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Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. Materials and methods. The retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM ) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no differences between Banff scores and clinical parameters 12 months after transplantation between recipients with TBM and recipients with normal GBM thickness. Zero-time renal biopsy is of great importance for allograft assessment and comparison with consecutive biopsies. Further investigation is needed to determine the long-term significance of TBM on graft survival.

Previous studies have demonstrated cardiovascular causes to be among the leading causes of death after liver (LT) and kidney transplantation (KT). Although both recipient populations have unique pre-transplant cardiovascular burdens, they share similarities in post-transplant exposure to cardiovascular risk factors. The aim of this study was to compare cardiovascular mortality after LT and KT.We analyzed causes of death in 370 consecutive LT and 207 KT recipients from in-hospital records at a single tertiary transplant center. Cardiovascular causes of death were defined as cardiac arrest, heart failure, pulmonary embolism, or myocardial infarction.After a median follow-up of 36.5 months, infection was the most common cause of death in both cohorts, followed by cardiovascular causes in KT recipients and graft-related causes in LT recipients in whom cardiovascular causes were the third most common. Cumulative incidence curves for cardiovascular mortality computed with death from other causes as the competing risk were not significantly different (P = .36). While 1-year cumulative cardiovascular mortality was similar (1.6% after LT and 1.5% after KT), the estimated 4-year probability was higher post-KT (3.8% vs. 1.6%). Significant pre-transplant risk factors for overall mortality after KT in multivariable analysis were age at transplantation, left ventricular ejection fraction

This report describes data collected by the Croatian Registry of Renal Biopsies (CRRB) for the year 2019. Patients and methods: nine centers (82%) provided data for 255 native kidney biopsies. We assessed the anthropometric data, data on serum creatinine concentration (sCr), 24 h proteinuria, haematuria, serum albumin level, arterial hypertension, histological diagnosis, and complications after renal biopsy. Results: examined group consisted of 58% males, median age 58 y (18-80 y) and 42% women, median age 57 y (20- 86 y). Males had a more impaired renal function at the time of renal biopsy, nephrotic syndrome, and hypertension. The most prevalent clinical presenta tion were urinary abnormalities (34.9%). Among all biopsy cases, primary glomerular diseases were the most often found histology group (41.5%), and IgA nephropathy was the most frequent diagno sis(47.1%). Among secondary glomerular diseases, pauci-immune glomerulonephritis (PIGN) was most often found (30.9%). The highest proteinuria was observed in minimal change disease and dia betic nephropathy (DN). The highest sCR values were found in membranoproliferative glomerulone phritis (MPGN) and necrotizing vasculitis. Patients with MPGN and DN had the highest blood pressure levels. Conclusion: CRRB provides important data on the epidemiology of biopsy-proven kidney diseases from the whole territory of Croatia.

