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Gołębiewska JE, Krawczyk B, Wysocka M, Dudziak A, Dębska-Ślizień A. Asymptomatic Bacteriuria in Kidney Transplant Recipients-A Narrative Review. Medicina (Kaunas) 2023; 59:medicina59020198. [PMID: 36837399 PMCID: PMC9958684 DOI: 10.3390/medicina59020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Urinary tract infections (UTIs) are the most prevalent complications in kidney transplant (KTx) recipients. The most frequent finding in this group of patients is asymptomatic bacteriuria (ASB). Here, we provide an overview of the available evidence regarding ASB in KTx recipients, including its etiopathology, clinical impact and management. There is a growing body of evidence from clinical trials that screening for and treating ASB is not beneficial in most KTx recipients. However, there are insufficient data to recommend or discourage the use of a "screen-and-treat strategy" for ASB during the first 1-2 months post-transplant or in the case of an indwelling urinary catheter. Despite its frequency, ASB after KTx is still an understudied phenomenon.
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Affiliation(s)
- Justyna E. Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Correspondence:
| | - Beata Krawczyk
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Magdalena Wysocka
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, CRUK Manchester Institute, University of Manchester, Manchester M13 9PL, UK
| | - Aleksandra Dudziak
- Microbiology Laboratory, University Clinical Center, 80-952 Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Gołębiewska JE, Wardowska A, Pietrowska M, Wojakowska A, Dębska-Ślizień A. Small Extracellular Vesicles in Transplant Rejection. Cells 2021; 10:cells10112989. [PMID: 34831212 PMCID: PMC8616261 DOI: 10.3390/cells10112989] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022] Open
Abstract
Small extracellular vesicles (sEV), which are released to body fluids (e.g., serum, urine) by all types of human cells, may stimulate or inhibit the innate and adaptive immune response through multiple mechanisms. Exosomes or sEV have on their surface many key receptors of immune response, including major histocompatibility complex (MHC) components, identical to their cellular origin. They also exhibit an ability to carry antigen and target leukocytes either via interaction with cell surface receptors or intracellular delivery of inflammatory mediators, receptors, enzymes, mRNAs, and noncoding RNAs. By the transfer of donor MHC antigens to recipient antigen presenting cells sEV may also contribute to T cell allorecognition and alloresponse. Here, we review the influence of sEV on the development of rejection or tolerance in the setting of solid organ and tissue allotransplantation. We also summarize and discuss potential applications of plasma and urinary sEV as biomarkers in the context of transplantation. We focus on the attempts to use sEV as a noninvasive approach to detecting allograft rejection. Preliminary studies show that both sEV total levels and a set of specific molecules included in their cargo may be an evidence of ongoing allograft rejection.
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Affiliation(s)
- Justyna E. Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence:
| | - Anna Wardowska
- Department of Physiopathology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Monika Pietrowska
- Centre for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
| | - Anna Wojakowska
- Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznań, Poland;
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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Bachul PJ, Gołębiewska JE, Basto L, Gołąb K, Anteby R, Wang LJ, Tibudan M, Thomas C, Fendler W, Lucander A, Grybowski DJ, Dębska-Ślizień A, Fung J, Witkowski P. BETA-2 score is an early predictor of graft decline and loss of insulin independence after pancreatic islet allotransplantation. Am J Transplant 2020; 20:844-851. [PMID: 31597009 DOI: 10.1111/ajt.15645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/10/2019] [Accepted: 09/29/2019] [Indexed: 01/25/2023]
Abstract
This study aimed to evaluate whether the BETA-2 score is a reliable early predictor of graft decline and loss of insulin independence after islet allotransplantation. Islet transplant procedures were stratified into 3 groups according to clinical outcome: long-term insulin independence without islet graft decline (group 1, N = 9), initial insulin independence with subsequent islet graft decline and loss of insulin independence (group 2, N = 13), and no insulin independence (group 3, N = 13). BETA-2 was calculated on day 75 and multiple times afterwards for up to 145 months posttransplantation. A BETA-2 score cut-off of 17.4 on day 75 posttransplantation was discerned between group 1 and groups 2 and 3 (area under the receiver operating characteristic 0.769, P = .005) with a sensitivity and negative predictive value of 100%. Additionally, BETA-2 ≥ 17.4 at any timepoint during follow-up reflected islet function required for long-term insulin independence. While BETA-2 did not decline below 17.4 for each of the 9 cases from group 1, the score decreased below 17.4 for all transplants from group 2 with subsequent loss of insulin independence. The reduction of BETA-2 below 17.4 predicted 9 (1.5-21) months in advance subsequent islet graft decline and loss of insulin independence (P = .03). This finding has important implications for posttransplant monitoring and patient care.
