[Kidney allotransplantation from alive related donor in patients with Alport syndrome].

AIM: To evaluate the results of kidney transplantation from alive related donor in patients with Alport syndrome and to compare with those in patients with kidney hypoplasia. MATERIAL AND METHODS: We have analyzed 8 and 27 medical records of patients with Alport syndrome and kidney hypoplasia respectively. Following parameters were used - Kaplan-Meier survival analysis, Wilcox overall risk, percentage of transplants loss and mortality (Fisher's exact test calculation). RESULTS: It is concluded that percentage of transplants loss and mortality rate as well as overall survival and risk were similar in both groups. CONCLUSION: Despite risk of anti-GBM nephritis development in patients with Alport syndrome results are comparable with those after transplatation for chronic renal failure caused by other reasons.

[Effect of tacrolimus on the results of living related kidney donor transplantation].

AIM: To elucidate whether and how tacrolimus affects the cumulative survival of patients after living related kidney donor transplantation. SUBJECTS AND METHODS: The clinical materials of 246 related kidney transplant recipients, including 108 patients in whom tacrolimus (Prograf and Advagraf) Astellas Pharma US, Inc) was included in the immunodepression protocol (Group 1) and 138 patients who did not receive the agent (Group 2), were analyzed. Comparative analysis used the following tests: the Kaplan Meier test estimating the cumulative survival of recipients and transplants; the Cox test assessing the cumulative risk; and the log-rank test. Allorenal graft losses and mortality rates were also calculated. RESULTS: Mathematical analysis of the above indicators demonstrated that the allograft and survival rates were far higher (p < 0.05) and the cumulative risk was much less in Group 1 (p < 0.02). Graft losses and the recipients' deaths were higher in Group 2. CONCLUSION: The analysis suggests that the incorporation of tacrolimus into the immunodepression therapy protocol positively impacts the results of lung related kidney donor transplantation.

[Kidney allotransplantation from the AB0-incompatible donors].

The experience of 28 kidney allotransplantations from the AB0-incompatible donors was analyzed. The comparative group consisted of 38 patients, who received the AB0-compatible organ. The results were assessed using the following parameters: renal function, morphology of the biopsy samples of the transplanted kidney and actuary survival of the recipients with functioning transplants in both groups. The comparative analysis showed no significant difference between the two groups, giving the right to consider the kidney allotransplantation from the AB0-incompatible donors safe and effective.

[The kidney transplantation from the ABO-incompatible donors].

The experience of 28 allotransplantations of ABO-incompatible kidneys was compared with the treatment results of 38 ABO-compatible renal transplantations. The transplanted kidney function, morphological changes of the transplanted kidney and the comparative analysis of actuary survival in both groups showed no significant difference. The results of the study prove the validity of the kidney transplantation from the ABO-incompatible donors.

[Anemia after renal transplantation].

The study aimed the estimation of posttransplantant anemia (PTA) frequency between the recepients of allogenic kidneys and testing the influence of different factors on the anemia development. The study was ased on the analysis of 129 patients with ERSD, to whom 129 donor kidneys were grafted. An actuarial survival of patients and allografts were calculated. The analysis demonstrated that a duration of the pretranplant hemodialysis influences the dynamics of hemoglobin level and the red blood cells count. The shorter were the dialysis terms, the easier was the anemia to correct. Shorter terms of the pretransplant dialysis also correlated with the higher rates of the overall survival after the transplantation.

[Efficacy and safety of cyclosporin A withdrawal in children long after kidney transplantation].

AIM: Evaluation of cyclosporine (CSA) withdrawal safety and efficacy in children late after kidney transplantation. MATERIAL AND METHODS: Graft and patient survival was analysed in 30 kidney recipients operated in the central children's hospital in 1991-1999. Fifteen of 30 patients came for follow-up to the Russian Research Center for Surgery where CsA was withdrawn 6.8 +/- 2.7 after transplantation. The other 15 children continued immunosuppression with CsA. RESULTS: Higher graft survival was observed in children in whom CsA was discontinued. CONCLUSION: Discontinuation of cyclosporine late after kidney transplantation results in improvement of graft survival in most of the patients.

[Phenomenon of synergism of immunodepressive drugs (addition of campath to the protocol of immunodepression)].

AIM: To determine kempas ability to potentiate the action of simultaneously used daklizumab. MATERIAL AND METHODS: Kempas was given to 7 patients twice: 18-21 days before transplantation and on the day of transplantation after plasmapheresis. The control group consisted of 9 patients who received induction immunodepression only with daklizumab. By demographic and clinico-laboratory parameters the groups were identical. The assessment was made by duration of the interval between administration of daklizumab. RESULTS: Patients given kempas had longer intervals between daklitumab administration (the difference was significant). CONCLUSION: Kempas potentiates an immunodepressive action of daklizumab.

