Objective: to analyze early outcomes of kidney transplantation (KT) in patients with type 1 diabetes mellitus (T1D) and stage 5 chronic kidney disease resulting from diabetic nephropathy.Materials and methods. The study group included 145 T1D patients who underwent KT at the kidney and pancreas transplant department of Sklifosovsky Research Institute for Emergency Medicine between January 1, 2007 and December 31, 2023. Among them were 57 men (39.3%) and 88 women (60.7%), the median age was 41.5 [35–47] years. The median age at disease onset was 14.6 [9–17] years. Organ donors consisted of 100 (69%) men, 40 (27.6%) women, and there was no information on the sex of 5 donors (3.4%). Donor median age was 46 [35.5–53] years.Results. Ninety-nine recipients (68.3%) had primary renal allograft function (PRAF), whereas 46 recipients (31.7%) had delayed function. The median time for azotemia to normalize was 6 [3; 6] days in PRAF patients and 20.5 [14; 27] days in those with delayed function. Overall, there were 9.7% (n = 14) surgical complications, 12.4% (n = 18) acute rejection crisis, and 9.7% (n = 14) infectious complications. Median serum creatinine and urea levels at discharge were 123 [99–164] μmol/L and 10 [7.4–14] mmol/L, respectively; median fasting blood glucose levels before transplantation and at discharge were 9.8 [7.8; 12] mmol/L and 8.1 [6.5; 10] mmol/L, respectively. A total of 125 patients (86.2%) were discharged with adequately functioning kidney graft, while 13 patients (9%) were discharged with graft dysfunction that did not require renal replacement therapy; one patient (0.7%) was transferred to the outpatient stage of treatment to continue dialysis therapy; however, renal allograft function was restored within 2 months post-transplant.Conclusion. Although T1D patients remain the most severe category of dialysis patients, our findings suggest that KT is an effective treatment option for them with high graft and recipient survival rates.

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.

Introduction. Histoplasmosis is not an endemic form of fungal infection in Russia; its sporadic cases are mainly associated with the import of the fungus from endemic countries. We consider it necessary to demonstrate a rare case of the disseminated histoplasmosis development in a kidney transplant recipient. Objective. Demonstration of a case of the disseminated histoplasmosis development in a kidney transplant recipient. Results. The clinical manifestations of the disease were described; the affected organs were macroscopically and histologically studied, which made it possible to diagnose disseminated histoplasmosis. Conclusions. This case prompts being on alert to potential occurrence of fungal infections, including non-endemic ones, in patients receiving immunosuppressive therapy.

Introduction. Despite improvements in immunosuppressive therapy procedures, immunological complications continue to be a major cause of kidney graft loss. The level of pre-existing and de novo synthesized anti-HLA antibodies (AB) has shown high significance in modern diagnosis of graft rejection and assessment of the efficacy of anti-crisis therapy.Objective: to analyze the frequency and specificity of pre-existing and de novo synthesized (including donor-specific), anti-HLA antibodies, to assess their impact on acute rejection crisis and kidney transplant (KT) outcomes in the early postoperative period.Materials and methods. We retrospectively analyzed the treatment outcomes of 637 patients, who received a deceased-donor kidney transplant at Sklifosovsky Research Institute of Emergency Care from 2020 to 2022. Pre-existing and de novo synthesized anti-HLA AB, including donor-specific antibodies (DSA), were determined and their impact on the incidence of acute rejection crisis (ARC) in the early postoperative period and on kidney graft function was assessed.Results. In non-sensitized patients, the ARC rate was 10.7% (n = 58), primary initial graft function was noted in 354 patients (65.6%), and satisfactory function at discharge was observed in 377 patients (70%). Pre-existing anti-HLA AB was detected in 97 recipients (15.2%); ARC developed in 14 recipients (14.4%) from this group, 51 (52.6%) patients had primary initial function, and 62 (63.9%) exhibited satisfactory function at discharge. De novo anti-HLA AB synthesis after transplantation was noted in 70 (11%) patients, ARC in 10 of them (16.7%), 38 (54.3%) had primary function, and 43 (61.4%) had satisfactory function at discharge. DSA synthesis was detected in 10 patients, ARC was diagnosed in 5 (50%) of them, primary initial function and satisfactory function at discharge were noted in 3 (30%) recipients.Conclusions. The presence of pre-existing and/or de novo anti-HLA AB synthesis after KT under rationally selected immunosuppressive therapy did not statistically significantly affect the early outcomes of graft function. However, DSA synthesis statistically significantly increased the incidence of acute rejection, kidney graft dysfunction and increased the time of recovery of nitrogen excretory function.

