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• Pre-transplantation dialysis duration and modality may affect patients' long- and short-term outcomes after kidney transplantation. • Delayed graft function (DGF) is a common complication associated with worse kidney graft and patient outcomes, and, in the peritransplant period, longer hospitalizations and higher costs. • Pretransplant pertioneal dialysis (PD) patients had lower incidence of DGF. • Patients dialyzed for less than 12 months, regardless of the method, had a lower incidence of DGF. • Strategies to promote PD as a bridge therapy before kidney transplantation and to shorten dialysis treatment time may be valuable methods of improving transplantation outcomes. Pre-transplantation dialysis duration and modality may affect patients' long-term (mortality and graft failure) and short-term (delayed graft function) outcomes after kidney transplantation. We aimed to assess the impact of the method and duration of dialysis therapy on the graft function in the first 6 months post-transplant. The analysis included 122 kidney transplant patients (109 from a deceased donor and 13 from a living donor). Before transplantation, 91 were on hemodialysis (HD), 19 were on peritoneal dialysis (PD), and 9 received preemptive transplants. The incidence of delayed graft function (DGF) and creatinine levels at discharge and 6 months after transplantation were assessed. PD and HD patients did not differ in age, number of mismatches, and cold ischemia time (CIT), but they had a significantly shorter dialysis vintage (18.3 ± 25.7 vs 39.6 ± 34.3 months, P =.01) and a lower incidence of DGF (5% vs 37%, P =.006). The duration of hospitalization and creatinine concentration at discharge and after 6 months were similar. Preemptively transplanted patients had a significantly shorter CIT (ND vs DO - 576 ± 362 vs 1113 ± 574, P =.01; ND vs HD - 576 ± 362 vs 1025 ± 585 minutes, P =.01). DGF did not occur in any of the patients transplanted preemptively. They had slightly shorter hospitalization times and, compared to HD, better graft function at discharge. After 6 months, creatinine levels were comparable to HD and PD. Patients dialyzed for less than 12 months, regardless of the method, had a lower incidence of DGF. Peritoneal dialysis and a short duration of pre-transplant dialysis may improve the early results of kidney transplantation. [ABSTRACT FROM AUTHOR]

• In patients with adult polycystic liver and kidney disease, combined liver-kidney transplantation is a viable option to consider. • There is continuous growth of combined liver-kidney transplantation (CLKTx) numbers with remarkable outcomes, especially among patient with liver cirrhosis and end-stage renal disease. • CLKTx is safe and effective in the treatment of both liver and kidney failure. There is continuous growth of combined liver-kidney transplantation (CLKTx) numbers with remarkable outcomes, especially among patient with liver cirrhosis and end-stage renal disease. The aim was to present a single center experience. Twenty patients (9 males) with a mean age of 48 (range: 20-62) years underwent CLKTx from 2005 to 2022. Indications were polycystic liver and kidney diseases (ADPKD) in 12 cases, cirrhosis due to hepatitis (4 patients), and 1 case of amyloidosis, alcoholic liver disease, nonalcoholic steatosis, and congenital hepatic fibrosis with concomitant glomerulonephritis. After hepatectomy, half of the patients had orthotopic liver transplantation with piggy-back technique, and the other had conventional technique. All but 1 recipient had biliary end-to-end anastomosis. 3 patients had preemptive kidney graft transplantation. 4 underwent simultaneous right-side nephrectomy due to volume of the right kidney. Kidney was transplanted from the separate incision after abdominal closure with typical anastomoses. Tacrolimus, mycophenolate mofetile, basiliximab, and steroids were applied for all recipients. Mean follow-up was 57.7 ± 54 months. No primary non-function of the grafts occurred. Delayed kidney graft function (DGF) occurred in 8 patients. Three-month, 1-year, and 5-year cumulative survival rates were: 90%, 80%, and 72% respectively. None of the patients required retransplantation, and 1 recipient returned to hemodialysis 19 months after transplantation. Preemptive kidney transplantation and simultaneous right-side nephrectomy were not significant for DGF and recipient survival. No deaths within the first year occurred in piggy-back technique. CLKTx is safe and effective in the treatment of both liver and kidney failure. [ABSTRACT FROM AUTHOR]

