28.9%. Diuretics and paracetamol were independently associated with increased PR of BSFS-diagnosed constipation (PR 2.86, 95% CI 1.28-6.37, = 0.01) and FC (PR 2.67, 95% CI 1.07-6.64, = 0.035), respectively. The most commonly reported symptoms were bloating (50.9%) and straining to pass a BM (42.7%). Abdominal discomfort (37.3%) was independently associated with worse scores in all analyzed HRQoL domains. In multiple regressions, FC and having <7 BM/week, but not BSFS-diagnosed constipation, were associated with lower scores in several HRQoL domains. Constipation and related symptoms are prevalent in CKD patients. FC and decreased frequency of defecation, but not BSFS-diagnosed constipation, are associated with worse assessment of HRQoL in conservatively-treated CKD patients.
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http://dx.doi.org/10.7150/ijms.49648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646105PMC
October 2020

ANCA-associated vasculitis patients treated in Polish intensive care units - retrospective characteristics based on the POLVAS registry.

Anaesthesiol Intensive Ther 2020 ;52(4):281-286

Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.

Introduction: ANCA-associated vasculitides (AAV) is a group of rare disorders where inflammation and damage of the small blood vessels lead to dysfunction of the supplied organs. In severe flares of the disease patients may require intensive care unit (ICU) admission and treatment. The study aims to characterize Polish patients with AAV who were admitted to the ICU and compare them to the others.

Material And Methods: An observational, retrospective study based on the POLVAS - registry of Polish adult patients with AAV was carried out. Patients admitted to the ICU (ICU group) were identified and compared with the patients who did not require ICU admission (non-ICU group). Characteristics and comparison between groups were made using standard statistic descriptive methods.

Results: 30 patients admitted to the ICU were identified among 573 cases included in the registry. All patients in the ICU group with available data were ANCA positive. The clinical manifestations related to the ICU admission were respiratory, renal and central nervous system involvement. The treatment regimen for remission induction was similar in both groups. Almost half of the patients in the ICU-group (48.3%) required dialysis, whereas in the non-ICU group it was 21.8% (P = 0.01). Infections were also more frequent in the ICU group (72.4% vs. 36.9% P < 0.001). The mortality rate among patients who needed ICU treatment was significantly higher when compared to the rest of the patients (53.6% vs. 7.8%; P < 0.001).

Conclusions: In the Polish AAV cohort one in twenty patients required ICU admission. This group was characterized by multiple organ involvement and high mortality.
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http://dx.doi.org/10.5114/ait.2020.100047DOI Listing
January 2020

KDIGO Controversies Conference on onco-nephrology: understanding kidney impairment and solid-organ malignancies, and managing kidney cancer.

Kidney Int 2020 11;98(5):1108-1119

Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Poland. Electronic address:

The association between kidney disease and cancer is multifaceted and complex. Persons with chronic kidney disease (CKD) have an increased incidence of cancer, and both cancer and cancer treatments can cause impaired kidney function. Renal issues in the setting of malignancy can worsen patient outcomes and diminish the adequacy of anticancer treatments. In addition, the oncology treatment landscape is changing rapidly, and data on tolerability of novel therapies in patients with CKD are often lacking. Caring for oncology patients has become more specialized and interdisciplinary, currently requiring collaboration among specialists in nephrology, medical oncology, critical care, clinical pharmacology/pharmacy, and palliative care, in addition to surgeons and urologists. To identify key management issues in nephrology relevant to patients with malignancy, KDIGO (Kidney Disease: Improving Global Outcomes) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology in December 2018. This report covers issues related to kidney impairment and solid organ malignancies as well as management and treatment of kidney cancer. Knowledge gaps, areas of controversy, and research priorities are described.
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http://dx.doi.org/10.1016/j.kint.2020.06.046DOI Listing
November 2020

Subphenotypes of ANCA-associated vasculitis identified by latent class analysis.

