Search

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

After successful kidney transplantation, the recovery of exocrine and endocrine kidney function occurs. Serum calcium, parathyroid hormone (PTH) phosphate, fibroblast growth factor 23 (FGF-23) and vitamin D values normalize. Therefore, positive changes in bone metabolism improve bone quality, reducing the frequency of fractures and vascular calcifications. In some patients, despite successful transplantation, disorders in bone metabolism remain. The incidence of hyperparathyroidism (HPT) after the first year of kidney transplantation ranges from 10-50%. The duration of dialysis and the degree of hyperplasia of the parathyroid glands are risk factors for the development of posttransplant HPT. The treatment of posttransplant HPT includes vitamin D therapy, vitamin D analogs, calcimimetics and parathyroidectomy (PTX). [ABSTRACT FROM AUTHOR]

Cilj: Važnost i uloga antitijela usmjerenih protiv humanih leukocitnih antigena (HLA) u reakcijama odbacivanja posredovanih antitijelima nakon transplantacije solidnih organa danas je jasno dokazana. Smatra se da su i antitijela usmjerena na antigene koji nisu dio sustava HLA, tzv. antitijela non-HLA, također povezana s humoralnim odbacivanjem te da mogu utjecati na preživljenje presatka. Prisutnost antitijela non-HLA dodatno ukazuje na bolesnike s povećanim imunološkim rizikom prije i nakon transplantacije organa. Cilj rada bio je odrediti prisutnost antitijela non-HLA u skupinama bolesnika prije i nakon transplantacije bubrega, odrediti njihovu učestalost pojavljivanja validiranim testovima probira te verificirati analizu rezultata. Ispitanici i metode: Analiza prisutnosti antitijela non-HLA provedena je u 17 visoko HLA-senzibiliziranih bolesnika na listi čekanja za transplantaciju bubrega (skupina pre-tx) i u 10 bolesnika s transplantiranim bubregom (skupina post-tx) čiji nalazi biopsija ukazuju na humoralno odbacivanje, a bez dokazanih prisutnih donor-specifičnih antitijela HLA (DSA). Za određivanje antitijela non-HLA korišten je test temeljen na tehnologiji Luminex koji omogućuje izravnu simultanu detekciju antitijela IgG protiv 60 različitih antigena non-HLA. Rezultati: Prisutnost antitijela non-HLA najmanje jedne specifičnosti dokazana je u 16/17 (94,1%) primatelja pre-tx skupine te u 7/10 (77,0%) primatelja post-tx skupine. Vrijednosti intenziteta fluorescencije pozitivnih reakcija bile su statistički značajno više u pre-tx skupini u usporedbi s post-tx skupinom. Broj specifičnosti antitijela non-HLA određenih po pojedinom primatelju bio je veći u pre-tx skupini. Zaključak: Test omogućuje vrlo osjetljivo dokazivanje prisutnosti i specifičnosti antitijela non-HLA. Prisutnost antitijela non-HLA visoka je u obje ispitivane skupine, a broj specifičnosti i intenzitet pozitivnih reakcija značajno je veći u visoko HLA-senzibiliziranih primatelja. Biopsijom dokazano humoralno odbacivanje bez prisutnih HLA DSA može biti povezano s antitijelima non-HLA u post-tx skupini.

Multisystem inflammatory syndrome after COVID-19 (MIS-A) is a consequence of an abnormal inflammatory response after COVID-19 resolution. Current criteria for diagnosis consist of the involvement of several organ systems. We present two cases, one in an immunosuppressed kidney transplant recipient and one in a patient on hemodialysis currently not on immunosuppression. The different clinical presentations and disease development may indicate that the current criteria for MIS-A diagnosis may be inadequate for immunosuppressed patients, as chronic immunosuppression may alter disease presentation. Both patients were treated with corticosteroids and intravenous immunoglobulins, and in both cases the treatment resulted in a prompt resolution of symptoms and stabilization of inflammatory parameters. [ABSTRACT FROM AUTHOR]

