P Małkowski

Medical University of Warsaw, Warszawa, Masovian Voivodeship, Poland

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Publications (45)25.28 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Immunosuppression (IS) following transplantation should focus on improving long-term graft and patient survival. The objective of this study was to assess patient and graft survival rates and adverse event (AE) incidence in patients treated with combinations of tacrolimus (TAC) and steroids (ST) with either azathioprine (AZA) or mycophenolate mofetil (MMF). Material and Methods Seventy-seven renal transplant recipients (RTRs) treated with TAC/AZA/ST (n=37) or TAC/MMF/ST (n=40) in a single center were studied retrospectively. For 6 months after transplantation, patients were managed according to the COSTAMP study protocol. Afterwards, the follow-up visits were performed yearly for 7 years. Intent-to-treat (ITT) and on randomized therapy (ORT) groups were compared. Primary endpoints were graft function, graft loss, and death. Secondary endpoints included incidence of post-transplant diabetes mellitus (PTDM) and other AEs as estimated by the length of the hospitalization per patient per year. Results Demographic characteristics were similar in both groups of patients. Patient and graft survival at 7 years were 89.2% and 70.3% in TAC/AZA ITT; 97.5% and 77.5% in TAC/MMF ITT; and 100% in both ORT groups, respectively (ns). Differences in renal function, PTDM, and other AE incidence were also non-significant. Conclusions Our results indicate that TAC-based IS with either MMF or AZA is equally effective with respect to patient and graft survival and AE incidence. Taking into account the costs of both regimens and those of related AE therapies, our results raise the question of whether increasing MMF use in RTRs is justified from the perspective of the long-term results.
    Annals of transplantation : quarterly of the Polish Transplantation Society. 01/2013; 18:384-92.
  • Jacek Rozga, Tomasz Piątek, Piotr Małkowski
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    ABSTRACT: Human serum albumin has been widely used in an array of clinical settings for nearly 7 decades. Although there is no evidence to support the use of albumin rather than crystalloid in acute volume resuscitation, many clinicians continue to use albumin because it has other important physiologic effects besides the oncotic function. In keeping with the improved understanding of albumin physiology and pathophysiology of many acute and chronic diseases, use of albumin for medical applications has increased in recent years. This, along with increased costs of manufacturing and lower production volume of medical-grade albumin, has lead to an ongoing shortage and rapid increase in albumin prices. This review is based on the analysis of major publications, related to albumin chemistry, physiology, and medical uses including guidelines developed by professional and governmental organizations. Results reflect current knowledge about the role of albumin in health and disease and relevance of albumin therapy in specific clinical settings. Albumin therapy is currently recommended in spontaneous bacterial peritonitis with ascites, refractory ascites not responsive to diuretics, large-volume paracentesis, post-paracentesis syndrome, and the treatment of hepatorenal syndrome as an adjunct to vasoconstrictors. New indications for albumin therapy are linked to the antioxidant activity of albumin and its effects on capillary integrity. In recent years, large-pore hemofiltration and albumin exchange have emerged as promising liver support therapies for liver failure and other toxic syndromes. They are designed to remove a broad range of blood-borne toxins and to restore normal functions of the circulating albumin by replacing defective forms of albumin and albumin molecules saturated with toxins with normal albumin. In view of the ongoing worldwide shortage and high cost of human albumin (native and recombinant), new usage criteria, protocols, and guidelines for appropriate utilization of albumin are needed.
    Annals of transplantation : quarterly of the Polish Transplantation Society. 01/2013; 18:205-17.
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    ABSTRACT: 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 jiroveci, and Cytomegalovirus infections were excluded. A transbronchial lung biopsy performed 9 days after the onset of symptoms revealed mild nonspecific inflammation with a fibrotic component in the bronchial walls. Withdrawal of everolimus on the third day of hospitalization and after 8 days of its usage resulted in quick clinical recovery and resolution of radiological abnormalities within 1 month. Conclusions: Diagnosis of drug-induced pulmonary toxicity is difficult because it is essentially a diagnosis of exclusion. Lack of response to empiric antibiotic treatment and an imaging pattern of organizing pneumonia should raise suspicion of everolimus-induced pneumonitis in patients undergoing therapy with this drug.