[Successful correction of post-transplantation nephrotic syndrome with mabtera].

On March 8, 2007, a patient was admitted to the Department of Renal Transplantation, Academician B. V. Petrovsky Russian Surgery Research Center, for end-stage chronic renal failure and uremia and on March 9, 2007, he underwent cadaveric kidney allografting. In the posttransplantation period, the patient developed significant nephrotic syndrome with proteinuria being as high as 3900 mg/day. This proteinuria was regarded as a manifestation of rejection; immunosuppressive therapy was intensified: the immunosuppression protocol again included oral metipred in a dose of 60 mg/day; pulse therapy was performed. However, proteinuria remained at the same level as before. Then the authors decided to administer Mabtera. The latter was injected in a daily dose of 600 mg on June 20 and July 20, 2007. Just following 2 weeks, proteinuria decreased to 132 mg/day and persisted throughout the observation period. Therefore, Mabtera may be effectively used for the successful correction of posttransplantation nephrotic syndrome.

[Cognated kidney allotransplantation in children].

47 children at the age from 7 months till 16 years in terminal stage of chronic renal failure underwent related kidney allotransplantation. Kidney donors were mother (25), father (10), grandmother (4), uncle (3), brother (3), cousin (1), grandfather (1). On purpose of evaluation of pretransplantation hemodialysis duration the patients were divided into 2 groups: 1) duration of dialysis 0-12 months, 2) duration of dialysis more than 12 months. Such characteristics as actuarial probability of survival, growth and weight dynamics in children were evaluated. The comparative analysis show that the weight and growth rate is higher in children from the first group. Five-year actuarial probability of survival was 94% in the first group and 85% in the second group (p<0.01). Thus the research results show that relative kidney transplantation is the optimum treatment mode for the children in terminal stage of chronic renal failure, contributes to treatment results improvement and reduction of pretransplantation hemodialysis duration.

[The radioecological situation in the agricultural sphere in the contaminated regions of russia during the long-term after the Chernobyl accident].

The results of the contamination monitoring of the agricultural land and products in 2000-2005 in the regions of Russia affected by the Chernobyl accident are presented. The contribution is assessed of foodstuffs to the formation of internal exposure doses to the population during the long-term after the accident. Prediction is made of the change in the radioecological situation in radioactively contaminated areas.

[Transplantation of kidney with multiple arteries].

One hundred and nine kidney transplantations have been performed. All the patients have been divided into 2 groups: 1st group consisted of 91 patients whose transplant had 1 artery, 2nd group -- 18 patients whose transplant had 2 to 5 arteries. In 2.5 years after transplantation the function of transplant and degree of arterial hypertension were identical in both groups. It is concluded that the short- and long-term results of transplantation of kidneys with multiple arteries don't differ from ones with single artery.

[The influence of Daclizumab (Zenapaxe) on the postoperative period in allogenic kidney recipients].

The subjects of the study were 48 patients who were administered Daclizumab (Zenapaxe) immediately after transplantation (main group), and 17 controls. The number of infusions depended on the dynamics of the absolute CD-25 number in the peripheral blood, and varied between 1 and 11. The following variables were measured in order to evaluate the influence of Zenapaxe on the course of the postoperative period: 24-hour proteinuria, blood creatinine, steroid pulse number, blood pressure, and the doses of oral corticosteroids. All the patients were examined before discharge and 1 year after transplantation. Comparative analysis revealed the following: 1. In the main group proteinuria was 1.5 times lower 1 year after surgery vs. its level before discharge, while in the controls proteinuria grew up; 2. Steroid pulses in the controls were 4 times more frequent than this parameter in the main group; 3. Blood pressure and blood creatinine in the main group decreased during the first year after surgery, while in the control group the situation was the opposite. Thus, Zenapaxe (Daclizumab) is an effective immunosuppressive agent, displaying positive influence on the course of the posttransplantation period.

[Regularities of changes in 137Cs content in milk in the long term after the Chernobyl nuclear reactor accident]. / Zakonomernosti izmeneniia soderzhaniia 137Cs v moloke v otdalennyi period posle avarii na Chernobyl'skoi AES.

Regularities of changes in 137Cs content in cattle milk in the long term after the Chernobyl accident have been analyzed. Contamination levels of haylands and pastures, soil properties, specific features of agricultural production and time after the fallout play a crucial role in 137Cs concentration changes in animal products. Trends have been studied that reflect the influence of these factors and their significance assessed. The half-life periods of 137Cs decay in milk vary over the period of 1994 to 2000 between 7.1 and 14.8 years and approach similar periods calculated for the long term after global radioactive fallout from nuclear weapons tests.

