Diagnostic Role of Dopplerography of Renal Vessels in Patients with Late Dysfunction of the Transplanted Kidney

Aims: Search for non-invasive methods for diagnosing late transplant kidney dysfunction, which can improve control and monitor the condition of the kidney transplant, characterization diagnostic role of dopplerography of renal vessels in patients with late dysfunction of the transplanted kidney. Study design: When conducting dopplerometry, blood flow indices were analyzed from 3 to 6 cycles of heart contractions, followed by an averaged indicator. In addition, the linear blood flow velocity was assessed separately from the renal vein. Place and Duration of Study: For the period 2016-2017 Ultrasound of an allopod was performed in 60 recipients of RT (RENAL TRANSPLANT) in the late postoperative period. Methodology: The average age of the patients was 38.89 ± 1.52 years. There were 34 men (56.6 7%), 26 women (43.33%). All patients were divided into two groups: patients with preserved function and patients with RT (RENAL TRANSPLANT) dysfunction. Related kidney transplantation (RRT) was performed in 55.0% of patients, in 45.0% - cadaveric kidney transplantation (CKP). The groups were comparable in the main clinical and demographic parameters. Results: The reverse dynamics was observed when examining the level of the renal filtration function indicator, the estimated glomerular filtration rate (SKF) - at a TAMX level of more than 15 cm/sec, glomerular filtration was 51.18 ± 1.93 (47.32-55.04) ml/min (p <0.01), and with a decrease in TAMX of less than 15 cm/sec, the level of SKF decreased significantly, more than twice, to the level of 25.40 ± 2.19 (21.02-29.78) ml/min <0.001). Conclusion: The determination of dopplerographic parameters for TP with preserved and especially with impaired depuration function with a direct assessment of TAMX opens up wide opportunities in non-invasive assessment of RT (RENAL TRANSPLANT) changes, identification of developing complications, as well as improved transplant survival.

FEATURES OF PERFORMING CADAVERIC KIDNEY TRANSPLANTATION

Purpose of the study: Reducing the risk of early postoperative complications associated with the disorder of the blood supply to the donor’s ureter while carrying out the transplantation of a cadaveric kidney. Material and methods: The analysis of a complicated course of the postoperative period, associated with the peculiarities of the blood supply to the donor’s ureter, was carried out for 20 out of 410 (4.9%) patients with chronic renal failure, who had the cadaveric kidney transplanted in Brest regional clinical hospital from 2011 to 2020. Results: A technique of determining the anatomical benchmarks indicating the location of the vessels that feed the donor’s ureter has been developed. Mastering specific technical methods used during the preparation of the renal allograph and its implantation, made it possible to reduce the number of urological complications after kidney transplantation by more than 2 times, and the number of cases of postoperative necrosis of the ureter by 4 times. Conclusions: The proposed surgical techniques make it possible to reduce the risk of postoperative complications associated with the violation of the blood supply of the donor’s ureter while transplanting the cadaveric kidney.

Cadaveric kidney allotransplantation at Krasnoyarsk Regional Clinical Hospital

Objective: to evaluate the early and long-term outcomes of cadaveric kidney allotransplantation (CKAT) based on a retrospective analysis of 71 cases treated at Krasnoyarsk Regional Clinical Hospital (KRCH).Materials and methods. From March 2014 to June 2019, 71 kidney transplants were performed at KRCH – 42 (59.15%) men and 29 (40.85%) women. The age of the patients varied from 20 to 59 years (mean age 39.6 ± 8.14 years). The causes of end-stage chronic kidney disease which subsequently led to CKAT were chronic glomerulonephritis, chronic tubulointerstitial nephritis, hypertensive nephropathy (HN), diabetic nephropathy resulting from type I diabetes (DN), nephropathy of mixed genesis (HN + DN), vesicoureteral reflux, congenital angiodysplasia of the kidneys, and Alport syndrome. The mean number of HLA mismatches was 4.5 ± 0.9.Results. Hospitalization lasted for an average of 34.05 ± 9.56 days. Primary function was observed in 32 (45.08%) patients, while 39 (54.92%) cases had delayed function. Post-transplant complications were noted in 23 (32.39%) patients, of whom 12 (16.9%) had early post-transplant complications, while 15 (21.13%) encountered complications in the late post-transplant period. The most frequently diagnosed were immunological, infectious, and urological complications. Vascular, surgical, oncological, and other complications were less frequent. The annual graft survival rate was 87.3%. Patient survival rate was 95.77%. One (1.4%) and 2 (2.81%) patients died in the early and late post-transplant periods, respectively. Hospital mortality – 1 case (1.4%).Conclusion. Kidney transplantation is the most effective treatment for patients with irreversible chronic kidney disease. About 87.33% of transplants were found to be effective. However, 32.39% of patients had postoperative complications. The vast majority of complications were reversible and were corrected conservatively or surgically. Nevertheless, graft loss occurred in 12.67% of cases. The success of transplantation depends on a number of factors related to both the donor and the recipient, as well as the immunological status and surgical technique. A personalized approach to recipients helps to reduce postoperative complications, prevent nephrotoxicity and rejection reactions.

