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ABSTRACT: Despite prospective crossmatching and modern immunosuppression, early acute rejection is still present in cadaveric renal transplantation. The purpose of this study was to evaluate the incidence of preformed anti-donor antibodies, detected by 2 solid-phase techniques, and to analyze their impact on early renal allograft outcome.
Flow crossmatch detecting the presence of anti-donor IgG and IgM antibodies was performed in pre-transplant sera of 279 patients with negative cytotoxic crossmatch. Screening for IgG antibodies detected by bead-based multiplex technique was performed in sera of 69 patients from the FCXM group. The incidence of early biopsy-proven rejection and graft failure within 3 months after transplantation was analyzed.
Anti-donor IgG antibodies were detected in 33 patients (11.8%) by flow crossmatch and in 10 patients by multiplex (14.5%). IgM antibodies were detected in 23 patients (8.2%). All multiplex-positive sera were also positive for IgG by flow crossmatch, but in 18 cases no antibodies were found by multiplex technique. Biopsy-proven acute rejection within 3 months after transplantation was observed in 16 patients, and 5 allografts were lost due to immunological reasons. Presence of IgG antibodies was found to have no effect on early outcome, while the presence of IgM antibodies was associated with significantly higher rejection rate and immune-related graft failure.
Anti-donor IgG antibodies detected by bead-based and cell-based technique have no impact on biopsy-proven rejection rate or graft failure. Anti-donor IgM detected by flow crossmatch have significant impact on early transplantation outcome.
Annals of transplantation: quarterly of the Polish Transplantation Society 12/2011; 16(4):32-9. · 2.02 Impact Factor
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Piotr Kaliciński,
Hor Ismail,
Dorota Broniszczak,
Joanna Teisserye,
Ludmiła Bacewicz,
Małgorzata Markiewicz-Kijewska,
Marek Szymczak,
Paweł Nachulewicz,
Bozenna Dembowska-Bagińska, Przemysław Kluge,
Andrzej Kościesza,
Adam Kowalski,
Marek Stefanowicz,
Weronika Kasprzyk,
Marek Krawczyk
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ABSTRACT: There is a group of children with primary hepatic tumors which can not be resected by conventional partial liver resection. Total hepatectomy followed by liver transplantation may be the only solution in such cases. Authors reviewed own experience with the liver transplantation for unresectable tumors in children and assessed the possible indications and role of transplantation in these patients.
Liver transplantation was performed in 17 children with unresectable hepatic tumors out of total number of 350 children transplanted. Hepatocarcinoma was present in 8 children, hepatoblastoma in 6 and benign giant hemangioma in 3. There was no other option for the treatment which would lead to the oncological cure of children with malignant tumors. All patients with giant hemangiomas were infants transplanted urgently due to circulatory and then multiorgan failure.
Survival within whole group is 75.5% (13 of 17 pts), 3 children died of malignant tumor recurrence, one of other causes. All 3 children with benign tumors are alive and well. Actual follow-up is from 3 months to 7 years.
Liver transplantation should be considered as option in the treatment of all children with unresectable hepatic tumors. With the careful and individual patient selection significant chances for survival can be achieved in this group of patients which would otherwise not survive with the conventional treatment.
Annals of transplantation: quarterly of the Polish Transplantation Society 06/2008; 13(2):37-41. · 2.02 Impact Factor
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ABSTRACT: Anti-CMV prophylaxis is currently a routine management in patients after organ transplantation. One of the clinical symptoms of CMV infection may be lesions in the oral cavity.The aim of this study was to determine the relationship between CMV infection, occurrence of Candida species and presence of oral mucosal ulceration in transplant recipients.
Twenty fi ve patients after kidney or liver transplantation (mean age 13 years +/-4 years), receiving immunosuppression (tacrolimus, cyclosporine or sirolimus), who presented minor and major recurrent aphtous stomatitis (RAS), atypical ulcerations or focal necrosis in the oral cavity were enrolled into the study. Mean duration of post-transplant follow-up was 4 years and 3 months (+/-3 years and 5 months). Clinical dental examination (Pl I, GI), mycological tests and blood tests for CMV infection (specific IgM antibodies and/or pp65 antygenemia) were performed in all patients. Eighteen specimens of oral mucosa were evaluated for CMV presence in situ.
CMV infection was confirmed in 13 patients with oral mucosal ulceration (46.43%); which were accompanied by gingivitis (average GI=1.34); in two cases Candida albicans was identified. DNA of HCMV was found in-situ in 5.5% of all biopsies, and in 9% of biopsies of patients with clinical CMV infection; changes did not show the presence of Candida spp.
There is a significant correlation between CMV infection and oral lesions; in some cases, CMV may be a direct cause.
Annals of transplantation: quarterly of the Polish Transplantation Society 02/2008; 13(4):28-33. · 2.02 Impact Factor
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ABSTRACT: The aim of study was to report the preliminary results and complications of HCV infection treatment after liver transplantation.
Six patients after liver transplantation (one after combine liver and kidney) had been qualified to treatment with pegylated interferon and ribavirin.
