The role of tissue typing Laboratory in the Historical Development of the Kidney Transplantation in Rijeka

Prva uspješna transplantacija bubrega u Jugoslaviji ostvarena je u Rijeci 30. siječnja 1971. kao rezultat multidisciplinarne suradnje u kojoj su značajni doprinos pružili djelatnici Laboratorija za tipizaciju tkiva, tada bolnice „Dr. Zdravko Kučić“ na Sušaku, a danas Kliničkog bolničkog centra (KBC) u Rijeci. Upravo su intenzivne pripreme za zahvat transplantacije potakle osnivanje prvog Laboratorija za tipizaciju tkiva u Hrvatskoj pri Stanici, kasnije Zavodu za transfuzijsku medicinu. Ovim radom prikazan je utjecaj povijesnog razvoja Laboratorija na uspješnost transplantacijskog programa te postizanje i održavanje statusa riječkog KBC-a kao jednog od vodećih transplantacijskih centara u Hrvatskoj. Temeljem proučavanja povijesnih dokumenata Laboratorija i arhive KBC-a prikazan je razvoj tipizacije tkiva u Rijeci od osnutka Laboratorija 1971. do danas. Opisan je napredak u usvajanju novih metoda tipizacije tkiva u određivanju polimorfizma sustava HLA, probiru seruma pacijenata na prisustvo protutijela HLA i određivanju njihove specifičnosti, te križnih proba u svrhu otkrivanja donor-specifičnih protutijela. Odabir i primjena optimalnih metoda rada u Laboratoriju pridonijela je usvajanju najnovijih spoznaja u transplantacijskoj imunologiji i povijesnom razvoju transplantacijskog programa u Rijeci.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 Based on the study of the historical documents of the Laboratory and CHC archives, the development of tissue typing in Rijeka has been presented here since the establishment of the Laboratory in 1971 until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

Jesu li hrvatski davatelji krvi pretili?

The rising prevalence of overweight and obesity is characterized as a pandemic of the modern era. The purpose of this study was to analyze the prevalence of overweight and obesity in healthy blood donors in Primorje-Gorski Kotar County, Croatia, and the relationship between sociodemographic factors, lifestyle and eating habits, and body mass index (BMI), including the association of these factors with overweight and obesity. This cross-sectional study included 1255 healthy individuals aged between 18 and 70 years who donated blood between January 2015 and October 2016 at the Clinical Institute of Transfusion Medicine. Each participant completed a questionnaire regarding weight, height, blood type, socio-demographic factors, health parameters, physical activity, alcohol consumption, and smoking habits. Overweight was defined as BMI of 25-29.9 kg/m2, and obesity as BMI ≥30 kg/m2. A logistic regression model was used on data assessment. BMI was normal in 33.6% of participants, whereas 44.1% were overweight and 21.8% were obese. Higher BMI was correlated with male sex (odds ratio [OR]=0.21), lower education level (OR=0.77) and unhealthy diet (OR=0.57), whereas lower BMI was correlated with lower age (OR=2.05) and unemployment (OR=1.85). To our knowledge, this is the first study to investigate the prevalence of BMI in a healthy Croatian population; our results confirmed the findings of studies conducted in other European countries. Our results highlighted the importance of improving education levels and raising awareness of healthy dietary habits in high-risk groups, i.e. men and older individuals with lower education levels.Sve veća učestalost pretilosti predstavlja pandemiju modernog doba. Svrha ovoga istraživanja bila je analiza učestalosti prekomjerne tjelesne težine i pretilosti u zdravih darivatelja krvi kao dijela zdrave populacije u Primorsko-goranskoj županiji, Hrvatska. Analiziran je utjecaj i povezanost socio-demografskih čimbenika, načina života, prehrambenih navika s indeksom tjelesne mase (ITM), prekomjernom težinom i pretilošću. Presječnim istraživanjem ispitano je 1255 zdravih osoba u dobi od 18 do 70 godina koje su darivale krv u razdoblju od siječnja 2015. do listopada 2016. u Kliničkom zavodu za transfuzijsku medicinu. Svaki sudionik ispunio je upitnik s podatcima o vlastitoj težini, visini, krvnoj grupi, socio-demografskim podatcima, pokazateljima zdravstvenog stanja, fizičkoj aktivnosti, konzumaciji alkohola i navikama pušenja. ITM od 25-29,9 kg/m2 definiran je kao prekomjerna težina, a ITM ≥30 kg/m2 kao pretilost. Za procjenu podataka korišten je logistički regresijski model. Normalan ITM imalo je 33,6% sudionika, 44,1% ispitanika je imalo prekomjernu težinu, a 21,8% je bilo pretilo. Visoki ITM bio je povezan s muškim spolom (omjer vjerojatnosti [OR]=0,21), nižom razinom obrazovanja (OR=0,77) i nezdravom prehranom (OR=0,57), dok je niži IT M bio povezan s nižom dobi (OR=2,05) i nezaposlenošću (OR=1,85). Prema našim saznanjima, ovo je prva studija koja istražuje učestalost IT M u zdravoj hrvatskoj populaciji; naši rezultati potvrđuju rezultate istraživanja provedenih u drugim europskim zemljama. Rezultati ovoga istraživanja naglašavaju važnost obrazovanja i podizanja svijesti o zdravim prehrambenim navikama, naročito u skupinama visokog rizika, tj. kod muškaraca i starijih osoba s nižim stupnjem obrazovanja

