Kidney Transplant for a Patient With Inferior Vena Cava and Abdominal Aorta Abnormalities.

Here, we describe an interesting case of a patient with the duplication of inferior vena cava, high-positioned bifurcation of the abdominal aorta with transposition of iliac arteries, and right renal aplasia associated with end-stage renal disease who underwent kidney transplant. In this case, the patient with anorectal malformations with a vaginal fistula was prepared and underwent a kidney transplant. During the surgery, we discovered duplicated inferior vena cava and transposed iliac arteries. After the surgery, computed tomography angiography revealed the inferior vena cava duplication with the 2 connections between the right and left inferior vena cava with the formation of an anomalous circle, high-positioned bifurcation of the abdominal aorta at the level of the L2 vertebral body, and transposition of right and left iliac arteries. Also, we observed the right kidney aplasia and absence of blood circulation in the left native kidney. In our case, a delayed diagnosis of pyelonephritis resulted in the progression to end-stage renal disease that necessitated a kidney transplant, during which we found these anomalies. We confirmed the asymptomatic course of these anomalies, diagnosed only during radiological imaging or surgical intervention. Patients with congenital anomalies of the kidney and urinary tract should undergo complete investigations before surgical decisions. Diagnosis of this pathology in the preoperative period, especially in transplant patients, will alert the surgery team in advance of the operation and allow preparation for the intraoperative difficulties that are typically associated with anomalies such as inferior vena cava transposition or aplasia.

State of Transplantation in the Republic Of Uzbekistan: Existing Problems of Donation.

Organ traTransplantation is one of the most successful achievements in modern medicine. For patients with end-stage chronic renal failure, transplantation undeniably improves their quality of life. The purpose of the study was to discuss the latest scientific data on the state of kidney transplantation in the world and to give an idea of the advantages, opportunities, and problems of kidney transplantation in the world and in the Republic of Uzbekistan. Transplantation in Uzbekistan developed in 5 stages. Stage I (1972-1991) began with the first kidney transplant in Uzbekistan on September 14, 1972, on the basis of the legislation on organ and tissue transplantation of 1970. Stage II (1991-1998) represented a break in the field of transplantation due to its prohibition by law. Stage III (1998-2017) comprised a series of 48 kidney transplants from living related donors on the basis of an order of the Ministry of Health of the Republic of Uzbekistan. Stage IV (2017-2022) comprised a series of 849 kidney transplants and 22 liver transplants from living related donors on the basis of Cabinet of Ministers Resolution No. 859 of October 17, 2017. Stage V began on May 11, 2022, with the adoption of the a new of the Republic of Uzbekistan, On Transplantation of Human Organs and Tissues. According to this new law, the objects of transplantation can be human organs and (or) tissues taken from either a living donor or a deceased donor. This law will expand the range of donors for patients in need. Transplantology is a sphere of life activity that can no longer be ignored; therefore, it is necessary to develop and implement humanistic principles on the basis of which it will be regulated.

Frequency of Complications After Kidney Transplant in the Early Postoperative Period.

OBJECTIVES: Complications after kidney transplant can be divided into surgical and nonsurgical. Our study investigated the incidence of postoperative complications and types of complications in a single center. MATERIALS AND METHODS: We retrospectively analyzed the occurrence of postoperative complications in 220 patients who underwent kidney transplantation at the Republican Scientific Center for Emergency Medical Care (Tashkent, Republic of Uzbekistan) from January 2019 to October 2022. RESULTS: Among the 220 patients, various types of complications were observed in 42 cases (19.1%). Of these, 31 patients (73.8%) had surgical complications and 11 patients (26.2%) had nonsurgical complications. Surgical complications included hematoma of the postoperative wound in 8 patients (19.2%), thrombosis of the graft artery in 1 patient (2.4%), thrombosis of the venous anastomosis in 1 patient (2.4%), lymphocele of the postoperative wound in 7 patients (16.6%), wound infections 4 patients (9.5%), bleeding from the arterial anastomosis 2 patients (4.7%), bleeding from the venous anastomosis 1 patient (2.4%), kink of the venous anastomosis in 3 patients (7.2%), postoperative hernia in 2 patients (4.7%), and urological complications in the form of ureteral necrosis in 2 patients (4.7%). Nonsurgical complications included hyperacute rejection, which led to the removal of the graft, in 2 patients (4.8%), acute cellular rejection of the graft, which was successfully treated with methylprednisolone pulse therapy, in 4 patients (9.5%), delayed graft function in 1 patients (2.4%) case, and posttransplant diabetes mellitus in 4 patients (9.5%). CONCLUSIONS: Despite the frequency of postoperative complications, timely assistance and further monitoring of patients can lead to normal functioning of the kidney transplant, except for cases of hyperacute rejection.

