Damjan Kovač - Academia.edu (original) (raw)
Papers by Damjan Kovač
Transplantation, 2014
518 0.001), diastolic blood pressure (p < 0.001), intact parathyroid hormone levels (p < 0.001), ... more 518 0.001), diastolic blood pressure (p < 0.001), intact parathyroid hormone levels (p < 0.001), and OPN (p = 0.003) than controls.There is no difference of aortic pulse wave velocitylevels between KT patients and control (p = 0.437). Sixteen patients (28.1%) were defi ned in high-risk aortic arterial stiffness group at KT patients.Body weight (p = 0.004), waist circumference (p = 0.009), body mass index (p = 0.011), creatinine (p = 0.012), and serum OPN level (p = 0.002) were higher in high-risk aortic arterial stiffness group compared with low-risk aortic arterial stiffness group. Multivariate logistic regression analysis showed that OPN (Odds ratio: 10.793, 95% confi dence interval: 1.268 to 91.393, p=0.029) was still the independent predictors of aortic arterial stiffness among the KT patients. Conclusion:These preliminary results suggest that OPN level was signifi cantly correlated with aortic arterial stiffness among the KT patients.
Transplantation Proceedings, 2005
The aim of the study was to analyze whether immunosuppressive treatment with basiliximab and myco... more The aim of the study was to analyze whether immunosuppressive treatment with basiliximab and mycophenolate mofetil (MMF), allowed a reduction in methylprednisolone and cyclosporine dosages without increasing the incidence of acute rejection episodes, reducing 1-year graft and patient survivals, or increasing the rates of infections and malignancy in the first year. The two groups were group A (n ϭ 72), treated with methylprednisolone and cyclosporine and in the first 2 weeks with azathioprine; group B (n ϭ 72), treated with basiliximab, MMF, and low-dose cyclosporine and methylprednisolone. The patients were followed for 1 year. The incidence of acute rejection episodes in the first year was significantly lower in group B (2.8%) than group A (12.5%; P Ͻ .05). The cumulative methylprednisolone dose, the daily dose, and the average cyclosporine trough blood level were significantly lower in group B (P Ͻ .001). One-year serum creatinine was significantly lower in group B (112 Ϯ 45 mol/L) than group A (138 Ϯ 51 mol/L; P Ͻ .01). One-year graft survival was 91.7% in group A and 98.6% in group B. One-year patient survival was 98.6% in group A and 100% in group B. The groups did not differ significantly in the incidence of bacterial, viral, or fungal infections. Immunosuppression with basiliximab and MMF allowed a reduction in cyclosporine and methylprednisolone dosages and was associated with significantly lower incidences of acute rejections episodes with better graft function in the first year as opposed to immunosuppression with higher doses of cyclosporine and methylprednisolone alone. Both immunosuppressive regimens showed the same infection rates and did not differ significantly in the occurrence of malignant diseases within the first year.