Introduction: primary membranous nephropathy (pMN) is glomerulopathy caused in the majority of cases by autoantibodies to Phospholipase-A2 receptors (PLA2R-AB). This study aimed to evaluate the clinical course and outcomes of the patients with pMN regarding PLA2R-AB status. Patients and methods: 32 patients (21 males, 11 females) with renal biopsy-proven pMN were included in the study. PLA2R-AB (ELI SA method) and outcomes (defined according to KDIGO) were evaluated after 21 and 64 months of follow-up in 28 patients. Results: 19 patients had positive PLA2R-AB (>20 RU /ml) (59.3%), with median titer of 97 (21-1418 RU /ml). The rate of remission in low PLA2R-AB titer group (< 200 RU /ml) after 21 months was significantly higher than in high PLA2R-AB group (> 200 RU /ml) (90% vs. 50%, p=0.045), and after 64 months the difference was not significant (80% vs. 50%, p=0.210). The relapse rate after 64 months was higher in the high PLA2R-AB group (87% vs. 63%). Multivariant linear regression found serum creatinine (ß=0.682, p, Uvod: primarna membranska nefropatija (pMN) je glomerulopatija, koja je u većini slučajeva uzrokovana autoprotutijelima na receptor za fosfolipazu A2 (PLA2R-PT). Cilj ovog istraživanja bio je analizirati povezanost PLA2R-PT s kliničkim tijekom i ishodima bolesti. Ispitanici i metode: 32 bolesnika (21 muškaraca, 11 žena), s biopsijom bubrega dijagnosticiranim pMN, bilo je uključeno u istraživanje. PLA2R-PT (ELI SA metoda) i ishodi (definirani u skladu s KDIGO) određeni su nakon 21 i 64 mjeseca praćenja u 28 bolesnika. Rezultati: 19 bolesnika imalo je pozitivna PLA2R-PT (>20 RU /ml) (59.3%), s medijanom titra 97 (21-1418 RU /ml). Stopa remisije u skupini s niskim titrom PLA2R-PT (< 200 RU /ml) nakon 21 mjeseca bila je značajno viša u odnosu na skupinu s visokim titrom PLA2R-PT (> 200 RU /ml) (90% vs. 50%, p=0.045), a nakon 64 mjeseca razlika nije bila značajna (80% vs 50%, p=0.210). Stopa relapsa nakon 64 mjeseca bila je viša u skupini s visokim titrom PLA2R-PT (87% vs. 63%). Multivarijatnom linearnom regresijom su kao značajni neovisni prediktori za bubrežnu funkciju na kraju praćenja nađeni serumski kreatinin (ß=0.682, p

Introduction: primary membranous nephropathy (pMN) is glomerulopathy caused in the majority of cases by autoantibodies to Phospholipase-A2 receptors (PLA2R-AB). This study aimed to evaluate the clinical course and outcomes of the patients with pMN regarding PLA2R-AB status. Patients and methods: 32 patients (21 males, 11 females) with renal biopsy-proven pMN were included in the study. PLA2R-AB (ELISA method) and outcomes (defined according to KDIGO) were evaluated after 21 and 64 months of follow-up in 28 patients. Results: 19 patients had positive PLA2R-AB (>20 RU/ml) (59.3%), with median titer of 97 (21-1418 RU/ml). The rate of remission in low PLA2R-AB titer group (< 200 RU/ml) after 21 months was significantly higher than in high PLA2R-AB group (> 200 RU/ml) (90% vs. 50%, p=0.045), and after 64 months the difference was not significant (80% vs. 50%, p=0.210). The relapse rate after 64 months was higher in the high PLA2R- AB group (87% vs. 63%). Multivariant linear regression found serum creatinine (ß=0.682, p

The aim was to determine the cost of hospitalization for a transplant procedure and identify the independent variables associated with the cost of transplantation. The investigation was designed as a retrospective single-center cohort study conducted at a tertiary university hospital transplant center in Zagreb, Croatia. The study included 219 consecutive kidney recipients transplanted during the 2007-2013 period at the Merkur University Hospital. There were 141 male and 78 female patients having undergone kidney transplantation during the study period. The majority of kidney transplants were from a deceased donor (n=179), while 40 were from a living donor. The mean cost of a transplantation was 86,140±42,240 HRK (11,460±5,600 €), ranging from 29,000 HRK (3,860 €) to 408,000 HRK (54,000 €). In the bivariate analysis, the variables associated with the cost of transplantation were the length of hospital stay, delayed graft function, death of the patient, graft loss, use of steroids, and death-censored graft loss. In the multivariate analysis, delayed graft function was the only statistically significant variable for the cost of transplantation. Since only delayed graft function had an impact on the cost of transplantation in this study, certain steps such as shortening of the cold ischemia time (better organization of organ transport), better education of family members for living donors, and higher percentage of patients on peritoneal dialysis should be taken to lower the percentage of delayed graft function., Cilj istraživanja bio je odrediti troškove hospitalizacije za postupak presađivanja bubrega i identificirati nezavisne varijable povezane s troškovima transplantacije. Istraživanje je provedeno kao retrospektivna kohortna studija u jednom kliničkom centru. Studija je obuhvatila 219 uzastopnih transplantacija bubrega u razdoblju od 2007. do 2013. godine u Kliničkoj bolnici Merkur, odnosno 219 bolesnika (141 muškaraca i 78 žena). Većina transplantiranih bubrega je bila od preminulog (n=179) donora, dok ih je 40 bilo od živog davatelja. Prosječni trošak transplantacije iznosio je 86.140±42.240 HRK (11.460±5.600 €). U bivarijatnoj analizi varijable povezane s cijenom transplantacije bile su trajanje hospitalizacije, odgođena funkcija presatka, smrt bolesnika, gubitak presatka, upotreba steroida i cenzurirani gubitak presatka. U multivarijatnoj analizi samo je odgođena funkcija presatka bila statistički značajna varijabla za troškove transplantacije. Budući da je samo odgođena funkcija presatka u ovom istraživanju utjecala na troškove transplantacije, potrebno je poduzeti određene korake kao što su skraćivanje vremena hladne ishemije (bolja organizacija transporta organa), bolje obrazovanje članova obitelji za žive donore i veći postotak bolesnika na peritonejskoj dijalizi kako bi se smanjila incidencija odgođene funkcije presatka.