Families of deceased potential donors often object to organ harvesting on religious grounds. The aim of this study was to learn the attitudes and opinions of Judaism followers regarding organ donation. The study included 97 Judaism followers living in the northeastern part of Poland. The research used the diagnostic survey method. A fairly large percentage (approximately 92%) of respondents accepted treatment using organ transplantation. The removal of organs for transplantation from a loved one after his death was accepted by about 90%. After his death, 14.43% expressed opposition to organ removal. About one-third of respondents did not talk to the family about their organ donation attitude. The average age of people who talked to their family about their will to donate was 49.69 ± 13.95 years. In total, 91.75% of the respondents had a positive attitude toward organ transplantation, 6.19% negative, and 2.06% indifferent. According to respondents, the most common reasons for a family's refusal to collect organs from the deceased are death-related emotions (53.61%), religious beliefs (36.08%), and fear of misuse of organs (22.68%). Judaism believers mostly accept treatment with organs taken from living and deceased people. In a larger percentage, young people with higher and secondary education more often accepted organ donation. [ABSTRACT FROM AUTHOR]

Renal impairment (RI) is one of the multiple myeloma (MM)–defining events for initiating therapy. After induction therapy, high-dose chemotherapy followed by autologous peripheral blood stem cell transplant (ASCT) remains the standard of care for transplant-eligible patients with MM. According to the International Myeloma Working Group (IMWG), the organ criterion for kidney damage is defined by a serum creatinine concentration (CrC) > 2 mg/dL or estimated glomerular filtration rate (eGFR) < 40 mL/min. In this long-term study, we evaluated the impact of CrC and eGFR calculated by the Modification of Diet in Renal Disease equation on progression-free and overall survival using a lower threshold than the IMWG criteria. We studied the longitudinal outcomes as measured by progression-free survival and overall survival in 59 transplant-eligible patients with MM: 38 patients with normal renal function and 21 patients with RI defined as a CrC higher than upper limit of normal (≥ 1.1 mg/dL), eGFR < 60 mL/min, treated with ASCT from 1998 to 2004. The risk of disease progression and death following ASCT increased by 16.5% (P =.005) and 19% (P <.0009) per 1 mg/dL of CrC, respectively. The thresholds for the association of renal insufficiency and negative outcomes were CrC > 1.4 mg/dL and eGFR < 55mL/min. We observed a negative correlation between minimal renal insufficiency and long-term outcomes. Management of patients with even marginally increased CrC and/or decreased eGFR not fulfilling IMWG RI criteria requires more concentrated effort to reverse even minimal renal insufficiency. [ABSTRACT FROM AUTHOR]

Copeptin, a C-terminal part of the precursor pre-provasopressin is a novel biomarker of arginine-vasopressin (AVP) system. Measurements of AVP concentration are not used in clinical practice because of technical difficulties. Copeptin is synthesized in stoichiometric ratio with AVP, hence it reflects vasopressin concentration in human plasma and serum. This review outlines current research concerning the role of copeptin as a prognostic marker in different diseases and its potential clinical value. [ABSTRACT FROM AUTHOR]

Abstract: Background: CD146 is a novel cell adhesion molecule localized at the endothelial junction. Its increased plasma levels in chronic renal failure are linked to endothelial dysfunction. Endothelial dysfunction and hemostatic disturbances, a common feature of nephrotic syndrome (NS), mimics a state of protein loosing by peritoneal membrane in patients on chronic ambulatory peritoneal dialyses (CAPD). The aim of the study was to assess CD146 in relation to other markers of endothelial cell injury in patients with NS in comparison to patients on CAPD. Materials and methods: We studied 45 CAPD patients, 43 patients with nephrotic syndrome and 25 healthy volunteers. Markers of endothelial cell injury: TFPI total, full length, truncated, von Willebrand factor, trombomodulin, P-selectin, E-selectin, ICAM, VCAM and CD146 were assessed using commercially available kits. Results: All these markers studied except selectins were significantly elevated in patients with NS and CAPD when compared to the healthy volunteers. In CAPD, VCAM, thrombomodulin and CD146 were significantly elevated over NS patients. CD146 correlated significantly with ICAM as well as total and truncated TFPI in CAPD patients. Moreover, total TFPI was positively related to VCAM. CD146 correlated with ICAM in NS, whereas in healthy volunteers CD146 correlated only with TFPI concentration. Conclusions: Our studies indicate that in nephrotic patients, as well as in CAPD, there is an evidence of endothelial cell injury. Correlations between CD146 and adhesion molecules and TFPI might further support its use as a endothelial cell function marker. [Copyright &y& Elsevier]

