Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very ...

Background. Brain death is associated with hemodynamic disturbances in systemic circulation and metabolic storm, and, thus, free radical-mediated injury to donor tissues was hypothesized. An assessment of oxidative stress in the donor and its effect on posttransplant kidney graft function comprised the scope of the study. Methods. A prospective study was performed in 27 donors and 50 kidney transplant recipients. Sera from 27 brain-dead organ donors and preservation media were tested for malondialdehyde (MDA) and for total antioxidant status (TAS). Kidneys were preserved in University of Wisconsin-gluconate solution with machine perfusion. Mean ischemia time was 36.7±8 hours. Organs were transplanted to recipients on the Polish National Waiting List and posttransplant kidney function was monitored periodically. Posttransplant delayed graft function (DF) was diagnosed when a patient required at least one dialysis within first week after transplantation. Acute rejection was diagnosed clinically and confirmed with fine-needle biopsy if necessary. Results. Thirty-two recipients had immediate graft function (IF), and 18 suffered from DF. MDA level in preservation solution at the end of machine perfusion was significantly higher in the DF group (52.6±31 vs. 25.3±19 μmol/L) whereas donor TAS activity was lower (1.14±0.2 vs. 0.97±0.3 mmol/mL). Patients who suffered from acute rejection received kidneys from donors with significantly higher serum MDA (66±73 μmol/ml vs. 23±49 for patients without rejection). Serum creatinine 12 to 48 months after transplantation correlated to donor- and preservation-solution MDA (P <0.006). Conclusions. Free-radical mediated injury occurring in the donor and during preservation is strictly correlated with immediate and long-term kidney function. It may also cause grafts to be prone to acute rejection.

Machine perfusion (MP) has been used as the kidney preservation method in our center for over 10 years. The first, small (n = 74) prospective, single-blinded randomized study comparing MP and Cold Storage (CS) showed that the incidence of delayed graft function was higher after CS. There have been no reports in the literature on the effect of storage modality on long-term function of renal allografts. This paper presents an analysis of long-term results of renal transplantation in 415 patients operated on between 1994 and 1999. Of those, 227 kidneys were MP-stored prior to KTx. The control group consisted of 188 CS kidney transplants. Kidneys were not randomized to MP or to CS. Donor demographics, medical and biochemical data, cold ischemia time, HLA match and recipient data were collected. Standard triple-drug immunosuppression was administered to both groups. Mortality, graft survival and incidence of return to hemodialysis treatment were analyzed. Despite longer cold ischemia time and poorer donor hemodynamics in MP group, 5-year Kaplan-Meier graft survival was better in MP-stored than in CS-stored kidneys (68.2% vs. 54.2%, p = 0.02). In this nonrandomized analysis, kidney storage by MP improved graft survival and reduced the number of patients who returned to dialysis.

Background: Obesity contributes to left ventricular diastolic dysfunction (LVDD) and may lead to diastolic heart failure. Weight loss (WL) after bariatric surgery (BS) may influence LV morphology and function. Using echocardiography, this study assessed the effect of WL on LV diastolic function (LVDF) and LV and left atrium (LA) morphology 6 months after BS in young women with morbid obesity. Methods: Echocardiography was performed in 60 women with BMI ≥ 40kg/m², aged 37.1 ± 9.6 years prior to and 6 months after BS. In 38 patients, well-controlled arterial hypertension was present. Heart failure, coronary artery disease, atrial fibrillation and mitral stenosis were exclusion criteria. Parameters of LV and LA morphology were obtained. To evaluate LVDF, mitral peak early (E) and atrial (A) velocities, E-deceleration time (DcT), pulmonary vein S, D and A reversal velocities were measured. Peak early diastolic mitral annular velocities (E’) and E/E’ were assessed. Results: Mean WL post BS was 35.7 kg (27%). A postoperative decrease in LV wall thickness was observed, LV mass (mean 183.7 to 171.5 g, p = 0.001) and LA parameters (area, volume). LVDD was diagnosed in 3 patients prior to and in two of them subsequent to the procedure. An improvement in LVDF Doppler indices were noted: increased E/A, D and E’ lateral, and decreased S/D and lateral E/E’. None of the patients showed increased LV filling pressure. No significant correlations between hypertension and echo-parameters were demonstrated. Conclusions: Six months after bariatric surgery weight loss resulted in the improvement of LVDF and left heart morphology in morbidly obese women. Background: Obesity contributes to left ventricular diastolic dysfunction (LVDD) and may lead to diastolic heart failure. Weight loss (WL) after bariatric surgery (BS) may influence LV morphology and function. Using echocardiography, this study assessed the effect of WL on LV diastolic function (LVDF) and LV and left atrium (LA) morphology 6 months after BS in young women with morbid obesity. Methods: Echocardiography was performed in 60 women with BMI ≥ 40kg/m², aged 37.1 ± 9.6 years prior to and 6 months after BS. In 38 patients, well-controlled arterial hypertension was present. Heart failure, coronary artery disease, atrial fibrillation and mitral stenosis were exclusion criteria. Parameters of LV and LA morphology were obtained. To evaluate LVDF, mitral peak early (E) and atrial (A) velocities, E-deceleration time (DcT), pulmonary vein S, D and A reversal velocities were measured. Peak early diastolic mitral annular velocities (E’) and E/E’ were assessed. Results: Mean WL post BS was 35.7 kg (27%). A postoperative decrease in LV wall thickness was observed, LV mass (mean 183.7 to 171.5 g, p = 0.001) and LA parameters (area, volume). LVDD was diagnosed in 3 patients prior to and in two of them subsequent to the procedure. An improvement in LVDF Doppler indices were noted: increased E/A, D and E’ lateral, and decreased S/D and lateral E/E’. None of the patients showed increased LV filling pressure. No significant correlations between hypertension and echo-parameters were demonstrated. Conclusions: Six months after bariatric surgery weight loss resulted in the improvement of LVDF and left heart morphology in morbidly obese women.