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Background: Following kidney transplantation (KT), new-onset diabetes mellitus (NODM) is one of the most common complications. NODM usually occurs early after KT, and is diagnosed according to the general guidelines relevant for general diabetes mellitus patients. Arterial stiffness is a surrogate marker of cardiovascular risk. According to the literature, a successful KT has only limited and late beneficial effects on aortic elastic properties. The present study aimed to assess whether NODM has any additive value on the worsening of echocardiography-derived aortic elastic properties in transplanted patients., Methods: We have included 28 nondiabetic post-KT patients in the study, older than 18 years (mean age: 48.2 ± 6.9 years; 13 men, 15 women). After an oral glucose tolerance test, 8 patients were diagnosed with NODM, and their results were compared to 23 age-, sex-, and risk factor-matched controls (mean age: 54.9 ± 11.0 years; 9 men, 14 women). All post-KT patients and matched controls underwent a complete transthoracic 2-dimensional Doppler echocardiography, together with an assessment of echocardiographic aortic elastic properties. The assessments included aortic strain, aortic distensibility, and aortic stiffness index., Results: Aortic elastic properties showed alterations in post-KT patients compared to matched controls (aortic strain: .084 ± .039 vs .057 ± .032, P  <  .05; aortic distensibility: 2.36 ± 1.09 cm 2 /dynes 10 -6 vs 1.83 ± 1.18 cm 2 /dynes 10 -6 , P = .07; aortic stiffness index: 7.15 ± 3.58 vs 11.2 ± 6.1, P <  .05). Further deterioration in the aortic stiffness index (14.8 ± 7.6 vs 9.68 ± 4.88, P <  .05) was detected in the presence of NODM., Conclusions: NODM following successful KT facilitates aortic stiffening., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: New-onset diabetes after transplantation (NODAT) is one of the most common complications after kidney transplantation., Methods: Patients were randomly assigned to receive cyclosporine A-based or tacrolimus-based immunosuppression. Fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following 3 groups, on the basis of the results: normal, impaired fasting glucose/impaired glucose tolerance, or NODAT. NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (P = .0002)., Results: Albumin levels were similar, but uric acid level (P = .002) and the age of the recipient (P = .003) were significantly different between the diabetic and the normal groups. Evaluation of tissue samples revealed that acute cellular rejection and interstitial fibrosis/tubular atrophy were significantly different in the NODAT group. Changes in the Banff score provided significant difference regarding tubulitis and interstitial inflammation (P = .05)., Conclusions: The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before the development of any sign of functional impairment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Transplant patients' representations of their illness, body, and emotional state significantly influence their recovery. In this study, our primary aim was to examine the possible connections between emotional factors, body and illness representations, and renal function after 58 kidney transplantations. To measure mental representations of transplanted kidneys, we developed a projective drawing test. Other assessment instruments were the Beck Depression Inventory, Spielberger's State and Trait Anxiety Scale, and an in-house questionnaire. We also measured conventional kidney function markers, such as serum creatinine and urea levels. Analysis of our results revealed that patients with higher anxiety levels drew significantly larger kidneys in their projective drawing tests, and displayed significantly higher 10-day creatinine and urea level leading us to consider interrelations of an organ's intrapsychic integration and kidney function. If the graft is not integrated mentally in the body image, the representations of the "foreign body" can be associated with such psycho-neuro-immunologic processes of anxiety, which eventually may lead to adverse physiological effects on kidney function., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

Despite the increased number of cadaver donors and overall organ transplantations, we have observed a dramatic increase in the waiting list. We evaluated transplantations performed using marginal (n = 63) and "ideal" or optimal donors (n = 86). Donor and recipient functional and histopathological data were studied at 1 and 5 years after transplantation. Among the marginal donor group, we investigated whether the age or pre-existent hypertension in the donor showed a strong impact on the functional deterioration of the grafts. Twenty-three graftectomies were performed in marginal, and 39 in ideal recipients (P = .002). Evaluating graft function, at 5 years, we observed the serum creatinine level (P = .0001) and the estimated glomerular filtration rate (P = .003) are significantly different between the two groups. At this time there was a significant difference in the serum creatinine level of patients who were older than the age of 55 years compared with those who showed hypertension (P = .0003). Evaluating morphological changes in the kidneys, acute rejection episodes (P = .0004) and interstitial fibrosis/tubular atrophy (P = .002) were significantly greater among the marginal versus the ideal groups. At 1 year after kidney transplantation, despite no significant difference regarding renal function, they were significant in the histology of marginal versus ideal donor kidneys., (Copyright © 2012. Published by Elsevier Inc.)