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: Uric acid (UA) has been identified as a prognostic marker of chronic kidne... more Introduction and Aims: Uric acid (UA) has been identified as a prognostic marker of chronic kidney disease (CKD) progression. Preclinical studies also support an independent pathophysiological role of UA in this process. Treatment of hyperuricemia in CKD can be challenging as it requires dose reduction of the most frequently used urate lowering therapy (ULT), the xanthineoxidase inhibitor allopurinol. The aim of the current study was to analyze the prevalence of ULT in patients with CKD stage 3. Further the dose adjustment of allopurinol was investigated in the baseline data of the German Chronic Kidney Disease (GCKD) study cohort. Methods: Baseline data and drug prescription pattern in a 1894 patient subset of the GCKD study, on whom medication dosing information for allopurinol was available, were evaluated. The GCKD study is a prospective observational national cohort study that enrolled more than 5000 patients with CKD of various aetiologies, who are under nephrological care, and currently follows them for up to 10 years. At the time of enrolment, male and female patients had an estimated glomerular filtration rate (eGFR) of 30-60 mL/min/1.73 m². Results: The mean age of the 1894 patients investigated was 62 ± 13 years. The average urate level in the entire cohort was 7.2 mg/dl ±1.86 mg/dl. 532 (28.1%) of patients received a UA lowering therapy. While patients without ULT had a urate level of 7.31 ± 1.9 mg/dl, patients being treated for high UA had a mean uric acid level of 6.9 ± 1.78 mg/dl. Among patients on ULT, 496 (93.2%) received allopurinol, 18 (3.4%) febuxostat and 18 (3.4%) benzbromarone. The median allopurinol dose was 150 mg/d, which is in line with the current recommendations at this GFR range. Nevertheless 30.2% of the allopurinol treated patients received a dose of 300 mg/d [Figure]. Despite this excessive dose these patients had a mean uric acid level of 6.31mg/dl ± 1.68 mg/dl. In the group of patients on ULT, 365 (68.6%) were above the recommended urate level of 6 mg/dl. Conclusions: Despite the fact that hyperurecemia is frequent in CKD 3, only a third of patients are treated. Treatment largely fails to lower urate level below 6 mg/dl. While the median dose was adequately adapted to GFR, a third of the patients received an allopurinol dose that would be considered inadequately high. Our data indicate that the treatment of hyperuricemia in CKD can be improved in both frequency of treatment and dose adjustment.
The American Journal of Gastroenterology, 2000
The American Journal of Gastroenterology, 2000
To assess the pharmacological and clinical efficacy and safety profile of this new synthetic porc... more To assess the pharmacological and clinical efficacy and safety profile of this new synthetic porcine secretin in facilitating cannulation of either the major or minor pancreatic orifice at ERCP. Methods: In this prospective study, patients were administered 0.4 ug/kg IV (max. 16ug) of synthetic porcine secretin if protracted efforts to locate or cannulate the major or minor pancreatic orifice had failed. Exclusion criteria were acute pancreatitis, known sensitivity or adverse reaction to secretin or pregnant or nursing females. Results: Between March and November, 1999, 29 patients were enrolled (M:F 8:21; Average age 52.8 years, range 23-81 years). The indications for secretin injection were: To aid in minor papilla cannulation in patients with pancreas divisum (18), to aid in finding main PD orifice (4), to find PD orifice post biliary sphincterotomy (3), to facilitate major papilla cannulation (2), to aid in finding minor papilla (1), and to facilitate minor papilla cannulation (1). Successful cannulation was achieved in 26/29 (89.7%) cases. In one case cannulation of the minor papilla was still not possible because of its location in a duodenal diverticulum. In the two remaining cases, deep cannulation of the pancreatic duct was not deemed essential and was not pursued. No adverse events were recorded. Summary: A new, pure, synthetic secretin aided successful cannulation of the major or minor pancreatic orifices in 26/29 patients in whom protracted efforts to locate or cannulate the pancreatic duct had failed. These data suggest this new agent is both effective and safe, with no adverse events recorded. Conclusions: Synthetic porcine secretin is a safe and useful agent, and its administration can be added to the armamentarium of techniques to facilitate pancreatic duct cannulation.
Zentralblatt für Chirurgie, 2005
We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entiti... more We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entities: gastrointestinal stromal tumor (GIST) and Crohn's disease. Within Meckel's diverticulum a polypous tumor, 3 cm in diameter, with preserved lumen was found. In the area of the terminal ileum, coecum and colon ascendens inflamed bowel loops were fixed together with fibrous adhesions. Partial resection of the ileum with end-to-end anastomosis and right hemicolectomy with resection of the terminal ileum and end-to-end ileotransverse anastomosis were performed. Pathohistological and immunohistochemical examination revealed the polypous tumor as GIST. Changes in terminal ileum, coecum and colon ascendens were referred as Crohn's disease. Although adenocarcinoma is well known in chronic, long-standing inflammatory bowel disease, other primary intestinal tumors are rare in those patients. Furthermore, Crohn's disease can be a part of differential diagnosis of ileus, also in such an old man.