Background. Simultaneous pancreas and kidney transplantation is a gold standard in the treatment of diabetes mellitus complicated by stage 5 chronic kidney disease as a result of diabetic nephropathy. One of the main problems of clinical pancreas transplantation is the pancreas graft exocrine drainage. In order to preserve the advantages of the retroperitoneal graft location and avoid the main disadvantage of duodenal drainage, namely, fatal complications potentially arising in case of necessary graft removal, we have proposed a modified method of retroperitoneal pancreatic transplantation with exocrine drainage via a modified Roux-en-Y duodenojejunostomy. It reduces the number of severe surgical complications and increases the recipient survival rate. When this method was used in previous years, it was not possible to assess the condition of donor duodenum mucosa and interintestinal anastomoses. Objective. To demonstrate the possibility of endoscopic assessment of interintestinal anastomoses when performing retroperitoneal pancreas transplantation with small intestine drainage of exocrine secretions. Results. The article presents the initial experience of endoscopic assessment of the interintestinal anastomoses and the mucous membrane of the donor duodenum after retroperitoneal pancreas transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy. Conclusion. The presented case demonstrates the feasibility of diagnostic endoscopic interventions when performing retroperitoneal pancreas transplantation with small intestine drainage of pancreatic secretions.

Background. Unexpected transmission of an infectious disease agent with a kidney graft to a recipient is a rare event but it is associated with significant morbidity and mortality, especially when exposed to multidrug-resistant bacteria that have not been eliminated by standard antibiotic prophylaxis.Objective. To demonstrate the need for immediate removal of a primary infected kidney graft in the event of local purulent complications due to the rapid development of sepsis in immunocompromised patients.Results. The paper describes a clinical course of the infectious process in two kidney recipients each of whom underwent transplantation of a primary infected graft from a single donor, taking into consideration the transplantectomy timing and the treatment outcomes.Conclusion. The Case Report shows the need for immediate transplantectomy in a kidney graft recipient when local purulent complications are detected with confirmed primary infection of the graft due to a high risk of the rapid development of sepsis and threat to life.

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.

Background. The possibility of inducing immunological tolerance in allogeneic organ transplant recipients is a research goal of the transplantology community, as it will ensure the likelihood of complete engraftment of a foreign organ. However, such a task presently remains difficult to accomplish. Objective: to demonstrate longterm kidney graft survival without signs of acute rejection and without immunosuppressive therapy in a patient who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from a haploidentical donor for post-transplant lymphoproliferative disorder (PTLD). Methods and materials. Recipient’s graft function was assessed using clinical, laboratory, instrumental and pathomorphological examination methods. Results. With no immunosuppressive therapy for more than four years, the kidney recipient showed stable, satisfactory graft function. Conclusion. The described clinical case demonstrates the development of immunological tolerance to a kidney graft in a recipient of allogeneic hematopoietic stem cells (HSCs).

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.

Introduction. The urinary tract incompetence ("extravasation of urine") of the renal allograft is the most common urological complication in the early postoperative period.The purpose was to evaluate the efficacy of the dynamic angionephroscintigraphy technique in diagnosing the extravasation of urine after kidney transplantation.Material and methods. The results of dynamic angionephroscintigraphy were analyzed for the purpose of verifying/ diagnosing the extravasation of urine in 63 patients who underwent kidney transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019. Dynamic angionephroscintigraphy of the renal allograft was performed with the glomerulotropic 99mTc-pentatech radiopharmaceutical on a two-detector single-photon emission tomography "Infinia II" and a combined CT SPECT / CT system "Discovery NM/CT670".Results. The sensitivity of dynamic angionephroscintigraphy in detecting the extravasation of urine was 100%, the specificity was 88%, and the accuracy of the method was 89%.Conclusion. Dynamic angionephroscintigraphy is a highly sensitive and specific method for diagnosing the extravasation of urine after kidney transplantation.