Background Everolimus permits reduced calcineurin inhibitor (CNI) exposure, but the efficacy and safety outcomes of this treatment after kidney transplant require confirmation.Methods In a multicenter noninferiority trial, we randomized 2037 de novo kidney transplant recipients to receive, in combination with induction therapy and corticosteroids, everolimus with reduced-exposure CNI (everolimus arm) or mycophenolic acid (MPA) with standard-exposure CNI (MPA arm). The primary end point was treated biopsy-proven acute rejection or eGFR Results In the intent-to-treat population (everolimus n=1022, MPA n=1015), the primary end point incidence was 48.2% (493) with everolimus and 45.1% (457) with MPA (difference 3.2%; 95% confidence interval, -1.3% to 7.6%). Similar between-treatment differences in incidence were observed in the subgroups of patients who received tacrolimus or cyclosporine. Treated biopsy-proven acute rejection, graft loss, or death at post-transplant month 12 occurred in 14.9% and 12.5% of patients treated with everolimus and MPA, respectively (difference 2.3%; 95% confidence interval, -1.7% to 6.4%). De novo donor-specific antibody incidence at 12 months and antibody-mediated rejection rate did not differ between arms. Cytomegalovirus (3.6% versus 13.3%) and BK virus infections (4.3% versus 8.0%) were less frequent in the everolimus arm than in the MPA arm. Overall, 23.0% and 11.9% of patients treated with everolimus and MPA, respectively, discontinued the study drug because of adverse events.Conclusions In kidney transplant recipients at mild-to-moderate immunologic risk, everolimus was non-inferior to MPA for a binary composite end point assessing immunosuppressive efficacy and preservation of graft function.

Glomerularne bolesti bubrega jedan su od glavnih uzroka zatajivanja bubrežne funkcije u bolesnika koji se pripremaju za transplantaciju bubrega. Kliničko praćenje takvih bolesnika može biti zahtjevno zbog varijabilnog tijeka različitih glomerulonefritisa kao i zbog mogućnosti povrata bolesti u transplantirani bubreg. U tekstu se opisuju fokalna segmentalna glomeruloskleroza, IgA nefropatija, C3 glomerulopatija i membranska nefropatija prije i poslije transplantacije. Rizični čimbenici i rano otkrivanje povrata bolesti, kliničke osobine, histološke karakteristike, terapijske mogućnosti i modifikacija imunosupresivne terapije te ishodi liječenja različitih oblika glomerulonefritisa u transplantiranom bubregu tema su ovoga preglednog članka., Glomerular kidney diseases are one of the major causes of renal failure in patients preparing for kidney transplantation. Clinical monitoring of these patients may be a great challenge because of the variable course of various types of glomerular diseases, as well as the possibility of disease recurrence in the transplanted kidney. Focal segmental glomerulosclerosis, IgA nephropathy, C3 glomerulopathy, and membrane nephropathy before and after transplantation are described in this text. Risk factors and early detection of disease recurrence, clinical features, histologic characteristics, therapeutic options, modification of immunosuppressive therapy, and treatment outcomes for various forms of glomerulonephritis in the transplanted kidney are the topics of this review article.