• Glomerulonephritis (GN) is an important cause of end-stage renal disease, and it can recur in transplanted kidney. • Kidney biopsy is the only method that can fully diagnose the recurrence of the disease. • The global data provide divergent information on the frequency of GN relapses depending on the research method adopted (protocolar biopsy or due to symptoms). • It seems that transplanted kidney biopsy should be performed in all symptomatic patients and asymptomatic patients without diagnosed primary disease. • We need to specify data regarding the diagnosis of recurrence depending on the adopted research method to know which patients should be treated. Glomerulonephritis (GN) after kidney transplantation is a common problem. Many of them are recurrences of the primary disease in the transplanted kidney. The course and prognosis of individual types of glomerulonephritis (GN) are very different and their appearance may worsen the graft survival. World statistics show significant discrepancies regarding the incidence of GN recurrence depending on the adopted protocol (protocolar biopsy or due to symptoms). We analyzed the transplanted kidney biopsy results that are performed only in symptomatic patients. A group of 125 patients transplanted and treated in one medical center were observed. In this group, in 32 patients, the primary kidney disease was GN, confirmed by kidney biopsy before transplantation. Twenty three kidney biopsies were performed; in 8, cases the primary disease was GN. The indication for biopsy were hematuria and/or proteinuria and/or graft failure. We diagnosed 5 cases of GN, including 4 cases of GN recurrence (12.5% in whole GN group, 50% in symptomatic GN group). In the relapse group, there was 1 case of IgA nephropathy (the earliest recurrence 1 month after transplantation), 1 case of focal segmental glomerulosclerosis, 1 case of membranous nephropathy, and 1 case of lupus nephritis (the latest recurrence 1 year and 4 months after transplantation). Our observation showed a high percentage of GN recurrences in symptomatic patients. This indicates the need to specify data regarding the diagnosis of recurrence depending on the adopted research method (protocolar or due to symptoms biopsy) to know which patients should be treated. [ABSTRACT FROM AUTHOR]

• Kidney damage remains a significant complication of HCT affecting the mortality of transplant patients. • Identifying risk factors and markers of kidney injury, understanding the causes and appropriate treatment of kidney injury are important to the safety of the HSCT procedure. • RBP4 was significantly higher in patients after HSCT when compared to healthy volunteers. • Nephroprotective strategies are key to prevent chronic kidney disease. Hematopoietic stem cell transplantation could be complicated by acute kidney injury and chronic kidney disease. It may be due to either previous chemotherapy or exposure to a variety of nephrotoxic drug or other causes. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after hematopoetic stem cell transplantation (HSCT) under ambulatory care of the Hematology, Transplantation and Internal Medicine Department. We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtain normal ranges of biomarkers. In this cross-sectional study we assessed retinol-binding protein 4 (RBP4), a biomarker of kidney injury in urine using commercially available assays. It was significantly higher in patients after HSCT when compared to healthy volunteers. When we divided patients according to kidney function (below and over 60 mL/min/1.72 m2), we found that the concentration of RBP4 was significantly higher in 23 patients with chronic kidney disease stage 3 compared to patients with estimated glomerular filtration (eGFR) over 60 mL/min/1.72 m2. In univariate correlations RBP4 was positively related to serum creatinine (r = 0.34, P <.01) and inversely to eGFR (r = −0.20, P <.05). Patients after allogeneic HSCT despite normal or near normal kidney function show evidence of kidney injury. [ABSTRACT FROM AUTHOR]