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Affiliation(s)
- Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, Illinois.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Roi Anteby
- Department of Surgery, University of Chicago, Chicago, Illinois.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Aaron Lucander
- Department of Surgery, University of Chicago, Chicago, Illinois
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - John Fung
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, Illinois
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Gołębiewska JE, Gołąb K, Gorycki T, Śledziński M, Gulczyński J, Żygowska I, Wolnik B, Hoffmann M, Witkowski P, Ricordi C, Szurowska E, Śledziński Z, Dębska-Ślizień A. "Old School" Islet Purification Based on the Unit Gravity Sedimentation as a Rescue Technique for Intraportal Islet Transplantation-A Case Report. Cell Transplant 2020; 29:963689720947098. [PMID: 32749147 PMCID: PMC7563026 DOI: 10.1177/0963689720947098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/15/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022] Open
Abstract
Here, we present a case that required a supplemental "old school" islet purification for a safe intraportal infusion. Following pancreas procurement from a brain-dead 26-year-old male donor (body mass index: 21.9), 24.6 ml of islet tissue was isolated after continuous density gradient centrifugation. The islet yield was 504,000 islet equivalent (IEQ), distributed among the following three fractions: 64,161 IEQ in 0.6 ml of pellet, 182,058 IEQ in 10 ml, and 258,010 IEQ in 14 ml with 95%, 20%, and 10% purity, respectively. After a 23-h culture, we applied supplemental islet purification, based on the separation of tissue subfractions during unit gravity sedimentation, a technique developed over 60 years ago ("old school"). This method enabled the reduction of the total pellet volume to 11.6 ml, while retaining 374,940 IEQ with a viability of over 90%. The final islet product was prepared in three infusion bags, containing 130,926 IEQ in 2.6 ml of pellet, 108,079 IEQ in 4 ml of pellet, and 135,935 IEQ in 5 ml of pellet with 65%, 40%, and 30% purity, respectively, and with the addition of unfractionated heparin (70 units/kg body weight). Upon the islet infusion from all three bags, portal pressure increased from 7 to 16 mmHg. Antithrombotic prophylaxis with heparin was continued for 48 h after the infusion, with target activated partial thromboplastin time 50-60 s, followed by fractionated heparin subcutaneous injections for 2 weeks. β-Cell graft function assessed on day 75 post-transplantation was good, according to Igls criteria, with complete elimination of severe hypoglycemic episodes and 50% reduction in insulin requirements. Time spent within the target glucose range (70-180 mg/dl) improved from 42% to 98% and HbA1c declined from 8.7% to 6.7%. Supplemental "old school" islet purification allowed for the safe and successful utilization of a robust and high-quality islet preparation, which otherwise would have been discarded.
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Affiliation(s)
- Justyna E. Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Karolina Gołąb
- Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Tomasz Gorycki
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Śledziński
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Gulczyński
- Laboratory for Cell and Tissue Banking and Transplantation- CellT, Gdańsk, Poland
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Iwona Żygowska
- Laboratory for Cell and Tissue Banking and Transplantation- CellT, Gdańsk, Poland
| | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Hoffmann
- Diabetes Research Institute and Cell Transplantation Center, University of Miami, Miami, FL, USA
| | - Piotr Witkowski
- Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplantation Center, University of Miami, Miami, FL, USA
| | - Edyta Szurowska
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zbigniew Śledziński
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Gołębiewska JE, Bachul PJ, Fillman N, Kijek MR, Basto L, Para M, Perea L, Gołąb K, Wang LJ, Tibudan M, Dębska-Ślizień A, Matthews JB, Fung J, Witkowski P. Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience. J Gastrointest Surg 2019; 23:2201-2210. [PMID: 30719679 DOI: 10.1007/s11605-019-04118-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/09/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We assessed whether positive microbiological cultures from the islet preparation had any effect on the risk of infectious complications (IC) after total pancreatectomy with islet autotransplantation (TPIAT) in our center. METHODS We analyzed preservation fluid and final islet product surveillance cultures with reference to clinical data of patients undergoing TPIAT. All patients received routine prophylactic broad-spectrum antibiotics. RESULTS The study involved 10 men and 18 women with a median age of 39 years. Over 30% of surveillance cultures during pancreas processing grew bacterial strains with predominantly polymicrobial contaminations (13 of 22 (59%)). At least one positive culture was identified in almost half of the patients (46%) undergoing TPIAT and a third had both surveillance cultures positive. Infectious complications affected 50% of patients. After excluding cases of PICC line-associated bacteremia/fungemia present on admission, incidence of IC was higher in cases of positive final islet product culture than in those with negative result (57% vs. 21%), which also corresponded with the duration of chronic pancreatitis (p = 0.04). Surgical site infections were the most common IC, followed by fever of unknown origin. There was no concordance between pathogens isolated from the pancreas and those identified during the infection. CONCLUSIONS While IC was common among TPIAT patients, we found no concordance between pathogens isolated from the pancreas and those identified during infection. Contamination of the final islet product was of clinical importance and could represent a surrogate marker for higher susceptibility to infection.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Monica Para
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Laurencia Perea
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeffrey B Matthews
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - John Fung
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA.