Objective Determining the cost of hospitalization for a transplant procedure and identifying the independent variables associated with the cost of transplantation. Design Retrospective single-center cohort study. Setting Tertiary university hospital transplant center in Zagreb, Croatia. Participants 219 consecutive kidney recipients, transplanted in the 2007– 2013 period, in the Merkur University Hospital. Results This study included 219 patients (141 males and 78 females) who received the KT between 2007 and 2013 in our center. The majority of kidney transplants were from a deceased donor (179), while 40 were from a living donor. The average cost of a transplantation was HRK 86140± 42240, with 29000 being the minimum and 408000 being the maximum. In the bivariate analysis, the variables associated with the cost of transplantation were the duration of hospitalization, DGF, death of the patient, graft loss, use of steroids, and death-censored graft loss. In the multivariate analysis, DGF was the only statistically significant variable for the cost of transplantation. Conclusions Since only DGF had an impact on the cost of transplantation in this study, certain steps, such as shortening of the cold ischemia time (better organization of organ transport), better education of family members for living donors, and higher percentage of patients on PD, should be taken to lower the percentage of DGF.

Sažetak. Cilj: Iako je transplantacija bubrega najbolja metoda nadomještanja bubrežne funkcije, još uvijek postoji potreba za poboljšanjem dugoročnih ishoda. Cilj rada bio je utvrditi neovisnu povezanost demografskih čimbenika primatelja i darivatelja, osnovne bubrežne bolesti, trajanja liječenja dijalizom, tkivne nepodudarnosti i senzibilizacije s ishodima transplantacije u suvremenoj kohorti pacijenata kojima je presađen bubreg. Ispitanici i metode: U istraživanje su uključeni pacijenti kojima je transplantiran bubreg u Kliničkoj bolnici Merkur od lipnja 2007. do kraja 2018. god. Ishodi transplantacije praćeni su do 31. 12. 2019. godine. Najkraće vrijeme praćenja bila je jedna godina. Podaci su prikupljeni korištenjem izvješća iz aplikacije Eurotransplant Network Information System (ENIS ; www. eurotransplant.org). Preživljenje je prikazano Kaplan-Meierovim krivuljama. Povezanost preživljenja s određenim obilježjima primatelja i darivatelja analizirana je univarijatnom i multivarijatnom Coxovom regresijom. Rezultati: U razdoblju od lipnja 2007. do konca 2018. presađeno je 480 bubrega u 472 pacijenta. 10- godišnje preživljenje pacijenata iznosilo je 72 %. Desetgodišnje preživljenje bubrega cenzurirano za smrt pacijenata s bubregom u funkciji bilo je 93 %. U multivarijatnoj analizi jedino dob primatelja pri transplantaciji, šećerna bolest kao uzrok osnovne bubrežne bolesti i trajanje liječenja dijalizom ostali su neovisno povezani s preživljenjem pacijenata. Zaključak: Transplantacija bubrega rezultira odličnim dugoročnim preživljenjem bubrega. Potrebno je poboljšati dugoročno preživljenje pacijenata, prevencijom, ranim otkrivanjem i intenzivnim liječenjem kroničnih bolesti.