• Although currently, the qualification for kidney transplantation is very extensive and detailed, the final examination and assessment at the transplant center is crucial for the success of the transplantation. • The limited time to commence kidney transplantation should not limit the physical examination of the potential organ recipient. • Large, life-threatening pneumothorax may be asymptomatic or mildly symptomatic. The risk of morbidity and mortality in the group of people qualified for kidney transplantation is high. Although currently, the qualification for kidney transplantation is very extensive and detailed, the final examination and assessment at the transplant center is crucial for the success of the transplantation. A 50-year-old woman with end-stage kidney disease was admitted to the Department of General, Vascular, and Transplant Surgery on July 21, 2023, for kidney transplantation. A month earlier, she had undergone surgery to create an arteriovenous fistula on the left forearm. The regional anesthesia was performed. Apart from temporary pain and cough, the postoperative course was uncomplicated. Upon admission to the Department, the patient was in good general condition, and only a dry cough was noted during the physical examination. Chest X-ray revealed pneumothorax on the left side with partial lung atelectasis. The patient was temporarily disqualified from kidney transplantation and the pneumothorax was cured. She is currently on the active list waiting for a kidney transplant. The analysis of the above case emphasizes the importance of a physical examination and final qualification at the transplant center. Detailed examination and evaluation at the above center can improve patients' quality of life and survival. [ABSTRACT FROM AUTHOR]

• Patients with chronic kidney disease very frequently develop anemia, and its frequency and severity increase with the progression of the failure. • Iron deficiency anemia is one of the most common problems in CKD—it affects up to 45% of patients, and causes significantly increased mortality. • Lower ferritin levels and lower Charlson Comorbidity Index scores in actively waitlisted populations, reflects the lower degree of inflammation, less frequent blood transfusions, and due to lower risk of immunization, increased chance of potential kidney transplantation Iron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. The study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. Patients on the active waiting list were significantly younger −53.2 vs 67.2 years (P <.001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P <.001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P =.416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P =.349) for hemoglobin concentration and 32.7% vs 33.4% (P =.513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P =.001). Patients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic significantly affected medical services in Poland. All restrictions, additional procedures, and numerous infections among medical staff affected transplantation in the country. This study aimed to analyze reports prepared by the Polish Transplant Coordination Center Poltransplant and internal Fresenius Nephrocare Poland to assess differences in the number of patients who qualified for kidney transplantation and transplanted during the pandemic compared with a pre-pandemic year. Official data from the Polish Transplant Coordinating Centre Poltransplant bulletin from 2019, 2020, and 2021 was analyzed to determine the number of patients on the waiting list for solid organ transplantation. The number of transplantations reported by Polish transplant centers was also considered. During the SARS-CoV-2 outbreak, the number of qualified and transplanted patients was significantly lower than in the pre-pandemic period. The worst data concerns the new qualifications, which were significantly lower in the first year of the pandemic due to all the restrictions implemented. The number of kidney transplant procedures provided during the 2-year pandemic period decreased significantly (-20.8%) in 2020, and in the second year, the negative trend continued (-0.8%). For private dialysis providers, the number of active patients on the waiting list for kidney transplantation was a bit better—it decreased from 265 to 239 in 2020 (-9.8%) and increased to 259 in 2021 (+8.4%). The decline in the number of patients treated in Fresenius Nephrocare dialysis centers was more significant, decreasing by 27.8% in 2020 compared with 2019. In 2021, the number of transplanted patients slightly increased by about 2.5%. The decrease in qualified and transplanted patients during the SARS-CoV-2 outbreak clearly shows the need to undertake multidisciplinary discussions among all stakeholders to create new procedures and processes that will help protect the health care system and patients in future crisis situations. [ABSTRACT FROM AUTHOR]

Background Religious issues may be a significant reason for the lack of organs for transplantation. Younger people have a more enthusiastic attitude toward organ donation. The goal of the present study was to determine whether age and religion affect people's attitudes to organ transplantation. Methods This trial was a diagnostic poll study using an original survey questionnaire involving 1273 people living in Podlaskie Voivodeship. Results Treatment with the use of organs from dead donors was approved by 88.3% of the respondents aged ≤60 years and 70.5% of those aged >60 years; the highest number of those who opposed this procedure occurred in the group aged >60 years (22.3%). Baptists approved of the method more often than persons of other religions; Muslims disapproved of it more often than others (25%). Approximately 96% of the participants, regardless of religion, had a positive attitude toward organ transplantation, but only 81% aged >60 years had a positive attitude toward organ donation; there were significantly more Catholics in this group ( P < .026). In the group aged >60 years, 63.8% expressed their consent; 66.7% of them were Muslims and Baptists. Approximately 86% of persons aged ≤60 years were willing to donate their own organs after death. These people were significantly more often Catholic ( P < .045). Conclusions Age and religion have a considerable influence on positive attitudes toward transplantation. The majority of younger people, as well as Catholics, approve of the removal of organs from living donors and from dead donors. [ABSTRACT FROM AUTHOR]

