ПЕРВЫЕ 100 ТРАНСПЛАНТАЦИЙ ПОЧКИ ОТ РОДСТВЕННОГО ДОНОРА: ОПЫТ ЦЕНТРА ЭКСТРЕННОЙ МЕДИЦИНСКОЙ ПОМОЩИ

Abstract

Topicality. The advances achieved in the field of transplantation make it possible to make this type of renaltherapy routine and define it as the “gold standard” in the treatment of patients with chronic renal failurewith the best indicators in comparison with other methods of substitution therapy. At the present stage,transplantologists are faced with achieving 95% graft survival within 5 years. Currently, the graft survival ratein the first year has significantly increased to 93.4% with LT from cadaveric donors and 97.2% from living22 Вестник экстренной медицины, 2021, том 14, № 4donors. An improvement in this indicator is possible due to the improvement of immunosuppression protocolsand the prevention of surgical complications.Aim. To analyze the results of the first 100 kidney transplants from related donors at the Republican ResearchCenter of Emergency Medicine.Material and methods. The work included 100 patients who underwent kidney transplantation from a livingdonor at the Republican Research Center of Emergency Medicine from March 2018 to January 2021.Results. Immediate graft function was noted in 84 (84%) cases, and DGF - in 16 (16%). SPT took place mainlyin the presence of multiple vessels of the donor kidney (35.5%) compared with a single renal artery and vein(12.1%), which was influenced by the average duration of warm ischemia - 80.26 ± 38.35 minutes with multiplearteries and 50.44 ± 14.44 with a single renal artery and vein (p = 0.001). In 3 (3%) cases, there was an acutecellular rejection of the graft, which was successfully treated with pulse therapy with methylprednisolone, in1 (1%) - hyperacute rejection, which resulted in the removal of the graft. Urological complications in the formof ureteral stenosis were observed in 2 (2%) cases and ureteral necrosis with anastomotic insufficiency - in1 (1%). Urological complications were mainly observed with ureteral-vesical anastomosis without stenting(50%) than with stenting (4.5%), RR = 21.5 (95% CI = 3.84 - 117.57) (p˂0.001) . Graft artery thrombosis wasdetected in 1 (1%) case, vein thrombosis of the transplanted kidney and external iliac vein was detected in 1(1%) case, bleeding was noted in 8 (8%) cases. In 13 (13%) recipients, purulent-infectious processes wereobserved, of which in 9 (9.3%) cases, wound infection developed. Two recipients (2%) underwent renal graftnephrectomy. In our short-term study, the one-year survival rate for patients with LT was 93% and the graftsurvival rate was 91%.Conclusions. Delayed graft function often develops with a long stay of the recipient on hemodialysis, as well asan increase in the time of thermal ischemia, which is influenced by the number of vessels in the donor kidneyand is an important prognostic factor for the development of acute rejection. Due to postoperative hemodialysisdue to the development of delayed graft function, the risk of developing vascular complications increases.The risk of developing urological complications is high with the imposition of a ureteral-vesical anastomosiswithout stenting. Hyperacute rejection and the development of a purulent infection leading to arrosive arterialbleeding may result from the loss of a kidney transplant. The cause of the death of the recipient in the first yearafter KT is mainly: pulmonary embolism, infection and sepsis as a result of immunosuppression, hypovolemicshock and acute ischemic stroke.