Introduction: Regular physical activity results in many health benefits, however many studies indicate that the le vel of activity of patients after transplantation is low. The purpose of the study was to assess the level of daily physical activity in patients after liver (LTx) or kidney transplantation (KTx) and the usefulness of a self-monitoring method in increasing their daily physical activity. Material and methods : Patients after LTx or KTx (n = 100) has been enrolled to the study and were randomly assi gned to either an intervention (IG) or control group (CG). Ninety-four participants completed the 3 month period of ob -servation. Participants assigned to IG were monitoring their daily physical activity using a pedometer and were required to complete a diary of daily number of steps. The level of physical activity was also assessed by International Physical Activity Questionnaire (IPAQ). In the statistical analysis the parametric and non-parametric tests has been used in consi stency with data distribution. A value of p ≤ 0.05 was considered significant. Results: The average daily number of steps in pre/posttest in both study groups was less than 7600. The study showed a significant relationship between the average daily number of steps and daily Total Physical Activity Score TPAS/day [MET-min/day] (p < 0.001; r = 0.57). The study did not revealed any effects of intervention. Conclusions: Daily physical activity in patients after KTx or LTx is low, but it does not differ from healthy population (<7500 steps). In post-transplant comprehensive medical management, long-term physical activity recommendations could be included together with the early post-surgery physiotherapy.

Organ transplantation has become the treatment of choice for end-stage organ failure, including renal and liver failure. The benefits of patient employment after transplantation are numerous, but factors determining the ability to work among these patients are not clearly defined. The growing interest in these factors has strong practical implications for organizations creating vocational rehabilitation programs. Given the interconnection between psychological and physical functioning in patients after transplantation, the present study examined the impact of anxiety on vocational rehabilitation and its relationship with functional tests. A total of 100 patients after liver or kidney transplantation underwent functional tests, including the 6-minute walking test and 30-second chair stand test (30"CST), and psychological tests, specifically the Inventory of Physical Activity Objectives, Work Ability Index, and State-Train Anxiety Inventory. Working ability was affected by psychological factors. State and trait anxiety exhibited inverse relationships with subjective readiness to occupational activity (P < .001,r = -.59 andP < .001,r = -.56, respectively). The level of anxiety was negatively related to the results of the 30"CST. State-Train Anxiety Inventory, State Anxiety subscale and State-Train Anxiety Inventory, State-Trait Anxiety subscale vs 30"CST:P < .001,r = -.43P < .001,r = -.44). Thus, state and trait anxiety influence perceived work ability and partially functional status. These observations may indicate the potential benefits of including psychologists in interdisciplinary teams for physical and especially vocational rehabilitation of patients after liver or kidney transplantation.

Objective The aim of the present study was to assess the employment rate among kidney and liver transplant recipients in Poland and identify the predictors of employment.Settings The study was based on a self-prepared questionnaire containing five parts: demographic data and professional, medical, physical and psychological factors. This is a multicentre study involving four hospitals in Poland.Participants The investigated group consisted of 285 individuals (92 women and 185 men; 8 no sex given) aged between 18 and 45 years who underwent kidney or liver transplantation 1–5 years prior. Because of missing data, 279 questionnaires were considered regarding employment status after transplantation and 277 when sex differences were considered.Results A total of 120 patients (43%) worked full-time, 42 (15%) part-time and 117 (42%) remained unemployed, with a higher employment rate post-transplantation among men than women (60% vs 55%, p=0.04). More women performed white collar work (74% vs 41%, p=0.0003) and had to modify their working position than men (22% vs 7%, p=0.0118). Factors determining employment after transplantation included higher level of education (OR=27.08; p=0.0096), employment 1 year prior to transplantation (OR=11.05; p<0.001) and good psychological adaptation (OR=4.23; p<0.001). Men working the year before transplantation had higher education (OR=9.66; p=0.0356). Among men, more kidney recipients worked compared with liver recipients (OR=3.567; p=0.0417). Among women, age determined employment status (OR=0.89; p=0.0234).Conclusion Higher education is the most important predictor of employment after transplantation. Therefore, rehabilitation programmes including vocational activity should be directed to increase the level of education, both pretransplantation and post-transplantation if possible.