• Transplant renal artery stenosis is the most common vascular complication in kidney transplant recipients, being a significant source of graft dysfunction, loss, and premature death. • Recognition of transplant renal artery stenosis (TRAS) is important because it is potentially curable and may influence graft and patient survival. • The best management of patients with TRAS is unknown with endovascular treatment; percutaneous transluminal angioplasty with or without stenting is thought to be the first-line therapy. Transplant renal artery stenosis (TRAS) constitutes 75% of all vascular complications in kidney transplant recipients, being a significant source of graft dysfunction and loss. TRAS is a heterogeneous disease with different risk factors and causes. The incidence differs greatly, and it is likely it will increase because of the aging population of potential recipients and donors of renal grafts and the expanding use of extended-criteria donors. Prompt diagnosis and treatment of TRAS can prevent irreversible allograft dysfunction and loss. Current evidence of risk factors, diagnostic challenges, and therapeutic options are presented in this short review. [ABSTRACT FROM AUTHOR]

• Kidney damage remains a significant complication of hematopoietic stem cell transplantation (HSCT), affecting the mortality of transplant patients. • Identifying risk factors and markers of kidney injury and understanding the causes and appropriate treatment of kidney injury are important to the safety of HSCT. • All of the biomarkers studied were significantly higher in patients after hematopoietic stem cell transplant when compared with healthy volunteers. • Nephroprotective strategies are key to preventing chronic kidney disease. Kidney function in patients undergoing hematopoietic stem cell transplant (HSCT) is frequently worsened by previous chemotherapy and exposure to a variety of nephrotoxic drugs. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after HSCT under ambulatory care of the Hematology, Oncology and Internal Medicine Department. We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtain normal ranges for biomarkers. In this cross-sectional study, the following biomarkers of kidney injury in urine were evaluated using commercially available assays: IGFBP7 and TIMP2 , netrin-1, and semaphorin A2. All of the biomarkers studied were significantly higher in patients after HSCT compared with the healthy volunteers. When we divided patients according to kidney function (below and over 60 mL/min/1.73m2), we found that only concentration of IGFBP7 was significantly higher in 23 patients with chronic kidney disease (CKD) stage 3 relative to patients with an estimated glomerular filtration rate (eGFR) over 60 mL/min/1.73m2. All biomarkers in both subgroups of patients with eGFRs below and over 60 mL/min/1.73m2 were significantly higher relative to healthy volunteers. In univariate correlations, semaphorin A2 was related to netrin-1 (r = 0.47, P <.001), IGFBP7 (r = 0.35, P <.01), and TIMP2 (r = 0.32, P <.01), whereas IGFBP7 was positively related to serum creatinine (r = 0.38, P <.001) and inversely to eGFR (r = -0.36, P <.001). Patients after allogeneic HSCT, despite normal or near normal kidney function, show evidence of kidney injury. [ABSTRACT FROM AUTHOR]

