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Eighty persons with haematological malignancies receiving stem cell transplantation (SCT) were examined over a 24 months period. Hyposalivation, a common complaint in patients treated by intensive chemotherapy and radiotherapy can predispose to oral candidal colonisation as well. This study was focused on correlation between the fungal colonisation of the oral cavity and the total unstimulated saliva flow rate of 80 patients with haematological malignancies before and after stem cell transplantation and in addition, on their oral health state. Despite the fact that prior to being involved in the transplantation programme, the patients were subjected to dental examination and decayed teeth were found in 20 out of 80 patients (25%). From the 2233 different oropharyngeal specimens fungi were isolated before conditioning from 16 patients (20%), and during aplasia from 19 patients (23.7%). Objective xerostomia (unstimulated total saliva flow rate = 0.1 ml/min) was detected in 28 patients (35%). Stem cell transplant patients with pretransplant mouth dryness had higher incidence of Candida albicans and other fungal colonisation than those with normal saliva secretion.

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Abstract

Hepatitis C (HCV) is one of the main causes of liver transplantation (OLT). Previously we have reported that high serum C RNA level correlates with the severity of histopathological signs and poor clinical outcome. The core antigen of virus C is known to interfere with chaperones in the hepatocytes, results in an endoplasmic reticulum (ER) stress. In this study HCV positive liver transplanted patients were evaluated, whether there are correlations among chaperone expression, recurrence and viral titer. Patients were enrolled after surviving the first month following OLT. Sera were collected regularly, and biopsies were taken on demand following OLT. The diagnosis of recurrent HCV was proven by Knodell-Ishak scoring. In this case ribavirin+interferon were initiated, and maintained for one year. All chaperones were upregulated in the transplanted liver graft showing recurrent hepatitis C disease. ATF6, GP96, GRP78, CNX and CLR chaperones were upregulated significantly compared to their levels in normal livers. Except for one chaperone, the level of upregulation did not correlate with the serum's HCV-RNA titre: the only difference between Group1 and 2 (RNA titre above and below 8.78 106 respectively) was that the level of ATF6 was 1.6 times higher in Group1 compared to Group2. The expression of all chaperones was reduced, and some even became downregulated after the interferon treatment. In accordance with the literature our results suggest that hepatitis C might induce apoptosis through ER-stress. Those cells exposed to a high C viral load, had a lower chance to be eliminated.

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The incidence of post-transplant diabetes mellitus and its effects on the kidney allograft function and morphology were assessed. Patients were divided into three groups according to their glucose metabolism. Risk factors for diabetes were first assessed, and then changes in renal function were checked. Morphological changes in the allografts were examined by protocol biopsies. The overall incidence of diabetes was 16%. The development of diabetes was influenced significantly by the body mass index, the body weight and the age of the recipient. The incidence of diabetes was 8.6% in patients on cyclosporine A therapy and 28.8% in those on tacrolimus (p < 0.05). As to the morphology of the kidney, a significantly higher proportion of the biopsies showed severe interstitial fibrosis/tubular atrophy (p = 0.0004) and subclinical acute rejection ( p = 0.001) in the diabetic group compared to the normal one. This clinical study has revealed that the adverse effect of diabetes on the allograft can be detected with protocol biopsy before the manifestation of a functional deterioration.

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Acta Physiologica Hungarica
Authors: J. Stark, Zs Tulassay, G. Lengyel, D. Szombath, B. Székács, I. Ádler, I. Marczell, P. Nagy-Répas, E. Dinya, K. Rácz, G. Békési, and Iván Horváth

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