Clin Exp Rheumatol 2021 Mar-Apr;39 Suppl 129(2):62-68. Epub 2020 Sep 1.

2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland.

Objectives: ANCA-associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown aetiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus, there is an unmet need for phenotype identification, especially among patients with granulomatosis with polyangiitis (GPA). Patients with microscopic polyangiitis (MPA) seem to be clinically much more uniform. Recently, three subcategories of AAV have been proposed and described as non-severe AAV, severe PR3-AAV, and severe MPO-AAV.

Methods: In line with these attempts, we decided to use an unbiased approach offered by latent class analysis (LCA) to subcategorise GPA and MPA in a large cohort of Polish AAV patients included in a multicentre POLVAS registry.

Results: LCA of our AAV group identified a four-class model of AAV, including previously proposed three subphenotypes and revealing a fourth (previously not described) clinically relevant subphenotype. This new subphenotype includes only GPA patients, usually diagnosed at a younger age as compared to other groups, and characterised by multiorgan involvement, high relapse rate, relatively high risk of death, but no end-stage kidney disease.

Conclusions: Based on multiple clinical and serological variables, LCA methodology identified 4-class model of AAV. This newly described fourth class of AAV may be of clinical relevance and may require prompt diagnosis and aggressive treatment due to the multiorgan involvement, high risk of relapse and marked mortality among these relatively young GPA subjects.
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May 2021

14 Congress of the Polish Transplantation Society.

Transplant Proc 2020 Sep;52(7):1963

Secretary of the Polish Transplantation Society in 2017-2019.

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http://dx.doi.org/10.1016/j.transproceed.2020.07.015DOI Listing
September 2020

"Old School" Islet Purification Based on the Unit Gravity Sedimentation as a Rescue Technique for Intraportal Islet Transplantation-A Case Report.

Cell Transplant 2020 Jan-Dec;29:963689720947098

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Here, we present a case that required a supplemental "old school" islet purification for a safe intraportal infusion. Following pancreas procurement from a brain-dead 26-year-old male donor (body mass index: 21.9), 24.6 ml of islet tissue was isolated after continuous density gradient centrifugation. The islet yield was 504,000 islet equivalent (IEQ), distributed among the following three fractions: 64,161 IEQ in 0.6 ml of pellet, 182,058 IEQ in 10 ml, and 258,010 IEQ in 14 ml with 95%, 20%, and 10% purity, respectively. After a 23-h culture, we applied supplemental islet purification, based on the separation of tissue subfractions during unit gravity sedimentation, a technique developed over 60 years ago ("old school"). This method enabled the reduction of the total pellet volume to 11.6 ml, while retaining 374,940 IEQ with a viability of over 90%. The final islet product was prepared in three infusion bags, containing 130,926 IEQ in 2.6 ml of pellet, 108,079 IEQ in 4 ml of pellet, and 135,935 IEQ in 5 ml of pellet with 65%, 40%, and 30% purity, respectively, and with the addition of unfractionated heparin (70 units/kg body weight). Upon the islet infusion from all three bags, portal pressure increased from 7 to 16 mmHg. Antithrombotic prophylaxis with heparin was continued for 48 h after the infusion, with target activated partial thromboplastin time 50-60 s, followed by fractionated heparin subcutaneous injections for 2 weeks. β-Cell graft function assessed on day 75 post-transplantation was good, according to Igls criteria, with complete elimination of severe hypoglycemic episodes and 50% reduction in insulin requirements. Time spent within the target glucose range (70-180 mg/dl) improved from 42% to 98% and HbA1c declined from 8.7% to 6.7%. Supplemental "old school" islet purification allowed for the safe and successful utilization of a robust and high-quality islet preparation, which otherwise would have been discarded.
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http://dx.doi.org/10.1177/0963689720947098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563026PMC
August 2020

Gastrointestinal Pathologies in Patients After Successful Renal Transplantation.

Transplant Proc 2020 Oct 23;52(8):2412-2416. Epub 2020 Jul 23.

Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Background: Kidney transplantation (KT) is the most desired and cost-effective modality of renal replacement therapy for patients with chronic kidney failure. KT protects the patient from complications that may develop during chronic dialysis. Unfortunately, evidence also suggests that KT patients are more prone to developing cancer than healthy persons. Many complications after renal transplantation can be prevented if they are detected early. The aim of this study was to evaluate the prevalence of gastrointestinal pathologies in patients after KT.

Methods: Adult patients after KT who are under the care of the Outpatient Department of Nephrology at the Medical University of Gdańsk, Poland, received alarm symptom questionnaires and referral for testing for the presence of fecal occult blood. Then, in 58 selected patients (36 men and 22 women), endoscopic examination was performed. Mean age was 57.34 ± 10.1 (range, 35-83) years.

Results: Out of 940 patients after KT, resting under supervision of the Outpatient Department, 208 patients completed the questionnaire and 118 gave a stool sample for testing: 40 results were positive. After analyzing the questionnaires and stool results, 100 patients qualified for further investigation. The endoscopic examination had been performed so far in 58 patients and revealed gastritis and/or duodenitis in 49 patients, diverticular colon disease in 26, esophagitis in 8, colon polyps in 16, stomach polyps in 4, inflammatory bowel disease in 12, and cancers in 3.

Conclusions: The preliminary results indicate that patients after KT have significant risk of gastrointestinal pathologies and require detailed diagnostic endoscopy.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.121DOI Listing
October 2020

Tunnelled haemodialysis catheter insertion into the persistent left superior vena cava.

J Vasc Access 2020 Jun 24:1129729820933529. Epub 2020 Jun 24.

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Persistent left superior vena cava is an uncommon abnormality of the venous system. Most commonly, it is diagnosed incidentally during central vein catheterisation on the left side or pacemaker implantation. We present the case of a patient with persistent left superior vena cava, which was diagnosed after the attempted insertion of tunnelled haemodialysis catheter through the left internal jugular vein. The presence of the persistent left superior vena cava was confirmed by cardiac echography and angio-computed tomography scan. The 19-cm long tunnelled haemodialysis catheter was inserted into persistent left superior vena cava through the left internal jugular vein with good long-term function.
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http://dx.doi.org/10.1177/1129729820933529DOI Listing
June 2020

Occupational Activity After Renal Transplantation vs Quality of Life, Personality Profile, and Stress Coping Styles.

Transplant Proc 2020 Oct 20;52(8):2423-2429. Epub 2020 Jun 20.

Clinic of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland.

Introduction: Kidney transplantation (KT) increases the quality of life (QoL) of patients with chronic kidney disease. Employment is one the objective indicators of KT success. The aim of the presented study was to assess the psychological predispositions of KT and hemodialysis (HD) patients, such as stress coping styles, chosen personality features, and their relationship with employment and QoL.

Material And Methods: One hundred and sixty-one persons were examined, 101 after KT, and 60 HD patients. The following methods were applied: NEO-FFI Personality Inventory; Coping Inventory for Stressful Situations (CISS); WHOQoL-BREF; and general survey, measuring sociodemographic data and work experience.

Results: In the KT group, 58 persons were employed and 43 were unemployed. HD patients were mostly unemployed, with only 15 persons working. Significant differences were identified between the results of the following variables: WHOQoL environmental scale (employed m= 16.8, standard deviation [SD] = 3; unemployed m= 15, SD = 2.8); extraversion (employed m = 6.7, SD = 2; unemployed m = 5.6, SD = 2); somatic WHOQoL scale (HD m = 12.2, SD = 2.7; KT m = 14.2, SD = 3.5). In the KT group, the following correlations were identified: extraversion with contact seeking strategy (r = 0.553), agreeableness (r = 0.245), and conscientiousness (r = 0.384); agreeableness with conscientiousness (r = 0.336). In the HD group, the following correlations were identified: task-oriented style with conscientiousness (r = 0.474); avoidance-oriented style with conscientiousness (r = -0.466); contact seeking with extraversion (r = 0.402) and agreeableness (r = 0.469).