In four patients the therapy was discontinued due to severe side effects (anaemia, cholestasis, sepsis, acute rejection). In two patients the normalization of biochemical parameters of liver function was achived after treatment.
HCV treatement in solid organ recipients should be individualised.
Przegla̧d epidemiologiczny 02/2006; 60(4):677-83.
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ABSTRACT: Renal cancer accounts for about 2% of all cancers in general population. One of the risk factors is acquired cystic kidney disease developed in course of end- stage renal failure. About 2% of cases of renal cancer are associated with inherited syndromes. We present here the case of 18-year old boy with papillary bilateral renal cell carcinoma, which was found 3 years after renal transplantation, in the stage of graft failure, few days after graphtectomy, while looking for the reason of persistent fever.
Przegla̧d lekarski 02/2006; 63 Suppl 3:187-8.
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ABSTRACT: We encountered on seven malignant hepatocellular tumors developing in older children and adolescents.
These tumors exhibit an unusual phenotype with respect to clinical presentation, histopathology, immunohistochemistry, and treatment response. As a working hypothesis, we suggest that these apparently novel, unusual, and aggressive tumors occurring in older children and adolescents may form a transition in the putative developmental pathway of hepatocarcinogenesis.
We therefore propose the term, transitional liver cell tumors (TLCT), to denote these lesions.
Medical and Pediatric Oncology 12/2002; 39(5):510-8.
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ABSTRACT: Hepatic vascular tumors (HVT) are the most common benign liver tumors present in infancy and childhood commonly associated with high output cardiac failure. Pediatric HVT usually are divided into infantile hemangioendothelioma (IHE), cavernous hemangioma (HC), and arteriovenous malformations (AVM). The aim of this study was to analyze clinical and histologic features of pediatric HVT in relation to treatment strategies.
During last 12 years, 17 children have been treated because of HVT. The diagnosis of HVT was established in all on the basis of clinical and imaging data. A retrospective analysis of clinical records and histopathology divided 17 into: Group 1, neonates; and Group 2, infants and older children.
Radiologic imaging revealed the vascular nature of the tumors in all patients. All nine from Group 1 were symptomatic from AVMs and seven were operated upon. Only one of eight children from Group 2 presented symptoms of AVM requiring surgery; four of five in this group had surgery because of the risk of malignancy. Within Group 1, a mixture of proliferating IHE with microscopic features of AVM was found in most. In three neonates with HVT immunologic and clinical features of cytomegalovirus (CMV) hepatitis were noted. In two Group 2 patients, pure HC was present and in another, the diagnosis of angiosarcoma was established after biopsy of a peritoneal metastasis.
HVT in children demonstrate internal morphologic heterogeneity and an age-related behavior of the disease. We also confirm the proliferative nature of all hemangioendotheliomas (HEs) in children. Further studies on the tumorigenesis of these lesions are needed.
Medical and Pediatric Oncology 12/2002; 39(5):524-9.
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Hor Ismail,
Piotr Kaliciński,
Małgorzata Markiewicz,
Irena Jankowska,
Joanna Pawłowska, Przemysław Kluge,
Eliana Eliadou,
Andrzej Kamiński,
Marek Szymczak,
Tomasz Drewniak,
Yann Revillon
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ABSTRACT: Progressive intrahepatic familial cholestasis (PFIC), previously called Byler’s disease, is a syndrome in which children develop severe cholestasis progressing to biliary cirrhosis and chronic liver failure, usually during the first decade of life. Clinical features include jaundice, hepatomegaly, splenomegaly, growth retardation and severe pruritis. Laboratory tests demonstrate elevated bilirubin and bile acids, without an increase in serum gamma-glutamyl-transpeptidase or cholesterol. This study was performed to evaluate our experience with medical therapy as well as two types of surgical treatment used in children with PFIC, particularly partial external biliary diversion (PEBD) as an alternative method of therapy to liver transplantation (OLTx). Between 1979 and 1998 we have treated 46 children with PFIC (27 boys and 19 girls), aged 10 months to 19 yr (at the time of this study). Medical treatment with ursodeoxycholic (UDCA) was used in 39 patients for the period between 6 and 82 months. PEBD (cholecysto-jejuno-cutaneostomy) was performed in 16 patients, OLTx in eight children (including one after unsuccessful PEBD). Retrospective analysis of the clinical course and selected laboratory tests (bilirubin, ASPAT, ALAT, bile acids), and histopathological examinations were performed. Results of treatment were assessed by means of influence of the type of treatment on clinical symptoms, laboratory tests, progress of liver cirrhosis and hepatic failure, as well as physical development and survival. Medical therapy was effective in the long term in four (10%) of the patients resulting in clinical and biochemical normalization. Both surgical methods of therapy of PFIC, PEBD and OLTx, resulted in an 80% success rate and therefore should be used as complementary therapies. In patients before established liver cirrhosis, PEBD should be the first choice of treatment. Patients presenting with cirrhosis or after ineffective PEBD should qualify for OLTx. With this strategy most children with PIFC can be cured.
Pediatric Transplantation 07/1999; 3(3):219 - 224. · 1.48 Impact Factor
