Suchergebnisse

Delayed renal graft function (DGF) is a frequent complication with negative impact on the course of early post-transplantation period. The data concerning the impact on the late results are contradictory. This study describes results of 5-year follow-up of 248 recipients after deceased donor renal transplantation. All patients were divided into two groups: with delayed graft function (DGF, n = 53) and immediate graft function, considered as the control group (IGF, n = 195). We evaluated factors that were associated with development of DGF and its impact on the survival of graft and recipient, and frequency of acute rejections and chronic dysfunctions. The rate of observed DGF was 21.4%. Its development was associated with the following factors: age of recipient and their weight, age of donor and their body mass index, high frequency of asystole/hypotension in donors prior to organ explantation (P < 0.05 for all), and longer time of cold ischemia (P = 0.058). The DGF group had higher rate of acute rejections (P < 0.001), and also lower 1.5 and 5-year graft survival and 1.5-year patient survival (P < 0.05 for all). The conclusion is that DGF has negative impact on the survival of renal grafts and patients, especially during the first 1.5 years after transplantation.

The article presents an overview of literature related to two topical issues in modern medicine: transplantation and biomarkers. There have been advances made in the use of immunoenzymometric and immunoadsorption assays in organ transplantation clinics for evaluating different situations. However, these methods fail to solve more complex and ambiguous transplantation problems: tolerance, personification of treatment, etc. In this regard, the first results of prospective studies using OMICS methods of genomics and proteinomics, in relation to the notion of transplantomics, are presented

A growing lack of donor organs has caused extension of criteria for deceased donation. Therefore, elderly donors and donors with increased serum creatinine levels, as well as donors after cardiocirculatory death, have become used more frequently. The examination of such donors is strongly limited due to the lack of time, and the determination of the quality of donor organs is still based on clinical and laboratory screening data of donors. Implementation of new examination methods is required to determine the functional condition of donor organs more accurately, which would allow correct selection of donors. This retrospective study included all consecutive deceased donor (DD) kidney transplantations (KTx) performed in a single centre during the period from 1 January 2010 till 30 November 2011. The donor examination was supplemented by the urine neutrophil gelatinase-associated lipocalin (U-NGAL) test. Recipients were available for follow- up for at least 12 months (totally 97 KTx from 63 DD). All cases were divided into four groups according to U-NGAL and serum creatinine (S-Crea) levels in donors: group I - normal U-NGAL and S-Crea (n = 70); group II - elevated U-NGAL and S-Crea (n = 10); group III - elevated U-NGAL and normal S-Crea (n = 9); group IV - normal U-NGAL and elevated S-Crea (n = 8). Information about rates of delayed graft function (DGF) and immediate graft function (IGF), acute rejection (AR), recipient S-Crea levels during the first post-transplant year for functioning grafts, graft losses and recipient deaths were summarised. Donor urine NGAL level showed moderate correlation with donor S-creatinie level (r = 0.543, P < 0.001). DGF was observed in 20 recipients (21%) and demonstrated association with increased donor S-creatinine (0.135 ± 0.061 vs. 0.108 ± 0.04 mmol/l in IGF, p < 0.05). Combination of increased donor S-Crea and U-NGAL (group II) was associated with worse graft function during the first year after transplantation. Recipients in group III had increased S-Crea at the time of discharge from hospital and at one year after transplantation. One-year death censored graft survival and recipient survival was similar in all groups (P = NS). Determination of U-NGAL can be used as a donor auxiliary examination method for determination of the kidney graft functional condition and for prediction of post-transplant results. The study needs to be continued with a higher number of observations and longer post-transplant follow-up.

Jau pagājuši 40 gadi kopš pirmās nieres transplantācijas Latvijā, un pa šo laiku šajā jomā ir uzkrāta liela pieredze. Eiropā Latvija ieņem stabilu pozīciju nieru transplantācijā. Tomēr turpmāka transplantācijas attīstība Latvijā prasa transplantācijas centra restrukturizāciju.

Abstract
Our study was focused on identification and correction of early hyperglycaemia, with the aim to reduce the risk of developing post-transplant diabetes mellitus (PTDM) and its associated complications. In a single centre, the prospective study included adult kidney transplant recipients without diabetes mellitus whose pre-transplant glucometabolic data did not show signs of diabetes mellitus. Starting from the first day after kidney transplantation, patients were closely monitored for hyperglycaemia; glucose level measurements were started to obtain pre-prandial levels. If the blood glucose level exceeded 11.1 mmol/l, hyperglycaemia was corrected with short-acting insulin. A total of 14 patients completed a three-month follow-up. During the first post-transplant week, the blood glucose level exceeded 11.1 mmol/l in nine patients (63.9%). From those patients five (55.5%) did not develop PTDM. None of the patients who did not need insulin treatment developed PTDM. Higher pre-lunch glucose levels increased the risk of developing PTDM (p = 0.006). Patients with diabetes required a two times higher insulin dosage than other patients during the first post-transplantation week. We found that hyperglycaemia is a common problem in the early post-transplant period. Early recognition and correction of inpatient hyperglycaemia was associated with reduction of the prevalence of PTDM in more than a half of the patients in the studied group at three months post transplant.