[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.

[Storage of cadaver kidney by trans-organ oxygen insufflation]. / Konservirovanie trupnoi pochki transorgannoi kislorodnoi insuffliatsiei.

Transorganic oxygen preservation was used in storage of 87 cadaver kidneys. The kidneys were stored for 14 to 56 h (34 +/- 1.95 on the average). After storage, all organs were transplanted to 87 patients with chronic renal insufficiency in the terminal stage. The patients age ranged from 18 to 55 years. All recipients were divided into 3 groups according to the results of the operation. Group 1 (55 patients)-the function of the organ was restored immediately, blood creatinine normalized on the 5th-10th postoperative day; subsidiary hemodialysis was not needed. Group 2 (22 patients)-the function of the transplant was restored 14-21 days after the operation; 2 to 8 sessions of hemodialysis had to be conducted. Group 3 (10 patients)-the transplant did not function due to acute irreversible canalicular necrosis or irreversible rejection. No correlative dependence between restoration of the transplant function and the duration of storage was noted (r = 0.15). Our experience allows us to assert that transorganic oxygen perfusion can ensure long-term safe storage of cadaver kidneys.

[Intraoperative hemodynamics in relative living donors]. / Intraoperatsionnaia gemodinamika u zhivykh rodstvennykh donorov.

The intraoperative hemodynamics was evaluated in 42 relative kidney donors. Electromagnetic flowmetry was used for the evaluation. The rate of blood flow was calculated with the formula of Hunt. The comparison of the existing rate of blood flow with a proper one has demonstrated the existence of intrakidney angiospasm. The donors over 50 years of age and the female donors are more predisposed to angiospasm. It was noted that in harvesting the right kidney the intraorganic angiospasm is expressed much more strongly than in harvesting the left kidney. The phenomena of intrakidney angiospasm in harvesting kidneys in live donors is of practical importance. Special measures should be undertaken to prevent this complication.

[Intraoperative hemodynamics in the recipients of kidney allografts from living related donors]. / Intraoperatsionnaia gemodinamika u retsipientov allopochek ot zhivykh rodstvennykh donorov.

Electromagnetic flowmetry was performed in 53 recipients of kidneys from related donors to investigate intraoperative hemodynamics and its relationships with such factors as the degree of histocompatibility between the donor and recipient, of blood relationship, renal laterality. The real total blood flow was compared to proper flow according to Inke formula. The result of this comparison gave evidence for angiospasm or vasodilation. The range of real flow was much wider in the recipients than in donors. This reflected much more frequent angiospasms and vasodilation in the recipients: the transplants displayed angiospasms in 26.2% of the cases. The angiospastic patients developed rejection crises 2 times more frequently than those without the spasms. It is concluded that intraoperative vasoconstriction denotes greater probability to develop rejection crisis in early postoperative period.

[Radiologically-guided dilatation in arterial stenosis of transplanted kidney]. / Rentgenovaskuliarnaia dilatatsiia pri stenoze arterii transplantirovannoi pochki.

Stenosis of the artery of a transplanted kidney is a grave complication of the posttransplanation period. Two method are applied for correction of the disease: reconstructive operation and radiologically-guided endovascular dilatation (RED). The primary method of choice is RED of the stenosis. We applied it in 20 patients. The result of the operation in the early postdilatation period was good in 15 (75%) patients, satisfactory in 2 (10%) patients. In 3 cases the method of RED of the stenosis failed because of technical complications. Restenosis occurred in 8 (47%) patients in the late-term periods after correction. Attempts to repeat RED were successful in 5 patients.

[Etiology and classification of arterial stenosis of transplanted kidney]. / Etiologiia i klassifikatsiia stenoza arterii peresazhennoi pochki.

Stenosis of the artery of a transplanted kidney, which developed in late-term periods after allogeneic kidney transplantation, was revealed in 30 patients, which accounts for 6% of the total number of patients who underwent transplantation. The authors discuss the etiology of this complication in detail and suggest their own classification.

[Status of the kallikrein-kinin system, proteinase inhibitors and nonspecific resistance factors in patients with chronic kidney failure on hemodialysis as well as in kidney transplant recipients]. / Sostoianie kallikrein-kininovoi sistemy, ingibitorov proteinaz i faktorov nespetsificheskoi rezistentnosti u bol'nykh s khronicheskoi pochechnoi nedostatochnostiu, nakhodiashchikhsiia na gemodialize, i uretsipientov pochechnogo transplantata.

A state of the kallikrein-kinin system, activity of proteolysis inhibitors were studied simultaneously with the functional activity of neutrophils and content of lysozyme in blood serum of 21 patients with chronic kidney insufficiency. Two types of alterations in the kallikrein-kinin system were found in 13 patients maintained on hemodialysis: in four patients content of kallikrein was increased 8-fold as compared with normal level with a decrease in content of prekallikrein, while in nine patients activity of kallikrein was similar to control values but content of prekallikrein was still further decreased. Content of alpha 1-proteinase inhibitor (PI) was distinctly decreased (2-2.5-fold) in these patients, however, the decrease of the inhibitor was not observed in four patients; activity of alpha 2-macroglobulin tended to decrease. The ratio of active neutrophils and content of lysozyme were increased in blood serum of the majority of the patients. Hemodialysis, activation of the kallikrein-kinin system and stimulation of neutrophils appear to be responsible for a decrease in PI activity. The decrease in the PI activity and stimulation of the kallikrein-kinin system suggest that impairments in regulation of proteolysis could be corrected by means of exogenous proteinase inhibitors. In crisis of allogenic kidney rejection activities of PI and prekallikrein were decreased. Drastic, uneven alterations of the patterns studied were detected in pyo-inflammatory complications not related to the rejection crisis.