    Annals of transplantation: quarterly of the Polish Transplantation Society 12/2012; 17(4):144-8. · 0.82 Impact Factor
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    ABSTRACT: Focal liver lesions are found on ultrasound or computed tomography performed for a reason unrelated to liver disease in up to 20% of examinations. As these studies are readily available today, more lesions are encountered, raising diagnostic and prognostic concern, and consuming substantial amount of healthcare resources. In these review, we tried to address the problem of incidental liver foci and propose a diagnostic algorithms which could be applied universally. Diagnosis should always be based on thorough anamnesis and patients ought to be separated in two major groups according to risk factors of primary liver cancer. In those with liver disease, HCC should be always suspected and when excluded, careful 6-monthly screening should be implemented. In patients with low HCC risk a history of neoplastic disease or symptoms of malignancy call for quick diagnosis and treatment. Patients with healthy liver and no signs of malignancy, vast majority of lesions are benign (simple cysts, hemangiomas and FNH) and require neither treatment, nor long term follow up. As lesion size correlates to the risk of malignancy and need for therapy as well as accuracy of visual studies, we also discuss diagnostic procedures applicable according to the diameter of the finding.
    Medical Science Review Hepatologia. 12/2012; 12(1):51-59.
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    ABSTRACT: Use of livers from cadaveric nonstandard donors has become justified, especially for recipients awaiting urgent transplantations. However, it is known that results are superior when organs are obtained from ideal rather than expanded-criteria donors. We designed a study to compare the characteristics of 582 liver donors whose organs were used for elective versus urgent transplantations in 2006-2008 and the recipients' outcomes. Donors and recipients were classified into 2 groups: 1) elective (n = 387); and 2) urgent transplantations (n = 195). We evaluated 12 donor risk factors: age >55 years, alcohol ingestion, intensive care unit stay >4 days, hypotensive episodes (<70 mm Hg >10 min), noradrenaline dose >0.1 μg/kg/min, anti-hepatitis B of core (+), Na level >155 mmol/L, international normalized ratio >1.5, aspartate transaminase >140 U/L, alanine transaminase >170 U/L, bilirubin >2.0 mg/dL, and changes in liver sonography. There were no significant differences in the frequency of incidence of 11 donor risk factors in both groups. Only sodium level >155 mEq/L significantly (P = .04) differed. Donors for elective recipients showed this factor more frequently than the urgent cohort. The mean number of risk factors per donor among the elective cases was 2.28 and for the urgent cases 2.3, a difference that was not significant. In almost all cases of liver transplantations (94%), donor-related risk factors were acceptable. The criteria for cadaveric liver donors were not different for elective versus urgent recipients; biologic characteristics of the transplanted organs were similar in both groups. A tendency was not observed to expand donor criteria for urgent recipients.
    Transplantation Proceedings 09/2012; 44(7):2250-2. · 0.95 Impact Factor
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    ABSTRACT: Epidemiological data on symptomatic HCV infection in Poland has shown that its prevalence among health care workers (HCWs) may exceed the prevalence notified among general population. Since such epidemiological situation would be similar to the increased prevalence of HBV infection among HCWs before anti-hepatitis B vaccine era, a seroprevalence study on HCV infection and immunity to HBV was performed in the group of volunteering HCWs. All the persons employed as HCWs in the two largest clinical hospitals in Warsaw were invited to participate in the study. They voluntarily gave a sample of blood for serological examination and were asked to fill-in a questionnaire containing questions relevant to the possible routes of infection, period of employment, and in part also to their life style. Both were done anonymously and in the unlinked manner. The activity of aminotransferases has also been determined in all the samples. 961 serum samples were collected from HCWs employed in both hospitals. Anti-HCV were detectable in 16 out of 961 sera (1.7%). HCV RNA was detected in 3 out of these 16 (19%) sera; in 2 serum samples genotype 2, in 1--genotype 1b HCV. Anti-HBs were detected in 943 out of 961 (98.1%) sera. Anti-HBc (total) were detectable in 151 out of 961 (15.7%) sera. Out of 151 sera with anti-HBc in 149 (98.7%) samples anti-HBs were also detected. HBV DNA was detected in 6 (4%) samples out of 151 sera containing anti-HBc. While the prevalence of asymptomatic HCV infection among HCWs is similar to that seen in general population in Poland, the 15.7% prevalence of anti-HBc exceeded almost three times the percentage found in another study. Since vaccination of health care personnel against HBV is at present obligatory, a large percentage of anti-HBs positive persons indicates for a high rate of immune response to vaccination. However, it seems that the presence of anti-HBs may not always be taken as indicating for immunity to HBV, but in some persons it may mask occult HBV infection. Since a younger population is immune to HBV infection due to universal vaccination of newborns and catch-up vaccination program for teenagers, older generations of HCWs may constitute a risk group for occult HBV infection.