Introduction/Aim. Patients who undergo kidney transplantation can encounter significant changes in body composition because of weight gain caused by fat mass accumulation and muscle mass loss, resulting in poor graft outcomes. The study aimed to investigate the impact of different obesity parameters on graft function in kidney transplant recipients. Methods. A cross-sectional study was conducted on 80 kidney transplant patients aged 25 - 75 years (40% females). All were on triple immunosuppressive therapy. Weight, height, waist, and hip circumferences measurements were taken to calculate body mass index (BMI) and waist-to-hip ratio (WHR). Body fat percentage (BF%) was measured using a 4-site skinfold method calculated through the Jackson-Pollock equation utilizing a Cescorf caliper. The patients were divided into two groups depending on their glomerular filtration rate (GFR). Results. BMI showed that 16.28% of males and 10% of females were obese. However, according to BF%, as many as 44.68% of males and 72.72% of females were obese. Statistically significant differences in BMI, WHR, and BF% were observed among patients with normal and lower GFR. After adjustment for covariables, lower GFR was related to higher levels of all obesity parameters. The combination of central obesity (WHR>0.85 for women and > 0.9 for men) and higher BF% was associated with lower GFR compared with that in lean subjects (p < 0.001 for both groups). Conclusion. High BF% and WHR may be important risk factors for reducing GFR in kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim. Monitoring the renal function following donor nephrectomy (DN) or radical nephrectomy (RN) due to kidney tumors is considered essential. The aim of this study was to compare pre-operative and post-operative renal function in patients who underwent DN in relation to patients who underwent RN due to renal malignancy. Methods. A retrospective case-control study was performed, which included 199 patients divided into two groups: group 1 (105 patients) were patients who underwent DN due to living-related/unrelated kidney transplantation, while group 2 (94 patients) was a control group, and included patients who underwent RN due to clear cell renal cell carcinoma in the T1bNoM0 clinical stage, where this surgical procedure was the final form of treatment. Results. Preoperative estimated glomerular filtration rate (eGFR) according to the Chronic Kidney Disease-Epidemiology Collaboration (EPI) equation (eGFR EPI) in the DN group was 94.95 mL/min/1.73 m2, while in the RN group, it was 71.00 mL/min/1.73 m2. Patients who underwent RN tended to have eGFR EPI below 60 mL/min/1.73 m2 after ten years of follow-up compared with patients who underwent DN. In the DN group, the average eGFR EPI was 80.40 mL/min/1.73 m2, and in the RN group, it was 56.00 mL/min/1.73 m2. A higher incidence of diabetes mellitus (DM) and arterial hypertension (AH) was also observed in the DN group of patients compared to the RN group (AH: 44.3% vs. 21.3%; DM: 22.6% vs. 9.6%, respectively). Conclusion. Comparative monitoring of these two groups showed that in both groups, the recovery of the renal reserve was achieved one year after nephrectomy due to the known adaptive mechanisms. Even though the initial renal reserve in a kidney donor is reduced after living kidney transplantation (nephrectomy, permanent loss of renal mass), kidney donors recover kidney function within the first year after surgery due to the adaptive mechanisms. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Tacrolimus is a widely used immunosuppressant that prevents solid organ transplant rejection. The pharmacokinetics of Tacrolimus show considerable variability. Interleukin-10 (IL-10), in the host's immune response after transplantation, contributes to the variable CYP3A-dependent drug disposition of Tacrolimus. In the current study, we aim to evaluate the impact of single nucleotide polymorphisms (SNP) in the promoter region of IL-10 on Tacrolimus dose requirements and the Dose Adjusted Concentration (DAC) of Tacrolimus among kidney transplantation recipients. Methods: Blood levels of Tacrolimus were measured using Microparticle Enzyme Immunoassay (MEIA) for six months post-transplantation. Genotyping analysis was utilized using specific Polymerase Chain Reaction (PCR) followed by sequencing methods for 98 Jordanian kidney transplant recipients. Results: Genotyping frequencies of IL-10 (-592) were (CC/CA/AA: 38, 46.7, 15.2%); IL-10 (-819) were (CC/CT/TT: 40.4, 44.1, 15.1%); and IL-10 (-1082) were (AA/AG/GG: 42.6, 44.7, 12.8%). The impact of IL-10 (-1082) on Tacrolimus DAC was gender dependent. Men carrying at least one A allele had significantly lower DAC than men carrying GG genotyping only in the first month post-transplantation [88.2±32.1 vs. 117.5±22.5 ng/mL per mg/kg/day, p=0.04]. Conclusions: Our current study showed that the interaction between gender and IL-10 -1082 affects Tacrolimus DAC in Jordanian kidney transplant recipients during the first-month post-transplantation. [ABSTRACT FROM AUTHOR]