[The electrical impedance indicator dilution method in studying the basic hemodynamic parameters during dialysis]. / Metod razvedeniia élektroimpedansnykh indikatorov v issledovanii osnovnykh parametrov gemodinamiki vo vremia dializa.

The procedure for measuring cardiac output and circulating blood volume is based on blood ability to modify its electrical conductance due to the amount of introduced ions (0.9% sodium chloride solution) or undissociated molecules (5% glucose solution). The cardiac output and circulating blood volume were calculated after measuring an area under the electrical impedance indicator dilution curve using the given formulas. With the described and thermodilution methods, the cardiac output was compared (r = 0.95). The correlation factor with the radioisotopic method in measuring the circulating blood volume was 0.88. Clinical investigations carried out in 47 patients on a programmed hemodialysis showed a significant decrease in cardiac output approximately by 700 ml/mi (7.9%) and circulating blood volume by an average of 900 ml (15.2%) by the end of a hemodialysis session, the rate of the circulating blood volume to body weight being also decreased. There was a predominant fluid "release" from the vascular bed.

[Characteristics of the early postoperative period following kidney allotransplantation and immunosuppression using Sandimmune (cyclosporin A)]. / Osobennosti rannego posleoperatsionnogo perioda posle allotransplantatsii pochki pri provedenii immunosuppressii sandimmunom (tsiklosporinom A).

The authors analysed the early postoperative period in 100 patients who received sandimmune (cyclosporine A) as the main immunosuppressant after kidney allotransplantation and compared it to that in a control group of 60 patients treated by the usual measures of immunosuppression: azathioprine and steroids. The number of rejection crises was 1.9 times less in the group of patients given sandimmune than in the control group and were more benign in character, while the number of irreversible crises reduced from 26% to 6%. In treatment with sandimmune the dose of oral prednisolone was reduced by 1.9 times and the dose of intravenous methypred by 1.4 times. Nephrotoxicity was the main side effect of sandimmune, it was encountered in 26% of patients. All sandimmune side effects are reversible in decreasing the dose. Sandimmune improves the results of kidney transplantation significantly.

[Selection of the approach to conducting nephrectomy in donors- patients' relatives]. / Vybor dostupa pri vypolnenii nefréktomii u rodstvennogo donora.

The comparative assessment of two types of an approach (lumbotomy and thoracolumbotomy) for the performance of nephrectomy in 99 related donors was carried out. Lumbotomy was performed in 47 donors, the complications developed in 6 (12.8%) of them, including the severe ones--in 4 (8.5%). Duration of hospital stay was in average 27.26 days. Thoracolumbotomy was performed in 52 donors, the complications developed in 14 (26.9%) of them, including a severe one--in 1 (1.9%). Duration of hospital stay of the donors was in average 16 days.

[Transplantation of the kidney with numerous arteries from a living relative-donor]. / Peresadka pochki s mnozhestvennymi arteriiami ot zhivogo rodstvennogo donora.

Among 99 operations for transplantation of a kidney from a living kindred donor 6 were carried out with the use of kidneys which had many arteries. Five patients received a kidney with 2 arteries, and one patient, a kidney with 3 arteries. The donors were: a mother (1), a father (2), a sister (2), a brother (1). The left kidney was transplanted in all cases. In 5 patients kidney implantation was preceded by extracorporeal reconstruction on the arteries of the kidney (accessory arteries were anastomosed end-to-side with the main trunk of the renal artery) carried out under conditions of cold storage. In one female patient first the kidney was implanted by the standard method whereas the artery of the lower pole was anastomosed end-to-end with the inferior epigastric artery by means of microsurgical techniques. The transplants functioned well from the first day after the operation in all patients. In one patient the transplant was rejected 2 years and 7 months after the operation. The others function satisfactorily. The longest follow-up period is 5 years and 8 months, the shortest, 9 months. It is concluded that transplantation of a kidney with numerous arteries from a living kindred donor is an effective method for the treatment of patients suffering from the terminal stage of chronic renal insufficiency.

[Early postoperative rejection crises after transplantation of the kidney from the living related donors]. / Rannie posleoperatsionnye krizy ottorzheniia pri peresadke pochki ot zhivogo rodstvennogo donora.

The frequency of the development of rejection crises in the early postoperative period in 32 recipients of allogeneic kidneys from alive related donors was analysed depending on the histocompatibility according to the antigens of the HLA-AB system and the nature of the immunosuppressant therapy. The results of the analysis showed that the frequency of rejection crises was 100% when the donor and recipient were compatible in 1-2 antigens, and 40% in compatibility according to 3-4 antigens. The incidence of rejection crises was 71.4% among patients who received the standard immunosuppressant therapy (corticosteroids + azathioprine) and 36% among those given also sandimmune. Analysis of the frequency of rejection crises according to the ABO blood group system to which the donor-recipient pair occurred, showed that rejection crises occurred most frequently among patients with A (II) blood group.