Additional file 1. Oral hygiene habits, alcohol consumption and smoking habits questionnaire

S obzirom na zabilježene slučajeve invazivne pneumokokne bolesti u bolesnika s kroničnom bubrežnom bolesti uznapredovala stadija, Upravni odbor Hrvatskog društva za nefrologiju, dijalizu i transplantaciju (HDNDT) Hrvatskoga liječničkog zbora donio je u svibnju 2017. godine odluku o izradi Preporuka/Smjernica za prevenciju pneumokoknih bolesti cijepljenjem u bolesnika s kroničnom bubrežnom bolesti. Preporuke/Smjernice temelje se na relevantnoj medicinskoj literaturi: smjernicama Europskog društva za kliničku mikrobiologiju i zarazne bolesti i Svjetskog udruženja za zarazne bolesti i imunosne poremećaje te na Programu imunizacije, seroprofilakse i kemoprofilakse za posebne skupine stanovništva Hrvatskog zavoda za javno zdravstvo. U njihovoj su izradi sudjelovali nefrolozi, infektolozi i epidemiolozi. U Republici Hrvatskoj dostupne su dvije vrste pneumokoknog cjepiva koje se mogu primijeniti u odraslih: konjugirano cjepivo PCV13 i polisaharidno cjepivo PPSV23. U Preporukama/Smjernicama navedena je detaljna shema cijepljenja koje se preporučuje provesti u bolesnika s kroničnom bubrežnom bolesti koji bubrežnu funkciju nadomještaju hemodijalizom, peritonealnom dijalizom, kandidati su za transplantacijsko liječenje ili su transplantirani i imaju jedan ili više komorbiditeta (šećernu bolest, kroničnu plućnu bolest, kroničnu srčanožilnu bolest, kroničnu uznapredovalu jetrenu bolest, kronični bubrežni bolesnici sa solidnim ili hematološkim tumorima te splenektomirani)., Considering the reported cases of invasive pneumococcal disease in advanced chronic kidney disease patients, in May 2017 the Steering Board of the Croatian Society of Nephrology, Dialysis and Transplantation (CSNDT) of the Croatian Medical Association issued a decision on the preparation of Guidelines for the prevention of pneumococcal diseases in patients with chronic kidney disease. The Guidelines are based on relevant medical literature, Guidelines of the European Society of Clinical Microbiology and Infectious Diseases, the World Association for Infectious Diseases and Immunological Disorders, and the Program for immunization, seroprophylaxis and chemoprophylaxis for special population groups of the Croatian Institute of Public Health. Nephrologists, infectologists and epidemiologists were involved in their development. There are two types of pneumococcal vaccine available in Croatia that can be used for adults, conjugated vaccine PCV13 and polysaccharide vaccine PPSV23. The Guidelines include planning and implementation of vaccination in chronic kidney disease patients who replace kidney function with hemodialysis, peritoneal dialysis, renal transplant, or are candidates for treatment by transplantation, having one or more comorbidities: diabetes mellitus, chronic pulmonary disease, chronic cardiovascular disease, chronic advanced liver disease, chronic kidney disease with solid or hematological tumors, and splenectomy.

Background: Hepatitis E virus (HEV) infection is an emerging infectious disease in many European countries. Previous studies in Europe indicate that HEV seroprevalence among patients on maintenance haemodialysis (HD) ranges from 1% to 37%. Risk factors for HEV infection among HD recipients are not fully understood. The aim of this study was to determine the prevalence and risk factors for HEV infection among HD recipients in Croatia, to propose recommendations for preventive measures. Methods: We implemented a cross-sectional study, inviting 515 individuals on HD from 6 medical facilities in 5 Croatian cities.Three facilities are in the continental region (Zagreb sites 1 and 2, and Osijek) and 3 in the coastal region (Sibenik, Dubrovnik and Pula). A self-administered questionnaire elicited risk factors for HEV infection: age, gender, food and water consumption, travel, household composition, animal contact, transfusion history and hemodialysis duration. Blood samples were tested for IgG HEV antibody using an enzyme immunoassay. Results: A total of 392 HD recipients (76%) participated ; their median age was 70.5 years (range 21-92 years) and 145 (37%) were female. IgG HEV antibodies were detected in 125 (32%) of participants. Multiple logistic regression indicated that age (OR=1.03 ; 95%CI=1.01-1.05) and living in the continental region (OR=3.55 ; 95%CI=2.12-5.96) were risk factors for HEV seropositivity. Conclusions: Almost 1/3 of HD recipients in Croatia had been exposed to HEV, which is among the highest seroprevalence rates reported in Europe. As HEV infection has been documented among pigs in the continental region of Croatia, we hypothesize that traditional pork- based food consumption could be an important risk factor, and should be investigated further. Routine HEV screening among HD recipients is recommended in this part of Croatia.

