The kidney cannot be successfully grafted without immunosuppressive therapy. A unicenter retrospective study has evaluated the efficiency of immunosuppression with daclizumab (Zenapax) versus alemtuzumab (Campath). Subjects and methods. After renal allotransplantation, 64 patients, including 34 and 30 patients, were treated with daclizumab and alemtuzumab, respectively. The absolute count of peripheral blood lymphocytes was measured. Renal grafts were morphologically assessed as described by Banff. Results. After administration of alemtuzumab, there was a more pronounced decrease in the absolute count of peripheral blood lymphocytes and the rate of acute rejection crisis was 1.5 times lower than that after use of daclizumab. Conclusion. During the study, alemtuzumab demonstrated a more marked immunosuppressive activity than did daclizumab and the ability of the former to generate donor-specific immunotolerance in renal-allograft recipients.

The kidney cannot be successfully grafted without immunosuppressive therapy. A unicenter retrospective study has evaluated the efficiency of immunosuppression with daclizumab (Zenapax) versus alemtuzumab (Campath).Subjects and methods. After renal allotransplantation, 64 patients, including 34 and 30 patients, were treated with daclizumab and alemtuzumab, respectively. The absolute count of peripheral blood lymphocytes was measured. Renal grafts were morphologically assessed as described by Banff.Results. After administration of alemtuzumab, there was a more pronounced decrease in the absolute count of peripheral blood lymphocytes and the rate of acute rejection crisis was 1.5 times lower than that after use of daclizumab.Conclusion. During the study, alemtuzumab demonstrated a more marked immunosuppressive activity than did daclizumab and the ability of the former to generate donor-specific immunotolerance in renal-allograft recipients.

The review deals with anemia, one of the posttransplantation complications. To define the ways of preventing this complication in the posttransplantation period, the factors favors its development are analyzed. Anemia is shown to negatively affect autografted kidney function and actuarial survival in allokidney graft recipients. The current principles in the treatment of posttransplantation anemia are reflected.

The experience of 28 kidney allotransplantations from the AB0-incompatible donors was analyzed. The comparative group consisted of 38 patients, who received the AB0-compatible organ. The results were assessed using the following parameters: renal function, morphology of the biopsy samples of the transplanted kidney and actuary survival of the recipients with functioning transplants in both groups. The comparative analysis showed no significant difference between the two groups, giving the right to consider the kidney allotransplantation from the AB0-incompatible donors safe and effective.

The article is dedicated to an extremely important issue of pediatric nephrology and pediatric transplantology – vaccination of children with chronic kidney disease for prevention of vaccine-manageable infections. Commonplace and often mild (in healthy children) viral and bacterial infections in the patients on immunosuppressive therapy may cause development of life-threatening conditions and loss of a transplant in children with transplanted kidneys. There are no common vaccination protocols for such children neither in Russia nor in any other country. Moreover, it is presumed that vaccination should not take place in children with chronic renal diseases, especially in the stage of renal failure; however, in many cases it is unreasonable. The authors present personal experience of children’s vaccination before and after kidney transplantation.

The experience of 28 allotransplantations of ABO-incompatible kidneys was compared with the treatment results of 38 ABO-compatible renal transplantations. The transplanted kidney function, morphological changes of the transplanted kidney and the comparative analysis of actuary survival in both groups showed no significant difference. The results of the study prove the validity of the kidney transplantation from the ABO-incompatible donors.

The aim is to investigate the effectiveness of SIRS pharmacological correction in patients after CABG when adding clarithromycin to the standard antibacterial therapy. Patients of the 1st group (n=25) received Klacid- CP ("Abbott") in perioperative period plus to standard antibacterial therapy (3rd generation cephalosporins), patients of 2nd group received standard therapy. At 1st screening stage, as well as on the 2-nd and 4-th day after operation were recorded data of an anamnesis, concomitant pathology, examination, were measured the level of white blood cells, LII, biochemical blood analysis (CRP), defined the concentration of interleukins (IL-1, 6, 8,10,12) and TNF - a. In all studied patients, laboratory' and physical data did not go beyond the reference values, intraoperation data, blood loss and ALV duration did not statistically differ. According to the results of research in patients of both groups there were manifestations of SIRS in the form of reliable significant increase in body temperature, as well as the level of Il-6, IL-8, CRP, LII, TNF - a, leukocytosis. While in the clarithromycin group body temperature was significantly lower in all time points. The level of CRP for the 4th day in 1.5 times, and TNF in 4 times less than in the control group, and the values of anti-inflammatory IL-10 to the 2nd day, on the contrary almost in 2 times higher than those in the control group. Thus, the obtained data confirmed that the CABG is accompanied by non-inflammatory SIRS development. At the same time clarithromycin gives an independent proven anti-inflammatory effect and can be recommended for application in the schemes of prophylactic antimicrobial therapy during perioperative period in this category of patients.

At present the problem of donor organs for transplantation shortage remains unsolved. Cautious and mixed attitude towards the transplantation of incompatible kidneys remains, while it could considerably reduce the donor organ waiting time for a recipient. Experience of 19 allotransplantations of ABO-incompatible kidneys in children is analyzed in the article. A group of 14 patients who received ABOcompatible kidneys was chosen for the comparative analysis. Such parameters as the assessment of function of allotransplanted kidneys, morphology character comparison of biopsy materials of allo-kidneys in both groups, actuarial survival rate of the recipients with functioning allografts are used to assess the results. Comparison of the aforementioned parameters showed practically the same results, and that enables us to assert that transplantations of kidneys of ABO-incompatible donors have the right to exist.