Kidney Transplant in a Pediatric Patient With Congenital Abnormalities of the Urinary Tract.

Kidney transplant is the gold standard surgical treatment for patients with end-stage chronic kidney disease. Over the past decade, the frequency and prevalence of chronic kidney disease in children have been increasing, with it being a serious problem worldwide. Kidney transplant in Uzbekistan is still at an early stage, with the first successful kidney transplant performed in 2018. Here, we describe a successful kidney transplant in a pediatric female patient with a congenital abnormality of the urinary tract. The patient first showed symptoms at 7 years of age and was diagnosed with urolithic illness with inflammation of both kidneys. At presentation, she was 14 years of age with end-stage chronic kidney disease (diagnosed with stage 5 chronic kidney disease at age 13 years) caused by an anomaly in the development of the urinary tract. She received a kidney transplant from her mother as a living donor. There was vesicoureteral reflux on both sides and ureterohydronephrosis from 2 sides. On day 9 posttransplant, her creatinine level decreased from 0.40 to 0.066 mmol/L. Doppler ultrasonogram showed normal size and echogenicity of the graft, as well as adequate blood flow in the renal and iliac vessels. The patient was discharged on day 10 posttransplant in a satisfactory condition. In about 50% of cases, the cause of chronic renal failure in children is congenital anomalies of the urinary tract. The most common causes of hydronephrosis in newborns and children are vesicourethral reflux, which leads to the expansion of the urinary tract collecting system and the development of chronic renal failure. Early and accurate diagnosis and timely treatment of urinary tract abnormalities can reduce the incidence of end-stage chronic kidney disease in children.

Case Report of Patient With Venous Thrombosis of the Transplanted Kidney in the Early Postoperative Period.

Renal allograft thrombosis is not a rare complication of kidney transplant and usually occurs in the early period after transplant, but it can also occur later after transplant. Several factors are associated with this infamous complication. The cause of venous anastomosis thrombosis is most often inflection or twisting of the renal vein, anastomosis stenosis, hypotension, hypercoagulation, or acute rejection of the graft. Doppler ultrasonography can allow identification of signs of thrombosis in the graft vein. With early diagnosis and timely intervention, graft function can be preserved and restored. Here, we describe a 13-year-old boy with a diagnosis of chronic kidney disease that was detected in 2017. He underwent kidney transplant, and the donor was a cousin from his mother's side of the family. HLA compatibility showed HLA-A, HLA-B, and HLADR matches, with 10% cross-matches. The patient underwent heterotopic kidney transplant in the right iliac region with the imposition of an end-toside anastomosis between the kidney artery and the external iliac artery and between the renal vein and external iliac vein. After surgery, the patient's hourly diuresis did not exceed 50 mL/hour. Graft Doppler ultrasonography showed a reversible blood flow of the graft vessels with high vascular resistance index. We suspected venous anastomosis thrombosis, and the patient was urgently taken to the operating room for revision. When the external iliac vein was opened below the anastomosis, thrombosis of the external iliac vein occurred with spread of the graft to the vein, completely covering the lumen of the vein. Thrombectomy was performed with reperfusion of the transplanted kidney with Custodial solution through the artery opening. The external iliac vein and artery opening were sutured. After blood flow started, the size, consistency, and color of the kidney returned to normal.