Background/Aim. As an optimal treatment of choice for patients with the latest stage of chronic kidney failure (CKD), renal transplantation (Tx) is performed. The resistance index (RI) of the renal artery is measured by Doppler ultrasonography routinely at certain time intervals to show the condition of the renal graft. The value of RI > 0.75 is considered abnormal. The aim of the study was to determine the correlation between the values of the RI index and the function of the transplanted kidney. Methods. We analyzed retrospectively 63 patients in whom kidney transplant was done at the Clinic for Nephrology and Clinical Immunology, the University Clinical Center of Vojvodina, Novi Sad, Serbia, in the period from 2013 to 2017. Doppler of renal blood vessels was made to all examined patients in the first month after the renal transplantation. In addition to standard demographic data, all patients had the RI index and its relationship to the function of the transplanted kidney analyzed immediately after transplantation, as well as in the 6th, 12th, and 18th month, and in a certain number of patients in the 24th and 48th month after transplantation. Results. Out of 63 patients, 63.5% were men, and 26.5% were women, with an average age of 47.67 ± 13.62 years. The primary diseases in patients which led to the terminal CKD stage were hypertension in 33.3% and different forms of glomerulonephritis; while other diseases (diabetes mellitus, chronic pyelonephritis, eclampsia, polycystic kidneys, kidney agenesia, and unknown cause) were present in a lower percentage. RI < 0.75 was present in 73%, and RI > 0.75 in 27% of patients. There was no statistically significant association between RI and serum creatinine or creatinine clearance at a given time, and there was no connection between RI and gender, as well as length of previous treatment by HD. There was a statistically significant association between RI and age of kidney recipient, as well as Tx type. Conclusion. In the observed group of patients, RI of renal arteries did not prove to be a good predictor of the function of the transplanted kidney either in the early or later post-transplant periods. RI might have greater predictive significance if it were determined on or immediately after the transplantation procedure. [ABSTRACT FROM AUTHOR]

Background/Aim. Renal transplantation is the best and preferred way of treating patients with end-stage renal disease, as it offers improved survival and better quality of life compared to dialysis. The aim of this study was to present single-center (Military Medical Academy in Belgrade, Serbia) results of the kidney allograft and patient survival from 1996 to 2017. Methods. A retrospective 22-year cohort study was conducted. Variables of interest were graft and patient survival in kidney transplanted patients. Age, gender, serum creatinine levels, and induction therapy after transplantation were analyzed in this group of patients as well. Results. Among 386 transplanted patients, 316 had a living donor and 70 patients had a deceased donor. Pre-emptive renal transplantation was done in 29 (7.5%) patients and AB0-incompatible kidney transplantation in 21 (5.4%) patients. One-year, 5-year, 10-year, and 20-year overall patient survival after kidney transplantation in the observed group was 97.7%, 95.3%, 93.8%, and 91.7%, respectively. One-year, 5-year, 10-year, and 20-year graft survival in our patients were 93.8%, 85.5%, 78.5%, and 73.3%, respectively. Conclusion. The outcome of graft and patient survival in the Belgrade Military Medical Academy kidney transplantation program is good and in line with the leading world medical centers. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. However, it took years and numerous attempts to achieve success, for the kidney to function well and for the patient to survive after the transplantation. Following this breakthrough made by Murray in 1954, the introduction of immunosuppressive therapy and tissue typing has significantly improved this program. Today we have new challenges in maintaining or improving a kidney transplant program, one of which is COVID-19 infection. This review presents the history and current status of kidney transplantation, emphasizing the Croatian Kidney Transplant Program. [ABSTRACT FROM AUTHOR]