Conclusions: The following conclusions were reached: Social competence, such as seeking and maintaining contacts, positively translates to features connected with occupational activity. Social skills strengthen the organization of healthier environment and increase QoL. Employed patients have higher social skills and QoL.
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http://dx.doi.org/10.1016/j.transproceed.2020.03.040DOI Listing
October 2020

Living Donor Preemptive Kidney Transplantation in Tuberous Sclerosis Complex Patient and the Role of Mammalian Target of Rapamycin Inhibitor: A Case Report.

Transplant Proc 2020 Oct 21;52(8):2520-2523. Epub 2020 May 21.

2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland.

Background: Kidney transplantation (KT) is the preferred treatment for end-stage kidney disease (ESKD), while preemptive (PE) living donor (LD) KT is associated with better survival, quality of life, and lower costs. Tuberous sclerosis complex (TSC) is a genetic multisystem disorder. Renal involvement (multiple bilateral angiomyolipoma [AMLs], cysts, renal cell carcinoma [RCC]) is related to significant morbidity, including ESKD and KT. Nephrectomy in TSC patients before KT is controversial. Affected kidneys carry a risk of hemorrhage or malignancy, while AMLs may be fat-poor and are often hardly distinguishable from RCC in magnetic resonance (MR)/computed tomography. On the other hand nephrectomy impedes PE KT. Mammalian target of rapamycin inhibitors (mTORi) have proved efficacy in many TSC complications, including AMLs, fat-poor AMLs, TSC-related RCC, and immunosuppressive (IS) treatment.

Case Report: A 29-year-old female TSC patient was referred for evaluation to the TSC reference center. Her family history was negative for TSC. A clinical evaluation revealed multisystem TSC manifestation (skin, brain, lungs, kidneys). MR disclosed indeterminate fat-poor renal lesions, possibly AMLs, but RCC could not be excluded. A comparison with previous MR did not show any significant progression. Due to ESKD, the patient was qualified for PE LD (mother) KT. mTORi, sirolimus, was used in IS. Creatinine at discharge was 2.1 mg/dL. Sixteen months later, MR showed significant reduction in tumor size. Two years after KT, graft function remained stable (creatinine 1.98 mg/dL). No complications related to renal lesions occurred.

Conclusions: mTORi are the therapy of choice in TSC patients after KT, achieving IS effect and improvement in TSC manifestations while avoiding nephrectomy and management of patients with indeterminate renal lesions, especially in the case of PE KT.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.128DOI Listing
October 2020

Obesity, Fat Tissue Parameters, and Arterial Stiffness in Renal Transplant Recipients.

Transplant Proc 2020 Oct 19;52(8):2341-2346. Epub 2020 May 19.

Department of Nephrology and Internal Medicine, Charité Medical University, Berlin, Germany.

Objective: Arterial stiffness and altered body composition (increased body fat mass [BFM] and decreased lean body mass) are acknowledged risk factors for adverse outcomes after kidney transplantation related to cardiovascular diseases. The aim of the study was the assessment of the relationship between arterial stiffness and fat tissue parameters in renal transplants recipients (RTrs).

Methods: A group of 344 RTrs with stable disease and a mean age of 52.7 years (62.5% men) who underwent transplantation between 1994 and 2018 were randomly enrolled in the study. The following parameters of arterial stiffness were measured: brachial-ankle and carotid-femoral pulse waves velocities (baPWVs left and right, cfPWVs). The obesity and fat tissue (body mass index [BMI], waist-to-hip ratio [WHR], BFM, fat free mass [FFM], percent body fat [PBF], trunk segmental fat analysis [TSFA], and visceral fat area [VFA]) parameters were assessed with InBody 170.