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Gołębiewska JE, Krawczyk B, Wysocka M, Ewiak A, Komarnicka J, Bronk M, Rutkowski B, Dębska-Ślizień A. Host and pathogen factors in Klebsiella pneumoniae upper urinary tract infections in renal transplant patients. J Med Microbiol 2019; 68:382-394. [PMID: 30747620 DOI: 10.1099/jmm.0.000942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To analyse the role of virulence factors (VFs) and host in Klebsiella pneumoniae upper urinary tract infections (UTIs) in renal transplant (RTx) recipients. METHODOLOGY Clinical and demographic data were registered prospectively. Phylogenetic background of K. pneumoniae isolates was analysed by PCR melting profiles (MP) and the following VFs genes: fimH-1, uge, kpn, ycfM, mrkD, rmpA, magA, hlyA, cnf-1, irp-1, irp-2, fyuA, entB, iutA, iroN by PCR. RESULTS We studied urine cultures and clinical data from 61 episodes of K. pneumoniae UTI in 54 RTx recipients. There were 32 cases of AB (53%), 10 cases of lower UTI (16%), 19 cases of AGPN (31%), including six cases of bacteraemia. In total, 74 % of strains were extended-spectrum beta-lactamase+, and there were two carbapenemase-producing strains. PCR MP typing showed a diverse population with 52 different genetic profiles of K. pneumoniae. Analysis of the DNA profiles indicated 45 unrelated, unique genotypes and 7 related (16 isolates from 15 patients) genotypes. Urine flow impairment emerged as an independent predictor of K. pneumoniae upper UTIs (OR 14.28, CI 2.7-75.56, P 0.002), while we did not find any association between the profile of VFs and developing upper UTIs. The prevalence of the uge gene was lower in RTx patients on everolimus when compared to isolates from patients not receiving mTOR inhibitors (33.3 % vs 82.8 % P<0.05). CONCLUSIONS K. pneumoniae upper UTI may be a marker of urine flow impairment. Bacterial VFs could not discriminate between upper and lower UTIs. However, immunosuppression may influence the selection of particular VFs.
