[Correction of cronic liver failure by transplantation of liver cells suspension and cell-engineering designs (experimental investigation)].

On an experimental model of chronic fibrotic liver damage (male rats Wistar (n-60), damage of CCl4, the duration of the experiment 90 days) it was studied the effectiveness of cell therapy for the correction of chronic liver failure. These rats were divided into 3 experimental groups: in the Ist-group (control, n=10) isotonic saline (650 mkl.) was injected; in the IInd-group (n=20) suspension of liver cells was applicated in a dose 8 - l0 x 10(6) cells; in the IIIrd-group (n=30) suspension of liver cells and bone marrow cells (mesenchymal stromal cells) in ratio 5:1 were used as cell associates on microparticles intjectable heterogeneous biopolymer hydrogel "SpheroGEL" (cell-engineering design) in common dose 8 - l0 x 10(6) It was ascertained that in the 2nd and in the 3rd groups the accelerated normalization of disturbed liver functional indices (ALT, AST, ALP) took place - to 30 days, but in the control group only to 90 days. The reliable differences in rats ofnormalization offunctional indices were absent between the IInd and the IIIrd groups. But in 90 days by using special histological dyeing it was found out that defibrotic processes in liver tissue were more expressed in the IIIrd group in comparison with the IIIrd group. Received results were consequence of prolonged vital activity of cells (liver cells and mesenchymal stromal bone marrow cells) into cell-engineering designs, which were transplanted in the IIIrd group. The obtained effect can be explained by that the developed cell-engineering designs provide adequate conditions for prolonged vital activity of the transplanted cells.

[Cytomegalovirus infection of allografted kidneys in children].

The study was based on 90 puncture bioptats of transplanted kidneys, received from 67 patients (33 males and 34 females) aged 8 to 18 or 14.1 +/- 4.7 years. The puncture biopsies were performed 8 days to 7 years after renal transplantation. In addition to histological techniques, the researchers used immunoperoxidase method with monoclonal antibodies to CMV-E and CMV-L antigens. The immunohistochemical method of CMV infection diagnostics revealed CMV infection in 15 (17.5%) of the bioptats of the renal allografts. The risk of CMV infection in renal transplants increases during the late postoperative period in the presence of chronic pathology (chronic nephropathy or chronic glomerulonephritis), especially in combination with late acute allograft rejection crises.

[A renoprotective effect of enalapril in chronic transplantation nephropathy]. / Renoprotektivnii éffekt énalaprila pri khronicheskoi transplantatsionnoi nephropatii.

AIM: To study safety and efficacy of ACE inhibitor enalapril in chronic transplantation nephropathy (CTN) as well as nephroprotective efficacy of this drug in various clinical variants of CTN. MATERIAL AND METHODS: A retrospective study covered 220 recipients with CRF. The patients were divided into the study group (n = 103) and the control group (n = 117). The study group was given ACE inhibitor enalapril the efficacy of which was assessed by arterial pressure (systolic, diastolic, mean) dynamics, 24 h proteinuria and the rate of CTN progression. This rate was suggested by probability of plasm creatinin doubling (Kaplan-Meier technique). RESULTS: Enalapril significantly inhibited CTN progression running with minimal or marked proteinuria, had a pronounced hypotensive effect, promoted stabilization of minimal proteinuria (in CTN with minimal proteinuria) or reduction of protein excretion (in a proteinuric variant of CTN). CONCLUSION: Use of enalapril in CTN in a daily dose 10 mg maximum is safe and can be used for inhibition of CTN progression.

[Immunosuppressive therapy with the use of cyclosporin A in the late period after a kidney transplant]. / Immunosupressivnaia terapiia s primeneniem tsiklosporina-A v otdalennom periode posle transplantatsii pochki.

A study was made of the results of kidney transplantation in 90 patients who received three-component immunosuppressive therapy (cyclosporin, azathioprine and prednisolone) in the induction phase, followed by cyclosporin conversion in the phase of maintenance therapy. The second patients' group (39 cases) received permanent three-component immunosuppressive therapy. Analysis of the data obtained makes it possible to regard the use of cyclosporin advisable not only in the induction, but also in the maintenance phases of immunosuppressive therapy.

[Fine-needle aspiration and puncture biopsies in the diagnosis of lesions of kidney transplants]. / Tonkoigol'naia aspiratsionnaia i punktsionnaia biopsiia v diagnostike porazhenii pochechnykh transplantatov.

270 fine needle aspiration and 41 puncture biopsies were fulfilled after 92 cadaveric renal transplantations to diagnose the status of the grafts. With the clinical and ultrasonographic data, the first method proved to be effective in diagnosing acute graft rejection in 79.9% of cases and in determining the status of graft reversibility or irreversibility, but the fine needle aspiration biopsy failed to differentiate the cellular or vascular types of the rejection. The method was also effective in diagnosing the tubular necrosis, acute cyclosporin nephrotoxicity, infectious transplant complications. The paracentetic biopsy essentially supplements the fine needle one and allows one to diagnose chronic cyclosporin nephrotoxicity and chronic transplant rejection. It appears to be the only method revealing the magnitude of graft rejection during oligoanuria caused by ischemic graft lesion. It was concluded that the results of fine needle aspiration biopsy were the most informative within the first postoperative month because later on it becomes difficult to obtain biopsy specimens adequate to interpret the results correctly.