Introduction. Expanding donation criteria is one way of solving the problem of the increasing need of transplantation. The article is dedicated to comparison of the outcomes of first and second repeated kidney transplantation using grafts from standard criteria and expanded criteria donors.Aim. To evaluate 1-year and 5-year recipient and kidney graft survival rates after first and second kidney transplantation according to the donor type – standard criteria or expanded criteria donors.Material and methods. From 2007 till 2019 we performed 1459 kidney transplantations. The comparison study of outcomes of first (n=196) and second (n=143) kidney transplantations from standard criteria (n=245) and expanded criteria (n=94) donors was made.Results. There were no significant differences in a 1-year patient survival according to the donor type (98% and 95%, p=0.13). A 5-year recipient survival was significantly poorer after kidney transplantation from expanded criteria donors (97.6% and 88%, p=0.01). There were no significant differences in 1-year and 5-year graft survival rates according to the order of transplantation (p=0.21 and p=0.36). We found no significant difference in 1-year recipient survival after kidney transplantation from expanded criteria donors according to the order of transplantation (p=0.50). A 5-year recipient survival was significantly difference poorer after second kidney transplantation from expanded criteria donors (p=0.04). One-year and 5-year graft survival rates were significantly lower after kidney transplantation from expanded criteria donors (94%, 88% vs 86%, 65%, p=0.0025 and p=0.0011, respectively). One-year and 5-year survival rates were higher after first kidney transplantation from standard criteria donors in comparison with second kidney transplantation (p=0.052 and p=0.02, statistically significant in both cases). Analyzing outcomes of kidney transplantation from expanded criteria donors we found 1-year and 5-year graft survivals to be higher after first kidney transplantation comparing with second kidney transplantation (p=0.030 and p=0.018, statistically significant in both cases).Conclusion. In case of second organ transplantation, it is reasonable to use organs from standard criteria donors.

Introduction . The urinary tract incompetence (extravasation of urine) of the renal allograft is the most common urological complication in the early postoperative period. The purpose was to evaluate the efficacy of the dynamic angionephroscintigraphy technique in diagnosing the extravasation of urine after kidney transplantation. Material and methods . The results of dynamic angionephroscintigraphy were analyzed for the purpose of verifying/ diagnosing the extravasation of urine in 63 patients who underwent kidney transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019. Dynamic angionephroscintigraphy of the renal allograft was performed with the glomerulotropic 99m Tc-pentatech radiopharmaceutical on a two-detector single-photon emission tomography Infinia II and a combined CT SPECT / CT system Discovery NM/CT670. Results . The sensitivity of dynamic angionephroscintigraphy in detecting the extravasation of urine was 100%, the specificity was 88%, and the accuracy of the method was 89%. Conclusion . Dynamic angionephroscintigraphy is a highly sensitive and specific method for diagnosing the extravasation of urine after kidney transplantation.

