Magdalena Durlik - Academia.edu (original) (raw)
Papers by Magdalena Durlik
Annals of transplantation: quarterly of the Polish Transplantation Society
A case of calcineurin inhibitor (CNI)--induced haemolytic uremic syndrome (HUS) after liver trans... more A case of calcineurin inhibitor (CNI)--induced haemolytic uremic syndrome (HUS) after liver transplantation leading to irreversible renal failure is described. We present case history of 25-years old male after liver transplantation due to cryptogenic cirrhosis with prolonged worsening graft function, who developed HUS. Unsatisfactory graft function was the reason of performing numerous graft biopsies. Features of acute and chronic rejection (CR) of liver were histopathologically confirmed. Vanishing bile duct syndrome as manifestation of CR was stated and immunosuppressive regimen was intensified (tacrolimus placed cyclosporin). High blood levels of tacrolimus were maintained (approximately 20-22 ng/ml) on dose 3 mg twice a day. No clinical effect was observed. Renal failure was improving (serum creatinine was 3.3 mg/dl and eGFR was 24 ml/min/1.73 m(2)). After four months of maintaining high dose of tacrolimus patient was referred to our center in order to estimate indications for liver retransplantation. On admission severe haemolytic anaemia, thrombocytopenia and acute renal failure were detected. Atypical HUS probably related to CNI was diagnosed. Tacrolimus administration was discontinued. Blood and plasma transfusion as well as plasmapheresis were implemented. Haemolysis was limited, but renal function was not improved. Renal biopsy revealed features of irreversible nephropathy in course of thrombotic microangiopathy. Despite previously maintaining high dose of CNI, there were no signs of CNI nephrotoxicity. Patient required haemodialysis. Due to necessity of haemodialysis and worsening function of liver, patient was accepted to liver and kidney transplantation. High CNI blood concentration in patient after liver transplantation can be atypical cause of HUS and leads to irreversible renal failure.
Polskie archiwum medycyny wewnȩtrznej
Antiphospholipid syndrome (APS) is an autoimmune disease with clinical manifestations of arterial... more Antiphospholipid syndrome (APS) is an autoimmune disease with clinical manifestations of arterial and venous thrombosis, concomitant fetal loss and the presence of antiphospholipid antibodies (APLA). This report focuses on the challenges of optimal treatment involving plasma exchange and intravenous human immunoglobulin infusions that is administered in patients with catastrophic APS (CAPS). CAPS is a rare variant of APS defined as acute failure of at least three tissues, organs or systems caused predominantly by small vessel thrombosis confirmed by histopathologic evidence. CAPS develops rapidly and leads to death in 50% of cases. We present the case of a 39-year-old male patient with APS with worsening renal function. Positive lupus anticoagulant, markedly high concentrations of anticardiolipin and anti-beta 2-glikoprotein I antibodies have been observed. According to the criteria introduced by Asherson, a catastrophic form of APS was diagnosed and the patient had been treated with low-molecular-weight heparin, glucocorticosteroids, and plasmapheresis. In order to maintain clinical improvement, the patient was given human immunoglobulins i.v. (1 g/kg body weight). After the procedure, gradual clinical improvement was observed and renal function remained stable (serum creatinine level of 1.5 mg/dl).
Annals of transplantation: quarterly of the Polish Transplantation Society
Anemia is not only a feature of chronic kidney disease of native or grafted kidneys, but also is ... more Anemia is not only a feature of chronic kidney disease of native or grafted kidneys, but also is frequently found in liver and heart transplant recipients. End-stage organ failure requiring transplantation is usually associated with failure or impaired function of other organs. Chronic kidney disease developing after non-renal solid organ transplantation is a significant issue, as reviewed previously. The degree of functional impairment in kidney function after non-solid organ transplantation and the rate of progression of CKD post-transplant depend to a large extent on pretransplant kidney function (ie, stage of preexisting CKD), the type of the transplanted organ, and the immunosuppressive protocol (use of calcineurin inhibitors), presence of comorbid conditions such as diabetes, hypertension, HCV infection, older age, surgical issues, and individual clinical features determining susceptibility to renal injury, even nephropathy resulting from BK virus infection, is presented.
