The first successful kidney autotransplantation was performed in 1902. The technique has undergone several changes since then. The indications and surgical technique are presented in this literature review. Kidney autotransplantation is the treatment of choice for preserving renal function. Three clinical observations on the use of kidney autotransplantation in urological and oncological practice are described: a patient after iatrogenic ureteral injury and two patients with primary retroperitoneal tumor. Literature analysis and clinical observations from urological and oncological practice show that kidney autotransplantation could be safely used for strictly selected indications.

Kidney transplantation is unique method of renal replacement therapy, allowing to improve quality and duration of life for patients with diabetes mellitus type 1 (DM1) and end-stage renal disease (ESRD) on dialysis therapy. Recently using of innovation technologies for diabetes management and modern immunosuppression enable achieving better results of posttransplant rehabilitation for patients with DM1, especially if kidney transplantation is performed early after initiation of dialysis. Detailed examination of patient with DM1 before potential kidney transplantation is very important to reduce of early and late postoperative complications. Kidney transplantation preparation includes effective glycemic control, adequate dialysis therapy, treatment of diabetes and ESRD complications and concomitant conditions, especially cardiovascular diseases, accounting for kidney transplantation perspective. Furthermore, diagnostics and treatment of any infectious process, timely vaccination, cancer screening are basic approaches of kidney transplantation preparation program, providing the best survival rate of kidney graft and patient.

Simultaneous pancreas-kidney transplantation (SPKT) is the most promising treatment option for patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) due to diabetic nephropathy (DN). Successful SPKT eliminates uremic intoxication and hyperglycemia – the leading trigger of vascular diabetic complications. Therefore, euglycemia is an important metabolic change in patients after surgery and remains only one of the factors for the saved renal allograft functioning. In the case of resuming renal replacement therapy by dialysis after SPKT, the management and monitoring of the pancreatic graft remains open. Special attention to the pancreatic graft’s function is due to both the potential risk of surgical complications, and some probability of T1DM relapse with the need to resume insulin therapy. In patients with saved function of both transplants, the assessment of the dynamics of diabetic complications in general becomes more important. The results of few studies in this regard remain contradictory. Thus, clinical options can be unpredictably diverse and require not only search for the root cause, but also optimization of rehabilitation tactics, even if the expected results are achieved.

Kidney transplantation is unique method of renal replacement therapy, allowing to improve quality and duration of life for patients with diabetes mellitus type 1 (DM1) and end-stage renal disease (ESRD) on dialysis therapy. Recently using of innovation technologies for diabetes management and modern immunosuppression enable achieving better results of posttransplant rehabilitation for patients with DM1, especially if kidney transplantation is performed early after initiation of dialysis. Detailed examination of patient with DM1 before potential kidney transplantation is very important to reduce of early and late postoperative complications. Kidney transplantation preparation includes effective glycemic control, adequate dialysis therapy, treatment of diabetes and ESRD complications and concomitant conditions, especially cardiovascular diseases, accounting for kidney transplantation perspective. Furthermore, diagnostics and treatment of any infectious process, timely vaccination, cancer screening are basic approaches of kidney transplantation preparation program, providing the best survival rate of kidney graft and patient.

With the presence of organ shortage, living donors remain important sources of grafts, especially for pediatric recipients. Laparoscopic nephrectomy has become the gold standard for living donors. Additionally, laparoscopic partial liver procurement in living donors has proven its safety and feasibility in the latest studies. We have combined both approaches to perform a simultaneous liver-kidney transplantation in a pediatric patient from the same living donor. Our experience of laparoscopic left lateral sectionectomy and laparoscopic nephrectomy in living donors was the basis for adapting to this procedure. A 29-year-old mother was an ABO-incompatible (ABOi) donor for the left lateral section (LLS) of the liver and left kidney for her 2-year-old son. The postoperative period was uneventful. Two sessions of plasmapheresis and rituximab induction were necessary to prepare for ABOi transplantation. The donor and recipient were discharged on postoperative days 5 and 28, respectively. Simultaneous laparoscopic left lateral sectionectomy and nephrectomy in the same living donor is feasible for transplantation from the parent to the child with advanced laparoscopic expertise.

Diabetes mellitus is a significant social problem. In the Russian Federation, the prevalence of diabetes type 1 is 340.000 people, 21% of them having diabetic nephropathy, as well as other secondary complications leading to disability and high mortality. There are several options for diabetic patients with chronic kidney disease dialysis: kidney transplantation with insulin therapy, simultaneous kidney-pancreas transplant or islet transplant. Good long-term results could be obtained by the whole pancreas and kidney combined transplantation through maximum metabolism recovery comparing to other replacement therapy options. The recipientselection with special attention to the cardiovascular system evaluation is essential to successful transplantation. The proper pancreatic graft assessment needs a wide range of criteria to be analyzed. Integral scores can simplify and systematize the assessment. The choice of preservation technique is important to pancreatic graft ischemia-reperfusion injury minimization. Despite the progress in graft preservation methods, cold storage using University of Wisconsin (UW) solution remains to be the gold standard. The evolution of surgical technique has resulted in utilizing the most physiologic variations of exocrine drainage and venous outflow of the pancreas, so-called portoenteric drainages, which were designed to improve remote metabolic effects and to reduce complications probability.

