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Article ; Online: THE COST OF KIDNEY TRANSPLANTATION AT THE MERKUR UNIVERSITY HOSPITAL, ZAGREB, CROATIA.

Neretljak, Ivan / Sučić, Mario / Kocman, Branislav / Knotek, Mladen

2021 Volume 60, Issue 2, Page(s) 178–183

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Cohort Studies ; Croatia/epidemiology ; Female ; Hospitals ; Humans ; Kidney Transplantation ; Male ; Retrospective Studies ; Tissue Donors ; Treatment Outcome
Language	English
Publishing date	2021-11-03
Publishing country	Croatia
Document type	Journal Article
ZDB-ID	1478635-7
ISSN	1333-9451 ; 0353-9466
ISSN (online)	1333-9451
ISSN	0353-9466
DOI	10.20471/acc.2021.60.02.02
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Article: 7. Drug-Induced Kidney Injury.

Knotek, Mladen

EJIFCC

2009 Volume 20, Issue 1, Page(s) 54–58

Language	English
Publishing date	2009-04-20
Publishing country	Italy
Document type	Journal Article
ISSN	1650-3414
ISSN	1650-3414
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Article: Combined liver-kidney transplantation for rare diseases.

Knotek, Mladen / Novak, Rafaela / Jaklin-Kekez, Alemka / Mrzljak, Anna

World journal of hepatology

2020 Volume 12, Issue 10, Page(s) 722–737

Abstract: Combined liver and kidney transplantation (CLKT) is indicated in patients with failure of both organs, or for the treatment of end-stage chronic kidney disease (ESKD) caused by a genetic defect in the liver. The aim of the present review is to provide ... ...

Abstract	Combined liver and kidney transplantation (CLKT) is indicated in patients with failure of both organs, or for the treatment of end-stage chronic kidney disease (ESKD) caused by a genetic defect in the liver. The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT. They are major indications for CLKT in children. However, in some of them (
Language	English
Publishing date	2020-11-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573703-X
ISSN	1948-5182
ISSN	1948-5182
DOI	10.4254/wjh.v12.i10.722
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Article ; Online: Periodontal inflamed surface area in patients on haemodialysis and peritoneal dialysis: a Croatian cross-sectional study.

Križan Smojver, Bojana / Altabas, Karmela / Knotek, Mladen / Bašić Jukić, Nikolina / Aurer, Andrej

BMC oral health

2020 Volume 20, Issue 1, Page(s) 95

Abstract: Background: The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. The purpose of this study was to quantify the inflammatory ... ...

Abstract	Background: The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. The purpose of this study was to quantify the inflammatory burden that periodontitis causes in dialysis patients and to examine whether patients on PD and HD differ in terms of the periodontal inflamed surface area (PISA), which can be helpful for selecting the most appropriate dialysis modality. Methods: A cross-sectional study was performed on 58 consecutive patients on HD and 31 consecutive patients on PD. PISA was calculated using measurements of the clinical attachment level, recession and bleeding on probing. We performed the primary analysis using multivariable robust regression. Results: Patients on PD had a 746 mm Conclusions: PISA levels in Croatian patients on dialysis indicate a high need for periodontal treatment. PD is associated with a smaller PISA independent of many sociodemographic, lifestyle, laboratory and clinical factors. The duration of dialysis does not influence PISA levels. Trial registration: ISRCTN17887630. A clinical study to investigate gum infection in patients undergoing kidney dialysis.
MeSH term(s)	Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Female ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Periodontitis/blood ; Periodontitis/complications ; Periodontitis/pathology ; Peritoneal Dialysis/adverse effects ; Renal Dialysis/adverse effects
Language	English
Publishing date	2020-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2091511-1
ISSN	1472-6831 ; 1472-6831
ISSN (online)	1472-6831
ISSN	1472-6831
DOI	10.1186/s12903-020-01086-7
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Article ; Online: Evaluation of cell-mediated immune response by QuantiFERON Monitor Assay in kidney transplant recipients presenting with infective complications.

Margeta, Ivan / Mareković, Ivana / Pešut, Ana / Zelenika, Marina / Dorotić, Marija / Mrnjec, Ivana / Knotek, Mladen

Medicine

2020 Volume 99, Issue 27, Page(s) e21010

Abstract: The net level of immunosuppression in kidney transplant recipients is difficult to assess. QuantiFERON Monitor (QFM) is an in vitro diagnostic test that detects interferon-γ (IFN-γ) release in peripheral blood. The aim of our study was to compare QFM ... ...