MO948CHANGES OF SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR (SUPAR) AFTER CADAVERIC KIDNEY TRANSPLANTATION AND ASSOCIATION WITH KIDNEY FUNCTION

Background and Aims The soluble urokinase plasminogen activator receptor (suPAR), a marker of podocyte injury, has been implicated in pathogenesis of various kidney diseases, especially in focal segmental glomerulosclerosis. It correlates to the activation level of immune system. SuPAR predicted all course mortality in hemodialysis patients, but was not tested as a prognostic biomarker in kidney transplant patients. The aim of this study was to evaluate changes of suPAR concentration after kidney transplantation and to test its relation to graft function. Method We examined patients, who underwent cadaveric kidney transplantation (Tx) from 2019/05/23 to 2020/07/30 in the Hospital of Lithuanian University of Health Sciences. We evaluated level of suPAR biomarker before Tx, 12 days after Tx and 3 months after Tx. We used the suPARnostic Quick Triage test by ViroGates (Medtech, Denmark) for testing suPAR concentration. The suPARnostic Quick Triage test is based on the lateral flow principle. The device consists of a nitrocellulose membrane with two immobilized antibody zones and a running buffer with gold particles. The quantitative results are read by the aLF Reader with a detection interval of 2-15 ng/mL suPAR. Data on serum creatinine level and eGFR were collected at the same time points. Creatinine was tested using Analyzer AU680, Beckman Coulter, USA (Kinetic Jaffe traceable to the IDMS reference method). The statistical data analysis was performed using SPSS 23.0 software. Results 35 patients were included into the study, 57% of men and 43% of woman. Mean age of patients - 47±13.5 years. Mean suPAR level before transplantation was 8.7±4.2 ng/ml. It was a trend towards lower mean suPAR level 12 days after Tx (5.9±2.8 ng/ml, p=0.1) as compared to before Tx. It was significant decrease of suPAR level 3 months after Tx (3.9±1.1 ng/ml, p=0.003) as compared to before Tx. There was no suPAR relation to patient’s age. Serum creatinine and eGFR did not correlate with suPAR levels measured at the same time (before Tx, 12 days, and 3 months after Tx). We did not find relation between suPAR level before transplantation and creatinine level and eGFR 12 days after Tx. We found a significant negative correlation between suPAR level before transplantation and creatinine level 3 months after transplantation (r = -0.4, p = 0.049), but not eGFR 3 months after Tx. In a group of patients with eGFR ≥45 ml/min/1.73m2 3 months after transplantation mean suPAR level before Tx (9.5±4.3 ng/ml), after 12 days (5.8±2.6 ng/ml), and 3 months after Tx (3.8±0.87 ng/ml) was not different than in group of patients with eGFR &lt; 45 ml/min/1.73m2 (8±4.1 ng/ml, 5.2±3.5 ng/ml, 3.9±1.5 ng/ml accordingly), p&gt;0.05. Conclusion There was a significant gradual decrease of suPAR levels during 3 months after transplantation. No correlation of suPAR levels and transplanted kidney function was confirmed. A larger study is needed to assess whether suPAR could predict long term outcomes in kidney transplantation.

Case Report: Kidney Transplantation in a Patient With Acquired Agammaglobulinemia and SLE. Issues and Challenges

Lupus nephritis in the context of Systemic Lupus Erythematosus (SLE) is characterized by an unpredicted course with remissions and flare-ups. Among others, it remains a significant cause of end-stage kidney disease (ESKD) in relatively young patients. Therapeutic regimens with newer immunosuppressive agents have been introduced in order to control SLE clinical manifestations more efficiently and limit organ damage induced by immune complex formation and sustained inflammation. Treatment is usually long-term, and the cumulative impact of immunosuppression is expressed through the increased frequency of infections and neoplasms. However, if the observed immunity dysregulation is secondary and pharmaceutically induced or there is a pre-existing, primary immunodeficiency that shares common pathogenetic pathways with SLE's autoimmunity is not always clear. Herein, we present the case of a 39-year-old woman, that reached ESKD due to lupus nephritis. After an upper respiratory cytomegalovirus (CMV) infection and concomitant CMV reactivations the investigation revealed significant immunodeficiency. Not long after the initiation of intravenous immunoglobulin (IVIG) administration, patient received a cadaveric kidney transplant. IVIG was continued along with standard immunosuppression so that both recurrent infections and allograft rejection are avoided. Patient is closely monitored, and her post-transplant course is remarkably satisfying so far. ESKD patients with immunodeficiency syndromes should not be excluded by definition from kidney transplantation.

Cadaveric kidney allograft transplantation using the Da Vinci robotic surgical system. Initial experience in the Russian Federation

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. In order to reduce the number of postoperative complications following open surgeries, a number of clinics in the USA and Europe are currently developing robot-assisted surgical techniques. Studies have shown that robotic surgery facilitates kidney transplantation under optimal ergonomic position for the surgeon, with functional results and patient safety comparable to those obtained under an open approach. We herein present our initial experience (in the Russian Federation) on heterotopic cadaveric kidney transplantation by laparoscopic surgery using the Da Vinci robotic surgical system.