[Vaccination in patients with chronic renal failure in the pre- and posttransplantation period].

AIM: To clarify whether vaccination provokes renal graft rejection. SUBJECTS AND METHODS: A total of 131 vaccinations were performed in 92 patients with chronic kidney failure (CKF), including 7 and 85 patients vaccinated before and in different periods after kidney transplantation, respectively. The patients were examined using needle graft biopsy, measurement of proteinuria, and estimation of changes in blood creatinine levels and glomerular filtration rate. RESULTS: Vaccination was not fount to provoke rejection, as suggested by the results of needle biopsy of renal allografts and examination of their function. CONCLUSION: Vaccination is safe for patients with CKF as it causes no rejection episodes.

[The combined transplantation of the pancreatoduodenal complex and kidney].

Patients with diabetic nephropathy comprise up to 30% of dialisis population. The treatment optimum for these patients remains the transplantation of pancreas and kidney. There were no successful attempts in Russia so long ago as the end of the previous century. The issue analyses the experience of the SCS (where the first successful transplantation of kidney-pancreas complex was conducted) and other Russian institutes, where the problem is elaborated. Flaws and advantages of the used operative methods of pancreas and Β-cells transplantation; early and long-term results are thoroughly discussed.

[Efficacy and safety of cyclosporin A withdrawal in children long after kidney transplantation].

AIM: Evaluation of cyclosporine (CSA) withdrawal safety and efficacy in children late after kidney transplantation. MATERIAL AND METHODS: Graft and patient survival was analysed in 30 kidney recipients operated in the central children's hospital in 1991-1999. Fifteen of 30 patients came for follow-up to the Russian Research Center for Surgery where CsA was withdrawn 6.8 +/- 2.7 after transplantation. The other 15 children continued immunosuppression with CsA. RESULTS: Higher graft survival was observed in children in whom CsA was discontinued. CONCLUSION: Discontinuation of cyclosporine late after kidney transplantation results in improvement of graft survival in most of the patients.

[Successful correction of post-transplantation nephrotic syndrome with mabtera].

On March 8, 2007, a patient was admitted to the Department of Renal Transplantation, Academician B. V. Petrovsky Russian Surgery Research Center, for end-stage chronic renal failure and uremia and on March 9, 2007, he underwent cadaveric kidney allografting. In the posttransplantation period, the patient developed significant nephrotic syndrome with proteinuria being as high as 3900 mg/day. This proteinuria was regarded as a manifestation of rejection; immunosuppressive therapy was intensified: the immunosuppression protocol again included oral metipred in a dose of 60 mg/day; pulse therapy was performed. However, proteinuria remained at the same level as before. Then the authors decided to administer Mabtera. The latter was injected in a daily dose of 600 mg on June 20 and July 20, 2007. Just following 2 weeks, proteinuria decreased to 132 mg/day and persisted throughout the observation period. Therefore, Mabtera may be effectively used for the successful correction of posttransplantation nephrotic syndrome.

[Cognated kidney allotransplantation in children].

47 children at the age from 7 months till 16 years in terminal stage of chronic renal failure underwent related kidney allotransplantation. Kidney donors were mother (25), father (10), grandmother (4), uncle (3), brother (3), cousin (1), grandfather (1). On purpose of evaluation of pretransplantation hemodialysis duration the patients were divided into 2 groups: 1) duration of dialysis 0-12 months, 2) duration of dialysis more than 12 months. Such characteristics as actuarial probability of survival, growth and weight dynamics in children were evaluated. The comparative analysis show that the weight and growth rate is higher in children from the first group. Five-year actuarial probability of survival was 94% in the first group and 85% in the second group (p<0.01). Thus the research results show that relative kidney transplantation is the optimum treatment mode for the children in terminal stage of chronic renal failure, contributes to treatment results improvement and reduction of pretransplantation hemodialysis duration.

[Transplantation of kidney with multiple arteries].

One hundred and nine kidney transplantations have been performed. All the patients have been divided into 2 groups: 1st group consisted of 91 patients whose transplant had 1 artery, 2nd group -- 18 patients whose transplant had 2 to 5 arteries. In 2.5 years after transplantation the function of transplant and degree of arterial hypertension were identical in both groups. It is concluded that the short- and long-term results of transplantation of kidneys with multiple arteries don't differ from ones with single artery.