    Przegla̧d epidemiologiczny 01/2012; 66(3):445-51.
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    ABSTRACT: The excellent results of vascularized organ transplantation have resulted in an increasing number of end-stage organ failure patients seeking such treatment. The results of organ transplantation depend on a number of factors--the quality of the donor (and an organ), living vs. deceased donation, magnitude of ischemic injury (and its prevention), and recipient-dependent factors. Ischemia/reperfusion injury in organ transplantation is a multifactorial process, which may lead to delayed graft function. In addition, surgical and preservation techniques, type of immunosuppressive regimens, complications after transplantation and post-transplant management may also have a significant impact on short- and long-term results of transplantation. In this paper we describe advances in transplantation in recent years, with particular emphasis on kidney, liver, intestines, whole pancreas and pancreatic islets.
    Medical science monitor: international medical journal of experimental and clinical research 12/2011; 17(12):RA282-91. · 1.22 Impact Factor
  • Polish Journal of Surgery 10/2011; 83(10):571-8.
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    ABSTRACT: First incidences of HIV or AIDS disease in Poland were reported in 1985. Up to the end of 2008 0,03% of polish population had been infected of HIV virus. The aim of this document was determination of HIV occurrence in Polish organ donor population in 1998–2008, determination of percentage of withdrawal in case of HIV infection, determination of HIV positive organ donor profile and comparison of frequency of HIV infection in deceased organ donors and general population in Poland. In 1998–2008 5954 possible deceased organ donors had been reported to Polish Transplant Coordinating Center Poltransplant, organ recovery took place in 4875 (82%) cases In 1079 cases (18 %) organs were not recovered because of medical reasons (46%) and family or prosecutor objections (54%). HIV antibodies had been tested in 90% possible organ donors. Positive HIV antibodies were reported in 0,3% cases. The occurrence of HIV infection in deceased organ donors in Poland in the years 1998–2008 was 10 times higher than in general Polish population. In general population HIV infections occur mainly in young people, in possible organ donor population infections occurred mostly between older one. HIV infection in donor is rare but significant reason of withdrawal.
    Corrosion Science - CORROS SCI. 01/2009; 8(2):20-23.
  • Polish Journal of Surgery. 01/2009; 81(9):400-404.
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    ABSTRACT: Liver transplantation (OLTx) is an optimal method of treatment of end-stage liver failure. It gives a chance to get back to an active life. 80-90% of patients survive over 1 year after liver transplantation with a perspective of a long life.Recently more attention is being paid to health related quality of life (QoL). It is considered as a combination of physical and mental condition, social and economical state and somatic experience. The aim of the study was to analyze patient's QoL after OLTx compared to the condition before OLTx. 123 patients 1-12 years after transplantation were included in the study. The study was conducted in Outpatients Clinic of Immunology, Transplantology and Internal Medicine Department and Transplantation Medicine and Nephrology Department of Warsaw Medical University between October 2007 and January 2008. Original questionnaire was used, consisting of 8 general questions and 44 detailed questions concerning pre- and posttransplant period. Information about physical condition (health, mobility, basic functions, drug side effects), mental condition (anxiety, happiness, cognition disorders), social function (family, friends, work) and economic status were gathered. "Never, sometimes, often, very often" score was used. Majority of subjects de fi ned their quality of life and physical condition before transplantation as poor, and post transplantation - as good. The respondent's mental condition didn't differ much before and after transplantation. Level of satisfaction was higher after transplantation. Health condition in some cases affected patients' family life, however it often devastated their social life before OLTx. Most patients were on disability pension and after transplantation they indicated the influence of health on their financial condition. The quality of life after liver transplantation gets better and it's de fi ned as good or very good. During the analysis of QoL a difference between conditions before and after LTX wasn't observed.