Transplantation Proceedings, 2002
S EVERE fungal infections remain a substantial cause of morbidity and mortality among kidney graf... more S EVERE fungal infections remain a substantial cause of morbidity and mortality among kidney graft recipients, although the incidence is less than that reported for other solid-organ transplant recipients. 1,2 The objective of our study was to analyze clinical and microbiological aspects and outcome of severe fungal infections in kidney graft recipients in our center. PATIENTS AND METHODS The study was based on an analysis of 398 consecutive patients who underwent kidney transplantation in our center from 1986 through August 2001. The characteristics of patients with and the risk factors for severe fungal infections after kidney transplantation are shown in Table 1. The diagnosis was established on the basis of clinical signs and symptoms of severe infection, microbiological cultures, serologic tests, and histological presentation of fungi in the tissues obtained by biopsy or at autopsy.
Transplantation Proceedings, 2001
Transplantation Journal, 2010
PLoS ONE, 2013
Background: The aim of our study was to evaluate the prognostic value of glomerular and tubular p... more Background: The aim of our study was to evaluate the prognostic value of glomerular and tubular proteinuria and tubular enzymuria as early indicators of therapeutic response to induction therapy with i.v. pulse cyclophosphamide (CyC) and methylprednisolone (MP) in patients with antineutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis. Methods and Findings: An observational single-center study was conducted in 30 patients with ANCA-associated glomerulonephritis. Patients were divided into subgroups with good or poor response to CyC therapy according to clinical and laboratory parameters. The diagnosis of ANCA-associated glomerulonephritis was based on the Chapel-Hill disease definitions. Good response to induction therapy was significantly associated with higher absolute values of urine N-acetyl-beta-D-glucosaminidase (NAG) to creatinine ratio (above 14.83 microcat/mol) and urine immunoglobulin G (IgG) to albumin ratio (above 0.09) at the time of diagnosis, while albuminuria or proteinuria did not have any early predictive value. The remission of renal disease was anticipated as early as 3 months after introduction of induction therapy in patients with reduction of urine NAG to creatinine ratio below the baseline value and in patients with at least 24% rise in eGFR. Conclusions: Urine IgG to albumin and urine NAG to creatinine ratio are better early predictors of treatment response in patients with ANCA-associated glomerulonephritis than proteinuria or albuminuria.
Nephrology Dialysis Transplantation, 1998
The cell count of peritoneal effluent revealed 200 WBC/mm3. ESR was 131 mm/h, CRP 88 mg/l, WBC 14... more The cell count of peritoneal effluent revealed 200 WBC/mm3. ESR was 131 mm/h, CRP 88 mg/l, WBC 14×109/l. The leukocyte differential count was normal. Peritoneal fluid cultures for bacteria were negative.
Clinical Transplantation, 2009
: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication in p... more : Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication in patients with end‐stage renal disease as well as in patients after renal transplantation. It should be suspected in patients with typical painful violaceous skin lesions on the extremities or on the trunk. Active multidisciplinary management approach, with intensive local wound care, is vital in these patients. Controlling parathyroid hormone, hyperbaric oxygenation, sodium thiosulphate, bisphosphonates, cinacalcet and skin grafting could be effective. In our report, we describe a case of CUA in a 43‐year‐old patient two years after kidney transplantation. Despite intensive standard treatment, his wounds progressed; therefore, we decided to use iloprost, in combination with hyperbaric oxygenation. The clean wounds were then covered with cultivated autologous skin cells to enhance wound epithelialization. Seven months after finishing iloprost and hyperbaric oxygen treatment and the first application of skin substitute, the wounds healed completely and remained healed during the four‐yr follow‐up period. We conclude that in patients with severe CUA‐induced wounds, the combined treatment with iloprost, hyperbaric oxygen and autologous cultured fibrin‐based skin substitutes can be effective. A combination of different treatment modalities is vital in patients with CUA.