Abstract	The net level of immunosuppression in kidney transplant recipients is difficult to assess. QuantiFERON Monitor (QFM) is an in vitro diagnostic test that detects interferon-γ (IFN-γ) release in peripheral blood. The aim of our study was to compare QFM testing results in stable kidney transplant recipients and kidney transplant recipients with infection, in a single-centre cohort.We enrolled 71 kidney transplant recipients from our transplantation centre. They were divided into 2 groups according to clinical presentation (Stable kidney transplant recipients or Infection).There were no significant differences in interferon-γ release between the 2 groups (Stable kidney transplant recipients 140.59 ± 215.28 IU/ml, Infection group 78.37 ± 197.03 IU/ml, P = .24). A further analysis revealed that kidney transplant recipients presenting with bacterial infection had significantly lower IFN-γ release when compared to stable kidney transplant recipients (26.52 ± 42.46 IU/ml vs 140.59 ± 215.28 IU/ml, P = .04).Kidney transplant recipients presenting with bacterial infection had lower IFN-γ release when compared to stable kidney transplant recipients. The QFM test may be useful as a tool to help guide immunosuppression dosing in kidney transplant recipients, but further studies are required to confirm its diagnostic value.
MeSH term(s)	Adult ; Case-Control Studies ; Cross-Sectional Studies ; Female ; Humans ; Immunity, Cellular/immunology ; Immunosuppression Therapy/adverse effects ; Interferon-gamma/blood ; Interferon-gamma Release Tests/methods ; Kidney Transplantation/adverse effects ; Male ; Middle Aged ; Transplant Recipients/statistics & numerical data
Chemical Substances	Interferon-gamma (82115-62-6)
Keywords	covid19
Language	English
Publishing date	2020-07-06
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000021010
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Article ; Online: Safety of Outpatient Kidney Biopsies.

Šimunov, Bojana / Gunjača, Mihaela / Čingel, Branislav / Škegro, Dinko / Knotek, Mladen

Nephron

2018 Volume 138, Issue 4, Page(s) 275–279

Abstract: Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The aim of this study was to evaluate the safety of biopsy in the outpatient setting.: Methods: We analysed kidney biopsies performed from March 2013 to ... ...

Abstract	Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The aim of this study was to evaluate the safety of biopsy in the outpatient setting. Methods: We analysed kidney biopsies performed from March 2013 to February 2017. Seven hundred twenty-five biopsies performed in the outpatient setting were identified: There were 592 transplant and 133 native biopsies including 3 solitary kidney biopsies. All were performed under ultrasound guidance using a 16G or 18G needle, with freehand technique. In all patients with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 desmopressin was administered. Patients were observed for 6h before discharge, with a complete blood count and urine test after 4 h. Major complications were haemorrhage requiring therapeutic intervention or transfusion. Minor complications were significant reduction in haemoglobin (Hb) levels (>10%), without need for transfusion or intervention and macrohaematuria. Results: There were 506 (69.8%) male patients. Average age was 50.3 ± 12.7 years. Indications for native kidney biopsy included nephrotic syndrome (39.8%), nephritic syndrome (42.9%), follow-up biopsy (15.8%), and other (1.5%). There were no major complications. A decline in Hb was observed in 72% of patients. Average Hb decline was 4.2 ± 6.3 g/L. In 10.1% patients there was >10% reduction in Hb level, with no evident bleeding, including by ultrasonography. In 2.5% of patients, macrohaematuria was present. In a multivariate analysis, male gender, lower eGFR, higher pre-biopsy Hb and native kidney biopsy were predictive for Hb decline. No therapeutic interventions were required. Conclusion: We found that kidney biopsy performed in an outpatient setting in select patients is only rarely associated with adverse events and is a safe procedure.
MeSH term(s)	Adult ; Aged ; Biopsy/adverse effects ; Biopsy/statistics & numerical data ; Female ; Glomerular Filtration Rate ; Hematuria/etiology ; Hemoglobins/analysis ; Hemoglobins/metabolism ; Hemorrhage/etiology ; Humans ; Image-Guided Biopsy ; Kidney/pathology ; Kidney Diseases/diagnosis ; Kidney Diseases/pathology ; Kidney Transplantation ; Male ; Middle Aged ; Outpatients ; Patient Safety ; Retrospective Studies ; Ultrasonography, Interventional
Chemical Substances	Hemoglobins
Language	English
Publishing date	2018-01-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000484991
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Article ; Online: Cardiovascular mortality in liver and kidney transplant recipients: A retrospective analysis from a single institution.