Cadaveric kidney transplantation is on the constant rise due to decreased mortality of younger individuals. In these transplantations, it is of great importance to determine not only the age limit of recipients, but also the status of donors. This investigation included 30 tissue samples of human cadaveric kidneys (both genders, aged 20-85). Tissue samples were stained with Mallory's trichrome stain and analyzed by a light microscope. Images were analyzed using ImageJ software. As a result of cluster analysis, 743 glomeruli were classified into 3 groups by morphometric characteristics and into 3 age groups (I with average age of 29, II with 44, III with average of 71 years old). By morphometric characteristics, there were 114 sclerotic glomeruli with the significantly (p ≤ 0.0001) smallest area and cellularity, and the highest connective tissue percentage in the first group. There were 430 morphologically normal glomeruli with the greatest number of cells/area unit in the second group (p ≤ 0.0001). In the third group, there were 199 hypertrophic glomeruli with the greatest area, significantly large cellularity and connective tissue area (p ≤ 0.0001). Out of 114 sclerotic glomeruli, the smallest number belonged to I age group (p ≤ 0.0001). There were 430 morphologically normal glomeruli in total. Most of them were in II age group (p ≤ 0.0001). Most of 199 hypertrophic glomeruli were in III age group vs. other two (p ≤ 0.0001), as well as in II vs. I (p ≤ 0.0001). Morphometric analysis of morphologically normal glomeruli should be of the greatest importance for transplantation, and not only the assessment of their total number and number of detected manifestly sclerotic glomeruli. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bradykinin (BK), a vasoactive peptide, is considered to exert the renoprotective and cardioprotective effects. Furthermore, most of its effects are mediated by the activation of BK type 2 receptor (B2R), whose level of expression is influenced by insertion/deletion (+9/-9) gene polymorphism. The aim of this study was to investigate the potential influence of B2R +9/-9 gene polymorphism on kidney function and blood pressure in kidney transplant recipients (KTRs) within the first post-transplantation year. Secondary, the study analyzed the correlation between hypertensive status and graft function, with respect to the B2R +9/-9 gene polymorphism. The pharmacogenetic study included 95 KTRs with clinical and biochemical parameters evaluated in three time-points (3rd, 6th, 12th month). The graft function was assessed using the estimated glomerular filtration rate (eGFR), while systolic (SBP), diastolic (DBP), and mean blood pressure (MAP) were used as parameters for the evaluation of blood pressure control. The carriers of -9/-9 genotype had more stable graft function compared to both, heterozygotes and homozygous for +9 allele, not only in the early (up to 6 months) but as well in the late post-transplantation period (beyond 6 months). Also, the -9/-9 genotype carriers showed a tendency to significantly decrease MAP, SBP, and DBP in the observed period, whereby only in this patient group the significant association between hypertensive status and graft function was demonstrated. In conclusion, genotyping of B2R +9/-9 gene polymorphism alongside with biochemical and clinical parameters may identify patients with respect to the risk of more prompt decline of graft function. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Although kidney transplantation is the best method of replacing renal function, there is still a need to improve long-term outcomes. The aim of this study was to determine the independent association of recipient and donor demographic factors, underlying renal disease, duration of dialysis treatment, tissue typing mismatch, and sensitization with transplant outcomes in a contemporary cohort of kidney transplant patients. Patients and methods: The study included patients who had a kidney transplantation at Clinical Hospital Merkur from June 2007 to the end of 2018. Transplant outcomes were monitored until December 31, 2019. The minimum follow-up time was 1 year. Data were collected using reports from the Eurotransplant Network Information System (ENIS) application (www.eurotransplant.org). Survival is shown by Kaplan-Meier curves. The association of survival with specific recipient and donor characteristics was analyzed by univariate and multivariate Cox regression. Results: In the period from June 2007 to the end of 2018, 480 kidneys were transplanted in 472 patients. The 10-year patient survival was 72%. Ten-year renal survival censored for the death of renal function patients was 93%. In the multivariate analysis, only recipient age at transplantation, diabetes as the cause of underlying renal disease and duration of dialysis remained independently associated with patient survival. Conclusion: Long-term graft survival is excellent after kidney transplantation. Long-term patient survival can be improved by prevention, early detection and intensive treatment of chronic diseases. [ABSTRACT FROM AUTHOR]