Medycyna doświadczalna i mikrobiologia
In diagnosis of CMV infection various laboratory methods are used. The methods based on detection... more In diagnosis of CMV infection various laboratory methods are used. The methods based on detection of viral nucleic acids have been introduced routinely in many laboratories. The aim of this study was to compare nucleic acid hybridisation method and various variants of PCR methods with respect to their ability to detect CMV DNA. The studied material comprised 60 blood samples from 19 patients including 13 renal transplant recipients and 6 with acute leukaemia. The samples were subjected to hybridisation (Murex Hybrid Capture System CMV DNA) and PCR carried out in 3 variants: with one pair of primers (single PCR), nested PCR and Digene SHARP System with detection of PCR product using a genetic probe in ELISA system. The sensitivity of the variants ranged from 10(0) particles of viral DNA in nested PCR to 10(2) in single PCR. The producer claimed the sensitivity of the hybridisation test to be 3 x 10(5) and it seems to be sufficient for detection of CMV infection. The obtained results show that sensitivity of hybridisation was comparable to that of single PCR and the possibility of obtaining quantitative results makes it superior, on efficacy of antiviral therapy, especially in monitoring CMV infection in immunossuppressed patients and in following the efficacy of antiviral treatment.
Acta microbiologica Polonica
Early diagnosis of CMV infection is very important mainly in transplant recipients because CMV in... more Early diagnosis of CMV infection is very important mainly in transplant recipients because CMV infection is a frequent complication after transplantation. In this work we compared different laboratory methods: ELISA (IgG, IgM), Western blot,shell vial, antigenemia assay (pp65), the immunofluorescent method with epithelial cells from urine (IF), DNA in leukocytes by PCR and DNA in leukocytes by hybridization (HCS) to estimate the most proper method for diagnosis of CMV in renal transplant recipients. This preliminary study showed that HCS, PCR and Western blot are sensitive methods for detecting CMV infection. Using HCS in quantitative variant we obtained a very good correlation between DNA load and clinical symptoms.
Neuro endocrinology letters
To assess safety of combined low-dose oral contraceptives in women after renal transplantation. T... more To assess safety of combined low-dose oral contraceptives in women after renal transplantation. Twenty six female renal graft-recipients, aged from 18 to 44 (mean 31 years), who used combined low-dose oral contraceptives after renal transplantation for at least 18 months were enrolled in the study. All patients had stable graft function with mean serum creatinine of 1.3 mg/dl. In 58% of women effective contraception was the mean indication for the therapy, in the remaining group pills were indicated additionally for the development of ovarian cysts and excessive menstrual bleedings. Ethinyl estradiol dose was 20 mug in 73% of cases and 30-35 microg in the remaining group. No case of pregnancy was observed. Contraceptive therapy was discontinued in two cases: for profound vein thrombosis in one and deterioration of liver function in the other case. No side effects of contraceptives were observed in the remaining group of patients within at least 18-month observational period. No case of ovarian cyst was reported. Oral contraceptives were not found to influence body mass index (BMI), mean blood pressure, serum creatinine and biochemical parameters (AST, ALT, total bilirubin, glucose and cholesterol). Despite the presence of relative contraindications for hormonal drugs (arterial hypertension and deteriorated liver function) in female renal recipients, administration of combined low-dose contraceptive pill should be taken into account as highly effective contraceptive method, that additionally regulates menstrual bleeding patterns, protects from ovarian cysts development and improves life quality of the patient.
Acta microbiologica Polonica
The comparison of two quantitative tests: hybridization (Murex Hybrid Capture System) and PCR (CO... more The comparison of two quantitative tests: hybridization (Murex Hybrid Capture System) and PCR (COBAS AMPLICOR CMV Monitor) detected CMV DNA was made. Investigation of viral load in serum by PCR gave better correlation with clinical manifestation in renal transplant recipients.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
The patients after renal transplantation with deteriorating graft function were included to the s... more The patients after renal transplantation with deteriorating graft function were included to the study. The aim of the study was to establish the usefulness of stabile complement split product C4d expression as the independent indicator of immunological activity in chronic rejection. The C4d expression was studied on fresh frozen tissue with immunofluorescence method. The intensification of immunosuppression regimen was also introduced and azathioprine was exchanged with mycofenolate mofetil. The protocol biopsies a year after inclusion are planned to be done. In our study there was positive correlation between C4d expression and previous acute rejection episodes, morphological changes specific for chronic rejection and clinical improvement after immunosuppression enhancement.