Three-Year Experience of Kidney Transplantation at a Single Center in Uzbekistan.

OBJECTIVES: In this study, we analyzed the results of the first 100 kidney transplants from related donors performed at the Republican Research Center of Emergency Medicine in Uzbekistan. MATERIALS AND METHODS: This study included 100 patients who underwent kidney transplant from a living donor at the Republican Research Center of Emergency Medicine from March 2018 to January 2021. RESULTS: Immediate graft function was noted in 84 cases (84%) and delayed graft function in 16 cases (16%). Delayed graft function occurred mainly when multiple vessels were present in a donor kidney (35.5%) compared with the presence of a single renal artery and vein (12.1%). The delayed graft function was influenced by the average duration of warm ischemia (80.26 ± 38.35 min with multiple arteries and 50.44 ± 14.44 min with a single renal artery and vein; P = .001). There were 3 cases (3%) of acute cellular rejection, which was successfully treated with pulse therapy and methylprednisolone; there was also 1 case (1%) of hyperacute rejection, which resulted in graft removal. Complications in the form of ureteral stenosis were noted in 2 cases (2%) and ureteral necrosis with anastomotic insufficiency in 1 case (1%). Two recipients (2%) underwent renal graft nephrectomy. In our short-term study, 1-year survival rate for kidney transplant patients was 93%, with graft survival rate of 91%. CONCLUSIONS: Delayed graft function developed when duration of warm ischemia was increased, which was influenced by the number of vessels in the donor kidney. This is an important prognostic factor for acute rejection development. The risk of vascular complications increases due to postoperative hemodialysis trough, with development of delayed graft function. Recipient deaths during the first year after kidney transplant were mainly from pulmonary embolism, infection, and sepsis as a result of immunosuppression, hypovolemic shock, and acute ischemic stroke.

Organ Donation in Uzbekistan: Achievements and Prospects for Further Development.

Here, we describe the current situation regarding organ transplant in Uzbekistan. The legalization of paired-kidney exchange programs for donors with incompatible blood types in Uzbekistan will allow more opportunities for organ donation. The phased implementation of the transplant program with that of deceased-donor organ transplant can be carried out only with the involvement of public, cultural, and religious figures, and not only health professionals, to permanently shift the paradigm in the population.

The First Successful Kidney Transplant to a Child With Abnormality of Urinary Tract in Uzbekistan: Case Report.

Kidney transplant has become a common surgical treatment for patients with end-stage chronic kidney disease. Chronic kidney disease in children is a major health problem in the world, with increasing incidence and prevalence. Uzbekistan is a young country, and surgeons were able to first perform kidney transplant surgery only in 2017. Here, we report a case of the first successful kidney transplant to a child in Uzbekistan. The patient, a 13-year-old boy with end-stage chronic kidney disease due to abnormal development of the urinary tract, received a kidney transplant from his father as a living donor. The diagnosis (abnormal development of the urinary tract, insufficiency of the vesicoureteral segment, and ureterohydronephrosis on both sides) was revealed when the boy was 4 years old, which resulted in vesicoureteral segment plastic surgery at diagnosis. Ten years later, the patient developed end-stage chronic kidney disease. At day 9 posttransplant, creatinine levels decreased from 0.53 to 0.043 mmol/L. Ultrasonography and Doppler imaging showed normal graft size and echogenicity and adequate flow in the renal and iliac vessels. The patient was discharged on posttransplant day 10 in good condition. For children with chronic kidney disease, the main cause is congenital abnormalities of the kidney and urinary tract. Kidney transplant in pediatric patients has become a common surgical procedure and is associated with high success rates. Early and accurate diagnosis and timely management of abnormal development of the urinary tract can reduce the rate of end-stage chronic kidney disease in children.