    Annals of transplantation: quarterly of the Polish Transplantation Society 02/2008; 13(4):67-71. · 0.82 Impact Factor
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    ABSTRACT: In 2007 the number of effective cadaveric donors and the number of transplanted organs in Poland significantly decreased. 466 possible deceased organ donors were reported to Polish Transplant Coordinating Center POLTRANSPLANT-Health Ministry Office responsible for organization of procurement, organ allocation and providing registries. Organ recovery took place in 352 (75.5%) cases (9.2 donors/pmp).
    Annals of transplantation: quarterly of the Polish Transplantation Society 02/2008; 13(4):16-20. · 0.82 Impact Factor
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    ABSTRACT: In the years 2001 to 2005 in Poland, 3146 potential deceased donors were referred with 2583 (82%) organs procured and 57 (2%) donors not used due to positive viral markers. According to Polish rules, in every case of possible organ harvest from a deceased donor we test viral markers of anti-HIV I/II, HBsAg, and anti-HCV. Organs from HBsAg-positive donors (the rule accepted in Poland a few years ago) are not transplanted; kidneys from anti-HCV(+) donors are transplanted into matched recipients. According to donor hospital capabilities, other viral tests are performed: anti-HBs, anti-HBc, HBeAg, and anti-HBe. We calculate the frequency of positive serological tests for viral markers among the population of deceased donors, for HBsAg it was 1.1% (from these donors 10 kidneys and 1 liver were transplanted); and for anti-HCV it was 2.6% (from these donors 78 kidneys were used). Anti-HBc-positive deceased donors, particularly liver donors (due to the high risk of viral transmission and de novo infection), are a major problem in transplantation, which reduced the number of used organs. Only 17 of 86 (20%) of the HBc-positive donors became liver donors compared with 257 of 524 (49%) donors from the HBc-negative group. But anti-HBc was checked only in 24% of potential donors (positive in 16.6% of cases), which means that 506 of 780 transplanted livers (65%) were obtained from donors of unknown anti-HBc status, 257 (33%) from anti-HBc-negative subjects and 17 (2%) from anti-HBc-positive subjects.
    Transplantation Proceedings 12/2007; 39(9):2695-7. · 0.95 Impact Factor
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    ABSTRACT: Grafts from genetically related living donors have better survival rates than ones from deceased donors. Immunological match is one of the beneficial factors involved. The aim of this paper is to discuss a case of a 55-year old patient living for 33 years with transplanted kidney, weaned off immunosuppressive therapy for 20 years. Perfect match between donor and recipient, homozygotic siblings, was vital for such long-term graft survival.
    Annals of transplantation: quarterly of the Polish Transplantation Society 02/2007; 12(1):46-8. · 0.82 Impact Factor
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    ABSTRACT: 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 due to clinical donor parameters could have been harvested from histological point of view. Several donor clinical risk factors (alcohol addiction, hyperbilirubinemia, increased transaminase activity) correlate with severe histological changes rending the liver "not suitable for transplantation".
    Annals of transplantation: quarterly of the Polish Transplantation Society 02/2007; 12(2):30-6. · 0.82 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma (HCC) is the most common primary malignant hepatic neoplasm. 80% of HCC's occur in cirrhotic liver. This article describes symptomatology of this neoplasm and its special, rare form - fibrolamellar carcinoma. The authors present current knowledge on liver imaging - especially ultrasound, computed tomography, and MRI, radiological findings, limitations of imaging the cirrhotic liver and usefulness of these procedures in diagnosis of HCC.
    Przegla̧d epidemiologiczny 02/2006; 60(4):741-8.
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    ABSTRACT: Hepatocellular carcinoma (HCC) is one of the most commonly occurring solid tumors worldwide and is the most frequent cause of cancer death in some parts of the world such as China and sub-Saharan Africa. HCC appears to be rising dramatically in incidence in developed western countries too. The most frequent underlying factors causing HCC are chronic viral hepatitis and cirrhosis. Early detection of HCC is a key factor in improving outcomes of therapies. There is growing evidence that HCC may be prevented with strategies aimed at preventing or treating viral hepatitis. Surgery, including liver transplantation, remains the most efficient treatment but only for 15-30% of patients. Recent developments suggest that other therapeutic modalities such as loco-regional (ablative) methods are also potentially curative.
