Satisfactory Graft Function Research Articles

Hypothermic machine perfusion of a donor kidney using an experimental dextran-40-based preservation solution and orthotopic transplantation (experimental study)

Objective: to evaluate the efficacy of hypothermic machine perfusion (HMP) of a donor kidney obtained from a non-heartbeating (NHB) donor, using an experimental dextran-40-based preservation solution, in subsequent orthotopic transplantation in a rabbit model.Materials and methods. Twenty grey giant rabbits weighing 2,500–3,100 g, divided into donors (n = 10) and recipients (n = 10), were used in the study. After obtaining kidney from an NHB donor, ex vivo HMP of the left donor kidney using a dextran-40-based preservation solution was performed and peripheral vascular resistance (PVR) parameters were measured. This was followed by bilateral nephrectomy and orthotopic transplantation. The follow-up period was 12 days. Creatinine levels, urea levels, and glomerular filtration rate (GFR) were measured during follow-up.Results. During ex vivo HMP of donor kidneys from NHBs, PVR dropped progressively from 1.90 ± 0.27 mmHg/mL/min to 0.72 ± 0.09 mmHg/mL/min at p < 0.001. In the early post-transplant period (during the first 2 days after implantation), creatinine and urea levels were moderately elevated compared to normal. Creatinine and urea levels were 91.07 ± 11.49 μmol/L at p < 0.011 and 9.09 ± 1.06 mmol/L at p < 0.009 on day 2, respectively, but by day 12, they reverted to physiologic values, which were 77.17 ± 10.19 μmol/L at p < 0.019 and 4.88 ± 0.54 mmol/L at p < 0.022, respectively. These findings were correlated with GFR values, which ranged from 26.29 to 26.74 mL/min/1.72 m2 in mean values over the course of a 12-day follow-up period.Conclusion. Ex vivo HMP using dextran-40-based preservation solution has a positive effect on the kidney at 30 minutes of warm ischemia following asystole and achieves satisfactory graft function over 12 days of follow-up.

Equivalents of the neutrophil-to-lymphocyte ratio of circulating pool of stem and immature hematopoietic cells for assessing liver transplant status

Objective: to study the applicability of the neutrophil-to-lymphocyte ratio (NLR) for monitoring recipient status and for possible minimization of maintenance immunosuppression in the long-term period after liver transplantation (LT).Materials and methods. Blood samples of 19 recipients with satisfactory graft function were examined by flow cytofluorometry at various time periods after LT using hematopoietic stem cell markers CD133, their CD31 derivatives, and alpha-fetoprotein (AFP), compared with the conventional NLR.Results. The use of NLR equivalents with CD133 and CD31 to assess liver transplant status is due to their high representation in liver tissue. Their values change in the long-term posttransplant period (from 1.5 to 6–7 years following LT) ≈20-fold and in different directions, but only when measuring their commissural to the liver cell fractions bearing the AFP marker.Conclusion. In contrast to the conventional NLR, maintenance of the lowest level of CD31 AFP, an NLR «equivalent», achieved at 1.5 years after LT, can be considered a criterion for the success of immunosuppressive therapy in the long-term post-LT period. The developed technique can be used to decide on whether to reduce or discontinue medication-assisted prophylaxis of graft rejection.

Pediatric liver transplantation for autoimmune liver disease: Ten-year experience from a liver transplant center in India.