Simultaneous liver and kidney transplants (SLKT) represent 1.1% of all liver transplants in Poland. Patients undergoing SLKT experience a longer operation time and concurrent kidney dysfunction may aggravate metabolic derangement associated with the procedure. The benefits of intraoperative dialysis (ioHD) in these patients have not been determined. A retrospective observational study of all adult patients undergoing SLKT in our center from January 2009 till December 2016. Study group consisted of 10 patients with End-Stage Kidney Disease (0.9% of all liver transplants): 6 patients treated with ioHD during SLKT (group 1) and 4 patients managed conservatively (group 2). All recipients were on chronic dialysis. The mean calculated Model for End-Stage Liver Disease score was 21 ± 0.9 in group 1 and 30 ± 9.5 in group 2 (P =.009). The mean preoperative serum potassium was 4.7 ± 0,6 mmol/L in group 1 and 3.97 ± 1,02 in group 2. Intraoperative serum potassium levels were comparable between the groups, but the maximum lactate and minimum bicarbonate levels were significantly worse in group 2. Postreperfusion syndrome occurred in no patient. Dialysis circuit clotting occurred in 50% of ioHD. Six patients (2 in group 1) required renal replacement therapy after SLKT; no patient was on dialysis on discharge. Three patients died within 1 year after surgery (2 in group 2). No patient developed intraoperative hyperkalemia or postreperfusion syndrome. We observed a high frequency of circuit system clotting during ioHD. Clinical benefits of intraoperative hemodialysis during SLKT need to be determined in a larger study. [ABSTRACT FROM AUTHOR]

• Waitlisted patients represent a very select and healthier dialyzed population. • Malignancy has become a more common comorbidity in dialyzed patients, which may have important clinical implication regarding therapy. • Guidelines for cancer screening in potential transplant recipients should be developed, as nowadays there are scarcity of data in this matter. Malignancy is the second cause of death in the dialyzed population. However, data on the prevalence of cancer are very scarce. Kidney transplantation improves quality of life, prolongs survival, and is cost-effective but bears some serious complications including malignancy. Therefore, active screening for cancer is of utmost importance. The aim of this study was to assess the prevalence of malignancy in dialyzed patients in relation to status on the on the waiting list and type of dialysis. This cross-sectional study was conducted in 108 hemodialyzed patients (mean age 65 years, 47 women) and 47 peritoneally dialyzed patients (mean age 51 years, 25 women). Among the population studied, 20 patients were actively waitlisted, including 14 peritoneal dialysis patients. Patients who had been active on the cadaver kidney waiting list and not listed did not differ in regard to sex, dialysis vintage, and causes of end-stage renal failure, but were significantly younger. Among hemodialysis patients, 24 of them had a history of malignancy and 10 in the peritoneal dialysis population. The most common were renal cell carcinoma in 6, breast cancer in 4, lung cancer in 3, prostate cancer in 3, hepatocellular cancer in 2, colorectal cancer in 2, esophageal cancer in 2, and others 14. In waitlisted patients, only 2 hemodialysis patients had a history of malignancy. Waitlisted patients represent a very selected and healthier dialyzed population. Malignancy has become a more common comorbidity in dialyzed patients, which may have important clinical implication regarding therapy. Guidelines for cancer screening in potential transplant recipients should be developed, as nowadays there are scarcity of data in this matter. [ABSTRACT FROM AUTHOR]

Kidney transplant is the preferred therapy for end-stage kidney disease; however, it has been associated with some serious complications, including malignancy, which became the second leading cause of death among kidney allograft recipients. The aim of this study was to assess the prevalence of malignancy in hemodialyzed patients and in kidney transplant recipients. A cross-sectional study was conducted in 114 prevalent hemodialyzed patients, including 7 on the waiting list and 350 kidney allograft recipients. Hemodialyzed patients and kidney allograft recipients did not differ in regard to sex, dialysis vintage, and cause of end-stage renal failure, but were significantly older. Among wait-listed patients, only 1 had a history of malignancy (gastric cancer stage G1). Among kidney allograft recipients, in 70 patients, malignancy developed (in total 20% of the studied population). The leading malignancy was skin cancer (18 cases), followed by post-transplant lymphoproliferative disorder (PTLD) in 10 cases, lung cancer (small cell and non–small cell lung cancer; 4 cases), renal cell carcinoma (3 cases), brain cancer (glioma; 3 cases), colorectal cancer (3 cases), Kaposi sarcoma (2 cases), Merkel carcinoma (2 cases), metastatic disease of unknown origin (2 cases), and other 23 malignancies were in a single patient (including 1 leukemia and 1 multiple myeloma). Twenty-six deaths were recorded in kidney allograft recipients with malignancy, mainly in PTLD, Kaposi sarcoma, Merkel carcinoma, sarcoma, glioma, and melanoma. Despite the lower prevalence of malignancy on hemodialyzed population, cancer screening in both potential transplant recipients and kidney allograft recipients is a prerequisite, because nowadays there is a scarcity of data in this area. It may be due to previous immunosuppression, long-term dialysis vintage, immunocompromised status, and immunosuppressive therapy after transplant, in particular in high-risk patients. [ABSTRACT FROM AUTHOR]

