Urinary Tract Infections in Renal Transplant Recipients

Renal transplantation (RTx) is the treatment-of-choice for a significant number of patients with end-stage renal disease. Despite recent accomplishments, both surgical and medical complications still exist. Urinary tract infection (UTI) is the most common infectious complication after RTx, while asymptomatic bacteriuria is the most common manifestation of bacteriuria. UTI can impair graft function, potentially reducing graft and patient survival. The aetiology changes with time after RTx. The epidemiology of most of these infections is also changing with resistant organisms being isolated more often than in the past. Several factors increase the risk of infection in RTx patients, and the presence of multiple risk factors in the same patient is not uncommon. These include immunosuppression, urinary flow impairment (most often caused by stenosis or strictures at the vesicoureteral junction, benign prostate hypertrophy or vesicoureteral reflux), and treatment-related factors such as the use of catheters and double-J stents. Early diagnosis and effective treatment are key elements in salvaging both the allograft and the patient. This chapter reviews the definitions, epidemiology, microbiology, screening, clinical manifestations, diagnosis, impact on renal allograft function, evaluation after diagnosis, treatment, prevention including long-term prophylaxis, and the unique challenges of diagnosing and managing recurrent bacterial UTIs in a RTx care setting

Przeszczepianie wysp trzustkowych

Patients with brittle type 1 diabetes who continue to experience life threatening severe hypoglycemia despite maximal medical management can benefit from β-cell replacement. Islet transplantation eliminates hypoglycemic episodes/unawareness, facilitates normalization of haemoglobin A1c (HbA1c) and decreases microvascular disease progression in patients with labile diabetes. In this article we review the first attempts of β-cell replacement, current indications and contraindications, expected benefits and possible complications of pancreas islets transplantation together with the available techniques that assess the transplanted β-cell function.Chorzy z cukrzycą typu 1 o chwiejnym przebiegu, którzy doświadczają zagrażających życiu epizodów ciężkiej hipoglikemii mimo zoptymalizowanego leczenia zachowawczego, mogą odnieść korzyść z przeszczepienia komórek β. Przeszczepienie wysp trzustkowych eliminuje epizody hipoglikemii/ nieświadomość hipoglikemii, ułatwia normalizację wartości hemoglobiny glikowanej (HbA1c) oraz spowalnia progresję powikłań mikronaczyniowych u chorych z chwiejną cukrzycą. W artykule omówiono pierwsze próby przeszczepienia komórek β, aktualne wskazania i przeciwwskazania, spodziewane korzyści oraz możliwe powikłania przeszczepienia wysp trzustkowych — łącznie z dostępnymi metodami umożliwiającymi monitorowanie czynności przeszczepionych komórek β

Zakażenia układu moczowego u pacjentów po transplantacji nerki

Zakażenie układu moczowego są często obserwowanym powikłaniem u chorych po transplantacji nerki. W artykule omówiono epidemiologię, czynniki ryzyka, najczęstsze czynniki etiologiczne, możliwe konsekwencje oraz zalecenia dotyczące profilaktyki oraz leczenia

Przeszczepienie wysp trzustkowych po transplantacji nerki — opis dwóch przypadków

Simultaneous pancreas and kidney transplantation is the best therapeutic option for patient with poorly controlled type 1 diabetes, end stage renal disease and with other secondary diabetic complications. However, when pancreas transplant is contraindicated or unavailable, pancreatic islet transplantation is alternative minimal-invasive procedure. It allows for improved and easier glucose control, prevent progression of secondary diabetic complications and improves quality of life. Here, we present two patients who receive an islet transplant some time after a kidney transplantation which led to improved glucose control, lower HbA1c, improved quality of life with stable and good kidney graft function.Jednoczasowe przeszczepienie nerki i trzustki jest najlepszą opcją terapeutyczną dla chorych z cukrzycą typu 1 o chwiejnym przebiegu, ze źle kontrolowaną glikemią prowadzącą do schyłkowej niewydolności nerek i innych wtórnych powikłań cukrzycy. Kiedy jednak przeszczep trzustki nie jest możliwy lub dostępny dla chorego, transplantacja wysp trzustkowych stanowi alternatywny, miniinwazyjny zabieg, który umożliwia lepszą i łatwiejszą kontrolę glikemii, zabezpiecza przed progresją wtórnych powikłań cukrzycy oraz poprawia jakość życia chorego. W artykule przedstawiono dwa przypadki chorych po transplantacji nerki, u których przeszczepiono wyspy trzustkowe, co doprowadziło do normalizacji poziomów glukozy w osoczu oraz wartości hemoglobiny glikowanej (HbA1c), przy zachowaniu stabilnej i dobrej funkcji nerki przeszczepionej i poprawie jakości życia pacjentów