Transplantation Proceedings, 2001
Senckenbergiana biologica
Transplantation, 2014
518 0.001), diastolic blood pressure (p < 0.001), intact parathyroid hormone levels (p < 0.001), ... more 518 0.001), diastolic blood pressure (p < 0.001), intact parathyroid hormone levels (p < 0.001), and OPN (p = 0.003) than controls.There is no difference of aortic pulse wave velocitylevels between KT patients and control (p = 0.437). Sixteen patients (28.1%) were defi ned in high-risk aortic arterial stiffness group at KT patients.Body weight (p = 0.004), waist circumference (p = 0.009), body mass index (p = 0.011), creatinine (p = 0.012), and serum OPN level (p = 0.002) were higher in high-risk aortic arterial stiffness group compared with low-risk aortic arterial stiffness group. Multivariate logistic regression analysis showed that OPN (Odds ratio: 10.793, 95% confi dence interval: 1.268 to 91.393, p=0.029) was still the independent predictors of aortic arterial stiffness among the KT patients. Conclusion:These preliminary results suggest that OPN level was signifi cantly correlated with aortic arterial stiffness among the KT patients.
Transplantation Proceedings, 2005
The aim of the study was to analyze whether immunosuppressive treatment with basiliximab and myco... more The aim of the study was to analyze whether immunosuppressive treatment with basiliximab and mycophenolate mofetil (MMF), allowed a reduction in methylprednisolone and cyclosporine dosages without increasing the incidence of acute rejection episodes, reducing 1-year graft and patient survivals, or increasing the rates of infections and malignancy in the first year. The two groups were group A (n ϭ 72), treated with methylprednisolone and cyclosporine and in the first 2 weeks with azathioprine; group B (n ϭ 72), treated with basiliximab, MMF, and low-dose cyclosporine and methylprednisolone. The patients were followed for 1 year. The incidence of acute rejection episodes in the first year was significantly lower in group B (2.8%) than group A (12.5%; P Ͻ .05). The cumulative methylprednisolone dose, the daily dose, and the average cyclosporine trough blood level were significantly lower in group B (P Ͻ .001). One-year serum creatinine was significantly lower in group B (112 Ϯ 45 mol/L) than group A (138 Ϯ 51 mol/L; P Ͻ .01). One-year graft survival was 91.7% in group A and 98.6% in group B. One-year patient survival was 98.6% in group A and 100% in group B. The groups did not differ significantly in the incidence of bacterial, viral, or fungal infections. Immunosuppression with basiliximab and MMF allowed a reduction in cyclosporine and methylprednisolone dosages and was associated with significantly lower incidences of acute rejections episodes with better graft function in the first year as opposed to immunosuppression with higher doses of cyclosporine and methylprednisolone alone. Both immunosuppressive regimens showed the same infection rates and did not differ significantly in the occurrence of malignant diseases within the first year.