INTRODUCTION: Histologic changes of kidney vessels are common finding on kidney graft biopsies at the time of kidney transplantation (Tx). There are two types of vascular changes: fibrointimal thickening of vessel wall (cv) affecting bigger vessels and arteriolar hyalinosis (ah) affecting afferent arterioles. We aimed to investigate prevalence, type and grade of graft vessel changes at time of Tx and their relation on graft function after Tx. METHODS: We retrospectively examined patients with kidney or simultaneous kidney and pancreas transplantation in University Hospital Merkur from 2008 until 2016. Eligible patients had to have protocol kidney biopsy at the time of implantation and 1 year after Tx. Kidney biopsies were analysed by light, immunoflorescence and electron microcopy. Graft vessel changes were scored in accordance with the Banff 97 classification and its updates. Progression of cv (∆cv) and ah (∆ah) score was calculated by subtracting implantation scores from scores 1 year post-transplant. In assesment of graft function we used eGFR based on MDRD formula and PCR (protein/creatinine ratio) in single urine sample. All statistical analyses were performed using “Statistica 17“ program and statistical significance was considered at p

Considering the reported cases of invasive pneumococcal disease in advanced chronic kidney disease patients, in May 2017 the Steering Board of the Croatian Society of Nephrology, Dialysis and Transplantation (CSNDT) of the Croatian Medical Association issued a decision on the preparation of Guidelines for the prevention of pneumococcal diseases in patients with chronic kidney disease. The Guidelines are based on relevant medical literature, Guidelines of the European Society of Clinical Microbiology and Infectious Diseases, the World Association for Infectious Diseases and Immunological Disorders, and the Program for immunization, seroprophylaxis and chemoprophylaxis for special population groups of the Croatian Institute of Public Health. Nephrologists, infectologists and epidemiologists were involved in their development. There are two types of pneumococcal vaccine available in Croatia that can be used for adults, conjugated vaccine PCV13 and polysaccharide vaccine PPSV23. The Guidelines include planning and implementation of vaccination in chronic kidney disease patients who replace kidney function with hemodialysis, peritoneal dialysis, renal transplant, or are candidates for treatment by transplantation, having one or more comorbidities: diabetes mellitus, chronic pulmonary disease, chronic cardiovascular disease, chronic advanced liver disease, chronic kidney disease with solid or hematological tumors, and splenectomy.