The study aimed the estimation of posttransplantant anemia (PTA) frequency between the recepients of allogenic kidneys and testing the influence of different factors on the anemia development. The study was ased on the analysis of 129 patients with ERSD, to whom 129 donor kidneys were grafted. An actuarial survival of patients and allografts were calculated. The analysis demonstrated that a duration of the pretranplant hemodialysis influences the dynamics of hemoglobin level and the red blood cells count. The shorter were the dialysis terms, the easier was the anemia to correct. Shorter terms of the pretransplant dialysis also correlated with the higher rates of the overall survival after the transplantation.

В статье приводятся результаты собственного исследования по оценке влияния индукционной иммуносупрессии с помощью антитимоцитарного глобулина (АТГ) на течение посттрансплантационного периода после пересадки почки. Авторы проанализировали 260 аллотрансплантаций трупных почек у 215 детей (части детей проводилась повторная трансплантация почки). У части детей (n = 25) АТГ применяли для индукционной терапии, у части (n = 10) — с целью подавления стероидрезистентного отторжения. Пациентам контрольной группы (n = 180) АТГ не назначали. Наиболее высокая актуарная выживаемость (как трансплантатов, так и пациентов) была в группе детей, в которой АТГ приме-няли для индукционной терапии, а не только лечения реакции отторжения.Ключевые слова: индукционная терапия, аллотрансплантация почки, антитимоцитарный глобулин, выживаемость, дети.

Персистирующее инфицирование вирусом гепатита С (ВГС) считалось значительным этиологическим факто-ром развития гепатитов ни А ни В [1, 2], было тесным образом связано с такими болезнями печени, как хро-нический гепатит, цирроз печени и гепатоцеллюлярная карцинома [3]. Эффективная анти-ВГС-терапия ограни-чивалась применением интерферона или комбинацией интерферона и рибавирина. Но связи с тем, что при терапии этими препаратами вирус гепатита С продол-жает персистировать в организме половины инфициро-ванных больных [4], потребовалась разработка альтер-нативных подходов к лечению ВГС-инфекции [5].В доступной литературе мы нашли публикации, каса-ющиеся, главным образом, трансплантации печени, и в связи с этим сочли целесообразным описать клини-ческий случай успешной ликвидации гепатита С у паци-ентки после повторной трансплантации трупной почки.Пациентка К., 1984 года рождения, поступила в отде-ление трансплантации почки с диагнозом: «Гипоплазия почек. Терминальная стадия хронической почечной недостаточности. Состояние при проведении программ-ного гемодиализа». Процедура программного гемодиа-лиза начата с 16.12.1992 года. Вскоре у больной был диагностирован гепатит С, по поводу которого ей про-ведено соответствующее лечение. Однако, ВГС-виремия сохранялась.04.11.1994 г. больной была выполнена аллотран-сплантация трупной почки. Донор почки — труп муж-чины, 35 лет, погибшего от черепно-мозговой травмы. Совместимость донора и реципиента — по АВО и двум антигенам системы HLA-A, B, Dr, несовместимость — по а3 и b12. Вскоре после включения почки в кровоток в ней развился острый тромбоз, и трансплантат при-шлось удалить. Больной продолжено программное экс-тракорпоральное очищение крови.19.10.1995 г. больной была выполнена повторная пересадка трупной почки. Донор — труп мужчины 40 лет, погибшего от черепно-мозговой травмы. Сов ме-стимость между донором и реципиентом — по АВО и двум антигенам системы HLA-A, B, Dr, несо вместимость — по а3 и b12. В посттрансплантационном периоде назначена иммуносупрессивная терапия: кортикосте-роиды и циклоспорин А (Сандиммун Неорал). Больная была выписана под наблюдение специалиста по месту жительства. При катамнестическом обследовании в 1997 г. зафиксировано повышение уровня трансами-наз (аспартатаминотрансферазы (АСТ) — до 74,3 ед/л, аланинаминотрансферазы (АЛТ) — до 59,7 ед/л), щелочной фосфатазы (ЩФ) — до 271 ед/л, лактатдеги-дрогеназы (ЛДГ) — до 339 ед/л. Больной проводилась гепатотропная терапия. Протокол иммуносупрессив-ной терапии был следующим: циклоспорин А в дозе

The article provides results of in-house research to assess the impact of induction immunosuppression using antithymocyte globulin (ATG) on the clinical course of post-transplantation period after kidney transplantation. The authors analysed 260 allotransplantations of cadaver kidneys (215 children). In some children (n = 25) the medicine was used for induction therapy, in some (n = 10) to suppress steroid-resistant rejection. Patients in the control group (n = 189) were not administered ATG. The highest actuarial survival rate (both transplants and patients) was recorded in the group of children where ATG was used for induction therapy, rather than just for treatment of rejection.Key words: induction therapy, allotransplantation of kidney, antithymocyte globulin, survival rate, children.

The review deals with anemia, one of the posttransplantation complications. To define the ways of preventing this complication in the posttransplantation period, the factors favors its development are analyzed. Anemia is shown to negatively affect autografted kidney function and actuarial survival in allokidney graft recipients. The current principles in the treatment of posttransplantation anemia are reflected.