Results: The median time of dialysis and after kidney transplantation was 58.5 and 78 months, respectively. Obesity according BMI, WHR, and VFA was diagnosed in 49.7%, 45.0%, and 44.5% of patients, respectively. The median value of BFM, FFM, VFA, and TSFA and the mean value of PBF were 19.3 kg, 55 kg, 93.2 cm, 24.9 kg, and 27.3%, respectively. We found significant positive correlations among WHR, VFA, baPWV right, baPWV left, and cfPWV.

Conclusions: Obesity and visceral fat tissue influence on arterial stiffness. The analysis of magnitude of obesity and body fat tissue parameters can be used as an additional cardiovascular risk factor in RTrs.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.118DOI Listing
October 2020

Pregnancy After Kidney Transplantation With Maternal and Pediatric Outcomes: A Single-Center Experience.

Transplant Proc 2020 Oct 19;52(8):2430-2435. Epub 2020 May 19.

Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland.

Outcomes of pregnancies after kidney transplantation were evaluated. Thirty-one pregnancies in 26 women were noted. The mean maternal age at pregnancy was 31 ± 5 years (range, 23-44 years). The interval between transplantation and conception was 54 ± 51 months (range, 7-213 months). The mean serum creatinine concentration before conception was 1.28 ± 0.4 mg/dL (range, 0.8-2.45 mg/dL), and mean estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration) was 62 ± 18 mL/min/1.73 m (range, 27-106 mL/min/1.73 m). There were no maternal deaths. There was 1 case of suspected acute rejection after delivery. There was 1 case of graft loss during pregnancy. Maternal complications included edema (6/26), hypertension (7/26), increase of (2/26) or appearance of proteinuria (5/26), and preeclampsia (4/26). Mean creatinine increase during pregnancy was 0.02 mg/dL. Mean creatinine 1 year after pregnancy was 1.54 mg/dL (±0.8 mg/dL). There were 19 cesarean sections. Fetal outcomes included 25 live births, 4 abortions, and 2 stillbirths. Out of 25 live births, 22 children were considered healthy, 2 children had congenital defects, and there were 2 deaths at neonatal age. Mean pregnancy age was 35 ± 4 weeks (range, 24-40 weeks). The rate of premature deliveries was 15 of 25. Mean neonate birth weight was 2363 ± 1029 grams (range, 490-4100 grams). The rate of babies small for gestational age was 19%. During follow-up (range, 0.5-30 years) 5 of 26 patients lost grafts (between 3 and 15 years after pregnancy); most (20) of the children previously considered healthy had good long-term development. Our results confirm that risk of pregnancy in kidney transplant recipients can be accepted, and children considered healthy at delivery develop well.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.122DOI Listing
October 2020

Ophthalmologic Diseases in Kidney Transplant Recipients: A Single-Center Prospective Study.

Transplant Proc 2020 Oct 10;52(8):2417-2422. Epub 2020 May 10.

Department of Ophthalmology, Medical University of Gdańsk, Gdańsk, Poland.

Background: Kidney transplant (KTx) recipients usually experience many comorbidities (eg, hypertension, diabetes, cardiovascular disease, glaucoma). They usually are older and have some ophthalmologic disorders, which may deteriorate after Ktx and some others may develop.

Objective: We aimed to review a 1-year examination of the eyesight characteristics in patients after KTx.

Methods: The study encompassed 82 eyes in 41 patients who underwent KTx in the years 2014 to 2018. All patients had visual acuity measurement, tonometry, slit lamp examination, and spectroscopic optical coherence tomography.

Results: The most frequently observed changes during the 1-year observation were cataract (46%), hypertensive angiopathy (20%), and glaucoma (20%). One year after the renal transplant visual acuity declined in 22 patients (54%). In 45% of those with eyesight deterioration the cause was cataract, while in patients with no changes in eyesight (n = 9) cataract was not diagnosed. Patients with cataracts had been more often treated with high doses of steroids (steroid boluses), mainly because of acute rejection, which was significantly associated with cataract developing after Ktx (42% vs 11%; P = .019). On univariate analysis Charlson Comorbidity Index, total ischemic time, and steroid boluses were significantly associated with cataract developing after Ktx; none of these factors were an independent predictor on multivariate analysis.