Beta cell replacement therapy

Beta cell replacement therapy is currently the only treatment method that allows restoration of physiological endogenous insulin secretion in the amounts corresponding to the current body requirements. Beta cell replacement options available for highly selected patients with brittle type 1 diabetes include solid- -organ pancreas and islet transplantation. Beta cell replacement therapy may be offered to patients with both good kidney function and renal failure. In progressive renal failure, beta cell transplantation may be performed simultaneously with kidney transplantation or afterwards. Islet autotransplantation is offered to patients submitted to total pancreatectomy. In patients with brittle type 1 diabetes who continue to experience life threatening severe hypoglycaemia episodes despite optimized insulin therapy, beta cell replacement helps improve hypoglycaemia awareness, thus reducing the risk of severe hypoglycaemia episodes, facilitates blood glucose control with normalization of haemoglobin A1c (HbA1c) level, and reduces microvascular disease progression. In patients undergoing total pancreatectomy, infusion of the patient’s own islets isolated from the removed pancreas prevents blood glucose level excursions and reduces the risk of surgically- -induced diabetes. In this article, we review the current indications and contraindications to beta cell replacement, expected benefits, and possible complications of beta cell transplantation.Beta cell replacement therapy is currently the only treatment method that allows restoration of physiological endogenous insulin secretion in the amounts corresponding to the current body requirements. Beta cell replacement options available for highly selected patients with brittle type 1 diabetes include solid- -organ pancreas and islet transplantation. Beta cell replacement therapy may be offered to patients with both good kidney function and renal failure. In progressive renal failure, beta cell transplantation may be performed simultaneously with kidney transplantation or afterwards. Islet autotransplantation is offered to patients submitted to total pancreatectomy. In patients with brittle type 1 diabetes who continue to experience life threatening severe hypoglycaemia episodes despite optimized insulin therapy, beta cell replacement helps improve hypoglycaemia awareness, thus reducing the risk of severe hypoglycaemia episodes, facilitates blood glucose control with normalization of haemoglobin A1c (HbA1c) level, and reduces microvascular disease progression. In patients undergoing total pancreatectomy, infusion of the patient’s own islets isolated from the removed pancreas prevents blood glucose level excursions and reduces the risk of surgically- -induced diabetes. In this article, we review the current indications and contraindications to beta cell replacement, expected benefits, and possible complications of beta cell transplantation

Pancreatic islet transplantation in a simultaneous pancreas and kidney transplant recipient — a case report

Beta cell replacement allows for adequate blood glucose control, reduced progression or even reversal of microvascular complications, and improves the quality of life. Simultaneous pancreas and kidney transplantation is the best therapeutic option for patients with type 1 diabetes and end-stage renal disease resulting from diabetic nephropathy. However, when pancreas transplantation is contraindicated or unavailable, pancreatic islet transplantation is an alternative minimally invasive procedure. We report a patient after earlier simultaneous kidney and pancreas transplantation with a failed pancreas graft, and no option for pancreas retransplantation. In this patient pancreatic islet transplantation was performed. The latter resulted in an improved blood glucose control, restoration of hypoglycaemia awareness, and improved quality of life with stable good function of the kidney allograft.Beta cell replacement allows for adequate blood glucosecontrol, reduced progression or even reversal ofmicrovascular complications, and improves the qualityof life. Simultaneous pancreas and kidney transplantationis the best therapeutic option for patients withtype 1 diabetes and end-stage renal disease resultingfrom diabetic nephropathy. However, when pancreastransplantation is contraindicated or unavailable, pancreaticislet transplantation is an alternative minimallyinvasive procedure. We report a patient after earliersimultaneous kidney and pancreas transplantationwith a failed pancreas graft, and no option for pancreasretransplantation. In this patient pancreatic islettransplantation was performed. The latter resultedin an improved blood glucose control, restoration ofhypoglycaemia awareness, and improved quality oflife with stable good function of the kidney allograft

European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates

Data Availability Statement: The original contributions presented in the study are included in the article/Supplementary Material (https://www.frontierspartnerships.org/articles/10.3389/ti.2023.11564/full#SM1), further inquiries can be directed to the corresponding author.Supplementary Material: The Supplementary Material for this article can be found online at: https://www.frontierspartnerships.org/articles/10.3389/ti.2023.11564/full#supplementary-materialCopyright © 2023 The Authors. There is increasingly growing evidence and awareness that prehabilitation in waitlisted solid organ transplant candidates may benefit clinical transplant outcomes and improve the patient’s overall health and quality of life. Lifestyle changes, consisting of physical training, dietary management, and psychosocial interventions, aim to optimize the patient’s physical and mental health before undergoing surgery, so as to enhance their ability to overcome procedure-associated stress, reduce complications, and accelerate post-operative recovery. Clinical data are promising but few, and evidence-based recommendations are scarce. To address the need for clinical guidelines, The European Society of Organ Transplantation (ESOT) convened a dedicated Working Group “Prehabilitation in Solid Organ Transplant Candidates,” comprising experts in physical exercise, nutrition and psychosocial interventions, to review the literature on prehabilitation in this population, and develop recommendations. These were discussed and voted upon during the Consensus Conference in Prague, 13–15 November 2022. A high degree of consensus existed amongst all stakeholders including transplant recipients and their representatives. Ten recommendations were formulated that are a balanced representation of current published evidence and real-world practice. The findings and recommendations of the Working Group on Prehabilitation for solid organ transplant candidates are presented in this article.All costs related to taskforce and workgroup meetings were covered by ESOT, without external funding