Aim: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a method of supporting cardiac function in patients with cardiogenic shock in whom medicament therapy is insufficient. The aim of this report is to show, by describing the course of the treatment of a patient with cardiogenic shock in the immediate postoperative period following a kidney transplant, the great potential of this treatment modality in such patients. The use of extracorporeal mechanical circulatory support allowed for both the survival of the patient and the maintenance of the transplanted organ’s function. Case report: A 61-year-old patient with end-stage chronic kidney disease was admitted to the Intensive care unit (ICU) after renal transplantation. The course of the surgery was complicated by the development of significant hemodynamic instability. Despite all the medicament treatment measures taken, the patient developed myocardial infarction with cardiogenic shock. Given that the condition was refractory to the applied drug therapy, a decision was made to initiate the extracorporeal mechanical support. Mechanical support led to hemodynamic stabilization of the patient and served as a bridge to recovery of cardiac function with successful preservation of transplant function Conclusions: In the growing number of papers that support this, mechanical circulatory support is the future of treatment for cardiogenic shock, regardless of its etiology. It is a method that carries its own risks which are slowly diminishing with the development of technology. It is becoming more widely available and its application is expanding to different patient groups. It is important to emphasize that the success of therapy requires the participation of specialists of different specialties in the treatment of such complex cases. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Cytomegalovirus is the most common cause of infections in the post-transplantation period. A reliable and timely laboratory diagnosis of cytomegalovirus infection in patients on dialysis and in the post-transplantation period is significant because of the possibility of preventing or mitigating the effects of cytomegalovirus disease. The main objective of this study was to compare serological and molecular polymerase chain reaction methods to determine the presence of cytomegalovirus in the blood of dialysis patients. Material and Methods. The study included 28 dialysis patients, potential renal transplant recipients. All patients were evaluated for the presence of cytomegalovirus in the blood by a quantitative polymerase chain reaction method as well as in the serum for the presence of anti-cytomegalovirus Immunoglobulin G and Immunoglobulin M antibodies. Results. According to the comparative enzyme-linked immunosorbent assay for detecting antibodies in dialysis patients, 96.4% were once exposed to the virus, while 7.1% showed current infection not confirmed by polymerase chain reaction test. No statistically significant association was found between the positive finding of anti-cytomegalovirus Immunoglobulin M antibodies and the findings of the polymerase chain reaction cytomegalovirus method when Chi-square (χ 2) and Fisher's correlation tests were conducted (p > 0.05). Conclusion. Due to 7.1% false positives results for the presence of anti-cytomegalovirus Immunoglobulin M antibodies in the serum of immunocompromised dialysis patients, not confirmed by polymerase chain reaction test, serological techniques are not reliable in detecting active cytomegalovirus infection causing positive finding of anti-cytomegalovirus Immunoglobulin M, so confirmation of cytomegalovirus deoxyribonucleic acid by polymerase chain reaction method is required. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to wide intra- and inter-individual pharmacokinetic variability and narrow therapeutic index of sirolimus, the therapeutic drug monitoring (TDM) of sirolimus with detailed biochemical and clinical monitoring is necessary for dose individualization in kidney transplant patients. The purpose of the study was to explore and identify factors that contribute to pharmacokinetic variability by developing and validating a population model using routine TDM data and routinely monitored biochemical and clinical parameters. The data obtained by routine monitoring of 38 patients over a period of one year from the sirolimus treatment initiation, were collected from patients' records. Population analysis was performed using the software NONMEM®. The validity of the model was tested by the internal and external validation techniques. The pharmacokinetic variability was partially explained with patient's age and liver function. CL/F was found to decrease with age. According to the developed model, sirolimus CL/F decreases by, in average, 37% in patients with aspartate aminotransferase (AST) greater than 37 IU/L. The internal and external validation confirmed the satisfactory prediction of the developed model. The population modeling of routinely monitored data allowed quantification of the age and liver function influence on sirolimus CL/F. According to the final model, patients with compromised liver function expressed via AST values require careful monitoring and dosing adjustments. Proven good predictive performance makes this model a useful tool in everyday clinical practice. [ABSTRACT FROM AUTHOR]