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: Uric acid (UA) has been identified as a prognostic marker of chronic kidne... more Introduction and Aims: Uric acid (UA) has been identified as a prognostic marker of chronic kidney disease (CKD) progression. Preclinical studies also support an independent pathophysiological role of UA in this process. Treatment of hyperuricemia in CKD can be challenging as it requires dose reduction of the most frequently used urate lowering therapy (ULT), the xanthineoxidase inhibitor allopurinol. The aim of the current study was to analyze the prevalence of ULT in patients with CKD stage 3. Further the dose adjustment of allopurinol was investigated in the baseline data of the German Chronic Kidney Disease (GCKD) study cohort. Methods: Baseline data and drug prescription pattern in a 1894 patient subset of the GCKD study, on whom medication dosing information for allopurinol was available, were evaluated. The GCKD study is a prospective observational national cohort study that enrolled more than 5000 patients with CKD of various aetiologies, who are under nephrological care, and currently follows them for up to 10 years. At the time of enrolment, male and female patients had an estimated glomerular filtration rate (eGFR) of 30-60 mL/min/1.73 m². Results: The mean age of the 1894 patients investigated was 62 ± 13 years. The average urate level in the entire cohort was 7.2 mg/dl ±1.86 mg/dl. 532 (28.1%) of patients received a UA lowering therapy. While patients without ULT had a urate level of 7.31 ± 1.9 mg/dl, patients being treated for high UA had a mean uric acid level of 6.9 ± 1.78 mg/dl. Among patients on ULT, 496 (93.2%) received allopurinol, 18 (3.4%) febuxostat and 18 (3.4%) benzbromarone. The median allopurinol dose was 150 mg/d, which is in line with the current recommendations at this GFR range. Nevertheless 30.2% of the allopurinol treated patients received a dose of 300 mg/d [Figure]. Despite this excessive dose these patients had a mean uric acid level of 6.31mg/dl ± 1.68 mg/dl. In the group of patients on ULT, 365 (68.6%) were above the recommended urate level of 6 mg/dl. Conclusions: Despite the fact that hyperurecemia is frequent in CKD 3, only a third of patients are treated. Treatment largely fails to lower urate level below 6 mg/dl. While the median dose was adequately adapted to GFR, a third of the patients received an allopurinol dose that would be considered inadequately high. Our data indicate that the treatment of hyperuricemia in CKD can be improved in both frequency of treatment and dose adjustment.
The American Journal of Gastroenterology, 2000
The American Journal of Gastroenterology, 2000
To assess the pharmacological and clinical efficacy and safety profile of this new synthetic porc... more To assess the pharmacological and clinical efficacy and safety profile of this new synthetic porcine secretin in facilitating cannulation of either the major or minor pancreatic orifice at ERCP. Methods: In this prospective study, patients were administered 0.4 ug/kg IV (max. 16ug) of synthetic porcine secretin if protracted efforts to locate or cannulate the major or minor pancreatic orifice had failed. Exclusion criteria were acute pancreatitis, known sensitivity or adverse reaction to secretin or pregnant or nursing females. Results: Between March and November, 1999, 29 patients were enrolled (M:F 8:21; Average age 52.8 years, range 23-81 years). The indications for secretin injection were: To aid in minor papilla cannulation in patients with pancreas divisum (18), to aid in finding main PD orifice (4), to find PD orifice post biliary sphincterotomy (3), to facilitate major papilla cannulation (2), to aid in finding minor papilla (1), and to facilitate minor papilla cannulation (1). Successful cannulation was achieved in 26/29 (89.7%) cases. In one case cannulation of the minor papilla was still not possible because of its location in a duodenal diverticulum. In the two remaining cases, deep cannulation of the pancreatic duct was not deemed essential and was not pursued. No adverse events were recorded. Summary: A new, pure, synthetic secretin aided successful cannulation of the major or minor pancreatic orifices in 26/29 patients in whom protracted efforts to locate or cannulate the pancreatic duct had failed. These data suggest this new agent is both effective and safe, with no adverse events recorded. Conclusions: Synthetic porcine secretin is a safe and useful agent, and its administration can be added to the armamentarium of techniques to facilitate pancreatic duct cannulation.
Zentralblatt für Chirurgie, 2005
We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entiti... more We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entities: gastrointestinal stromal tumor (GIST) and Crohn's disease. Within Meckel's diverticulum a polypous tumor, 3 cm in diameter, with preserved lumen was found. In the area of the terminal ileum, coecum and colon ascendens inflamed bowel loops were fixed together with fibrous adhesions. Partial resection of the ileum with end-to-end anastomosis and right hemicolectomy with resection of the terminal ileum and end-to-end ileotransverse anastomosis were performed. Pathohistological and immunohistochemical examination revealed the polypous tumor as GIST. Changes in terminal ileum, coecum and colon ascendens were referred as Crohn's disease. Although adenocarcinoma is well known in chronic, long-standing inflammatory bowel disease, other primary intestinal tumors are rare in those patients. Furthermore, Crohn's disease can be a part of differential diagnosis of ileus, also in such an old man.