Sertić, Zrinka / Letilović, Tomislav / Kanižaj, Tajana Filipec / Knotek, Mladen / Hadžibegović, Irzal / Starovečki, Inga / Jerkić, Helena

Medicine

2021 Volume 100, Issue 20, Page(s) e26019

Abstract: Abstract: 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 ... ...

Abstract	Abstract: 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 <50%, and diastolic dysfunction grade 2 or greater, while significant risk factors for cardiovascular mortality were peripheral artery disease and left ventricular ejection fraction <50%. In the LT group no variables remained significant in a multivariable model for either overall or cardiovascular mortality.The present study found no significant overall difference in cardiovascular mortality after LT and KT. While LT and KT recipients may have similar early cardiovascular mortality, long-term risk is potentially lower after LT. Differing characteristics of cardiovascular death between these two patient populations should be further investigated.
MeSH term(s)	Adult ; Aged ; Cardiovascular Diseases/mortality ; End Stage Liver Disease/complications ; End Stage Liver Disease/mortality ; End Stage Liver Disease/surgery ; Female ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/surgery ; Kidney Transplantation ; Liver Transplantation ; Male ; Middle Aged ; Retrospective Studies
Language	English
Publishing date	2021-06-08
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000026019
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Article ; Online: Long-term effects of peritonitis on peritoneal dialysis outcomes.

Klarić, Dragan / Knotek, Mladen

International urology and nephrology

2012 Volume 45, Issue 2, Page(s) 519–525

Abstract: Purpose: Prevalence of peritoneal dialysis is low in part because of the perceived high risk for complications such as peritonitis. However, in the most recent era, peritonitis incidence and its effects on patient outcomes may have diminished. The aim ... ...

Abstract	Purpose: Prevalence of peritoneal dialysis is low in part because of the perceived high risk for complications such as peritonitis. However, in the most recent era, peritonitis incidence and its effects on patient outcomes may have diminished. The aim of this study was to analyze peritonitis incidence and its impact on patient and technique survival, as well as on the kidney transplantation rate and outcome. Methods: All peritoneal dialysis patients from a county hospital between year 2001 and 2011 were retrospectively included. Patients were divided into two groups with respect to peritonitis. The primary composite end-point consisted of a 3-year patient mortality or technique loss. Secondary end-points were patient survival and probability of kidney transplantation with respect to peritonitis history. Results: Among 85 study patients, there were 61 peritonitis episodes. The incidence of peritonitis was 0.339 ± 0.71 episode per patient per 12 months or one episode per 29.3 ± 22.2 patient-months. The time to peritonitis was shorter, and peritonitis was more likely in patients on continuous ambulatory peritoneal dialysis than in automated peritoneal dialysis patients. Patient and technique survival and transplantation rate were similar in the group with and without peritonitis history. The primary end-point was recorded in 35 % of patients with peritonitis history and in 54 % of those without peritonitis (p = 0.04). In a multivariate analysis, the only variable significantly associated with the primary end-point and with patient survival was patient age at start of peritoneal dialysis. Conclusions: In contemporary peritoneal dialysis patients, timely treated peritonitis may not be associated with adverse patient and technique outcomes. The transplantation rate is unaffected by the peritonitis history. Peritoneal dialysis may be promoted as the first dialysis method in appropriate patients.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; Peritonitis/complications ; Peritonitis/epidemiology ; Retrospective Studies ; Time ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2012-08-15
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-012-0257-2
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Zs.A 733: Show issues

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Article: Kalcificirajuća uremijska arteriolopatija: klinička slika i liječenje.

Kudumija, Boris / Knotek, Mladen / Pavlović, Drasko / Dits, Sonja

Lijecnicki vjesnik

2015 Volume 137, Issue 3-4, Page(s) 91–95

Abstract: Calcific uremic arteriolopathy or alciphylaxis is a malignant form of calcification of small arteries and arterioles, usually present in patients with chronic kidney disease and dialysis therapy. It causes high mortality. Histological distinctive feature ...