Background: After the introduction of MELD score in liver allocation, the number of simultaneous liver- kidney transplantations (SLKT) significantly increased therefore contributing to the shortage of allografts for patients waitlisted for kidney transplantation. We analyzed the data in our high- volume transplant center with a stable number of SLKT and reviewed our biopsy-guided kidney allocation policy in pts with renal dysfunction undergoing liver transplantation (LT). Methods: We analyzed LT and SLKT performed in UH Merkur, Croatia from April 2007 to April 2018. As significant renal impairment at time of enlisting we defined serum creatinine higher or equal to 2 mg/dL, renal replacement therapy (RRT) or pathologic proteinuria higher than p/c 1 g/g. Results: In total 1056 LT and 19 SLKT were identified. 129 pts fulfilled the criteria for renal impairment given above. There were 95 male pts (73, 6%). 13 patients had ESRD receiving RRT prior to referral for LT and were automatically enlisted for SLKT. From those 13, in 2 pts SLKT was performed because of primary hyperoxaluria. In evaluation of other pts with renal dysfunction 22 renal biopsies were performed under US guidance after correction of coagulation parameters. There were no major complications of biopsies. Other 94 pts were diagnosed with acute kidney injury/hepatorenal syndrome (AKI/HRS). The most common pathohistological diagnosis was IgA nephropathy (63, 6%), followed by ATN (18, 2%) and diabetic nephropathy (9, 1%). The cut-off for SLKT was more than 40% interstitial fibrosis and tubule atrophy (IFTA), or more than 30% of globally sclerosed glomeruli (GS) on biopsy. Based on biopsy results additional 6 pts were enlisted for SLKT. None of the patients with presumed AKI/HRS who received only LT and survived for more than one- month post-LT required RRT at one-month post-LT. Conclusions: We believe that kidney biopsy is a useful and safe tool to avoid kidney graft wasting when evaluating enlistment for SLKT. We enlist a patient for SLKT if IFTA is higher than 40% or GS more than 30%. A separate indication for SLKT are metabolic diseases. In decompensated liver cirrhosis HRS develops and makes evaluation of kidney recovery potential speculative. In our experience, percutaneous kidney biopsy in pts with advanced liver disease was not linked to adverse events and is a safe procedure in experienced centers.

HLA mismatches between donor and recipient frequently lead to production of HLA-specific antibodies. The HLAMatchmaker is a computer algorithm that compares HLA compatibility at the structural level and considers each HLA specificity as multiple linear triplet-defined epitopes to identify the number of shared and nonshared epitopes between donor and recipient. The PIRCHE-II (predicted indirectly recognizable HLA epitopes) is another algorithm which predicts donor-HLA-derived peptides presented by the recipient’s HLA-DRB1 molecules which may be detected by the patients’ T cells. It has been shown that the result score of both algorithms correlate with the risk of HLA donor-specific antibodies (DSA) development. This case present prediction of immunogenicity and the risk of DSA formation based on the mismatched (MM) HLA antigens between cadaveric donor and patient waiting the third kidney transplantation, using HLAMatchmaker and PIRCHE-II algorithm. The patient is 38 years old male who recieved first kidney graft from living donor in 2007 (ABDR MM 000), and only two months later was re-transplanted with the kidney from the second living donor (ABDR MM 011). At the time of returning to the waiting list in 2017, the antibody profile of the patient, determined by Luminex LSA class I and class II Single Antigens beads (SA1, SA2), was negative for antibodies against HLA class I antigens and positive for the presence of HLA class II antibodies (DR1, DR7, DR9, DR10, DR15, DR16, DR51, DR53, DQ8, DQ9, DQA1*03) among which there were DSAs against the second donor: DR53 (MFI 6100), DQ8 (MFI 2200-3400) and DQA1*03 (MFI 2600-3800 ). In October 2017, the patient received kidney offer from cadaveric donor and the chance for the third transplantation. The donor/patient ABCDRDQ MM was 12200, with Luminex SA1, SA2 testing results negative for all ABCDRDQ MM antigens. Patient's and potential third donor's HLA-A, -B, -C, -DRB1 and DQB1 alleles, determined at low resolution level, were assigned to the most common corresponding four digit HLA allele and were entered into the HLAMatchmaker program (version 02) to determine the number of donor eplets that were absent in the patient as well as in the PIRCHE-II algorithm (version 2.4.21) to predict the presentation of HLA-derived mismatched peptide by the patient’s HLA-DRB1 molecules. The donor and patient were mismatched for HLA-A3, B27, B35, Cw2 and Cw4 antigens. The HLAMatchmaker analysis revealed 12 epitopes in total differing beetwen donor and the patient among which only 5 epitopes were „Antibody-verified Epitopes“ (AbVerEp ; identified experimentally with informative HLA antibodies). The PIRCHE-II score was 29. According to Lachmann et al. patients with a HLAMatchmaker score ≥5 to