Transplantation Proceedings, 2002
S EVERE fungal infections remain a substantial cause of morbidity and mortality among kidney graf... more S EVERE fungal infections remain a substantial cause of morbidity and mortality among kidney graft recipients, although the incidence is less than that reported for other solid-organ transplant recipients. 1,2 The objective of our study was to analyze clinical and microbiological aspects and outcome of severe fungal infections in kidney graft recipients in our center. PATIENTS AND METHODS The study was based on an analysis of 398 consecutive patients who underwent kidney transplantation in our center from 1986 through August 2001. The characteristics of patients with and the risk factors for severe fungal infections after kidney transplantation are shown in Table 1. The diagnosis was established on the basis of clinical signs and symptoms of severe infection, microbiological cultures, serologic tests, and histological presentation of fungi in the tissues obtained by biopsy or at autopsy.
Transplantation Proceedings, 2001
Transplantation Journal, 2010
PLoS ONE, 2013
Background: The aim of our study was to evaluate the prognostic value of glomerular and tubular p... more Background: The aim of our study was to evaluate the prognostic value of glomerular and tubular proteinuria and tubular enzymuria as early indicators of therapeutic response to induction therapy with i.v. pulse cyclophosphamide (CyC) and methylprednisolone (MP) in patients with antineutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis. Methods and Findings: An observational single-center study was conducted in 30 patients with ANCA-associated glomerulonephritis. Patients were divided into subgroups with good or poor response to CyC therapy according to clinical and laboratory parameters. The diagnosis of ANCA-associated glomerulonephritis was based on the Chapel-Hill disease definitions. Good response to induction therapy was significantly associated with higher absolute values of urine N-acetyl-beta-D-glucosaminidase (NAG) to creatinine ratio (above 14.83 microcat/mol) and urine immunoglobulin G (IgG) to albumin ratio (above 0.09) at the time of diagnosis, while albuminuria or proteinuria did not have any early predictive value. The remission of renal disease was anticipated as early as 3 months after introduction of induction therapy in patients with reduction of urine NAG to creatinine ratio below the baseline value and in patients with at least 24% rise in eGFR. Conclusions: Urine IgG to albumin and urine NAG to creatinine ratio are better early predictors of treatment response in patients with ANCA-associated glomerulonephritis than proteinuria or albuminuria.
Nephrology Dialysis Transplantation, 1998
The cell count of peritoneal effluent revealed 200 WBC/mm3. ESR was 131 mm/h, CRP 88 mg/l, WBC 14... more The cell count of peritoneal effluent revealed 200 WBC/mm3. ESR was 131 mm/h, CRP 88 mg/l, WBC 14×109/l. The leukocyte differential count was normal. Peritoneal fluid cultures for bacteria were negative.
Clinical Transplantation, 2009
: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication in p... more : Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication in patients with end‐stage renal disease as well as in patients after renal transplantation. It should be suspected in patients with typical painful violaceous skin lesions on the extremities or on the trunk. Active multidisciplinary management approach, with intensive local wound care, is vital in these patients. Controlling parathyroid hormone, hyperbaric oxygenation, sodium thiosulphate, bisphosphonates, cinacalcet and skin grafting could be effective. In our report, we describe a case of CUA in a 43‐year‐old patient two years after kidney transplantation. Despite intensive standard treatment, his wounds progressed; therefore, we decided to use iloprost, in combination with hyperbaric oxygenation. The clean wounds were then covered with cultivated autologous skin cells to enhance wound epithelialization. Seven months after finishing iloprost and hyperbaric oxygen treatment and the first application of skin substitute, the wounds healed completely and remained healed during the four‐yr follow‐up period. We conclude that in patients with severe CUA‐induced wounds, the combined treatment with iloprost, hyperbaric oxygen and autologous cultured fibrin‐based skin substitutes can be effective. A combination of different treatment modalities is vital in patients with CUA.
Transplantation Proceedings, 2001
Senckenbergiana biologica