Aim. To analyze the efficacy and safety of different induction therapy protocols experience based on depleting antibodies for kidney transplantation (ATGAM, Timoglobulin). Material and methods. The study included 107 non-sensitized patients who underwent primary kidney allotransplantation in the period from January 2012 to March 2014. Patients were divided into 3 groups according to the ongoing induction immunosuppressive therapy. Group I, patients receiving the drug ATGAM (n = 67). Group II – Timoglobulin (n = 30). Group III, patients received a combination of the introduction of basiliximab and ATGAM (n = 10). All patients received basic triple immunosuppressive therapy: tacrolimus, mycophenolic acid, methylprednisolone tapering. Results. The incidence of acute rejection in group I – 7,5% , in group II – 0%, in group III – 0% (p = 0,15). The incidence of severe thrombocytopenia in group I – 2,7%, in group II – 0% (p 0,05). In the 2-nd and 3-rd group registered one case of CMV pneumonia in the early postoperative period. Conclusion. Use of exhaustible polyclonal antibodies as drugs of choice for renal transplantation induction therapy in primary unsensitized patients is warranted. Further research is needed for evaluation of 5- and 10-year results.

Aim. To analyze the efficacy and safety of different induction therapy protocols experience based on depleting antibodies for kidney transplantation (ATGAM, Timoglobulin).Material and methods. The study included 107 non-sensitized patients who underwent primary kidney allotransplantation in the period from January 2012 to March 2014. Patients were divided into 3 groups according to the ongoing induction immunosuppressive therapy. Group I, patients receiving the drug ATGAM (n = 67). Group II – Timoglobulin (n = 30). Group III, patients received a combination of the introduction of basiliximab and ATGAM (n = 10). All patients received basic triple immunosuppressive therapy: tacrolimus, mycophenolic acid, methylprednisolone tapering.Results. The incidence of acute rejection in group I – 7,5% , in group II – 0%, in group III – 0% (p = 0,15). The incidence of severe thrombocytopenia in group I – 2,7%, in group II – 0% (p < 0,05), in group III – 10%. Incidence of CMV viremia in group I – 6,16%, in group II – 6,6%, in the group III – 10%, respectively (p > 0,05). In the 2-nd and 3-rd group registered one case of CMV pneumonia in the early postoperative period.Conclusion. Use of exhaustible polyclonal antibodies as drugs of choice for renal transplantation induction therapy in primary unsensitized patients is warranted. Further research is needed for evaluation of 5- and 10-year results.

AAim. To identify factors influencing upon decision on pancreas allograft suitability for transplant and their clinical significance. Materials and methods. We reviewed 95 multiorgan donors under the age of 45, who were considered as pancreas donor between January 2010 and December 2013. 28 pancreata were procured (Group I), 67 pancreata were refused (Group II). Demographic, clinical and laboratory data, anatomical hepatopancreatoduodenal varieties were taken into account. Results. We found that only three factors have an effect on pancreas allograft refusal probability. According to our data, non-transplantation of the liver from the same donor increases the pancreas graft refusal in 4 times. Elevated donor’s sodium and urea blood levels also increase the probability of donor pancreas denial for transplantation. For example, the probability of pancreas graft refusal from the donor with sodium level 145 mmol/l and urea level 6.0 mol/l is only 32%. As compared to the donor with sodium level 160 mmol/l and urea 12.0 mol/l where probability reaches 85%. Other factors: demographic, laboratory, clinical indicators, gepatopancreatoduodenal blood supply variations were not predictive for the procurement decision. Conclusion. Main predictors of pancreas allograft refusal to be taken into account, appropriate correction of donor metabolic disturbances and sufficient experience of the surgeon performing the procurement can increase the availability of pancreas transplantation.

Combined liver-pancreas transplantation is considered to be a reasonable treatment of patients with end-stage liver disease and concomitant insulin-dependent diabetes mellitus, so it may become a standard treatment of this category of patients. As known, diabetes mellitus negatively affects the long-term results of isolated liver transplantation and increases a risk of posttransplant complications. Notwithstanding the widening range of indi- cations for simultaneous liver-pancreas transplantation and advances of transplantology, this operation continues to be a rare event in world medical practice. In May 2010 in Academician V.I. Shumakov Federal Research Cen- ter of Transplantology and Arti fi cial Organs there was performed a fi rst in Russia simultaneous liver-pancreas transplantation to 17-years old recipient, suffering with liver cirrhosis (as a result of autoimmune hepatitis) and concomitant insulin-dependent diabetes mellitus. In this article we give an overview of indications for simultaneous liver-pancreas transplantation, different ope- rative techniques, immunological aspects and immunosuppression regimes, as well as we describe the fi rst in Russian experience of such transplantation.