Epigenetic biomarkers in kidney transplantation

Križna proba, koncentracija kreatinina u serumu i procjena glomerularne filtracije, proteinurije te patohistološki nalaz biopsijom dobivenoga tkiva presatka biološki su markeri koji se koriste u transplantacijskoj medicini. Razvoj genetike i novih tehnologija omogućio je otkriće novih biomarkera kao ranih prediktora akutne reakcije odbacivanja, odgođene funkcije presatka, ishemijsko-reperfuzijske ozljede, intersticijske fibroze i atrofije tubula te dugoročnoga preživljavanja presatka. Radi boljega razumijevanja utjecaja okolišnih čimbenika na humani genom i njihove povezanosti s imunosnim odgovorom u presađivanju bubrega, provedena su brojna istraživanja o epigenetičkim mehanizmima. Cilj je rada prikazati potencijalne epigenetičke biomarkere, produkte epigenetičkih mehanizama i njihovu važnost u ishodu presađivanja bubrega.Currently used prognostic biomarkers in kidney transplantation are – crossmatch, serum creatinine concentration and evaluation of glomerular filtration rate, proteinuria and a histopathological analysis of graft biopsy. The development of genetics and new technologies has enabled the discovery of new biomarkers as early predictors of acute rejection response, delayed graft function, ischemia-reperfusion injury, interstitial fibrosis, tubular atrophy and long-term graft survival. Numerous studies have been conducted to examine the influence of environmental factors on human genome and its relation with the immune response in kidney transplantation. The aim of this article is to present potential epigenetic biomarkers – the products of epigenetic mechanisms, and their importance in the outcome of renal transplantation

Dental Caries in Disabled Children

The aim of the study was to evaluate oral health conditions and dental caries status in disabled and healthy children. Two groups of randomly selected children 3–17 years old were examined. The first group comprised 80 children with disabilities (cerebral palsy, mental retardation, Down syndrome, autism and hearing-speaking disorders) and the second (control) group included 80 healthy children. Examined children were selected from several institutions which take care of disabled persons, kindergardens and four elementary schools. Clinical examination was performed by using a mirror and a probe and revealed the presence of dental caries, missing (extracted) and filled teeth. All clinically detected cavitations were registered as dental caries. The degree of oral hygiene was evaluated according to the OHI-S index values, which was determined by marking the plaque with 1% eozine solution. The values of OHI-S index ranged from 3.8–4.53 in disabled children and 2.73–2.84 in healthy children. In disabled children, the average dft values were 3.42 in deciduous teeth and 5.24 in mixed dentition. In healthy children, the average dft values were 1.43 in deciduous teeth and 5.1 in mixed dentition. The average DMFT index in disabled children was 1.41 for mixed and 6.39 for permanent dentitions. In healthy children, the average DMFT values were 1.23 in mixed and 4.76 in permanent dentitions. In general, the results revealed significantly poor level of oral hygiene and quite high level of caries prevalence in both disabled and healthy children, accentuating the need to reorganize preventive care measurments and improve dental care, particularly in disabled children in Croatia

Complement-dependent cytotoxicity and Luminex technology for human leucocyte antigen antibody detection in kidney transplant candidates exposed to different sensitizing events

Background: The aim of this study was to determine the frequency of exposure to different sensitizing events (SEs) and to assess their effects on human leucocyte antigen (HLA) alloimmunization in transplant candidates using two different HLA antibody screening techniques: complement-dependent cytotoxicity (CDC) and Luminex. Methods: This retrospective study included HLA antibody screening results for 163 patients on the kidney transplant waiting list (WL) tested from March 2012 until the end of December 2015 at the Tissue Typing Laboratory, Rijeka, Croatia. All sera samples were tested using the CDC and Luminex techniques in parallel. Results: Two-thirds of the patients [114 (70%)] on the WL were exposed to transfusions, pregnancies and/or kidney transplant. The pre-transplant sera of 104 (63.80%) patients were negative for antibodies. In the sera of 23 (14.11%) patients, HLA antibodies were detected by CDC and Luminex and in the sera of 36 (22.09%) patients by Luminex only. Conclusion: In patients on kidney WL, previous organ transplantation represents the strongest immunogenic stimulus, followed by blood transfusions (the most frequent SE) and pregnancies. Although Luminex is more sensitive than CDC in HLA antibody detection, the decision on unacceptable HLA antigens in WL patients has to be based on the results of both assays and the patient’s immunization history

