Background: Chronic calcineurin inhibitor (CNI) toxicity remains a major focus of transplant research because it influences long-term patient and graft survival.We describe here our experience with late CsA withdrawal in 121 kidney graft recipients with a 10 year follow-up period.Methods: Between April 2000 and September 2006, 155 consecutive kidney transplantations were performed (89 from deceased donor (DD), 15 children below 7 yr, 19 second transplants or greater).CD-25 receptor blockers were the main induction agent, ATG was used in 18 patients with delayed graft function.Initial immunosuppression was CsA+MF+steroids.After 1-2 years, CsA was tapered and withdrawn in 121 patients.Besides routine monitoring, 242 graft biopsies before and 295 after CsA withdrawal were taken.This retrospective study compiled the CADi, Banff scores, graft and patient survival rates over the follow-up period of 87-164 month (121 ± 22).Results: Ten year graft/patient survival was 64.0 ± 2.2%/84.8± 2.2%.Mortality rate between the first and the tenth year post transplant was only 11.4% of DD recipients and 8.4% of LD recipients.Dynamics of Banff scores were different than well-known patterns: ci and cv increased significantly (p<0.05) in patients receiving CsA treatment but did not rise during CsA-free period.Cg scores were higher in patients after CsA withdrawal than those in patients on CsA (p=0.0009).Ah scores were not dependent on CsA. Conclusion:CsA withdrawal late after transplantation improves graft/patient survival and graft morphology when graft biopsy is obligatory for rejection diagnosis.

Цель: оценить возможности мониторинга трансплантированной почки по данным ультразвуковой диагностики в развитии криза отторжения.Материал и методы. В анализ результатов включены 154 пациента после трансплантации почки. Регистрировали размеры трансплантата, скорость кровотока в сосудах в интраоперационном и послеоперационном периодах.Результаты. Пациенты подразделены на две подгруппы: 1-я – с дисфункцией трансплантата, но без признаков криза отторжения; 2-я – с острой реакцией отторжения.

Aim: To assess the Eculizumab effect on the allografted kidney function in the immediate and early postoperative period.Materials and methods: In kidney transplantation, 33 patients received Eculizumab in combination with Alemtuzumab (group 1). Other 38 patients (group 2) were enrolled for a comparative analysis. They received their induction immunosuppressive therapy with Alemtuzumab and plasmapheresis sessions. The following parameters were used for analysis: the urine output in the first 24 hours after surgery, the period of creatinine level drop to 3 mg/dL, a 24-hour protein excretion at day 30 after surgery, a glomerular filtration rate at day 30 after transplantation, histology of kidney allograft biopsy at 1 month post surgery.Results: A comparative analysis has demonstrated much lower values of 24 hour proteinuria in group 1 than in group 2. As to the glomerular filtration rate, it was 1.9 times higher in group 1 than in group 2. The period of blood creatinine subnormalization was significantly shorter in group 1. The differences were statistically significant in all studied parameters (p=0.002–0.003).Conclusion: The allografted kidney function was much better in group 1 than in group 2. Thus, the combination of Eculizumab + Alemtuzumab had a more favorable effect on the function and morphology of allografted kidneys in the immediate and early postoperative periods compared to that of Alemtuzumab + plasmapheresis combination.

Background. Prevention of ischemia-reperfusion injury of the allograft (IRIA) is an urgent problem in transplantology, which largely determines the prognosis for both the transplanted organ and the patient as a whole. Objective. Our aim was to study the effectiveness of eculizumab in comparison with plasmapheresis during induction  immunosuppressive therapy in kidney transplantation in children. Methods. The retrospective study includes children with terminal phase of chronic renal failure who have received kidney transplants from either a living relative or deceased donor. The age of patients is from 1 year to 18 years. Induction immunosuppression in both groups was performed with alemtuzumab. Group 1 (main) included children who were treated with eculizumab to prevent IRIA, Group 2 (comparison) included children who were treated with plasmapheresis for the same purpose. The comparative analysis was carried out according to the following criteria: the rate of blood creatinine subnormalization (in days), the rate of glomerular filtration (in ml/min) 30 days after the operation; daily protein excretion (mg/24 h) 30 days after organ transplantation; morphological characteristics of renal biopsy samples by Banff 30 days after surgery. Results. During the comparative analysis from December 2012 to November 2016, eculizumab was administered to 32 patients, 24 patients underwent plasmapheresis. In Group 1, blood creatinine normalized almost 4 days earlier than in Group 2 (p=0.0049); the glomerular filtration rate in Group 1 was 4.5 times higher than in Group 2 (p=0.0018). Daily proteinuria in Group 1 was 4 times lower than in Group 2 (p=0.0019). Conclusion . The carried out study showed better indices of renal allograft function when using eculizumab in comparison with plasmapheresis: consequently, eculizumab more effectively suppresses IRIA than plasmapheresis.

