Introduction. There is an annual increasing of kidney transplantion all over the world. The number of recipients with hyperhomocysteinemia before and after the operation is also increasing, which increases the risk of cardiovascular complications, graft loss and patients’ death. Materials and methods. A 28-year-old patient with terminal chronic renal desiase in the outcome of chronic glomerulonephritis had underwent an allogeneic kidney transplant from a 52-year-old donor, with confirmed brain death in the outcome of acute hemorrhagic cerebral circulatory disorders. Results. The early postoperative period has complicated by thrombosis. Conclusion. The study of blood homocysteine levels is mandatory when examining patients for kidney transplantation.

Kidney transplantation (KT) remains the best treatment for patients with chronic kidney disease (CKD) stage 4–5. It helps patients live longer, have better quality of life, and undergo improved medical and social rehabilitation. This paper examines the outcomes of KT performed between 2019 and 2023.Materials and methods. There were 1,106 KTs deceased donor KTs performed between January 1, 2029, and December 31, 2023. The recipients had a median age of 45 (37–54) years, with 664 (60%) males and 442 (40%) females. Donors were mainly males (n = 706, 63.8%), with the median donor age being 50 (43–57) years. Induction immunosuppressive therapy (IST) with monoclonal antibodies was administered to 859 (77.7%) recipients, with polyclonal antibodies to 122 recipients (11%), and induction without antibodies to 125 recipients (11.3%). Triple-drug baseline IST consisted of a combination of calcineurin inhibitors, antimetabolites and glucocorticoids. Tacrolimus was the most often utilized calcineurin inhibitor (n = 961, 86.9%), while cyclosporine was used less often (n = 145, 13.1%). Mycophenolic acid (n = 1041, 94.1%) was used as the second medication in most recipients, while everolimus (n = 54, 4.9%) and azathioprine (n = 11, 1%) were used less often.Results. Primary initial renal graft function was noted in 714 patients (64.6%) and delayed in 392 recipients (35.4%). Overall incidence of surgical complications was 11.6% (n = 130), and immunological complications 9.9% (n = 109). At hospital discharge, 768 recipients (69.4%) had satisfactory kidney allograft (KAG) function, while 276 recipients (25%) were discharged with graft dysfunction; median serum creatinine and blood urea levels were 158 (120–204) μmol/L and 11 (8–16) mmol/L, respectively. Twenty-six recipients (2.4%) were discharged to continue renal replacement therapy; 28 recipients (2.6%) underwent in-hospital graft nephrectomy. Twelve individuals passed away during the hospitalization phase. The cumulative uncensored in-hospital graft and recipient survival rates were 97.5% (n = 1078) and 98.9% (n = 1094), respectively.Conclusion. KT is an effective and safe transplant modality for stage 4–5 CKD. Our KT outcomes are consistent with those of reputable transplant centers around the globe.

Introduction. The high prevalence of chronic kidney disease (CKD) has a negative impact on the length and quality of life of patients, especially in the older age group. Renal replacement therapy is required when the disease progresses to end-stage renal failure. In elderly patients with comorbidities, dialysis therapy has its own peculiarities and challenges, often prolonging life for a short period. The increase in the number of patients aged ≥70 years requesting to be placed in the kidney transplant waitlist (KTWL) at Sklifosovsky Research Institu- te of Emergency Care has led to the need to evaluate kidney transplant (KT) outcomes in this patient cohort.Objective. To analyze the early and long-term outcomes of deceased-donor KT in recipients aged ≥70 years.Materials and methods. The retrospective study included 23 kidney recipients aged ≥70 years who underwent a deceased-donor KT in the period from 2014 to 2023 at the Kidney and Pancreas Transplantation Department, Sklifosovsky Research Institute of Emergency Care. Recipient survival was computed using the Kaplan–Meier estimate.Results. Sixteen recipients (69.6%) had primary function and 7 (30.4%) had delayed function. Nineteen recipients (82.6%) showed a drop in blood creatinine below 200 μmol/L after KT. Hospital, 1- and 3-year survival were 96% (n = 22), 84.8% [95% CI 72–95] and 79% [95% CI 65–92], respectively; 1- and 3-year graft survival were 84.8 [95% CI 72–95] and 73% [95% CI 59–87], respectively.Conclusion. KT for patients aged ≥70 is a feasible treatment option for CKD stage 5.

Introduction . Infectious complications contribute to a significant decrease in graft and recipient survival rates. The article describes a case report of transplantation of the primary infected kidney transplant. Material and methods . A 33-year-old patient with type 1 diabetes mellitus and end-stage renal disease underwent kidney transplantation. The deceased donor was a 46-year-old man with a confirmed brain death as a result of acute cerebrovascular accident. Results . The early postoperative period was complicated by the development of primary infection of kidney transplant. Despite the ongoing treatment aimed at preserving the transplant, we had to remove it in order to prevent the development of further complications. Conclusion . Kidney transplantation improves the quality of life of patients with end-stage renal disease. In case of uncontrolled course of the infectious process after primary infected graft transplantation, it is necessary to perform transplantectomy in a timely manner in order to save the recipient’s life, since the graft itself is the source of infection.