Orthotopic liver transplantation (LT) is a technically complex surgical procedure associated with a major risk of hemodynamic instability and metabolic derangement, especially in patients with coexisting renal dysfunction. Some centers have applied intraoperative renal replacement therapy (ioRRT) to support patients with preoperative renal failure and prevent critical complications. Although there is a strong theoretical rationale for this treatment, there remains a paucity of definite data demonstrating its benefits. This was a retrospective observational study of all adult patients undergoing intraoperative dialysis in our center from January 2010 till December 2016. The study group consisted of 88 patients with a mean MELD score of 31.4. Six patients underwent simultaneous liver and kidney transplantation. Forty-four (50%) recipients were admitted to the intensive care unit before transplantation, and 19 (21.6%) needed mechanical ventilation. Twenty-eight (31.8%) of the procedures were retransplantations, and 40 (45.4%) patients had been undergoing renal replacement therapy before LT. The mean preoperative serum creatinine was 2.82 ± 1.13 mg/dL. The majority of patients (54.5%) was operated on using the veno-venous bypass technique. The mean arterial blood pH and potassium levels after reperfusion were 7.2 ± 0.12 and 4.04 ± 0.95 mmol/L, respectively. Postreperfusion syndrome (PRS) occurred in 11 (13.9%) patients in whom dialysis started at least 15 minutes before reperfusion. Dialysis circuit clotting occurred in 9.1% of cases. There were no other adverse events of ioRRT. Our data suggests that intraoperative dialysis in severely ill patients with a high MELD score is safe and effective. Lower than expected PRS occurrence needs to be confirmed in a study with a control group. • Intraoperative dialysis during liver transplantation in severely ill patients with a high MELD score and elevated serum creatinine is safe and feasible. • Patients treated with intraoperative dialysis had stable potassium levels during liver transplantation. • Lower-than-expected postreperfusion syndrome occurrence needs to be confirmed in a study with a control group. [ABSTRACT FROM AUTHOR]

Kidney transplantation improves quality of life, prolongs survival, and is cost-effective, but bears some serious complications including malignancy. The aim of this study was to assess the prevalence of malignancy in dialyzed patients on the waiting list and in kidney allograft recipients. The cross-sectional study was conducted in 50 prevalent patients on the waiting list and 300 kidney allograft recipients. Patients who had been registered in the cadaver kidney waiting list and kidney allograft recipients did not differ in regard to age, sex, dialysis vintage, and causes of end-stage renal failure. In waitlisted patients, only 3 had a history of malignancy. In kidney allograft recipients, 52 patients developed malignancy. The leading malignancy was skin cancer with 9 cases, followed by post-transplant lymphoproliferative disorder in 5 cases, Kaposi sarcoma in 2 cases, brain cancer in 2 cases, Merkel carcinoma in 2 cases, lung cancer (small cell and non--small cell), unknown origin in 2 cases, and the other 22 malignancies were in single patients (including 1 leukemia and 1 multiple myeloma). Seventeen deaths were recorded in kidney allograft recipients with malignancy mainly in post-transplant lymphoproliferative disorder, Kaposi sarcoma, Merkel carcinoma, sarcoma, and brain cancer. Concluding, waitlisted patients represent a very selected and healthier dialyzed population. Guidelines for cancer screening in both potential transplant recipients and kidney allograft recipients should be developed as nowadays a scarcity of data exists in this matter. Minimization of immunosuppressive regimen should be considered, in particular, in high-risk patients. • Malignancy is less prevalent on the active waiting list relative to kidney transplant recipients. • Prevalence of malignancy is increasing in kidney allograft recipients, particularly in the early period of transplantation; screening in this population is of the utmost importance as well as meticulous evaluation while on the waiting list. [ABSTRACT FROM AUTHOR]