Annals of transplantation: quarterly of the Polish Transplantation Society
Hypertension (HT) is one of the most frequent complications of solid organ transplantation; about... more Hypertension (HT) is one of the most frequent complications of solid organ transplantation; about 70-90% of this population have high blood pressure or require antihypertensive therapy. Abnormal blood pressure is a potent non-immunological risk factor directly related to patient and graft survival. The etiology of hypertension after orthotopic heart transplantation is multifactorial and varies depending on the time following transplantation. In the early period after transplantation, hypertension is generally related to intravascular volume expansion and persistently increased systemic vascular resistance. Other factors predominant in kidney allograft recipients include: donor age, donor familial history of hypertension, transplant renal artery stenosis, graft function, the recurrence or de novo appearance of glomerulonephritis in transplanted kidney, and post-biopsy arteriovenous fistula. In liver and heart transplantation, hypertension is mainly due to impaired kidney function, with all its consequences. Another contributing factor is immunosuppressive regimen based on calcineurin inhibitors and steroids. The management of post-transplant hypertension usually requests non-pharmacological and pharmacological treatment. In this review, the pathogenesis and treatment of post-transplant hypertension in solid organ transplantation is presented.
Annals of transplantation: quarterly of the Polish Transplantation Society
Background: Everolimus is a derivative of sirolimus, and is considered to be free of the latter&#... more Background: Everolimus is a derivative of sirolimus, and is considered to be free of the latter's pulmonary toxicity. Recently, a few cases of everolimus-induced lung injury have been reported. Early recognition of drug-induced lung disease is important because it can be reversed if appropriate therapy is instituted soon after the onset of symptoms. Case report: We present the case of an everolimus-induced pneumonitis in a renal transplant recipient, which occurred as early as on the 5th day after everolimus introduction. Shortly after the transplant procedure, the patient presented with typical symptoms of pulmonary infection. Chest radiography and computed tomography showed bilateral patchy lung infiltrates with peribronchial distribution that were suggestive of bacterial pneumonia. However, there was no improvement with empiric antibiotic treatment. Repeated cultures from the blood, sputum, and broncho-alveolar lavage (BAL) also were negative. Tuberculosis, Pneumocystis jirov...
Transplantation Proceedings
Acta Biochimica Polonica, 2015
Hypercholesterolemia is a common disorder in adult population, but total cholesterol concentratio... more Hypercholesterolemia is a common disorder in adult population, but total cholesterol concentrations beyond 1000 mg/dl occur rarely, and are found in patients with homozygous familial hypercholesterolemia and familial lecithin-cholesterol acyltransferase deficiency, in chronic graft-versus-host disease of the liver, after intravenous infusion of fat emulsion (intralipid), in newborn infants with immature liver function, and in obstructive biliary cholestasis. Cholestasis induces a dramatic increase in plasma cholesterol and the appearance of an abnormal lipoprotein, lipoprotein X (LpX), in the plasma. We report a case of severe hypercholesterolemia mediated by LpX in a patient transplanted for primary biliary cirrhosis (PBC), who was qualified for liver re-transplantation (re-LTx) due to chronic cholestasis. Four months after re-LTx, the cholesterol concentration was normal. The problems in diagnosis and treatment are discussed.
Annals of transplantation: quarterly of the Polish Transplantation Society
We evaluated the impact of concomitant infection with Hepatitis B virus (HBV) and Hepatitis C vir... more We evaluated the impact of concomitant infection with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) on the clinical course after renal transplantation (Tx). In 335 patients (pts) transplanted between 1991 and 1993 we found 30 (9%) recipients who were positive for Hepatitis B surface antigen (HBsAg) (ELISA, Organon) and anti-HCV antibodies (immunoblot assay Lia Tek) preTx. Chronic liver disease (CLD) (two-fold or greater increase in serum ALT and AST levels for at least six months) developed in 40.7% coinfected pts as compared to 24.4% and 25.7% pts infected only with HCV or HBV, respectively. Maintenance immunosuppression consisted of P + Aza + CsA, mean follow-up time was 28 +/- 15 months. The mean time of the onset of CLD was 3.0 months (range: 1-18 months) after Tx. Percutaneous liver biopsy performed in 5 CLD pts revealed chronic active hepatitis (CAH) in 4 and chronic persistent hepatitis (CPH) in 1 pt. Four pts who had CAH and were positive for HCV RNA (RT PCR) in serum ...