The origin of the recipient is one of the recipient-related factors that statistically significantly affects the outcomes of kidney transplantation, but this factor is not so relevant in our country. The article presents the first experience of kidney transplantation in a patient of African descent at the N.I. N.V. Sklifosovsky. Material and methods . Allogeneic renal graft transplantation from a post-mortem donor was performed in a 60-year-old African male patient with stage 5 chronic kidney disease as a result of hypertensive nephroangiosclerosis. Results . The early postoperative period was complicated by the development of acute cellular graft rejection grade 1a-b according to Banff. Anti-crisis therapy was performed with some positive effect, however, in the late postoperative period, a loss of renal graft function was noted, and the patient was returned to renal replacement therapy with program hemodialysis. Conclusion . Patients of African ancestry are at increased risk of adverse outcomes due to immunological causes and require more careful immunological selection of a donor organ, an enhanced immunosuppressive regimen, and close monitoring after transplantation.

Introduction. Despite the improvements in immunosuppressive therapy, the growing number of repeat kidney transplantations and associated risks of acute rejection make it relevant to assess the impact of early acute rejection on a long-term kidney graft survival.Objective. The aim of the study was to evaluate the rate, the clinical aspects of early acute rejection after repeat kidney transplantation and the outcomes of its treatment, to perform the assessment of the impact of rejection episodes on a long-term kidney graft survival.Material and methods. We carried out the retrospective analysis of kidney graft survival after 121 repeat kidney transplantations performed in N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2007 to 2018. Group I included 96 recipients after kidney transplantation without acute rejection in postoperative period. Group II consisted of 25 patients with early acute rejection after kidney transplantation. We performed the assessment of the impact of early acute rejection on the kidney graft survival in comparison with recipients with uncomplicated postoperative period. Statistical processing was carried out by nonparametric methods. Survival was assessed using the Kaplan–Meier curves.Results. 1-year and 3-year kidney graft survival rates amounted to 90.3% (95%, confidence interval 85–95) and 85.4% (95%, CI 79–91), respectively, in recipients of Group I; and 72% (95%, CI 58–86) and 60% (95%, CI 46–76) in patients of Group II. Significant differences in 1-year and 3-year kidney graft survival between patients of Group I and II have been noticed (P=0.0022 and P=0.0065, respectively).Conclusions. Patients with early acute rejection after kidney transplantation had poorer kidney graft survival in comparison with patients without rejection episodes in postoperative period.

This paper describes the observation of 47 patients suffering from various kidney diseases and related metabolic syndrome. The evaluation of disorders of metabolic changes is carried out and a set of preventive measures including the use of non-drug means (not smoking, diet, physical rehabilitation), and drug therapy (statins, insulinotherapy if necessary) is proposed. Studies have shown that successful kidney transplantation in patients suffering from a chronic renal failure, coupled with the metabolic syndrome when using the complex measures aimed at the treatment of metabolic disorders can significantly improve the quality of life of patients.

The paper presents a 5-year experience of the Sklifosovsky Research Institute for Emergency Medicine in the treatment of patients after liver transplantation. The authors have reviewed the data on acute rejection in liver transplant recipients, analyzed the incidence of early liver transplant loss resulted from a non-controllable rejection, proposed prevention and treatment modalities for the cases of acute rejection.

The paper presents a 5-year experience of the Sklifosovsky Research Institute for Emergency Medicine in the treatment of patients after liver transplantation. The authors have reviewed the data on acute rejection in liver transplant recipients, analyzed the incidence of early liver transplant loss resulted from a non-controllable rejection, proposed prevention and treatment modalities for the cases of acute rejection.

Introduction: the use of standardized questionnaires for assessment of patients’ life quality after organ transplantation has not been widely used in our country.Purpose: The assessment of patients’ quality of life after the simultaneous pancreas & kidney transplantation using the SF-36 questionnaire.Material and methods: 35 patients with type I diabetes mellitus (DM1) complicated by end-stage chronic renal failure were investigated. There were 16 women (45.7%) and 19 men (54.3%). The median age was 36 [33; 45] years. The patients were divided into 2 groups depending on the transplantation type: group I included the patients who underwent isolated kidney transplantation, group II included those after combined kidney and pancreas transplantation. Patients’ life quality was estimated using the SF-36 questionnaire.Results: Patients in group II had significantly better physical functions, general health status, and vital activity.Conclusion: Simultaneous pancreas & kidney transplantation considerably improves the life quality of patients with DM1.

The Review deals with the problem of post-transplant diabetes mellitus as one of the complications after kidney transplantation. The authors have reviewed the clinical and experimental studies, described the mechanisms of immunosuppressive drug effects on carbohydrate metabolism and the risk factors for posttransplant diabetes mellitus and its complications, discussed the main drugs used for the carbohydrate metabolism correction and their mechanisms of action.