Diagnosis of inherited coagulation disorders in Clinical Hospital Centre Rijeka

Cilj: Analizirati podatke o dijagnosti ci nasljednih koagulacijskih poremećaja u Kliničkom bolničkom centru Rijeka te utvrditi pojavnost pojedinih koagulopati ja, dob u vrijeme postavljanja dijagnoze i indikacije za laboratorijsku obradu. Materijali i metode: U radu je retrospekti vno analizirana dijagnosti ka nasljednih koagulopati ja u Kliničkom bolničkom centru Rijeka od 1975. godine do 2014. godine. Korištena je laboratorijska i medicinska dokumentacija Laboratorija za ispiti vanje poremećaja zgrušavanja krvi Kliničkog zavoda za transfuzijsku medicinu. Rezultati : U navedenom razdoblju dijagnosti cirano je 117 nasljednih koagulopati ja. Najčešće su dijagnosti cirane hemofi lija A u 33 % slučajeva (39/117) i von Willebrandova bolest u 21 % (25/117), slijede hemofi lija B 10 % (12/117), hipofi brinogenemija 10 % (12/117), te ostale rijetke koagulopati je: defi cit faktora VII:11/117 (9 %), XI: 8/117 (7 %), V: 3/117(3 %), XIII: 3/117 (3 %), X:2/117 (2 %) i kombinirani defi cit faktora V i VIII:2/117 (2 %). Teški oblik hemofi lije A dijagnosti ciran je kod 7/39 (18 %), umjereni oblik kod 9/39 (23 %), te blagi oblik kod 23/39 (59 %). Teški oblik hemofi lije B dijagnosti ciran je kod jedne osobe (8 %), umjereni kod 6 (50 %), a blagi kod 5 (42 %). Indikacija za dijagnosti ku poremećaja kod teških oblika koagulopati ja bilo je isključivo krvarenje u ranoj dječjoj dobi, a za ostale koagulopati je, uz krvarenje, razlog za dijagnosti ciranje su bili prijeoperati vna i obiteljska obrada. Zaključak: Tijekom četrdesetogodišnjeg razdoblja u Kliničkom bolničkom centru Rijeka dijagnosti cirano je 117 nasljednih koagulopati ja. Najčešće su hemofi lija A i von Willebrandova bolest, slijede hemofi lija B i defi cit fi brinogena, dok su ostale koagulopati je rijetke. Dobiveni podaci sukladni su s podacima iz literature, izuzev povećane učestalosti hipofi brinogenemije u našoj populaciji.Aim: To analyse diagnostic data of inherited coagulati on disorders in Clinical Hospital Centre Rijeka, to determine the frequency, age of diagnosis and the reasons for laboratory testing. Methods: A retrospecti ve analysis of diagnosti c data for inherited coagulopathies in Clinical Hospital Centre Rijeka in period from 1975 to 2014. The data were collected from laboratory and medical documentati on of Coagulati on Laboratory of Clinical Insti tute for Transfusion Medicine. Results: During the study period 117 inherited coagulopathies were diagnosed. The most frequent were haemophilia A 33 % (39/117), von Willebrand disease 21 % (25/117), followed by haemophilia B 10 % (12/117) hypofi brinogenemia 10 % (12/117), and other rare inherited coagulopathies: factor VII: 11/117 (9 %), XI: 8/117 (7 %), V: 3/117 (3 %), XIII: 3/117 (3 %), X: 2/117 (2 %), and combined defi ciency of factors V and VIII: 2/117 (2 %). Severe haemophilia A has been diagnosed in 7/39 (18 %), moderate in 9/39 (23 %) and mild in 23739 (59 %) of cases. Severe haemophilia B has been diagnosed in one case (8 %), moderate in 6 (50 %) and mild in 5 (42 %). The reason for severe coagulopathies diagnosis has been enti rely a bleeding in early children’s age, while the reasons for other coagulopathies diagnoses have been bleeding, preoperati ve testi ng and family screening. Conclusion: In Clinical Hospital Centre Rijeka during forty years period 117 inherited coagulati on disorders have been diagnosed. The most common have been haemophlia A, von Willebrand disease, haemophilia B and factor I defi ciency, while other coagulopathies have been rare. Collected data are comparable with literature, except higher frequency of hypofibrinogenemia in our population