Przegla̧d lekarski
Cardiovascular disease is the leading cause of death in renal transplant recipients. Death with a... more Cardiovascular disease is the leading cause of death in renal transplant recipients. Death with a functioning graft is the main cause of graft failure. Risk factors for cardiovascular complications and modification of methods are discussed.
Przegla̧d lekarski
Some of living kidney donors have medical conditions associated with future risk of cardiovascula... more Some of living kidney donors have medical conditions associated with future risk of cardiovascular diseases. It seems justified to identify risk factors and cardiological disorders prior to the donation. To determine the cardiological status of persons qualified as a living kidney donor. We analyzed the data of 109 potential living kidney donors, aged 25-70 (mean 45.7 ± 10.9) years. They underwent clinical and biochemical examination. In some of them extended diagnostics was performed. The presence of risk factors of coronary artery disease were registered. Only 46 (42%) persons were qualified for kidney donation. As many as 40 of them had 21 risk factor. In 75 (68.8%) patients without hypertension, 24-hours ambulatory blood pressure monitoring was done. The masked hypertension was found in 6 persons. In 22 candidates aged > 50 years the exercise test was performed (positive or inconclusive in 3 persons). Coronarography was done in 5 individuals (in no any significant atheroscler...
Transplantation Proceedings
Przegla̧d epidemiologiczny
Human herpesvirus 6 (HHV-6) is a lymphotropic herpesvirus of emerging clinical significance in im... more Human herpesvirus 6 (HHV-6) is a lymphotropic herpesvirus of emerging clinical significance in immunocompromised patients. Little is known about clinical impact and relevance of HHV-6 variant A infection in renal transplant recipients. We describe the case of a 44-year-old woman who underwent second allogenic kidney transplantation (Tx). On day 6 after Tx she presented with high fever. She developed thrombocytopenia, anemia, diarrhea, liver dysfunction and graft failure. Renal graft biopsies that followed revealed acute rejection. Apart from the introduction of anti-rejection therapy, empiric gancyclovir, as well as antibacterial treatment was initiated. To determine the serostatus of HHV-6 and load of HHV-6A and -6B DNA in paired sera samples an enzyme-linked immunosorbent assay, indirect immunofluorescence assay and real time quantitative polymerase chain reaction (PCR) assay based on the exonuclease format (TaqMan) was devised. HHV-6A was the sole pathogen, the DNA of which was r...
Annals of transplantation: quarterly of the Polish Transplantation Society
We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers dis... more We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology. Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation. In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation. Results of biopsies suggested that approximately in one third of livers discarded from transplantation...
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
Chronic allograft nephropathy (CAN) is the most important cause of late renal allograft loss. The... more Chronic allograft nephropathy (CAN) is the most important cause of late renal allograft loss. The standard diagnosis of CAN is based on pathological examinations according to Banff'97 scheme. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria in non-invasive recognition of vascular changes accompanying CAN (AH--arteriolar hyaline thickening, CV--vascular fibrous intimal thickening). beta 2- and alpha 2-microglobulin (beta 2-m and alpha 2-m), albumin (alb), immunoglobulin G (IgG), total protein (tp) and creatinine (cr) concentration were measured in the second time urine specimen in 66 renal allograft recipients. Then the subsequent renal biopsies were done. The aim of statistical analysis (MANOVA, Stepwise Discriminant Analysis, SDA) was to diagnose CV and AH changes based on results of urine analysis listed above and the patient's age, time after transplantation and serum creatinine level (scr). Results obtained with statistical analys...
Transplantation Proceedings
Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacteri... more Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacterial infections, due to the possibility of micro-organism translocation from their physiological habitat. Infectious complications may occur both in the early and late post-transplantation periods. The purpose of this study was to evaluate the proportion as well as susceptibility profiles of obligatory anaerobes in the etiology of infections in patients hospitalized at transplantation wards of a large clinical hospital in Warsaw. A total of 104 strains of obligatory anaerobes derived from patients hospitalized in two transplantation clinics at a clinical hospital in Warsaw were evaluated. The strains were isolated from 87 clinical samples collected from 84 patients of two transplantation wards between 2007 and 2012. A total of 104 obligatory anaerobic bacterial strains were isolated and identified, with Gram-positive and Gram-negative bacteria constituting 60.6% and 39.4% of the isolates, ...