    Przegla̧d epidemiologiczny 02/2006; 60(4):731-40.
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    ABSTRACT: Rak wątrobowokomórkowy jest piątym, co do częstości występowania, w świecie, nowotworem złośliwym, a jako przyczyna zgonu, spośród nowotworów zajmuje czwarte miejsce. Największą liczbę zachorowań odnotowuje się w krajach rozwijających się, w krajach zachodnich oraz Japonii. Zapadalność na HCC ulega zwiększeniu. Najistotniejszym czynnikiem ryzyka powstania HCC są wirusowe zapalenia wątroby oraz marskość. Wczesne rozpoznanie choroby jest kluczowe w poprawieniu wyników leczenia. Zapobieganie powinno polegać na zapobieganiu wirusowym zakażeniom oraz ich leczeniu. Leczenie chirurgiczne, w tym przeszczepienie wątroby (LT) jest najskuteczniejszą metodą, ale jedynie u 15-30% chorych. Ostatnie badania potwierdzają również skuteczność innych, miejscowych metod ablacyjnych, jako metod potencjalnie leczących.
    Przegla̧d epidemiologiczny 01/2006; 60(4):731-740.
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    ABSTRACT: Fifty-one simultaneous pancreas-kidney transplants (SPKT) were performed between 1988 and 2004 in patients of mean age 34 years and 23 years duration of diabetes treatment. All kidney and pancreas recipients were on maintenance hemodialysis therapy prior to SPKT. The pancreas with duodenal segment and the kidneys were harvested from cadaveric heart-beating donors. Cold ischemia time in UW solution varied from 4 to 14 hours (mean, 9 hours 35 minutes). Twenty patients had the duodenal segment sutured to the urinary bladder, and the remaining 31 grafts were drained to an isolated ileal loop. Quadruple immunosuppression was administered as well as an anticoagulant and antibiotic prophylaxis. Forty-nine patients (49/51, 96%) regained insulin independence in the immediate postoperative period; 44 (86%) displayed immediate graft function. The remaining patients experienced postoperative ATN, the longest duration was 18 days. Of 51 patients, 38 (14.5%) are alive (follow-up, 6 to 180 months), 26 (68.5%) have good pancreatic function, and 34 (89%), good kidney function. Nineteen (50%) patients regard their quality of life as improved compared to their pretransplant status, which is mainly attributed to being dialysis and insulin free. Of 19 patients, 14 (74%) reported measuring glycemia regularly due to fear of losing the pancreas graft. Of 19 persons, seven (37%) returned to work after transplantation. Four (8.3%) lost their kidney graft secondary to vascular complications (n = 2) or rejection (n = 2). Four pancreas grafts with bladder drainage required conversion to enteric drainage owing to persistent urinary infections or urinary fistulae. Fifteen (29%) patients lost their pancreatic grafts within 1 year of transplantation due to the following: vascular complications (n = 12), septic complications (n = 1), or rejection (n = 2). Thirteen patients died within 1 year after transplantation, 5 of septic complications, 5 of neuroinfection, 1 of pulmonary embolism, and 2 of myocardial infarction. In conclusion, SPKT is a successful treatment for diabetic nephropathy, burdened by the possibility of serious complications.
    Transplantation Proceedings 11/2005; 37(8):3555-7. · 0.95 Impact Factor
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    ABSTRACT: Throughout the history of liver transplantation many improvements have been made in the field of surgical technique. The technical progress improved results of liver transplantation; the split liver transplantation and living donor liver transplantation increased the number of cadaveric grafts, expanding primary the pediatric and later the adult liver graft pool. The authors present most of current methods of liver transplantation: orthotopic liver transplantation with or without preservation, of the inferior vena cava, "domino" liver transplantation, split liver transplantation, auxiliary liver transplantation and living donor liver transplantation.
    Przegla̧d epidemiologiczny 02/2005; 59(2):567-79.

Publication Stats

61 Citations
25.28 Total Impact Points

Institutions

  • 2001–2013
    • Medical University of Warsaw
      • • Katedra i Klinika Chirurgii Ogólnej i Transplantacyjnej
      • • Department of General, Transplant and Liver Surgery
      Warszawa, Masovian Voivodeship, Poland
  • 2008
    • University of Warsaw
      Warszawa, Masovian Voivodeship, Poland