Conclusions: The most common ophthalmologic diagnoses in patients after Ktx include cataract, glaucoma, and hypertensive angiopathy. Visual acuity deterioration, seen so often in the studied group of the patients, was mainly the effect of cataract progress. The effect of steroid boluses on cataract progress was meaningful.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.098DOI Listing
October 2020

Obesity After Successful Kidney Transplantation.

Transplant Proc 2020 Oct 29;52(8):2352-2356. Epub 2020 Apr 29.

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland.

Background: Kidney transplantation is the most effective method of renal replacement therapy, providing better quality of life and improving survival prognosis. However, immunosuppressive therapy may negatively affect balance in recipients' body mass components, such as fat mass and lean tissue mass and consequently may result in weight gain. The purpose of the study was to investigate body composition and prevalence of obesity in a group of kidney transplant recipients (KTRs) during 2 years of observation.

Methods: The study population consisted of 95 patients after kidney transplantation. Anthropometry were performed using an electronic scale, dynamometer, and multi-frequency bioimpedance analysis at baseline and over a 24-month observation period. Obesity diagnosis was based on body mass index (BMI). Sarcopenia was defined according to The European Working Group on Sarcopenia.

Results: At baseline, overweight and obesity were found in 42.1% and 10.5% of KTRs, respectively. BMI correlated positively with body fat, lean body mass, and waist circumference (P < .05). Of all KTRs, 31.6% at baseline and 33.6% after 2 years met criteria of sarcopenia. During 24 months' observation, the kidney graft function and mean BMI were stable, but significant increase of body fat content with decrease of lean body mass was observed. Multivariate regression analysis showed a relationship between the risk of sarcopenia and low BMI and high waist circumference.

Conclusions: Successful transplantation was associated with weight gain with increase of body fat without increase in lean body mass (sarcopenic obesity). Results suggest the need for routine assessment of body composition and nutritional education that could prevent the consequences of adipose tissue accumulation in kidney transplant recipients.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.091DOI Listing
October 2020

Disorders of Serum Polyunsaturated Fatty Acids in Renal Transplant Patients.

Transplant Proc 2020 Oct 23;52(8):2324-2330. Epub 2020 Apr 23.

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.

Background: Disturbances in polyunsaturated fatty acids (PUFA) could predispose renal transplant (RTx) patients to cardiovascular risk. The purpose of this study was to evaluate serum content of ω-3 and ω-6 PUFA in RTx subjects, in comparison to nontransplanted chronic kidney disease (CKD) patients in predialysis stages and to healthy controls. In the second part of the study, PUFA were analyzed in subcutaneous adipose tissue of CKD subjects at the time of kidney transplantation.

Methods: The first part of the study was conducted in a cohort (n = 134) of 3 groups: patients after renal transplantation (RTx group, n = 24), patients with CKD in stages 2-5, not on dialysis (CKD-ND group, n = 67), and controls without CKD (control group, n = 43). The fatty acids (FA) assessed by gas chromatography-mass spectrometry (GC-MS) were alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), linoleic acid (LA), and arachidonic acid (AA). Diet was assessed by food frequency questionnaire FFQ-6. In the second part of the study, the same FA were evaluated in samples of adipose tissue taken during the kidney transplantation procedure and compared with FA of controls from the adipose tissue collected during hernia surgeries.

Results: The first part of the study showed that RTx patients presented significantly lower serum content of all the examined PUFA, in comparison to the CKD-ND group and controls. For instance, EPA in RTx equaled 0.65 ± 0.32%, in CKD-ND 0.82 ± 0.43%, and in controls 1.06 ± 0.68% (P = .005). No significant correlations were found between serum PUFA and diet in RTx patients. The second part of the study revealed no significant difference in the adipose tissue PUFA between CKD patients at the time of kidney transplantation and controls.