Annals of transplantation: quarterly of the Polish Transplantation Society
A case of calcineurin inhibitor (CNI)--induced haemolytic uremic syndrome (HUS) after liver trans... more A case of calcineurin inhibitor (CNI)--induced haemolytic uremic syndrome (HUS) after liver transplantation leading to irreversible renal failure is described. We present case history of 25-years old male after liver transplantation due to cryptogenic cirrhosis with prolonged worsening graft function, who developed HUS. Unsatisfactory graft function was the reason of performing numerous graft biopsies. Features of acute and chronic rejection (CR) of liver were histopathologically confirmed. Vanishing bile duct syndrome as manifestation of CR was stated and immunosuppressive regimen was intensified (tacrolimus placed cyclosporin). High blood levels of tacrolimus were maintained (approximately 20-22 ng/ml) on dose 3 mg twice a day. No clinical effect was observed. Renal failure was improving (serum creatinine was 3.3 mg/dl and eGFR was 24 ml/min/1.73 m(2)). After four months of maintaining high dose of tacrolimus patient was referred to our center in order to estimate indications for liver retransplantation. On admission severe haemolytic anaemia, thrombocytopenia and acute renal failure were detected. Atypical HUS probably related to CNI was diagnosed. Tacrolimus administration was discontinued. Blood and plasma transfusion as well as plasmapheresis were implemented. Haemolysis was limited, but renal function was not improved. Renal biopsy revealed features of irreversible nephropathy in course of thrombotic microangiopathy. Despite previously maintaining high dose of CNI, there were no signs of CNI nephrotoxicity. Patient required haemodialysis. Due to necessity of haemodialysis and worsening function of liver, patient was accepted to liver and kidney transplantation. High CNI blood concentration in patient after liver transplantation can be atypical cause of HUS and leads to irreversible renal failure.
Polskie archiwum medycyny wewnȩtrznej
Antiphospholipid syndrome (APS) is an autoimmune disease with clinical manifestations of arterial... more Antiphospholipid syndrome (APS) is an autoimmune disease with clinical manifestations of arterial and venous thrombosis, concomitant fetal loss and the presence of antiphospholipid antibodies (APLA). This report focuses on the challenges of optimal treatment involving plasma exchange and intravenous human immunoglobulin infusions that is administered in patients with catastrophic APS (CAPS). CAPS is a rare variant of APS defined as acute failure of at least three tissues, organs or systems caused predominantly by small vessel thrombosis confirmed by histopathologic evidence. CAPS develops rapidly and leads to death in 50% of cases. We present the case of a 39-year-old male patient with APS with worsening renal function. Positive lupus anticoagulant, markedly high concentrations of anticardiolipin and anti-beta 2-glikoprotein I antibodies have been observed. According to the criteria introduced by Asherson, a catastrophic form of APS was diagnosed and the patient had been treated with low-molecular-weight heparin, glucocorticosteroids, and plasmapheresis. In order to maintain clinical improvement, the patient was given human immunoglobulins i.v. (1 g/kg body weight). After the procedure, gradual clinical improvement was observed and renal function remained stable (serum creatinine level of 1.5 mg/dl).
Annals of transplantation: quarterly of the Polish Transplantation Society
Anemia is not only a feature of chronic kidney disease of native or grafted kidneys, but also is ... more Anemia is not only a feature of chronic kidney disease of native or grafted kidneys, but also is frequently found in liver and heart transplant recipients. End-stage organ failure requiring transplantation is usually associated with failure or impaired function of other organs. Chronic kidney disease developing after non-renal solid organ transplantation is a significant issue, as reviewed previously. The degree of functional impairment in kidney function after non-solid organ transplantation and the rate of progression of CKD post-transplant depend to a large extent on pretransplant kidney function (ie, stage of preexisting CKD), the type of the transplanted organ, and the immunosuppressive protocol (use of calcineurin inhibitors), presence of comorbid conditions such as diabetes, hypertension, HCV infection, older age, surgical issues, and individual clinical features determining susceptibility to renal injury, even nephropathy resulting from BK virus infection, is presented.
