[Clinical effect of induction therapy with monoclonal antibodies after deceased-donor kidney transplantation (an experience from Vilnius Center)]. / Gydymo monokloniniais antikunais klinikinis poveikis persodinus mirusiu donoru inkstus (Vilniaus centro patirtis).

We aimed at evaluating the impact of monoclonal antibodies on immune response against deceased-donor kidney transplant: the frequency and severity of acute rejection episodes during first 3 months after transplantation and graft loss rate at one year. The frequency of infectious complications during the first 6 months after transplantation and patient survival rate during one year were also analyzed. Our study included 187 deceased-donor renal transplants performed in Santariskes Clinics of Vilnius University Hospital from January 2000 to December 2004. Study group (Group 1) consisted of 66 patients who received additional induction therapy with monoclonal antibodies (31 patients treated with basiliximab and 35 patients treated with daclizumab); 121 patients in control group (Group 2) were treated only with conventional immunosuppression. Both groups received maintenance immunosuppressive therapy including cyclosporine, mycophenolate mofetil, and steroids. Patient and graft survival rates were calculated by Kaplan-Meier method. There were no significant differences in the age of patients, HLA mismatches, percentages of highly sensitized patients (panel-reactive antibody level more than 50%), and repeated transplantation between both groups. The incidence of biopsy-proven acute rejection during the first 3 months after transplantation was significantly lower in Group 1 than in Group 2 (15.2% vs. 28.1%, P<0.05). There were no significant differences in patient survival rates (95.5% vs. 90.1%) between two groups at one year, but graft survival rate was significantly higher in Group 1 than in Group 2 (94.0% vs. 77.0%, P<0.05). The proportion of patients with infectious complications during the first 6 months after transplantation was significantly lower in study group than in control group (33.3% vs. 49.6%, P<0.05). Therefore, induction therapy with monoclonal antibodies reduced the incidence and severity of acute rejection in early period after transplantation and led to higher graft survival rate. The lower frequency of infectious complications was observed in patients receiving induction therapy with monoclonal antibodies.

[Living donor kidney transplantation after resection of carcinoma]. / Gyvo donoro inksto persodinimas po jo naviko rezekcijos.

The aim of the article is to present a case of incidental renal cell carcinoma in living donor kidney, which was successfully transplanted following resection of carcinoma. A 38-year-old female recipient with end-stage renal disease was on maintenance hemodialysis for 4 months. The donor was her mother aged 60 years. Preoperative renal scintigraphy, aortography, and ultrasound examination confirmed good function of donor kidneys. The reason for transplanting the right kidney was slightly diminished phase of secretion revealed by scintigraphy. On February 14, 2001, mother's right kidney was removed, and after hypothermic perfusion, yellowish nodule in the upper part of the kidney was found. Microscopic investigation of the resected material revealed renal clear cell carcinoma. Decision on complete tumor resection was based on the findings of microscopic examination. After suturing the resected segment, mother's kidney was transplanted successfully. The postoperative course was normal in the donor and the recipient as well. Cyclosporine A was replaced with Rapamune. No tumor recurrence was seen for more than 6 years after transplantation, and transplant function was normal.