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.

Urethral diverticulum is a pathological lesion characterized by a sac-shaped protrusion of the urethra. Diverticulum is a rare condition in the urological practice. Clinical case. The diagnosis, conservative management of diverticulum during pregnancy and surgical treatment on the 7th day after natural childbirth is presented in the article. A review of similar cases showed that urethral diverticulum in pregnant women should be managed conservatively, using antibiotic therapy, anesthesia, puncture aspiration, and cystoscopic drainage. Diverticulectomy during pregnancy is not recommended, as it is associated with increased anesthetic and surgical risks. It is necessary to carry out additional training of urologists, obstetricians, gynecologists to improve knowledge about this rare disease.

Introduction. Post-coital cystitis is not a separate nosologic unit, but belongs to recurrent urinary tract infection. Surgical interventions are only recommended in cases where conservative treatment fails to provide relief.Objective. To evaluate the results of post-coital cystitis prophylaxis in urethral transposition.Materials & methods. A retrospective study of 46 patients who underwent surgical treatment in the volume of transposition of the distal urethra from 2011 to 2013 was conducted in the clinic of Urology of MSUMD based on the Spasokukotsky Moscow Clinical Hospital.Results. Based on subjective reports from patients, urethral transposition was found to be effective in 71.7% of cases. Half of the participants reported no recurrence of cystitis within the past year, and over half (67%) reported no inflammatory episodes after undergoing surgery.Conclusion. The findings suggest that urethral transposition is an effective and relatively safe treatment option for patients with post-coital cystitis who have failed to respond to conservative treatments.

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. 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.

Fibroadenoma of the vulva is a benign fibroepithelial tumor that is extremely rare. We present a rare clinical case of a 49-year-old woman with a large slow-growing paraurethral fibroadenoma of the vulva, confirmed by histological examination. This observation describes a rare pathology that contributed to urination disorders, which required surgical treatment and confirmation of the benign process by immunohistochemical examination.

Diabetes mellitus (DM) is one of the most common and rapidly progressing diseases worldwide. Diabetic retinopathy (DR) is a common complication of diabetes and the main cause of vision loss in middle-aged and elderly people. The development and progression of DR is closely related to the duration of diabetes, hyperglycemia, and arterial hypertension. There is growing evidence that inflammation is one of the key links in the pathogenesis of diabetic retinal damage, but the exact molecular mechanisms remain to be known. Pancreas transplantation (PT) is currently the only effective treatment for diabetes that restores normal physiological glucose metabolism. Due to the limited number of PT surgeries associated with the severity of intra- and postoperative complications and the acute issue of organ donation, studies on the assessment of DR after PT are few and contradictory. There is a need for further studies of the DR state after PT with the study of the influence of risk factors, determination of the level of immunological markers and the use of modern instrumental research methods to create effective patient management regimens in the postoperative period.

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.

Diabetes mellitus is a serious health problem in both developed and developing countries. It is expected that by 2040 the incidence of diabetes mellitus in the world will increase to 642 million people. With the increase in the incidence of diabetes mellitus, the incidence of diabetic vascular complications increases, which worsen the quality of life of patients and triple the risk of death. Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus, leading to progressive loss of visual function. Diabetic retinopathy occurs in conjunction with diabetic nephropathy. This fact is associated with the anatomical similarity of the blood-retinal barrier and the glomerular filtration barrier, as well as with the general pathogenetic mechanisms of the effect of hyperglycemia on peripheral microcirculation. On average, after 10–15 years, patients with decompensated diabetes mellitus develop end-stage renal failure, requiring renal replacement therapy, such as peritoneal dialysis, programmed hemodialysis, and kidney transplantation. This article highlights the latest data on the effect of programmed hemodialysis on the morphofunctional state of the retina in patients with diabetes mellitus.

Diabetes mellitus is a serious health problem in both developed and developing countries. It is expected that by 2040 the incidence of diabetes mellitus in the world will increase to 642 million people. With the increase in the incidence of diabetes mellitus, the incidence of diabetic vascular complications increases, which worsen the quality of life of patients and triple the risk of death. Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus, leading to progressive loss of visual function. Diabetic retinopathy occurs in conjunction with diabetic nephropathy. This fact is associated with the anatomical similarity of the blood-retinal barrier and the glomerular filtration barrier, as well as with the general pathogenetic mechanisms of the effect of hyperglycemia on peripheral microcirculation. On average, after 10–15 years, patients with decompensated diabetes mellitus develop end-stage renal failure, requiring renal replacement therapy, such as peritoneal dialysis, programmed hemodialysis, and kidney transplantation. This article highlights the latest data on the effect of programmed hemodialysis on the morphofunctional state of the retina in patients with diabetes mellitus.

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.

The paper describes the use of the artificial pancreatic analogue – a cybernetic complex of insulin therapy – to correct carbohydrate metabolism in patients with diabetes mellitus in the early postoperative period after cadaveric renal allotransplantation.

The paper describes the use of the artificial pancreatic analogue – a cybernetic complex of insulin therapy – to correct carbohydrate metabolism in patients with diabetes mellitus in the early postoperative period after cadaveric renal allotransplantation.

Variants of vascular anastomoses in related donor kidney transplantation with multiple vascular blood supply and the parameters of intrarenal hemodynamics and renal graft function in this group of recipients in the postoperative period are described.

The mechanisms of the action of immunosuppressive agents and the risk factors for the development of posttransplantation diabetes mellitus and its complications are described.

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.

Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation. Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported. Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%. Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community.

Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation.Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported.Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%.Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community.

Simultaneous pancreas-kidney transplantation is a valid therapeutic option for patients with type 1 diabetes mellitus (DM) and secondary diabetic nephropathy, which enables to achieve an insulin-independent euglycemic state with normalization of glycosylated hemoglobin levels, prevent the secondary complications of diabetes and consequently improve patients, quality of life. There are various transplantation procedures exist. Although pancreas is transplanted because of its endocrine function, one of the main issues, which prevent the successful development of pancreas transplantation, is an exocrine drainage. The aim of this paper was to summarize our first experience of retroperitoneal pancreas transplantation with the formation of duodeno-duodenal anastomosis for enteric drainage.