Medycyna doświadczalna i mikrobiologia
In diagnosis of CMV infection various laboratory methods are used. The methods based on detection... more In diagnosis of CMV infection various laboratory methods are used. The methods based on detection of viral nucleic acids have been introduced routinely in many laboratories. The aim of this study was to compare nucleic acid hybridisation method and various variants of PCR methods with respect to their ability to detect CMV DNA. The studied material comprised 60 blood samples from 19 patients including 13 renal transplant recipients and 6 with acute leukaemia. The samples were subjected to hybridisation (Murex Hybrid Capture System CMV DNA) and PCR carried out in 3 variants: with one pair of primers (single PCR), nested PCR and Digene SHARP System with detection of PCR product using a genetic probe in ELISA system. The sensitivity of the variants ranged from 10(0) particles of viral DNA in nested PCR to 10(2) in single PCR. The producer claimed the sensitivity of the hybridisation test to be 3 x 10(5) and it seems to be sufficient for detection of CMV infection. The obtained results show that sensitivity of hybridisation was comparable to that of single PCR and the possibility of obtaining quantitative results makes it superior, on efficacy of antiviral therapy, especially in monitoring CMV infection in immunossuppressed patients and in following the efficacy of antiviral treatment.
Acta microbiologica Polonica
Early diagnosis of CMV infection is very important mainly in transplant recipients because CMV in... more Early diagnosis of CMV infection is very important mainly in transplant recipients because CMV infection is a frequent complication after transplantation. In this work we compared different laboratory methods: ELISA (IgG, IgM), Western blot,shell vial, antigenemia assay (pp65), the immunofluorescent method with epithelial cells from urine (IF), DNA in leukocytes by PCR and DNA in leukocytes by hybridization (HCS) to estimate the most proper method for diagnosis of CMV in renal transplant recipients. This preliminary study showed that HCS, PCR and Western blot are sensitive methods for detecting CMV infection. Using HCS in quantitative variant we obtained a very good correlation between DNA load and clinical symptoms.
Neuro endocrinology letters
To assess safety of combined low-dose oral contraceptives in women after renal transplantation. T... more To assess safety of combined low-dose oral contraceptives in women after renal transplantation. Twenty six female renal graft-recipients, aged from 18 to 44 (mean 31 years), who used combined low-dose oral contraceptives after renal transplantation for at least 18 months were enrolled in the study. All patients had stable graft function with mean serum creatinine of 1.3 mg/dl. In 58% of women effective contraception was the mean indication for the therapy, in the remaining group pills were indicated additionally for the development of ovarian cysts and excessive menstrual bleedings. Ethinyl estradiol dose was 20 mug in 73% of cases and 30-35 microg in the remaining group. No case of pregnancy was observed. Contraceptive therapy was discontinued in two cases: for profound vein thrombosis in one and deterioration of liver function in the other case. No side effects of contraceptives were observed in the remaining group of patients within at least 18-month observational period. No case of ovarian cyst was reported. Oral contraceptives were not found to influence body mass index (BMI), mean blood pressure, serum creatinine and biochemical parameters (AST, ALT, total bilirubin, glucose and cholesterol). Despite the presence of relative contraindications for hormonal drugs (arterial hypertension and deteriorated liver function) in female renal recipients, administration of combined low-dose contraceptive pill should be taken into account as highly effective contraceptive method, that additionally regulates menstrual bleeding patterns, protects from ovarian cysts development and improves life quality of the patient.
Acta microbiologica Polonica
The comparison of two quantitative tests: hybridization (Murex Hybrid Capture System) and PCR (CO... more The comparison of two quantitative tests: hybridization (Murex Hybrid Capture System) and PCR (COBAS AMPLICOR CMV Monitor) detected CMV DNA was made. Investigation of viral load in serum by PCR gave better correlation with clinical manifestation in renal transplant recipients.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
The patients after renal transplantation with deteriorating graft function were included to the s... more The patients after renal transplantation with deteriorating graft function were included to the study. The aim of the study was to establish the usefulness of stabile complement split product C4d expression as the independent indicator of immunological activity in chronic rejection. The C4d expression was studied on fresh frozen tissue with immunofluorescence method. The intensification of immunosuppression regimen was also introduced and azathioprine was exchanged with mycofenolate mofetil. The protocol biopsies a year after inclusion are planned to be done. In our study there was positive correlation between C4d expression and previous acute rejection episodes, morphological changes specific for chronic rejection and clinical improvement after immunosuppression enhancement.