The progress of transplantation in Poland is influenced not only by medical staff, but also by the legislative organ, which approves amendments to the Act of the Collection, Storage and Transplantation of Cells, Tissues and Organs. This is why young lawyers should be aware of the scale of the problem and have current statistics on transplant issues. To assess the awareness of existing problems in the field of transplantation in Poland among law students. A survey (with 11 questions) of 209 law students at the University of Bialystok (64% women and 36% men). Of respondents, 32% do not see the difference between dialysis treatment and transplantation, and 47% are convinced that the 5-year survival of dialysis patients is as much as 70% (in fact this number is twice as low). Still, 13% of people consider the stereotype of family consent for organ procurement is necessary. Of law students, 5% indicated that organ trafficking is allowed in Poland, and 41% believe that as many as 5% of people in Poland stated in writing opposition to removal of their organs after death. Fortunately, this number is much smaller (2%). The respondents have current knowledge about the place of Poland in the world in terms of the number of donors. Relatively good results were recorded in questions about medical knowledge. In most questions, the correct answer obtained the highest score, but it was not an absolute majority. There is a trend among law students for an optimistic approach to statistics and the real problems in transplantology. • Young lawyers should be aware of the scale of the problem and have current statistics on transplantation issues. • Law students are interested in and have a good knowledge of the medical aspects of transplantation. [ABSTRACT FROM AUTHOR]

Transplantology is one of the fastest growing specialties of medicine. However, data on actual students' knowledge in this field is lacking. Assessing the education of medical students; level of current basic knowledge in the field of medicine, law, and statistics on transplantology in Poland. Survey (with 48 questions) conducted among 165 medical students (1st-6th year). The average age was 22 years; 62.0% women. Only 29.7% of the respondents are blood donors, 36.4% are registered as a potential bone marrow donor, and 11.8% have the donor card. None of these factors had a clear impact on transplantology knowledge. The respondents obtained a result of 54.9% correct answers (medicine, 58.2%; law, 55.8%; statistic, 39.9%). An increase in the level of knowledge in subsequent years of education can be seen. Students in the first year marked 49.4% correct answers compared to people in the sixth year who marked 62.9% correct. Students base their knowledge about transplantation mainly on messages obtained in class (89.1%). The survey showed that 18.8% of respondents consider the family's consent for organ procurement from their deceased member as legally valid; 27.9% do not treat brain death as synonymous with death; and 9.1% believed that organ trafficking is allowed. Nobody is registered in the Central Register of Objections. Despite the increase in the level of knowledge about transplantation during the study, it does not reach a satisfactory level. The number of sources of knowledge does not correlate with the quality of acquired knowledge. • Knowledge about organ transplantation increases during medical education but still is not sufficient. • Co-creating events at the university, the involvement of students of all years, and active discussion could encourage being a donor and raise the level of knowledge and awareness of future doctors. [ABSTRACT FROM AUTHOR]

Introduction Organ transplantation is connected with many very difficult ethical and social issues that evoke a lot of emotion. The aim of this work was to determine the knowledge and opinions of the 612 residents of selected towns in Podlaskie voivodeship (in northeastern Poland) on organ transplantation. Material and Methods A diagnostic poll with the use of a survey questionnaire was implemented in the study. The respondents were divided into 2 groups (towns <100,000 and >100,000 residents). Results Respondents from larger towns were more often willing to donate organs of close relatives for transplantation than those from small towns (67.1% vs 32.9%; P = .022). Respondents with higher education levels accepted organ donation from close relatives after their death significantly often than those with no more than a primary education (46.7% vs 22.2%; P < .001). Of the respondents, 83% would agree to donation after death and to donating their own organs (higher with primary education, 90.6% vs 63.5%; P < .001). Of respondents from big towns, 61.0% have informed their family of the decision for donation after death compared with 38.5% of respondents from small towns. Respondents with higher education significantly more often informed their family of such decision than persons with primary education (60.9% vs 42.9%; P < .007). Conclusions More emphasis should be on educating the communities living in small towns and people with primary and vocational education, because an adequate level of knowledge is a significant factor influencing the readiness to give one's organs for transplantation. [ABSTRACT FROM AUTHOR]