[The diagnosis of cyclosporin nephrotoxicity in patients after kidney transplantation]. / Diagnostika nefrotoksichnosti tsiklosporina u bol'nykh posle transplantatsii pochki.

The authors review possibilities of thin needle aspiration biopsy of renal allotransplants in the diagnosis of cyclosporin nephrotoxicity. 151 thin needle aspiration biopsy specimens were explored in 55 patients following kidney transplantation. According to the authors, this method when applied in the early postoperative period may turn an informative one. However, if the time elapsed after operation exceeds 3 months, they recommend performing puncture biopsy of renal transplants.

[Clinico-anatomical evaluation of donor kidneys unsuitable for transplantation]. / Kliniko-anatomicheskaia otsenka donorskikh pochek, neprigodnykh dlia transplantatsii.

The authors conducted clinicoanatomical analysis of 112 donor kidneys which clinicians found to be unfit for transplantation. The procedure of preparing the donors in these cases did not differ from that commonly accepted. An essential moment was prolonged arterial hypotension (6.0 +/- 0.8 hours), in donors whose kidneys were used for transplantation it lasted 2.0 +/- 0.2 hours. Examination showed that in 90% of cases the kidneys were unfit because of congenital or acquired diseases. It is concluded that the existing clinical methods for appraising the fitness of donor kidneys are adequate.

[Transplantation of pancreatic islet cell cultures in the treatment of suppurative surgical diseases in patients with diabetes mellitus]. / Transplantatsiia kul'tur ostrovkovykh kletok podzheludochnoi zhelezy pri lechenii gnoinykh khirurgicheskikh zabolevanii u bol'nykh sakharnym diabetom.

The authors have analyzed the possibility to use transplantation of the pancreatic islet cell cultures of pig embryos as a method of preoperative preparing patients with type II diabetes mellitus having pyo-surgical diseases.

[Treatment of labile forms of diabetes mellitus by transplantation of cultured pancreatic islet cells]. / Lechenie labil'nykh form sakharnogo diabeta transplantatsiei kul'tur ostrovkovykh kletok podzheludochnoi zhelezy.

The authors presented data on the transplantation of human fetal and pig pancreatic islet cell cultures to 89 patients with type I diabetes mellitus of a labile course. Allo- and xeno-transplantations of pancreatic islet cell cultures in combination with exogenous insulin administration were shown to improve the patients' general status raising their working capacity. As a result of 118 islet cell transplantations hypoglycemic comas either stopped or became milder and were better corrected. Stabilization of metabolic processes was observed in the patients. Clinicobiochemical indices and subjective signs of diabetes stabilization were observed within 12-15 months after transplantation.

[Renal osteodystrophy and its possible correction in patients on chronic hemodialysis]. / Pochechnaia osteodistrofiia i vozmozhnosti ee korrektsii u bol'nykh, nakhodiashchikhsia na khronicheskom gemodialize.

Results of diagnosis and treatment of renal osteodystrophy are discussed concerning 162 patients with chronic renal failure treated by hemodialysis. In most cases (15%) osteopenia and hyperparathyroidism were revealed. Roentgenologic investigation revealed metastatic calcification mostly in foot vessels, whereas microscopic study of internal organs in the lungs. The increase of calcium concentration in dialysate from 1.75 to 2.5 Mmol/l was not followed by greater calcinosis in patients with hyperphosphatemia. Uremic pruritus was treated by ultraviolet irradiation and administration of prednisolone for 3-5 days. The effect of I alpha-hydroxy-vitamin D3 was studied in 30 patients. Improvement of clinical status and, principally, relief of muscular pains in the extremities was observed as well as positive changes in blood serum biochemical indices.

[Structure of the causes of fatal outcome and functional disorder of grafts in patients following kidney transplantation]. / Struktura prichin smertel'nykh iskhodov i narusheniia funktsii transplantatov u bol'nykh posle peresadki pochki.

The postmortem analysis of 146 kidney transplantations that have been performed in the Latvian centre for kidney transplantation from 1974 to 1980 is presented. The following three groups of complications as the direct causes of death are found: the complications of the immunosuppressive therapy, those of uncorrected arterial hypertension and uremic complications. These results indicate the necessity of a rational approach to the choice of immunosuppressant doses, the control and correction of the arterial pressure as well as an early programmed hemodialysis of patients with non-functioning transplanted kidneys.

[Causes of removal of kidney allotransplants]. / Prichiny udaleniia pochechnykh allotransplantatov.

The most frequent causes of cessation of the functioning of 60 kidney transplants was an acute rejection reaction and thrombosis of main vessels of the transplanted kidney. The authors believe the attraction of the cytological analysis of the urine, instrumental and roentgen-radiological examinations as well as biochemical data to improve the diagnosis of pathological changes in the transplant.

[Contralateral donor kidney study for predicting the fate of transplants in the recipient body]. / Issledovanie kontralateral'nykh donorskikh pochek dlia prognozirovaniia sud'by transplantatov v organizme retsikientov.

An analysis of clinico--laboratory findings concerning functional condition of cadaver donor kidneys in the recipient's organism and morphological changes in 12 contralateral donor kidneys is set forth in the article. It has been found that in a cadaver donor kidney an impairment or an arrest of the graft function may be due to various pathological processes present in the donor intravitally.