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Affiliation(s)
- Justyna E Gołębiewska
- 1 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland
| | - Beata Krawczyk
- 2 Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, ul. Narutowicza 11/12, 80-233 Gdańsk, Poland
| | - Magdalena Wysocka
- 2 Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, ul. Narutowicza 11/12, 80-233 Gdańsk, Poland
| | - Aleksandra Ewiak
- 3 Laboratory of Clinical Microbiology, University Centre for Laboratory Diagnostics, Medical University of Gdańsk Clinical Centre, ul. Dębinki 7, 80-952 Gdańsk, Poland
| | - Jolanta Komarnicka
- 3 Laboratory of Clinical Microbiology, University Centre for Laboratory Diagnostics, Medical University of Gdańsk Clinical Centre, ul. Dębinki 7, 80-952 Gdańsk, Poland
| | - Marek Bronk
- 3 Laboratory of Clinical Microbiology, University Centre for Laboratory Diagnostics, Medical University of Gdańsk Clinical Centre, ul. Dębinki 7, 80-952 Gdańsk, Poland
| | - Bolesław Rutkowski
- 1 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- 1 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland
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Gołębiewska JE, Bachul PJ, Wang LJ, Matosz S, Basto L, Kijek MR, Fillman N, Gołąb K, Tibudan M, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Validation of a New North American Islet Donor Score for Donor Pancreas Selection and Successful Islet Isolation in a Medium-Volume Islet Transplant Center. Cell Transplant 2018; 28:185-194. [PMID: 30520321 PMCID: PMC6362524 DOI: 10.1177/0963689718816989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The selection of optimal pancreas donors is one of the key factors in determining the ultimate outcome of clinical islet isolation. North American Islet Donor Score (NAIDS) allows for estimating the chance of the success of islet isolation. It was developed based on the data from over 1000 donors from 11 islet isolation centers and validated in the University of Alberta, Edmonton, on the cohort from the most active islet transplant center. Now we aimed to also validate it in our much less active program. Areas under the receiver operating characteristic curves (AUROCs) and logistic regression analyses were obtained to test if NAIDS would better predict successful islet isolation (defined as post-purification islet yield >400,000 islet equivalents (IEQ)) than previously described Edmonton islet donor score (IDS) and our modified version of IDS. We analyzed the donor scores with reference to 82 of our islet isolation outcomes. The success rate increased proportionally as NAIDS increased, from 0% success in NAIDS < 50 points to 40% success in NAIDS ≥ 80 points. AUROCs were 0.67 (95% confidence interval (CI) 0.55–0.79) for NAIDS, 0.58 (95% CI 0.44–0.71) for modified IDS, and 0.51 (95% CI 0.37–0.65) for IDS and did not differ significantly. However, based on logistic regression analyses, NAIDS was the only statistically significant predictor of successful isolation (p = 0.01). The main advantage of NAIDS is an enhanced ability to discriminate poor-quality donors than previously used scoring systems at University of Chicago, with 0% chance for success when NAIDS was <50 as compared with 40% success rate for IDS <50. NAIDS was found to be the most useful available tool for donor pancreas selection in clinical and research practice in our center, allowing for identification and rejection of poor-quality donors, saving time and resources.
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Affiliation(s)
- Justyna E Gołębiewska
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA.,2 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA.,3 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Ling-Jia Wang
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sabrina Matosz
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Natalie Fillman
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- 2 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Michael Millis
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - John Fung
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
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8
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Gołębiewska JE, Bachul PJ, Fillman N, Basto L, Kijek MR, Gołąb K, Wang LJ, Tibudan M, Thomas C, Dębska-Ślizień A, Gelrud A, Matthews JB, Millis JM, Fung J, Witkowski P. Assessment of simple indices based on a single fasting blood sample as a tool to estimate beta-cell function after total pancreatectomy with islet autotransplantation - a prospective study. Transpl Int 2018; 32:280-290. [PMID: 30353611 DOI: 10.1111/tri.13364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
We investigated six indices based on a single fasting blood sample for evaluation of the beta-cell function after total pancreatectomy with islet autotransplantation (TP-IAT). The Secretory Unit of Islet Transplant Objects (SUITO), transplant estimated function (TEF), homeostasis model assessment (HOMA-2B%), C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr) and BETA-2 score were compared against a 90-min serum glucose level, weighted mean C-peptide in mixed meal tolerance test (MMTT), beta score and the Igls score adjusted for islet function in the setting of IAT. We analyzed values from 32 MMTTs in 15 patients after TP-IAT with a follow-up of up to 3 years. Four (27%) individuals had discontinued insulin completely prior to day 75, while 6 out of 12 patients (50%) did not require insulin support at 1-year follow-up with HbA1c 6.0% (5.5-6.8). BETA-2 was the most consistent among indices strongly correlating with all reference measures of beta-cell function (r = 0.62-0.68). In addition, it identified insulin independence (cut-off = 16.2) and optimal/good versus marginal islet function in the Igls score well, with AUROC of 0.85 and 0.96, respectively. Based on a single fasting blood sample, BETA-2 score has the most reliable discriminant value for the assessment of graft function in patients undergoing TP-IAT.