Background: The long-term benefit of early treatment of subclinical disorders detected in kidney allografts by protocol biopsy is controversial. We collected 145 protocol biopsies from 113 recipients for comparison with 51 control patients in a single-center, prospective, randomized trial., Methods: Ultrasound-guided biopsies were performed in recipients with stable renal function. Samples were taken at 3 (n=66) and/or 12 months (n=79) after transplantation. The biopsies were evaluated according to the Banff scheme, and patients were treated based on the diagnosis. Changes in glomerular filtration rate (GFR) were compared with 51 patients who were randomized as a control group., Results: The findings on 38 samples (29%) were considered to be normal. Based on the pathology findings, such as subclinical acute rejection (n=23), calcineurin inhibitor toxicity (n=28), chronic rejection (n=6), and other specific pathologies (n=23), including polyoma virus nephropathy (n=2), induced treatment among 82 recipients (57%). Significantly better graft function was observed at 3-year follow-up among the biopsy group, compared with controls: GFR = 46.0 ± 13.8 vs 35 ± 15 mL/min (P=.002). The 5-year graft survival was significantly higher in the biopsy (81%) than in the control (55.6%) group (P=.0012)., Conclusion: Early detection and treatment of subclinical pathologies improved graft function and long-term survival. Protocol biopsies were a valuable tool for posttransplantation management., (Copyright © 2011. Published by Elsevier Inc.)

Background: The principal risk factors for cardiovascular mortality posttransplantation are hyperglycemia, hypertriglyceridemia, obesity, and smoking., Methods: Among 115 patients, we assessed the risk factors for new-onset diabetes (NODM) and dyslipidemia (NODL), and their effects on the function and histopathologic changes in the allografts at 1 year posttransplantation., Results: When evaluating the risk factors and the initial recipient data, we observed a significant difference in age when comparing normal vs NODM patients (P=.004), normal versus NODL patients (P=.002), and normal versus NODL + NODM patients (P=.0001). The difference in body mass index (BMI) was significant when comparing normal with NODM + NODL patients (P=.003). In regard to immunosuppressive therapy, NODM was significantly more frequent among/prescribed tacrolimus (tac; P=.005), whereas subjects who received cyclosporine (CsA) showed a significantly higher incidence of NODL (P=.001). The triglyceride levels were 3.02 ± 1.51 mmol/L among those on CsA versus 2.15 ± 1.57 mmol/L for (P=.004). The difference also proved to be significant for total cholesterol level: 5.43 ± 1.23 mmol/L versus 4.42 ± 1.31 mmol/L respectively (P=.001). In regard to allograft function a significant difference was noted at 1 year after transplantation between the NODM + NODL and the normal group in serum creatinine level (P=.02) as well as the estimated glomerular filtration rate (P=.004). Among diabetic patients, the serum creatinine level measured at posttransplant year 5 was significantly higher than that in 1 year (212.43 vs 147.00 μmol/L; P=.0003). When assessing morphologic changes in the kidney, we observed significantly more frequent interstitial fibrosis/tubular atrophy in all 3 groups compared with normal function patients., Conclusion: Our clinical study suggested that at 1 year after transplantation allograft function is already impaired in the presence of both medical conditions (NODM and NODL). However, in regard to morphology, a single condition (NODM or NODL) was sufficient to produce histologic changes in the kidney., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The colocalization of GABA, enkephalin and neuropeptide Y immunoreactivity in neurons in the pretectal area and in the mesencephalic tectum of the green frog (Rana esculenta) was studied. Several Met-enkephalin immunoreactive perikarya were found in layer 6 of the tectum and every third of these neurons showed GABA-ir as well. Colocalization of GABA and NPY could also be shown in half of the neuropeptide Y immunopositive cells in the 6th layer of the tectum, but only a few cells were double stained in layers 9 and 4. In the pretectal area no colocalization of the investigated peptides and GABA was found.