Annals of transplantation: quarterly of the Polish Transplantation Society
Hypertension (HT) is one of the most frequent complications of solid organ transplantation; about... more Hypertension (HT) is one of the most frequent complications of solid organ transplantation; about 70-90% of this population have high blood pressure or require antihypertensive therapy. Abnormal blood pressure is a potent non-immunological risk factor directly related to patient and graft survival. The etiology of hypertension after orthotopic heart transplantation is multifactorial and varies depending on the time following transplantation. In the early period after transplantation, hypertension is generally related to intravascular volume expansion and persistently increased systemic vascular resistance. Other factors predominant in kidney allograft recipients include: donor age, donor familial history of hypertension, transplant renal artery stenosis, graft function, the recurrence or de novo appearance of glomerulonephritis in transplanted kidney, and post-biopsy arteriovenous fistula. In liver and heart transplantation, hypertension is mainly due to impaired kidney function, with all its consequences. Another contributing factor is immunosuppressive regimen based on calcineurin inhibitors and steroids. The management of post-transplant hypertension usually requests non-pharmacological and pharmacological treatment. In this review, the pathogenesis and treatment of post-transplant hypertension in solid organ transplantation is presented.
Annals of transplantation: quarterly of the Polish Transplantation Society
Background: Everolimus is a derivative of sirolimus, and is considered to be free of the latter&#... more Background: Everolimus is a derivative of sirolimus, and is considered to be free of the latter's pulmonary toxicity. Recently, a few cases of everolimus-induced lung injury have been reported. Early recognition of drug-induced lung disease is important because it can be reversed if appropriate therapy is instituted soon after the onset of symptoms. Case report: We present the case of an everolimus-induced pneumonitis in a renal transplant recipient, which occurred as early as on the 5th day after everolimus introduction. Shortly after the transplant procedure, the patient presented with typical symptoms of pulmonary infection. Chest radiography and computed tomography showed bilateral patchy lung infiltrates with peribronchial distribution that were suggestive of bacterial pneumonia. However, there was no improvement with empiric antibiotic treatment. Repeated cultures from the blood, sputum, and broncho-alveolar lavage (BAL) also were negative. Tuberculosis, Pneumocystis jirov...
Transplantation Proceedings
Acta Biochimica Polonica, 2015
Hypercholesterolemia is a common disorder in adult population, but total cholesterol concentratio... more Hypercholesterolemia is a common disorder in adult population, but total cholesterol concentrations beyond 1000 mg/dl occur rarely, and are found in patients with homozygous familial hypercholesterolemia and familial lecithin-cholesterol acyltransferase deficiency, in chronic graft-versus-host disease of the liver, after intravenous infusion of fat emulsion (intralipid), in newborn infants with immature liver function, and in obstructive biliary cholestasis. Cholestasis induces a dramatic increase in plasma cholesterol and the appearance of an abnormal lipoprotein, lipoprotein X (LpX), in the plasma. We report a case of severe hypercholesterolemia mediated by LpX in a patient transplanted for primary biliary cirrhosis (PBC), who was qualified for liver re-transplantation (re-LTx) due to chronic cholestasis. Four months after re-LTx, the cholesterol concentration was normal. The problems in diagnosis and treatment are discussed.
Annals of transplantation: quarterly of the Polish Transplantation Society
We evaluated the impact of concomitant infection with Hepatitis B virus (HBV) and Hepatitis C vir... more We evaluated the impact of concomitant infection with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) on the clinical course after renal transplantation (Tx). In 335 patients (pts) transplanted between 1991 and 1993 we found 30 (9%) recipients who were positive for Hepatitis B surface antigen (HBsAg) (ELISA, Organon) and anti-HCV antibodies (immunoblot assay Lia Tek) preTx. Chronic liver disease (CLD) (two-fold or greater increase in serum ALT and AST levels for at least six months) developed in 40.7% coinfected pts as compared to 24.4% and 25.7% pts infected only with HCV or HBV, respectively. Maintenance immunosuppression consisted of P + Aza + CsA, mean follow-up time was 28 +/- 15 months. The mean time of the onset of CLD was 3.0 months (range: 1-18 months) after Tx. Percutaneous liver biopsy performed in 5 CLD pts revealed chronic active hepatitis (CAH) in 4 and chronic persistent hepatitis (CPH) in 1 pt. Four pts who had CAH and were positive for HCV RNA (RT PCR) in serum ...