Background. Prevention of ischemia-reperfusion injury of the allograft (IRIA) is an urgent problem in transplantology, which largely determines the prognosis for both the transplanted organ and the patient as a whole.Objective. Our aim was to study the effectiveness of eculizumab in comparison with plasmapheresis during induction immunosuppressive therapy in kidney transplantation in children.Methods. The retrospective study includes children with terminal phase of chronic renal failure who have received kidney transplants from either a living relative or deceased donor. The age of patients is from 1 year to 18 years. Induction immunosuppression in both groups was performed with alemtuzumab. Group 1 (main) included children who were treated with eculizumab to prevent IRIA, Group 2 (comparison) included children who were treated with plasmapheresis for the same purpose. The comparative analysis was carried out according to the following criteria: the rate of blood creatinine subnormalization (in days), the rate of glomerular filtration (in ml/min) 30 days after the operation; daily protein excretion (mg/24 h) 30 days after organ transplantation; morphological characteristics of renal biopsy samples by Banff 30 days after surgery.Results. During the comparative analysis from December 2012 to November 2016, eculizumab was administered to 32 patients, 24 patients underwent plasmapheresis. In Group 1, blood creatinine normalized almost 4 days earlier than in Group 2 (p=0.0049); the glomerular filtration rate in Group 1 was 4.5 times higher than in Group 2 (p=0.0018). Daily proteinuria in Group 1 was 4 times lower than in Group 2 (p=0.0019).Conclusion. The carried out study showed better indices of renal allograft function when using eculizumab in comparison with plasmapheresis: consequently, eculizumab more effectively suppresses IRIA than plasmapheresis.

Aim : To assess the Eculizumab effect on the allografted kidney function in the immediate and early postoperative period. Materials and methods : In kidney transplantation, 33 patients received Eculizumab in combination with Alemtuzumab (group 1). Other 38 patients (group 2) were enrolled for a comparative analysis. They received their induction immunosuppressive therapy with Alemtuzumab and plasmapheresis sessions. The following parameters were used for analysis: the urine output in the first 24 hours after surgery, the period of creatinine level drop to 3 mg/dL, a 24-hour protein excretion at day 30 after surgery, a glomerular filtration rate at day 30 after transplantation, histology of kidney allograft biopsy at 1 month post surgery. Results : A comparative analysis has demonstrated much lower values of 24 hour proteinuria in group 1 than in group 2. As to the glomerular filtration rate, it was 1.9 times higher in group 1 than in group 2. The period of blood creatinine subnormalization was significantly shorter in group 1. The differences were statistically significant in all studied parameters (p=0.002–0.003). Conclusion: The allografted kidney function was much better in group 1 than in group 2. Thus, the combination of Eculizumab + Alemtuzumab had a more favorable effect on the function and morphology of allografted kidneys in the immediate and early postoperative periods compared to that of Alemtuzumab + plasmapheresis combination.

AIMTo clarify whether cytomegalovirus (CMV) infection can affect the results of living related donor kidney transplantation.SUBJECTS AND METHODSA study group included 17 (7.27%) patients (10 men and 7 women; 8 children and 9 adults) aged 3 to 51 years who had developed resistant CMV infection. For comparative analysis, a control group was formed from 113 patients (61 men and 52 women; 40 children and 73 adults) aged 1 to 61 years, whose CMV polymerase chain reaction (PCR) had always been negative, i.e. CMV DNA was absent. The duration of CMV infection episodes was 44 to 232 days.RESULTSThe patients were given valganciclovir in a dose of 450 mg/day. CMV PCR was negative in all the patients at the end of therapy. None of the patients died; one graft was lost. In the control (negative CMV PCR) group, 6 grafts were lost in 113 patients lost and 4 patients died. Statistical analysis showed that the results of related donor kidney transplantation were virtually equal.CONCLUSIONSuppression of resistant CMV infection can be achieved with the longer use of valganciclovir or its higher dose. CMV infection fails to affect the results of related donor kidney transplantation.