The first successful kidney transplantation in Yugoslavia was performed in Rijeka, on the 30th of January, 1971, at that time in the "Dr. Zdravko Kučić" Hospital at Sušak, and today in the Clinical Hospital Centre (CHC) in Rijeka. The transplantation was a result of a multidisciplinary cooperation where a significant contribution was provided by the Tissue Typing Laboratory employees. Intensive preparations for the transplant procedure have been crucial for the founding of the first Tissue Typing Laboratory in Croatia as a part of the Station, later the Transfusion Medicine Institute. This paper presents the impact of the historical development of the Laboratory on the success of the transplant programme, the achievement and maintenance of the status of the CHC Rijeka, as one of the leading transplant centre in Croatia. Based on the study of the historical documents of the Laboratory and CHC archives, the development of tissue typing in Rijeka has been presented here since the establishment of the Laboratory in 1971 until the present day. The progress has been described in the adoption of new tissue typing methods in determining the polymorphism of the HLA system, the serum screening for the presence of HLA antibodies and determination of their specificity, as well as crossmatches for detecting donor-specific antibodies. Selection and application of optimal work methods at the Tissue Typing Laboratory contributed to the adoption of the latest findings in transplant immunology and the historical development of the transplant programme in Rijeka. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate potential influence of cytochrome P450 3A5 (CYP3A5) 6986A>G gene polymorphisms on inter- and intravariability (IPV) in tacrolimus (Tac) exposure within the first year after renal transplantation. Secondary, we aimed to analyze the change in distribution of patients regarding IPV between early (<6 months) and late posttransplant period (>6 months). The study enrolled 91 renal transplant recipients, who were on Tac-based immunosuppressive protocol. Dose-adjusted concentration (C0/D) of Tac was used as a measure of Tac exposure, while coefficient of variation (CV%) and mean absolute deviation (MAD%) of C0/D as IPV parameters. Individuals carrying CYP3A5*1/*3 genotype had lower C0/D than CYP3A5*3/*3 carriers within the entire observation period (p < 0.01). The study reported higher IPV in a period of 1-6 months compared to a period of 7-12 months posttransplant, for CV% and MAD% (p < 0.05). The results showed that there was no difference in IPV regarding CYP3A5 genotype. Considering CV%, 32% and 24% of the patients had high IPV (above 30%) in the first and second half of the first post-transplant year, respectively. Analyzing the MAD%, 13% and 7% of the patients had high variability of Tac exposure in the first and second half of the first year, respectively. This study confirms that the CYP3A5 gene polymorphism contributes to the interindividual, but not in intraindividual, variability in Tac exposure within the first post-transplant year. [ABSTRACT FROM AUTHOR]

Aim: The aim was to present an unusual spontaneous disappearance of HBsAg after a long-lasting infection. Case report: A 26-year-old man started chronic hemodialysis (HD) in 1994 for chronic glomerulonephritis. Serological analysis was positive for hepatitis B virus (HBV) infection. During the following years he was treated with HD and his HBV markers remained unchanged (HBsAg positivity). When antiviral therapy became available the patient refused to be treated. In 2006 his HBsAg was negative for the first time in 12 years, while anti-HBs and anti- HBc were positive, which would indicate that he became immune late after a natural infection. To date, all repeated check-ups have been negative for HBsAg. In 2008 he received a kidney transplant from a deceased donor and was put on immunosuppressive (IS) therapy. During the IS treatment, which is still ongoing, he was stable and without HBV viremia (HBsAg-negative). Conclusion: It still remains unclear how spontaneous HBsAg seroconversion happened in our patient after a long lasting infection. It is also interesting that 11 years after seroconversion his HBV markers are still unchanged (HBsAg negative) and show signs of a resolved HBV infection, even though he has been immunosuppressed due to kidney transplantation for already 9 years. It is possible that his anti-HBs levels are high enough to protect him and inhibit HBV reactivation or the virus has not been dormant in his hepatic cells at all. [ABSTRACT FROM AUTHOR]

