Our technique of combined renal and segmental pancreas transplantation

This case, however, confirms our hypothesis that intraperitoneal positioning of a segmental pancreatic graft into the Douglas' pouch and an end to side arterial anastomosis bring several advantages as far as venous thrombosis and tryptic lesions are concerned.     

Favorable course of pregnancy in a patient two years after kidney transplantation]

A 30-year old female underwent kidney transplantation after unsuccessful 3-year dialysis for renal cortex necrosis. Immunosuppression was achieved with cyclosporin followed by azathioprine with prednisone. The patient conceived after 22 months with kidney transplantation. Mild decrease in arterial blood pressure and marked increased in glomerular filtration rate were seen during the first three months of pregnancy. Arterial blood pressure increased but insignificantly at the end of pregnancy. That time, gradual decrease in creatinine clearance was observed. An increase in serum bilirubin and alkaline phosphatase was noted. Pregnancy was terminated by cesarean section on the 38th week. Newborn was female, full-termed, viable, with body weight of 3,300 g. All examined parameters were normalized after delivery. Described case indicates that transplanted kidney functioning during pregnancy is similar to that in healthy women.     

Obesity and adiponectin after kidney transplantation

Obesity and hyperlipidaemia are found very frequently after kidney transplantation (Tx) and may represent independent risk factors for development of atherosclerosis and chronic allograft nephropathy. In a prospective metabolic study, we monitored, a total of 68 obese transplant patients [body mass index (BMI) > 30 kg/m2] with dyslipidaemia over a period of 24 months. We compared the findings of a new therapeutic regimen 1 year (start of the study) and 2 years after renal transplantation. Based on a Subjective Global Assessment Scoring Sheet, we started at the end of the first year with an individualized hypoenergic-hypolipidaemic diet (IHHD). Subsequently, after corticoid withdrawal, IHHD was supplemented regularly with statins (atorvastatin 10-20 mg/day)) and followed-up for 2 years. All patients were on a regimen of cyclosporin A or tacrolimus and mycophenolate mofetil. During the study period, there was a significant decrease in BMI (p < 0.025) and an increase of the adiponectin level (p < 0.01). Long-term therapy was associated with a significant decrease in serum leptin (p < 0.01) and lipid metabolism parameters (p < 0.01). Inulin clearance, mean systolic and diastolic blood pressure, proteinuria, lipoprotein(a) and apo-lipoprotein E isoforms did not differ significantly. Based on our results, we assume that obesity and hyperlipidaemia after renal transplantation can be treated effectively by modified immunosuppression (corticosteroid withdrawal), statins and long-term diet (IHHD). The increased level of adiponectin may be a marker of reducing atherosclerotic and chronic allograft nephropathy processes.     

Allogeneic segmental pancreas transplantation in diabetic dogs with and without occlusion of the pancreatic duct

Currently the rate of complications in segmental pancreas transplantation is very high. Reasons for this come from technical failures and from the site of immunology. To prove the cause of technical complications, several methods were used for the allogeneic segmental pancreas transplantation in diabetic dogs. To influence the exocrine pancreas secretion in grafts, we applied the intraductal injection of Ethibloc and Neoprene and the intraperitoneal drainage. By all these approaches it was possible to ameliorate an experimental diabetes in the recipients. Clearly better results were achieved in the Ethibloc-injected and open-duct grafts. The longest function time was about 6 months. Main complications, especially in the Neoprene-injected group, were venous thrombosis, pancreatitis and graft rejection.     

Fibronectin plasma levels after cadaver kidney transplantation

The fibronectin plasma levels of 17 patients undergoing cadaver kidney transplantation were determined serially in the postoperative course using laser nephelometry. While 9 patients retained their grafts (group A), the grafts of 8 patients had to be removed (group B), mainly due to rejection, 3 patients had severe infections. In both groups a significant drop of the plasma fibronectin occurred after surgery. There were no significant differences between the two groups in the mean fibronectin levels. After the initial drop the group A patients exhibited rising values leading to a stable level. Progressively declining fibronectin plasma concentrations were found in 2 of 3 severely infected patients. Fluctuating values were found in 3 group B patients without a clear correlation to the rejection crises or the kidney function. The data suggest that the fibronectin plasma level does not seem to be a prognostic marker for graft rejection. But it might be useful in the important and often difficult differentiation between rejection and infection.     