AIM:To define the effect of donor and recipient gender on the results of kidney transplantation from living related donor.MATERIAL AND METHODS:Group of 271 patients who underwent kidney transplantation from living related donor was analyzed. There were 115 women and 156 men. Age varied from 1 to 63 years (mean 21.30±12.32). There were 127 children aged 1-18 years (mean 11.28±4.63) and 144 adults aged 19-63 years (mean 29.81±11.24). Donors included 162 women and 109 men. Overall survival was calculated using Kaplan-Mayer. Mortality and incidence of transplants failure were determined using Fisher's exact test.RESULTS:All patients were divided into 2 groups depending on recipients' gender and then into 4 subgroups depending on gender of donors and recipients. Comparative statistical analysis showed that transplants survival was higher in women vs. men (T=2.7, p=0.007). Survival of patients was similar in both groups. Moreover it was the best in subgroup of recipients-women with kidneys from donors-men. Difference was statistically significant (T=2.16, p=0.03). There was no significant difference in all other cases.CONCLUSION:The results of kidney transplantation are better in recipients-women than in men.

In the Department of Kidney Transplantation of Petrovsky National Research Centre of Surgery, the investigations of kidney biopsy specimens for С4d started in 2009. The study was performed in 119 patients with impaired function of kidneys allografted from living related donors. The staining for C4d was negative in 85 cases, and positive in 34 cases. The groups were compared on the following parameters: the patient mortality, and allograft loss. Besides, morphologic findings in the biopsy were compared by nature between the groups. There were 6 deaths among 85 patients in Group 1, and 16 deaths among 34 patients in Group 2. Comparative analysis of results, using Fischer's criterion, demonstrated a statistically significant difference in mortality between the groups ( 2 = 4,86, p = 0,0275). As for graft losses, and the nature of assessed morphology findings, they were nearly similar in both groups. Therefore, according to our data, the presence of C4d protein was associated with increased mortality. The differences between the groups in all other parameters were not statistically significant.

AIM:To evaluate the results of kidney transplantation from alive related donor in patients with Alport syndrome and to compare with those in patients with kidney hypoplasia.MATERIAL AND METHODS:We have analyzed 8 and 27 medical records of patients with Alport syndrome and kidney hypoplasia respectively. Following parameters were used - Kaplan-Meier survival analysis, Wilcox overall risk, percentage of transplants loss and mortality (Fisher's exact test calculation).RESULTS:It is concluded that percentage of transplants loss and mortality rate as well as overall survival and risk were similar in both groups.CONCLUSION:Despite risk of anti-GBM nephritis development in patients with Alport syndrome results are comparable with those after transplatation for chronic renal failure caused by other reasons.

In the Department of Kidney Transplantation of Petrovsky National Research Centre of Surgery, the investigations of kidney biopsy specimens for С4d started in 2009. The study was performed in 119 patients with impaired function of kidneys allografted from living related donors. The staining for C4d was negative in 85 cases, and positive in 34 cases. The groups were compared on the following parameters: the patient mortality, and allograft loss. Besides, morphologic findings in the biopsy were compared by nature between the groups. There were 6 deaths among 85 patients in Group 1, and 16 deaths among 34 patients in Group 2. Comparative analysis of results, using Fischer's criterion, demonstrated a statistically significant difference in mortality between the groups ( 2 = 4,86, p = 0,0275). As for graft losses, and the nature of assessed morphology findings, they were nearly similar in both groups. Therefore, according to our data, the presence of C4d protein was associated with increased mortality. The differences between the groups in all other parameters were not statistically significant.

To understand whether the presence of cytomegalovirus in blood influences the results of kidney transplantation from live relative donors, we analysed materials from 258 recipients divided into 2 groups. Group 1 included 113 patients with negative results of PCR for cytomegalovirus, group 2 contained 139 patients with positive PCR. We evaluated lethality, the loss of transplanted kidneys, frequency of rejection and infectious complications. Statistical treatment of the data obtained included Kaplan-Meier survival analysis, the Wilcoxon test showing the cumulative hazard risk, and comparative analysis by Fisher’s and Student’s tests. It was shown that cytomegalovirus present in blood increases lethality and the frequency of infectious complications in recipients of transplanted kidneys but does not influence their rejection. The cumulative survival rate was significantly higher and cumulative risk lower in group 1 than in group 2.

