Authors:Bernadett Borda, Cs. Lengyel, T. Várkonyi, É. Kemény, A. Ottlakán, A. Kubik, Cs. Keresztes and Gy. Lázár
New-onset diabetes after transplantation (NODAT) is one of the frequent complications following kidney transplantation. Patients were randomized to receive cyclosporine A- or tacrolimus-based immunosuppression. Fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), or NODAT. NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p = 0.0002). Albumin levels were similar, but uric acid level (p = 0.002) and the age of the recipient (p = 0.003) were significantly different comparing the diabetic and the normal groups. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/tubular atrophy (IF/TA) were significantly different in the NODAT group. 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.
Authors:Bernadett Borda, Cs Lengyel, E. Szederkényi, J. Eller, Cs Keresztes and G. Lázár
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.
Authors:Attila Nemes, GyÁ Piros, P Domsik, A Kalapos, Cs Lengyel, A Orosz and T Forster
Left atrial (LA) distension has been demonstrated to be linked with aortic stiffness in different patient populations. Three-dimensional (3D) speckle-tracking echocardiography (STE) seems to be a promising tool for volumetric and functional evaluation of the LA. The aim of the present study was to determine whether correlations exist between 3DSTE-derived LA volume-based and strain parameters characterizing all phasic functions of the LA and echocardiographic aortic elastic properties in healthy subjects. The study included 19 healthy volunteers (mean age: 37.9 ± 11.4 years, 11 men) who had undergone complete two-dimensional (2D) Doppler transthoracic echocardiography extended with the assessment of aortic elastic properties and 3DSTE. Results: None of LA volumes correlated with echocardiographic aortic elastic properties. Active atrial stroke volume correlated with aortic stiffness index (ASI, r = 0.45, p = 0.05). None of other volume-based functional properties signifcantly correlated with aortic stiffness parameters. Global peak 3D strain correlated with aortic strain (r = ‒0.46, p = 0.05). global radial pre-atrial contraction strain correlated with ASI (r = ‒0.49, p = 0.04) and AS (r = ‒0.50, p = 0.04). Conclusions: Correlations exist between 3DSTE-derived LA functional parameters and eschocardiographic aortic elastic properties in healthy subjects.