Title translation	Calcific uremic arteriolopathy: clinical features and treatment.
Abstract	Calcific uremic arteriolopathy or alciphylaxis is a malignant form of calcification of small arteries and arterioles, usually present in patients with chronic kidney disease and dialysis therapy. It causes high mortality. Histological distinctive feature are calcium deposits lining vascular intima. Calcification of medial muscle layer, inflammation and necrosis of subcutaneous adipose tissue are frequent. The disease begins with painful violaceous mottling, resembling livedo reticularis. Ths skin lesion progresses to ulcers and eschars, sometimes it becomes very vulnerable to secondary infection which can often develop into fatal sepsis. Our first patient with proximal form of calciphylaxis dies in repeated sepsis. The second patient with the distal form of calciphylaxis was treated successfully. The decisive moment was the use of calcimimetic. A multiinterventional strategy is likely to be more effective than any single therapy. It is necessary to regulate metabolism of calcium phosphate and secondary hyperparathyroidism. Effectiveness has been demonstrated using calcimimetics, sodium thiosulfate, oxygen therapy, careful application of biphosphonates and surgical procedures. Warfarin withdrawal is urgently recommended and subsequent vitamin K supplementation is appropriate. The control of infection is critically important and the use of carbonylated hemoglobin in the stage without infections could accelerate the wound healing.
MeSH term(s)	Arterioles/pathology ; Calciphylaxis/complications ; Calciphylaxis/pathology ; Calciphylaxis/therapy ; Combined Modality Therapy ; Diphosphonates/therapeutic use ; Female ; Humans ; Oxygen Inhalation Therapy ; Sepsis/complications ; Thiosulfates/therapeutic use ; Vascular Calcification/complications ; Vascular Calcification/pathology ; Vascular Calcification/therapy ; Vitamin K/therapeutic use
Chemical Substances	Diphosphonates ; Thiosulfates ; Vitamin K (12001-79-5) ; sodium thiosulfate (HX1032V43M)
Language	Croatian
Publishing date	2015-03
Publishing country	Croatia
Document type	English Abstract ; Journal Article
ZDB-ID	128938-x
ISSN	1849-2177 ; 0024-3477 ; 1330-4917
ISSN (online)	1849-2177
ISSN	0024-3477 ; 1330-4917
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Article: Pre- and intraoperative predictors of acute kidney injury after liver transplantation.

Mrzljak, Anna / Franusic, Lucija / Pavicic-Saric, Jadranka / Kelava, Tomislav / Jurekovic, Zeljka / Kocman, Branislav / Mikulic, Danko / Budimir-Bekan, Ivan / Knotek, Mladen

World journal of clinical cases

2020 Volume 8, Issue 18, Page(s) 4034–4042

Abstract: Background: Acute kidney injury (AKI) after liver transplantation (LT) is a frequent and multifactorial event related to increased morbidity and mortality. Risk factors for AKI after LT still need to be clarified.: Aim: To identify the predictors of ... ...

Abstract	Background: Acute kidney injury (AKI) after liver transplantation (LT) is a frequent and multifactorial event related to increased morbidity and mortality. Risk factors for AKI after LT still need to be clarified. Aim: To identify the predictors of acute kidney injury after liver transplantation. Methods: The frequency and pre- and intraoperative predictors of AKI within the first 7 d after LT were evaluated in adult liver transplant candidates in a single LT center in Croatia. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Results: Out of 205 patients (mean age 57 ± 10 years; 73.7% males, 52.7% with alcohol-related liver disease) 93 (45.36%) developed AKI, and the majority of them (58.06%) had stage 1. Only 5.38% of patients required renal replacement therapy after LT. The majority of patients (82.8%) developed AKI within the first two days after the procedure. Multivariate logistic regression identified pre-LT body mass index (OR = 1.1, 95%CI: 1.05-1.24) and red blood cell transfusion (OR = 1.66, 95%CI: 1.09-2.53) as independent predictors of early post-LT AKI occurrence. 30-d survival after LT was significantly better for patients without AKI ( Conclusion: Early AKI after LT is a frequent event that negatively impacts short-term survival. The pathogenesis of AKI is multifactorial, but pre-LT BMI and intraoperative volume shifts are major contributors.
Language	English
Publishing date	2020-09-11
Publishing country	United States
Document type	Journal Article
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v8.i18.4034
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