To understand whether the presence of cytomegalovirus in blood influences the results of kidney transplantation from live relative donors, we analysed materials from 258 recipients divided into 2 groups. Group 1 included 113 patients with negative results of PCR for cytomegalovirus, group 2 contained 139 patients with positive PCR. We evaluated lethality, the loss of transplanted kidneys, frequency of rejection and infectious complications. Statistical treatment of the data obtained included Kaplan-Meier survival analysis, the Wilcoxon test showing the cumulative hazard risk, and comparative analysis by Fisher's and Student's tests. It was shown that cytomegalovirus present in blood increases lethality and the frequency of infectious complications in recipients of transplanted kidneys but does not influence their rejection. The cumulative survival rate was significantly higher and cumulative risk lower in group 1 than in group 2.

The aim of investigation is analysis of factors forecasting the results of kidney transplantation from living-related donors. This research is based on the analysis of 272 kidneys' transplantation from living-related donors. It was analyzed such parameters as recipients' age, donors' age, donors' sex, degree of relationship between donor and recipient, degree of HLA-compatibility, type of inductive immunosuppression (monoclonal antibodies, corticosteroids, polyclonal antibodies), recipient's sex, presence or absence of rejection episodes for whole postoperative period. We recognized that far not all above-mentioned parameters could predict the results of kidney transplantation from living-related donors.

Relevance . Successful living relative donor (LRD) kidney transplantation is the most effective method of treating children with terminal chronic renal failure. Materials and methods . 148 living relative donor kidney transplantations to children were performed at the department of kidney transplantation of the Federal State Budgetary Research Institution “Academician Petrovskiy Russian Surgical Research Center” from December 2012 to March 2015. We used the following parameters to evaluate the factors affecting results of such an operation: recipient’s age and sex; living relative donor’s age and sex; antigen donor/recipient compatibility (system HLA-A, -B, -DR); type of induced immunosuppression; donor/recipient degree of kindred; presence or absence of rejection episodes throughout the whole observation period. Student’s test, Fisher’s test and Kaplan–Meier’s cumulative survival analysis of recipients and transplants were used for statistical processing. Results . 4 allokidneys out of 71 were rejected in group 1 (5.63%), in group 2 — 4 out of 77 (5.19%). The relative rates of transplant and patient survival were higher if LRD were 24–40 years of age than if LRD were 41–68 years of age. 12 patients out of 77 died in group 1 (15.58%), in group 2 — 3 out of 65 (4.62%). 7 allokidneys out of 67 were rejected in girls (7 fatal outcomes), in boys — 6 out of 81 (8 fatal outcomes). The highest rates of fatal outcomes and transplant rejection were observed in the group of patients prescribed daclizumab for induced immunosuppression, the lowest — in the group of patients prescribed methyl prednisolone. Conclusion . The conducted clinical material analysis led us to a conclusion that only two factors affect results of relative donor kidney transplantation in children — antigen donor/recipient compatibility (system HLA-A, -B, -DR) and presence of rejection episodes in the 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.

Relevance. Successful living relative donor (LRD) kidney transplantation is the most effective method of treating children with terminal chronic renal failure. Materials and methods. 148 living relative donor kidney transplantations to children were performed at the department of kidney transplantation of the Federal State Budgetary Research Institution “Academician Petrovskiy Russian Surgical Research Center” from December 2012 to March 2015. We used the following parameters to evaluate the factors affecting results of such an operation: recipient’s age and sex; living relative donor’s age and sex; antigen donor/recipient compatibility (system HLA-A, -B, -DR); type of induced immunosuppression; donor/recipient degree of kindred; presence or absence of rejection episodes throughout the whole observation period. Student’s test, Fisher’s test and Kaplan–Meier’s cumulative survival analysis of recipients and transplants were used for statistical processing. Results. 4 allokidneys out of 71 were rejected in group 1 (5.63%), in group 2 — 4 out of 77 (5.19%). The relative rates of transplant and patient survival were higher if LRD were 24–40 years of age than if LRD were 41–68 years of age. 12 patients out of 77 died in group 1 (15.58%), in group 2 — 3 out of 65 (4.62%). 7 allokidneys out of 67 were rejected in girls (7 fatal outcomes), in boys — 6 out of 81 (8 fatal outcomes). The highest rates of fatal outcomes and transplant rejection were observed in the group of patients prescribed daclizumab for induced immunosuppression, the lowest — in the group of patients prescribed methyl prednisolone. Conclusion. The conducted clinical material analysis led us to a conclusion that only two factors affect results of relative donor kidney transplantation in children — antigen donor/recipient compatibility (system HLA-A, -B, -DR) and presence of rejection episodes in the posttransplantation period.