Background/Aim. The management of kidney graft hydronephrosis (KGH) is usually surgical, although some cases require expectant management and follow-up. The aim of the study was to discuss the criteria for expectant management or immediate surgical intervention in the series of patients with KGH. Methods. The paper is based on a retrospective study of 42 patients with KGH. The patients underwent kidney transplantation from January 2007 to December 2012. There were 19 cadaveric donor recipients and 23 living donor recipients. The average follow-up was 15,2 (range 12-21) months. The average recipient's age was 41,6 years. In every case study, the diagnosis of graft hydronephrosis was established using abdominal ultrasonography. The degree of hydronephrosis was estimated on the basis of measuring the maximal diameter of the pelvicalyceal dilatation (PD). Results. There were no patients with graft failure after the period during which they were under medical observation. Hydronephrosis resolved completely in six (14%) patients. The median maximal PD was 28 ± 9 (range 14 -38) mm and the median last PD was 23 ± 11 (range 0- 35) mm and they did not differ significantly (p = 0.23). The last serum creatinine was significantly lower than the maximal creatinine value (p < 0.05). In twelve (29%) patients renal function normalized. Renal function remained stable during the period of medical observation. At the end of the follow-up, all patients had sterile urine culture. Conclusion. The traditional doctrine, according to which KGH represents an absolute indication for surgery, can be debated; the majority of the patients observed require just active surveillance. Prompt surgical correction is recommended only in cases with increasing pelvicalyceal dilatation and the development of symptoms, progressively decreasing renal function or recurrent urinary tract infection. [ABSTRACT FROM AUTHOR]

Background/Aim. Tacrolimus concentration-dose ratio as a potential therapeutic drug monitoring strategy was suggested to be used for the patients subjected to renal transplantation. The aim of this study was examining the relationship between tacrolimus concentration-dose ratio, suggested to be used as a therapeutic drug monitoring strategy and the polymorphisms of genes encoding the most important enzymes, such as CYP3A5 and CYP3A4, as well as the transporter P-glycoprotein, for its metabolism and elimination. Methods. The study was designed as a prospective case series study, in which the unit of monitoring was the outpatient examination of 54 patients subjected to renal transplantation. Genotyping was performed by 7500 RealTime PCR System by assessing allelic discrimination based on TaqMan® methodology. Results. Patients (n = 13) who were treated with less than 2 mg of tacrolimus/day (0.024 ± 0.006 mg/kg/day) had the tacrolimus concentration-dose ratio larger than 150 ng/mL/mg/kg. In this group, 84.62% patients had CYP3A5 *3*3 allele. All of these patients had CYP3A4 *1*1/*1*1B allele. Regarding ABCB1 C3435T gene, 30.77% of patients had the TT gene variant, while 69.23% of our patients had CC and CT gene variants. Conclusion. Tacrolimus concentration-dose ratio greater than 150 ng/mL/mg/kg is cut-off value in patients subjected to renal transplantation which might point to patients who are poor CYP3A5 metabolizers and/or with dysfunctional P-glycoprotein. [ABSTRACT FROM AUTHOR]

Objective While kidney transplantation is the best treatment of renal insufficiency and is recommended for patients with a glomerular filtration rate below 30 mL/min, new onset diabetes after transplantation (NODAT) reduces the benefits of this treatment, and present a significant, independent predictor of patient mortality and loss of graft function. The aim of the study was to determine the incidence of NODAT, as well as the risk factors for new onset diabetes mellitus (DM). The study included 84 patients older than 18 years, who underwent kidney transplantation in the Clinical Center Niš in the period from 2007 to 2016. Impaired glucose tolerance was found in all of these patients in the first three post-transplantation months. In addition to physical examination and basic laboratory analyses, in all of kidney transplant patinents the levels of tacrolimus and glycosylated hemoglobin HbA1c were determined. NODAT was registered in 7 (8.3%) patients after average 17.2+10.8 days of kidney transplantation. The patients with NODAT had significantly higher levels of serum creatinine 210.72±120.29 μol/L and decreased creatinine clearance 43.31±17.57 ml/min/1.73m² compared with a group of patients with diabetes prior to kidney trans-plantation 180.16±82.78 μmol/L and 52.12±18.45 ml/min/1.73m2, respectively (p <0.01), and a statistically significantly shorter follow-up period after kidney transplantation (p <0.05). The results showed a significantly higher level of body mass index (BMI) 30.6 ± 6.4% compared to patients with already present diabetes before transplantation 28.5±6.8%, as well as the level of triglycerides 2.87±0.79 mmol/L vs. 1.73±0.82 mmol/L (p <0.05). The level of tacrolimus was adequate for the given post-transplantation period. NODAT is a significant complication of kidney transplantation and is associated with risk factors, primarily with older recipient age and hereditary burden, but also with variable factors such as obesity and hypertriglyceridemia. We believe that the prevalence of NODAT can be changed if oral glucose tolerance test (OGTT) is done prior to transplantation in the potential kidney graft recipients. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)