Conclusions: RTx patients present with low serum content of potentially beneficial PUFA. This finding does not seem to be solely due to an altered diet. Observed disorders might result from immunosuppressive drugs or other, yet undetermined, causes.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.106DOI Listing
October 2020

Influence of lipid profile and statin administration on arterial stiffness in renal transplant recipients.

Cardiol J 2020 Apr 24. Epub 2020 Apr 24.

Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin, Berlin, Germany, Charitépl. 1, 10117 Berlin, Germany.

Background: Hyperlipidemia is one of the major risk factors for developing a cardiovascular disease (CVD) and it is a frequent post-transplant complication, occurring in up to 60% of the renal transplant recipients (RTRs). Lipid lowering therapy with HMG-CoA reductase inhibitors (statins) is generally recommended and may reduce the overall cardiovascular risk. The aim of this study was to evaluate the lipid profile, statin administration and their relationship with arterial stiffness parameters in renal transplant recipients.

Methods: Three hundred and forty-four stable RTRs (62.5% male) transplanted between 1994 and 2018 were randomly enrolled to the study. The following parameters of arterial stiffness was measured in each patient: carotid femoral pulse wave velocity (baPWV left and right, cfPWV) and pulse pressure (PP right and left). The study group was divided based on the use statins: 143 (41.6%) and 201 (58.4%). RTRs were qualified to the statin (+) and the statin (-) group, respectively.

Results: In the statin (+) as compared to statin (-) group there were more patients with a CVD (32.9% vs. 14.9%) and diabetes (25.2% vs. 14.4%). In the whole study group, CVD was associated with a significant increase of both baPWV and cfPWV as well as PP (8.5 mmHg). There were significant differences in arterial stiffness parameters (baPWV, cfPWV, PP) between the statin (+) and the statin (-) group.

Conclusions: Arterial stiffness was increased in RTRs with CVD and hyperlipidemia. The control of hyperlipidemia was poor in RTRs.
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http://dx.doi.org/10.5603/CJ.a2020.0063DOI Listing
April 2020

Application of Total Kidney Volume and Its Predictive Value in Assessment of Kidney Transplant Waitlist Candidates With Autosomal Dominant Polycystic Kidney Disease.

Transplant Proc 2020 Oct 17;52(8):2273-2277. Epub 2020 Apr 17.

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of kidney transplantation (KTx) worldwide. About 40% of ADPKD patients require peritransplant native kidney nephrectomy (NKN). The decision regarding qualification for NKN usually relies on the surgeon's expertise. Currently used qualification criteria are subjective and incomparable between clinical centers. There is a need to identify the indications for NKN by applying radiologically based methods to the decision-making process.

Aim: To assess the usefulness of radiologic parameters in the qualification process of ADPKD waitlist candidates for the NKN procedure.

Method: A retrospective, observational study in a cohort of ADPKD patients in a single institution was conducted. The study included the participation of waitlist candidates and kidney transplant recipients with computed tomography (CT) or magnetic resonance imaging (MRI) obtained in the peritransplant period. The correlation of imaging-based measurements with the results of clinical qualification for the NKN procedure was assessed.

Results: In the years 2012 to 2019, 19 patients completed the inclusion criteria. Total kidney volume (TKV) values were statistically more significant in the NKN group (n = 10) than in the non-NKN group (n = 9), with medians of 3351 mL and 1654 mL, respectively (P = .016). There were no significant differences between the groups in terms of the ratio of complex cyst volume to TKV, with the NKN group having a ratio of 19.2% and the non-NKN group 15.6% (P = .095). Venous compression was found only in the NKN group (n = 2).

Conclusions: TKV highly correlates with the results of clinical qualification for NKN. Radiologic assessment enables the detection of complicated cysts or clinically silent states of venous compression. Pretransplant imaging should be routinely obtained.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.080DOI Listing
October 2020

The C18:3n6/C22:4n6 ratio is a good lipid marker of chronic kidney disease (CKD) progression.