Introduction. Currently, the type 2 diabetes mellitus is in the nature of an epidemic of non-infectious etiology. In this regard, the incidence of diabetes mellitus complications, including diabetic nephropathy, which lead to end-stage chronic renal disease, is also increasing. The treatment of type 2 diabetic patients with end-stage chronic renal disease presents significant difficulties, which is associated with an additional risk of developing infectious complications and, as a rule, the presence of concomitant pathology of the cardiovascular system.Objective. To analyze the results of kidney transplantation in elderly patients with diabetes mellitus in the early postoperative period.Material and methods. The study is based on a retrospective analysis of the results of 77 kidney transplants ations performed to elderly recipients at N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2015 to 2019. The study group included 22 recipients over 60 years old with type 2 diabetes mellitus, as main or concomitant disease. The comparison group consisted of 55 recipients over 60 years without diabetes.Results. Survival of recipients with type 2 diabetes mellitus was significantly lower (p = 0.026). So, there were 20 surviving recipients (90.9%) in the group of patients with type 2 diabetes mellitus, and 55 (100%) surviving recipients in the group without diabetes. When comparing the kidney graft survival rates in the recipients between the two groups, no statistically significant difference (p = 0.29) was found. The overall graft survival was 77.3% (n = 17) in the group of recipients with type 2 diabetes mellitus, and 89.1% (n = 49) in the comparison group.Conclusions. It has been proven that kidney transplant recipients with type 2 diabetes mellitus have a significantly lower survival rate after transplantation than recipients without diabetes; and the kidney graft survivals were not significantly different early after transplantation. The recipients did not show differences in the recovery of the transplanted kidney function depending on the presence of type 2 diabetes mellitus.Authors declare no conflict of interest.

Introduction. In spite of improvements in quality of life and lifetime of kidney transplant recipients the limited time of kidney transplant survival dictate the need for returning back to dialysis or repeat kidney transplantation. In respect that the need of repeat kidney transplantation usually observed in elderly recipients we attach importance in the analysis of outcomes of kidney retransplantation in patients over 60-s. Aim: to analyse the early outcomes of kidney re-transplantations in middle-aged and elderly recipients. Material and methods : the retrospective analysis of outcomes of 124 repeat kidney transplantations was made (16 transplantations in elderly recipients -Group I; 108 transplantations in recipients aged 20-59 yrs - Group II). The recovery of kidney transplants, acute rejection rates, the causes and the rate of kidney transplant dysfunction and failure, early patient’s and kidney transplant’ survival rates were analyzed. We used clinical, laboratory, histological and instrumental diagnostics. Results : in both groups there were no differences in kidney transplant recovery rates (p = 0,546), kidney transplant function (normal function 81,2% vs 86,1%, dysfunction 6,3% vs 4,3%, graft failure 12,5% vs 9,3% (p = 0,876), recipient 100% vs 99,1% (p = 0,34) and graft survival rates 87,5% vs 90,7% (p = 0,30). There were no episodes of acute rejection in patients of group I (0% vs 30,6% (p = 0,006). The reason of graft failure in group I - the graft’s pathology (nephroangiosclerosis (12,5%), group II - intractable acute rejection (4,6%), graft’s pathology (3,7%), patient’s death with functioning graft (0,9%). Conclusion: there were similar recipient and graft survival rates in both groups. We observed lower acute rejection rate in patients of group I using sufficient immunosuppressive regimens.

Seeking to develop immunosuppression regimens that would take into account the patient's level of sensitization to the antigens of the main histocompatibility complex, we studied 123 patients after kidney transplantation. Depending on the choice of immunosuppressive therapy, two groups were formed. The study group included 55 patients who received the immunosuppression regimen adapted to their HLA sensitization level. In the comparison group, 68 patients received baseline immunosuppression, including calcineurin inhibitors, mycophenolic acid preparations, and corticosteroids. AntiHLA antibody detection was performed by assessing the mean fluorescence intensity (MFI) on the Luminex platform when patient's placing on the transplant waiting list. It was found that highly HLA-sensitized recipients should receive antithymocyte polyclonal antibodies with or without plasmapheresis immediately after surgery in order to prevent the rejection reaction. The moderately HLA-sensitized patients should receive the baseline immunosuppression in combination with administration of monoclonal antibodies (simulect); the polyclonal antibodies should be administered only if necessary (in decreased diuresis rate, increased creatinine, etc.). In unsensitized patients, the baseline immunosuppression is enough to induce tolerance. Thus, the administration of immunosuppressive therapy adapted to the pre-existing HLA-sensitization level can significantly improve the treatment oucomes in kidney transplant recipients in the post-transplant period.

The data generalized in this review characterize angionephroscintigraphy as a high informative technique for separate quantification of the perfusion, filtration and excretory function of a renal graft that is particularly important to be used for monitoring renal function after allotropic cadaveric kidney transplantation to timely detect complications.