[Influence of posttransplantation plasmapheresis on results of transplantation of a cadaveric kidney]. / Vliianie posttransplantatsionnogo plazmafereza na rezul'taty peresadki trupnoi pochki.

Plasmapheresis was performed with "Haemonetics" (USA), PCS-Ultralite and MCS+ devices. During one procedure 1750-3550 ml of plasma were removed. Results were evaluated by the following parameters: diuresis within 24 hours after surgery, number of hemodialysis sessions after surgery, period of normalization of creatinine in blood. In patients of the study group oligoanuria was seen 4.5 times more rarely than in the control group, they needed less sessions of hemodialysis. Level of creatinine normalized earlier in the study group. Actually survival of patients with potent transplants was higher in the study group than in the controls. It is concluded that plasmapheresis has positive influence on the course of posttransplantation period.

[Pyogenic infectious complications in recipients with allogenic kidneys: clinical and bacteriological aspects]. / Infektsionno-gnoinye oslozhneniia u retsipientov allogennykh pochek (klinicheskie i bakteriologicheskie aspekty).

The bacteriological study of wound discharge indicated no changes in the structure of the microflora in the allogenic kidneys of recipients throughout the follow-up. Among microbes isolated there were prevalent gram-positive microbes whose proportion has slightly increased in the past year, with Staphylococcus, mainly epidermal Staphylococcus, which contributes to the etiology. At the same time, studies of wound discharge in the past years showed that the incidence of mixed infections had increased from 4.3 in 1989-1991 to 15.6% in 1994-1997. Bacteriological urinalysis found no great differences in the etiological structures of the microflora. Gram-negative microbes are prevalent in all patients in three periods of follow-up. Noteworthy, there was an increase in the amount of yeast fungi (from 5.7 to 21.1%). Urinalysis showed that the rates in the isolation of bacterial and bacterial and fungal associations were steady-state and higher in all patients (20, 4-23, 5%). Examining the etiological structure of the pathogens of sepsis ascertained that patients of the early observation were found to isolate gram-negative microorganisms more frequently, while those of other observation periods have gram-positive ones. The overall proportion of microbial and microbe-fungal associations was 10.3% in the past 9 years. Since the patient's body is occupied by other pathogens due to immunosuppression, sepsis or wound infection was accompanied by high bacteriuria, cytomegalovirus infection, pneumocystic pneumonia, fungal infection, etc. For this reason, the patients had actually much higher quantities of mixed infections in sepsis, wound infection, or urinary infection than those taken into account while studying the only type of an infectious complication. The above leads to the conclusion that the incidence of mixed infection of recipients of allogenic kidneys is rather high. This infection substantially makes the choice of drugs and therapy difficult, the course of a wound process aggravated. For successful control of mixed infections, it is necessary to introduce new drugs having a high activity against bacteria, fungi, viruses, and protozoa and to use the latest differentially diagnostic culture media, to make diagnosis and treatment of pyoseptic diseases better.

[Aspects of the transplantation of kidneys from relatives]. / Aspekty peresadki rodstvennykh pochek.

104 transplantations of the kidney from living relative donors (LRD) in patients with an end-stage of chronic renal insufficiency (CRI) were carried out in Research Center of Surgery from April 15, 1965 to November, 1993. Donors of the kidneys were: mother (55), father (21), sister (18), brother (10). Analysis of the accumulated data showed, that the results of LRD transplantations (one year survival of recipients 84 +/- 6%) are much better than those from cadaver donors (one year survival of recipients 33 +/- 6%). The examination of the relative donors in long-term periods after the operation has demonstrated, that nephrectomy in them entails small risk, because it does not negatively influence their psycho-emotional sphere and social status. The reserved (retained) kidney is able to support homeostasis of donor organism during all his life. Therefore the operation of kidney transplantation from living relative donors is the most effective method of treatment of patients with an end-stage of chronic renal insufficiency.

[Kidney allotransplantation from living related donors]. / Allotransplantatsiia pochki ot zhivogo rodstvennogo donora.

From April 15, 1965, to November 1993, 104 kidneys from living related donors (LRD) were transplanted to 104 patients with endstage chronic renal failure. The kidneys were taken from the patients' mother (n = 55), fathers (n = 21), sisters (n = 18), and brothers (n = 10). Analysis of the experience accumulated has demonstrated that the outcomes of kidney grafting from LRD are much better than those from cadaver donors. All the living donors were investigated in the late postoperative period. There were no negative influences on their health and social position. The residual was able to maintain the donors' homeostasis throughout their life. Thus, transplantation of the kidney from living related donors is the method of choice in patients with end-stage chronic renal failure.