Attitude of healthcare professionals: a major limiting factor in organ donation from brain-dead donors.

Public attitude toward deceased donor organ recovery in Poland is quite positive, with only 15% opposing to donation of their own organs, yet actual donation rate is only 16/pmp. Moreover, donation rate varies greatly (from 5 to 28 pmp) in different regions of the country. To identify the barriers of organ donation, we surveyed 587 physicians involved in brain death diagnosis from regions with low (LDR) and high donation rates (HDR).

Effective optimization of living donor kidney transplantation activity ensuring adequate donor safety.

Results of kidney transplantation are excellent, but the number of patients on the waiting lists far exceeds the number of available organs. Living kidney donation must be considered as an important part of organ transplantation programmes. In the European Union countries, nearly 20% of all kidney transplants in 2010 were done with organs from living donors.

Progress in abdominal organ transplantation.

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.

Bacterial infections in the early period after liver transplantation: etiological agents and their susceptibility.

Background: The study comprises an analysis of bacterial infections in the early period after liver transplantation (LT) in adults.

Material/methods: Eighty-three patients were followed for four weeks after LT. Samples comprised mainly blood, urine, surgical-site specimens, sputum, and stool.

Long term medical and economical benefit of machine perfusion (MP) kidney storage in comparison to cold storage (CS).

Background: Despite documented positive effect of MachinePerfusion (MP) on long-term kidneys-graft function its wide use is restricted due to higher costs. The aim of this study was to analyze the difference in costs of kidney transplantation in patients who received organ stored in ColdStorage (CS) vs those who received kidneys stored with MP.


Material/methods: Analysis was done on kidney transplantations performed between 1994-1999 in 415 patients.

Influence of preservation method on histopathological lesions of kidney allografts.

Background: Cold storage (CS) of cadaveric kidneys procured from hemodynamically stable donors for less than 24 hours is a safe procedure. Some papers indicate that continuous pulsatile machine perfusion (MP) allows for extension of preservation times, permits a wider use of kidneys damaged by preagonal ischemia, results in superior immediate function rate as compared to CS and improves long-term graft survival. The aim of the study was to evaluate the influence of kidney preservation method prior to transplantation on the characteristics of histopathological lesions of allografts at long-term post transplantation.

The early and long term function and survival of kidney allografts stored before transplantation by hypothermic pulsatile perfusion. A prospective randomized study.

Background: A prospective evaluation of the influence of methods of kidney storage prior to transplantation on long-term graft function has not been shown so far. A retrospective study undertaken in 415 patients in our department showed the benefit of machine perfusion (MP) on long-term results. The aim of the present study was to assess prospectively the long term function and survival of paired kidney allografts retrieved from the same donor, comparing the influence of cold storage (CS) and MP.

Safety and efficacy of high dose ATG bolus administration on rewascularization in kidney graft patients--long term results.

Background: Various preparations of ALG/ATG have been used in clinical transplantation for more than 30 years. In recent years the number of high immunological risk patients has increased and biological agents are being used as induction therapy. The aim of this prospective, randomized study was to asses the safety and efficacy of a single high dose of antithymocyte globulin (9 mg/kg ATG Fresenius S) in cadaveric renal transplantation.

Assessment of cadaveric livers discarded from transplantation. A correlation between clinical and histological parameters.

Background: 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.

Material/methods: Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation.

Results: In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation".

Future of transplantation medicine.

Organ transplantation has become very successful method of treatment of end stage organ disease. However the waiting lists of patients aiming such treatment are exponentially growing due to insufficient organ supply. Prognosis of the future for transplantation medicine is truly difficult.

Ethical and social aspects of transplantation medicine in Poland and worldwide.

New medical technologies are products of human mind and the result of development in the field of diagnostic techniques, pharmacotherapy and biotechnology. Transplantation medicine, which is also a new medical technology, differs from the others in that it requires a living organ obtained from a dead person or a living donor. Development of market economy and globalization have made the new technologies available almost in every country.

Organ transplantation at the Medical University of Warsaw.