Przegla̧d lekarski
Cardiovascular disease is the leading cause of death in renal transplant recipients. Death with a... more Cardiovascular disease is the leading cause of death in renal transplant recipients. Death with a functioning graft is the main cause of graft failure. Risk factors for cardiovascular complications and modification of methods are discussed.
Przegla̧d lekarski
Some of living kidney donors have medical conditions associated with future risk of cardiovascula... more Some of living kidney donors have medical conditions associated with future risk of cardiovascular diseases. It seems justified to identify risk factors and cardiological disorders prior to the donation. To determine the cardiological status of persons qualified as a living kidney donor. We analyzed the data of 109 potential living kidney donors, aged 25-70 (mean 45.7 ± 10.9) years. They underwent clinical and biochemical examination. In some of them extended diagnostics was performed. The presence of risk factors of coronary artery disease were registered. Only 46 (42%) persons were qualified for kidney donation. As many as 40 of them had 21 risk factor. In 75 (68.8%) patients without hypertension, 24-hours ambulatory blood pressure monitoring was done. The masked hypertension was found in 6 persons. In 22 candidates aged > 50 years the exercise test was performed (positive or inconclusive in 3 persons). Coronarography was done in 5 individuals (in no any significant atheroscler...
Transplantation Proceedings
Przegla̧d epidemiologiczny
Human herpesvirus 6 (HHV-6) is a lymphotropic herpesvirus of emerging clinical significance in im... more Human herpesvirus 6 (HHV-6) is a lymphotropic herpesvirus of emerging clinical significance in immunocompromised patients. Little is known about clinical impact and relevance of HHV-6 variant A infection in renal transplant recipients. We describe the case of a 44-year-old woman who underwent second allogenic kidney transplantation (Tx). On day 6 after Tx she presented with high fever. She developed thrombocytopenia, anemia, diarrhea, liver dysfunction and graft failure. Renal graft biopsies that followed revealed acute rejection. Apart from the introduction of anti-rejection therapy, empiric gancyclovir, as well as antibacterial treatment was initiated. To determine the serostatus of HHV-6 and load of HHV-6A and -6B DNA in paired sera samples an enzyme-linked immunosorbent assay, indirect immunofluorescence assay and real time quantitative polymerase chain reaction (PCR) assay based on the exonuclease format (TaqMan) was devised. HHV-6A was the sole pathogen, the DNA of which was r...
Annals of transplantation: quarterly of the Polish Transplantation Society
We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers dis... more We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology. Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation. In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation. Results of biopsies suggested that approximately in one third of livers discarded from transplantation...
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
Chronic allograft nephropathy (CAN) is the most important cause of late renal allograft loss. The... more Chronic allograft nephropathy (CAN) is the most important cause of late renal allograft loss. The standard diagnosis of CAN is based on pathological examinations according to Banff'97 scheme. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria in non-invasive recognition of vascular changes accompanying CAN (AH--arteriolar hyaline thickening, CV--vascular fibrous intimal thickening). beta 2- and alpha 2-microglobulin (beta 2-m and alpha 2-m), albumin (alb), immunoglobulin G (IgG), total protein (tp) and creatinine (cr) concentration were measured in the second time urine specimen in 66 renal allograft recipients. Then the subsequent renal biopsies were done. The aim of statistical analysis (MANOVA, Stepwise Discriminant Analysis, SDA) was to diagnose CV and AH changes based on results of urine analysis listed above and the patient's age, time after transplantation and serum creatinine level (scr). Results obtained with statistical analys...
Transplantation Proceedings
Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacteri... more Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacterial infections, due to the possibility of micro-organism translocation from their physiological habitat. Infectious complications may occur both in the early and late post-transplantation periods. The purpose of this study was to evaluate the proportion as well as susceptibility profiles of obligatory anaerobes in the etiology of infections in patients hospitalized at transplantation wards of a large clinical hospital in Warsaw. A total of 104 strains of obligatory anaerobes derived from patients hospitalized in two transplantation clinics at a clinical hospital in Warsaw were evaluated. The strains were isolated from 87 clinical samples collected from 84 patients of two transplantation wards between 2007 and 2012. A total of 104 obligatory anaerobic bacterial strains were isolated and identified, with Gram-positive and Gram-negative bacteria constituting 60.6% and 39.4% of the isolates, ...