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.