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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Gołębiewska JE, Solomina J, Thomas C, Kijek MR, Bachul PJ, Basto L, Gołąb K, Wang LJ, Fillman N, Tibudan M, Ciepły K, Philipson L, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Comparative evaluation of simple indices using a single fasting blood sample to estimate beta cell function after islet transplantation. Am J Transplant 2018; 18:990-997. [PMID: 29218834 DOI: 10.1111/ajt.14620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 01/25/2023]
Abstract
Six single fasting blood sample-based indices-Secretory Unit of Islet Transplant Objects (SUITO), Transplant Estimated Function (TEF), Homeostasis Model Assessment (HOMA)2-B%, C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr), and BETA-2 score-were compared against commonly used 90-minute mixed meal tolerance test (MMTT) serum glucose and beta score to assess which of them best recognizes the state of acceptable blood glucose control without insulin supplementation after islet allotransplantation (ITx). We also tested whether the indices could identify the success of ITx based on the Igls classification of beta cell graft function. We analyzed values from 47 MMTT tests in 4 patients with up to 140 months follow-up and from 54 MMTT tests in 13 patients with up to 42 months follow-up. SUITO, CP/G, HOMA2-B%, and BETA-2 correlated well with the 90-minute glucose of the MMTT and beta-score (r 0.54-0.76), whereas CP/GCr showed a modest performance (r 0.41-0.52) while TEF showed little correlation. BETA-2 and SUITO were the best identifiers and predictors of the need for insulin support, glucose intolerance, and ITx success (P < .001), while HOMA2-B% and TEF were unreliable. Single fasting blood sample SUITO and BETA-2 scores are very practical alternative tools that allow for frequent assessments of graft function.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Julia Solomina
- Department of Surgery, University of Chicago, Chicago, IL
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL
| | - Kamil Ciepły
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL
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10
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Gołębiewska JE, Dębska-Ślizień A, Rutkowski B. Urinary tract infections during the first year after renal transplantation: one center's experience and a review of the literature. Clin Transplant 2014; 28:1263-70. [DOI: 10.1111/ctr.12465] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Justyna E. Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
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Gołębiewska JE, Lichodziejewska-Niemierko M, Aleksandrowicz-Wrona E, Majkowicz M, Lysiak-Szydłowska W, Rutkowski B. Influence of megestrol acetate on nutrition, inflammation and quality of life in dialysis patients. Int Urol Nephrol 2011; 44:1211-22. [PMID: 21805328 PMCID: PMC3401504 DOI: 10.1007/s11255-011-0025-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 06/17/2011] [Indexed: 12/21/2022]
Abstract
AIM Malnutrition is a common clinical problem in dialysis patients. The objective of this study was to evaluate the efficacy and safety of megestrol acetate in malnourished dialysis patients. Thirty-two hypoalbuminemic dialysis patients took 160 mg of megestrol acetate daily for up to 6 months. METHODS We measured height, dry weight, BMI, modified Subjective Global Assessment (SGA) score, and serum albumin, triglycerides, total cholesterol, hsCRP, IL-1β and IL-6 concentrations. We used validated questionnaires to evaluate selected dimensions of the quality of life. RESULTS Only 12 patients completed the study. All patients reported improved appetite, and there were concurrent statistically significant increases in weight, BMI, SGA and albumin concentration (P < 0.05). For the 12 patients who completed 6 months of treatment the increase in these parameters was from 63.26 ± 13.04 to 65.58 ± 12.53 kg, from 23.5 ± 3.8 to 24.66 ± 4.23 kg/m(2), from 5.16 ± 0.94 to 6.16 ± 0.72 points, and from 36.45 ± 1.82 to 40.33 ± 2.71 g/l, respectively. However, there were no significant changes in the levels of inflammatory markers and in quality of life. Side effects included overhydration, excessive weight gain and hyperglycaemia. CONCLUSION Megestrol acetate may be effective in reversing poor appetite in carefully selected maintenance dialysis patients, but it might not reduce inflammation or improve the quality of life. Because of the potential side effects, close monitoring is essential.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland.
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12
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Gołębiewska JE, Lichodziejewska-Niemierko M, Aleksandrowicz-Wrona E, Majkowicz M, Łysiak-Szydłowska W, Rutkowski B. Megestrol acetate use in hypoalbuminemic dialysis patients. J Ren Nutr 2011; 21:200-2. [PMID: 21239187 DOI: 10.1053/j.jrn.2010.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/20/2010] [Accepted: 08/22/2010] [Indexed: 01/07/2023] Open
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