Lipids Health Dis 2020 Apr 17;19(1):77. Epub 2020 Apr 17.

Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Szczecin, Poland.

Background: Chronic kidney disease (CKD) is a major challenge for public health due to increased risk of cardiovascular diseases (CVD) and premature death. The aim of this study was to determine the clinical picture of FA and the course of the pathophysiological mechanisms of CKD.

Methods: The study involved 149 patients with CKD and a control group including 43 people. Fatty acid profiles were investigated using gas chromatography. A total of 30 fatty acids and their derivatives were identified and quantified. The omega3, omega6, SFA, MUFA, and PUFA fatty acid contents were calculated. The correlation matrix was obtained for parameters relating to patients with CKD vs. FA, taking patients' sex into consideration. The index C18:3n6/C22:4n6 was calculated according to the length of the treatment. Statistica 12.0 software (Tulsa, Oklahoma, USA) was used for the statistical analyses.

Results: The results showed decreased levels of total PUFA and increased concentrations of MUFA, including the activation of the palmitic and oleic acid pathway. An increase in the levels of n-6 9C22: 4n6 family fatty acids in all the patients and a reduction in the n-3 family (EPA, DHA) were observed. C18:3n6 was negatively correlated and C22:4n6 was positively correlated with the duration of the treatment. The index C18:3n6/C22:4n6 was defined as a new marker in the progression of the disease. Moreover, the index C18:3n6/ C22:4n6 was drastically decreased in later period. Nervonic acid was higher in the CKD group. In the group of men with CKD, there was a negative correlation between the excretion of K+, anthropometric measurements, and the levels of EPA and DHA.

Conclusions: The course of inflammation in CKD occurs through the decrease in PUFA and the synthesis of MUFA. The dominating cascade of changes is the elongation of GLA-C18:3n6 into DGLA-C20:3n6 and AA-C20:4n6. As CKD progresses, along with worsening anthropometrical parameters and increased secretion of potassium, the activity of Ʌ6-desaturase decreases, reducing the synthesis of EPA and DHA. The synthesis of AdA-C22:4n6 increases and the ratio C18:3n6/C22:4n6 drastically decreases after 5 years. This parameter can be used to diagnose disease progression.
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http://dx.doi.org/10.1186/s12944-020-01258-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164198PMC
April 2020

Immune Algorithm Optimization for Organ Transplantation in Poland.

Transplant Proc 2020 Sep 9;52(7):2026-2032. Epub 2020 Apr 9.

Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland.

The lack of a uniform method for determining unacceptable HLA mismatches (UAMs) for organ transplantation worldwide has resulted in many different algorithms for donor-recipient matching. Here we present our proposal for changes to the current algorithm for immune evaluation of potential kidney recipients in Poland based on the experience of various transplantation centers. The most important finding of this article is an algorithm that stratifies the pretransplant immunologic risk based on strict laboratory criteria, enabling harmonization between transplant centers in Poland. This is because of a step-by-step algorithm for alloantibody assessment using solid-phase assays (SPA) and clearly defined technical issues, as well as cutoffs for reporting UAMs. Our novel approach focuses on a laboratory testing extension in the scope of HLA typing; detection and characterization of alloantibodies before transplantation; desensitization; and post-transplant monitoring. The proposed changes will allow for the assessment of clinically relevant anti-HLA antibodies with complement binding properties; the determination of UAMs in the potential donor; the calculation of virtual panel reactive antibodies (vPRA); the calculation of the recipient's immunologic rejection risk stratification; the assessment of the donor-recipient virtual cross-match (vXM); and the determination of the final recipient's selection for the biological cross-match testing. Collectively, the optimized algorithm permit for UAM verification is based on laboratory proofed data and will firmly improve organ allocation and transplant outcomes in Poland. We hope that this novel approach also improves the individual patient's risk stratification and future personalized treatment.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.082DOI Listing
September 2020