Analysis of urine sediments after kidney transplantation

We applied multiparameter flow cytometry for the first time to the classification of cells and particles of urine sediments after kidney transplantation. After fluorescent staining with acridine orange, cells and particles were checked for their size and their peak intensity of green and red fluorescences, known to be related to the amounts of intracellular DNA and intracellular RNA, respectively. Urine sediments were tested daily during a period of up to three weeks. Occurrence and disappearance of certain classes of cells and particles were found to be similar among different patients during normal healing. The results from patients without rejection of the graft are suggested as baseline data, differences from which should be detectable with high sensitivity due to the large number of cells being examined.     

Cytologic evaluation of urine after kidney transplantation

Over a ten-month period, 54 kidney transplant patients returning for routine clinic visits were prospectively evaluated utilizing urinary cytology; 101 urine specimens were examined. The incidence of undetected infection was low. Two patients were noted to have polyomavirus infections, and two had candiduria. No patient had urinary tract malignancy.     

胰腺或胰岛移植后1型糖尿病复发的预测

胰腺或胰岛移植后的1型糖尿病复发(T1DR)是影响远期移植物功能的关键因素之一。由T1DR导致的移植物功能丧失约占7﹪,与慢性同种排斥反应的发生率相当。然而,由于T1DR引起的复发性高血糖缺乏特异性,导致一直以来临床上T1DR发生被严重低估。移植物组织活检提示特异性靶向β细胞的炎性T细胞浸润是诊断T1DR的“金标准”。但是,作为一种有创性操作,组织活检不作为常规筛查T1DR方法。研究显示监测移植受者的胰岛自身抗体和抗原特异性T细胞对T1DR具有预测价值。本文就胰岛自身抗体和抗原特异性T细胞对预测T1DR作一综述。     

Characterization of vaginal lactobacilli in women after kidney transplantation

Limited number of publications described vaginal microflora after kidney transplantation. Our PubMed search revealed only 18 publications including words “vaginal bacteria &; kidney transplant” in the period of 1978–2011. The aim of this study was to characterize lactobacilli isolated from vaginal swabs of women after kidney transplantation, compared with healthy women. Eighteen renal transplant recipients (mean age 36.1) and 20 healthy women (mean age 36.0) were evaluated. Lactobacilli were cultured on MRS and Columbia blood agars. Biochemical identification with API 50 CHL (bioMerieux, Marcy L’Etoile, France) and multiplex PCR according to Song et al. was performed. Lactobacilli were tested for production of H₂O₂. Minimal inhibitory concentrations (MICs) of selected antimicrobial agents were determined with E-tests (bioMerieux, Marcy L’Etoile, France) and interpreted with CLSI and EUCAST criteria. No bacterial vaginosis was found among studied women. Two strains of group I were identified as Lactobacillus delbrueckii; 18 strains as Lactobacillus gasseri and 15 strains as Lactobacillus crispatus. Only 3 strains from group II were not identified by species-specific mPCR. Group IV was represented with 2 unidentified strains. Vaginal lactobacilli isolated from healthy women represented more homogenous group compared with heterogenous renal transplant recipients. Biochemical identification of lactobacilli by API 50 CHL kits was concordant with mPCR results only in 7 cases (17.5%), all 7 strains were identified as L. crispatus. Majority (93%) of lactobacilli were H₂O₂ producers. All isolated lactobacilli (100%) demonstrated high resistance to metronidazole (MIC > 256 μg/ml). Only 2 strains resistant to vancomycin (MICs: 32 and 256 μg/ml respectively), in the study and control group, and one to moxifloxacin (MIC = 32 μg/ml), were found. Resistance to metronidazole and vancomycin was concordant in CLSI and EUCAST (2010) criteria. Although significant differences between lactobacilli isolated from vaginas of kidney transplant and healthy women were not demonstrated, we demonstrated strains resistant to metronidazole, vancomycin and moxifloxacin in groups of examined women. Our study was performed on a small group of kidney transplant recipients and further more detailed molecular studies on a larger group of patients are required to confirm our results.