The Warsaw Transplant Center comprises 3 programs for transplantation of kidney, pancreas and liver. At the end of 2005, 3,616 kidney, 131 simultaneous pancreas kidney and 592 liver transplants had been performed. The one-year patient and graft survival rates were 92.

[Current status of liver transplantation].

The authors present current status of liver transplantation (LTx) in Poland. Till 2004, 845 LTx were performed: 604 in adults and 241 in children; 71 of them were the living donor LTx. Post-inflammatory cirrhosis in adults and biliary atresia in children were the most common indications for LTx.

Application of sulforaphane--does it lead to improvement of islet graft survival after warm and/or cold ischemia.

Objectives: Brain stem death results in ischemic damage of organs. To prevent many agents are being tested this damage. The aim of our study was to determine effects of sulforaphane (SF) on recovery, viability, lipid peroxidation, metabolic and endocrine function of islets isolated from rat pancreata and treated with warm and/or cold ischemia and then transplanted syngeneically.

Clinical significance of arginase after liver transplantation.

Liver graft function after transplantation is dependent on ischemia-reperfusion injury, toxicity of drugs (immunosuppression, antibiotics and other) and transplant rejection. Although routinely monitored with enzymatic tests (AST, ALT, GGT, ALP), bilirubin and coagulation parameters, differentiation between these pathologies is hardly possible without liver biopsy. Arginase (3.

Efficacy of rapamycin in patient with juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis (JRA) is an immune-mediated disease characterized by articular inflammation and subsequent tissue damage that may result in severe disability. Several combinations of drugs, including immunosuppressive agents have been used to control disease progression. Although there is no information available on rapamycin efficacy in JRA, it has demonstrated a potential to inhibit inflammatory processes observed in adult rheumatoid arthritis (RA).

Ethical and societal problems in organ transplantation.

Transplantation medicine, like no other medical specialty, is connected with a wide range of very difficult ethical issues. Among those are: availability of the treatment, consent for cadaveric donation, allocation of available organs, new categories of living unrelated donors and economic aspects of this method of treatment. Authors discuss sensitive aspects in societal perception of the Polish Transplantation Act, ethical issues of living donor kidney transplantation, the role of mass media and economic aspects of transplantation.

Chemoprevention of cancerogenesis--the role of sulforaphane.

Isothiocyanates are a group of naturally occurring compounds with interesting medical properties, such as antimicrobial, antioxidant and antitumor activities. In our work we were trying to present the tumoricidal activity of new synthesized derivatives of one isothiocyanate: 1-isothio-cyanato-(4R)-(methylsulfinyl) butane [sulforaphane]. Many chemical substances derived from plants, undoubtedly have protective properties.

Prognostic significance of free radicals: mediated injury occurring in the kidney donor.

Background: Brain death is associated with hemodynamic disturbances in systemic circulation and metabolic storm, and, thus, free radical-mediated injury to donor tissues was hypothesized. An assessment of oxidative stress in the donor and its effect on posttransplant kidney graft function comprised the scope of the study.

Methods: A prospective study was performed in 27 donors and 50 kidney transplant recipients.

[Effect of immunosuppressive treatment on diurnal profile of blood pressure].

Prevalence of arterial hypertension suddenly rose in patients after renal transplantation since cyclosporine A was introduced. Arterial hypertension is now diagnosed in 67-90% of patients after renal transplantation. It has not only negative effect on cardiovascular system but also shortens survival of renal graft.

[Expression of mRNA for growth factors and cytokines in the renal artery wall of chronically rejected renal allograft].

The vascular hallmark of chronic rejection (CR), as well as of atherosclerosis, is initial hyperplasia. It results from migration and proliferation of vascular smooth muscle cell and increased deposition of extracellular matrix proteins. A possible mechanism responsible for formation of neointima is the release of growth factors and cytokines, such as: transforming growth factor beta (TGF-beta), tumour necrosis factor alfa (TNF-alpha), interleukin 1 (IL-1) and interleukin 6 (IL-6).