The burden of Klebsiella pneumoniae (KP) producing extended-spectrum beta-lactamases (ESBL+) urinary tract infections (UTIs) is a growing problem after kidney transplantation (KTX). The study was aimed at evaluating the incidence of KP ESBL+ gut colonization in KTX recipients and its correlation with clinical outcomes with special regard to UTIs. The study included all KTX patients hospitalized in our department between January 2014 and December 2016. During this period 2018 KTX patients were admitted: 605 in 2014, 750 in 2015, and 663 in 2016, respectively. Screening for drug-multiresistant Enterobacteriaceae gut carriage was performed in 104 patients (2014), 122 (2015), and 166 (2016). In 2014, 2015, and 2016, 18 (17.3%), 26 (21.3%), and 30 (18.1%) patients had positive test results, and 44 (42.3%), 36 (29.5%), and 45 (27.4%) KTX patients were diagnosed with KP ESBL+ UTI. In 2014, KP ESBL+ UTI was diagnosed in 30 (34.9%) cases with negative anal swab and in 14 patients (77.8%) with positive test result (P = .0008). In 2015, KP ESBL+ UTI was diagnosed in 21 patients (21.9%) with negative anal swab and in 15 (57.7%) with positive test result (P = .0004). In 2016, KP ESBL+ UTI was diagnosed in 24 patients (17.8%) with negative anal swab and in 21 (72.4%) with positive test result (P = .000001). In conclusion, we have revealed a strong association between gut K pneumoniae colonization, female sex, and MPA intake and KP ESBL+ urinary tract infections in kidney transplant recipients. Our results indicate the very important role of KP ESBL+ screening, while strategies of identified carriers require further research.

Background. Organ transplantation is currently the treatment of choice in end-stage organ failure. Organ replacement therapy compensates for most of organ function loss and offers recipients the potential for an independent life; nevertheless, the employment rate after kidney or liver transplant is low vs the general population. The purpose of this study was to create a questionnaire for kidney and liver transplant patients that comprehensively assesses factors affecting employment among these people including demographic, physical, and psychosocial variables. Material and Methods. The study was based on a self-prepared questionnaire developed by a team of specialists in the field of medicine, rehabilitation, psychology, and employment. The questionnaire contained 5 parts: demographic data, professional factors, medical factors, physical factors, and psychological factors. The normalization sample consisted of 64 individuals (women and men) aged between 18 to 45 years 1 to 5 years after kidney or liver transplant. The Determinants of Professional Activity after Kidney and Liver Transplantation Questionnaire (DPATQ) was developed based on descriptive statistics, Spearman rho coefficient, principal component analysis, Cronbach alpha, and item response theory analysis. Results. The Cronbach alpha reliability coefficient for the psychological part reached 0.88. Conclusion. The DPATQ is a new method for measuring post-transplant adaptation and other factors influencing employment status. It offers good psychometric reliability. The DPATQ may be useful in the preparation process of vocational rehabilitation programs or in research studying problems with employment after solid organ transplant.

Background. Hepatitis C virus (HCV) infection deregulates function of many organs and systems, affecting patient's daily functioning. The results of treatment of HCV infection recurrence after liver transplantation have improved significantly as a result of the introduction of direct-acting antiviral agents (DAA). This study was aimed at prospective assessment of the effect of HCV elimination with DAA on physical performance of liver transplant recipients. Methods. Eight women and 21 men, median age 61.3 (range, 20.1-71.5) years, participated in the study. Assessment of serum total bilirubin, alanine and aspartate aminotransferase, muscle strength, body composition, and 6-minute walk test (6MWT) were performed before treatment and 12 weeks after the end of the treatment period. Results. In the 6MWT test we observed significant subjective (dyspnea: 58.3% pretreatment vs 27.6% posttreatment, P = .018; fatigue: 96.6% pretreatment vs 51.7% posttreatment, P = .0001) and objective improvement (distance: 415.4 meters pretreatment vs 505.2 meters posttreatment, P < .0000001). We did not observe an increase in muscle mass nor improvement in blood biochemical parameters. Conclusion. A significant objective and subjective improvement in physical performance was seen in liver transplant recipients after successful treatment of HCV infection with DAA.

Introduction: An increase in the number of infections with Klebsiella pneumoniae producing Extended-Spectrum beta-Lactamase (ESBL+) is a clinical issue, because there are no guidelines regarding the correct choice of an antibiotic and duration of treatment in kidney transplant recipients. The bacterial capacity to degrade almost all beta-lactam antibiotics, except carbapenems, causes resistance to standard treatment and makes long-term intravenous antibiotic therapy necessary. Case Presentation: This report describes the case of a 44-year-old patient after kidney transplantation, who developed recurrent urinary tract infections (UTIs) caused by ESBL-producing K. pneumoniae despite prolonged antibiotic targeted treatments with imipenem/cilastatin, meropenem, imipenem/cilastatin with amikacin and oral phosphomycin for UTI prophylaxis. Ineffectiveness of previous treatments caused the necessity to use a non-standard therapy of the consecutive UTI episode with high doses of amoxicillin combined with standard doses of clavulanic acid to break the bacteria's resistance. There was no recurrence of UTI and control urine cultures were sterile over the entire course of treatment, lasting 165 days, and throughout the follow-up period of more than 1 year. Conclusions: It has been shown in this case that UTI with the aetiology of K. pneumoniae could be treated on an outpatient basis with high doses of amoxicillin in combination with standard doses of clavulanic acid followed by prolonged antibiotic prophylaxis.