Liver transplantation (LT) has emerged as the best therapeutic modality for end-stage liver disease in pediatric autoimmune liver disease (AILD). We aimed to describe our experience of pediatric living donor liver transplantation for AILD from India over a period of 10 years.We did a retrospective analysis of 244 liver transplants at our center over the last 10 years to identify children with AILD (18 years or younger). We aimed to describe the demographic features, clinical profile, graft survival, patient outcome, and predictors of mortality in our cohort.Between July 2010 and May 2020, 13 liver transplants were performed for AILD out of total 244 children transplanted over the last 10 years at our center. Mean (standard deviation [SD]) age at LT was 12 (± 3.84) years. Leading indications for LT were decompensated liver disease (61.5%), acute-on-chronic liver failure (23.1%), acute liver failure (ALF) (7.7%), and recurrent cholangitis and growth failure (7.7%). Mean Pediatric End-stage Liver Disease (PELD) score/model for end-stage liver disease (MELD) score and international normalized ratio (INR) (SD) at presentation were 24 (± 12.81) and 2.48 (± 1.54), respectively. Median discharge duration was 23 days (interquartile range [IQR] 21-36 days). 30.7% (4/13) of the subjects had no postoperative complications. Diarrhea (15.3%), pneumonia (7.7%), jejunostomy site bleed (7.7%), tacrolimus toxicity (7.7%), and vascular complications (7.7%) were seen, which resolved with satisfactory graft function. Three subjects died post-LT; causes of death included sepsis (n=3), renal dysfunction (n=1), and pneumonia (n=1). Others have been well on follow-up with no graft rejection or need for re-transplantation. Overall, 1-year and 5-year patient survival rates were 76.9% and 70%, respectively. Lower platelet count, autoimmune hepatitis (AIH) 2, and PELD/MELD score were found to be significant predictors of mortality on univariate analysis, which were not significant on multivariate modelling.Thecomplications, graft and patient survival rates in our experience were quite encouraging, and are comparable with the best centers worldwide. After instituting appropriate treatment, early referral of such patients to an equipped center should be facilitated.

Результаты применения мультидисциплинарного подхода в лечении больных циррозом печени в исходе хронических вирусных гепатитов

Aim – to evaluate the results of applying a multidisciplinary approach to the treatment of patients with liver cirrhosis in the outcome of chronic viral hepatitis. Material and methods. From July 2018 to September 2021, 94 orthotopic liver transplants (OTLT) from a posthumous donor were performed at the surgical clinic of the Botkin Hospital. Of 94 recipients, 48 (51.1%) indicated for surgery as liver cirrhosis as a result of chronic viral hepatitis C (CVHC), in 8 (8.5%) cirrhosis as a result of chronic viral hepatitis B (CVHB). In the case of cirrhosis as a result of CVHB, the presence of viral replication was a contraindication for transplantation; patients with its presence at the stage of placing on the waiting list were sent to an infectious disease specialist to receive antiviral therapy (AVT). Prevention of recurrence of CVHB in the graft consisted of intraoperative, as well as early and late postoperative administration of 400–800 IU of immunoglobulin against hepatitis B. Among liver transplant recipients with liver cirrhosis in the outcome of CVHC, less than half (43.75%) did not have HCV RNA against the background of passed or the OEM received by the time of the operation. The rest of the patients had contraindications to AVT, and HCV eradication was performed after transplantation. Results. The average follow-up period for hepatic transplant recipients with liver cirrhosis as a result of CVHB was 12.28 ± 4.11 (7–23) months. Satisfactory graft function against the background of constant antiviral therapy was observed in all patients. No deaths were recorded. The average follow-up time for patients with cirrhosis of the liver in the outcome of chronic hepatitis C after OTTP was 21.67 ± 4.85 (1–38) months. Antiviral therapy was prescribed to 24 patients 2.7 ± 0.34 (2–4) months after surgery. Three patients did not receive AVT after surgery due to their low adherence to treatment. Satisfactory graft function was observed in all patients, confident virological response against the background of AVT – in 17 patients (70.8%). 7 patients (29.2%) are currently undergoing antiviral therapy. Of the three patients who did not receive AVT in the postoperative period of their own free will, 1 patient (33.3%) developed graft cirrhosis and death from decompensation of liver failure at 23 months after transplantation. Conclusion. The use of a multidisciplinary approach in the treatment of patients with liver cirrhosis as a result of chronic viral hepatitis allows achieving a confident virological response, radically curing liver cirrhosis, thereby preventing associated complications, improving the quality of life of patients and restoring their ability to work.

ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report.

Introduction and importanceABO-incompatible living donor liver transplantation (ABOi-LDLT) is essential for expanding the donor pool. ABOi-LDLT prognosis has improved since desensitization treatment with rituximab; however, patients with high antibody titers are considered to be at high risk of antibody mediated rejection (AMR). Nevertheless, the preoperative antibody titer cutoff levels that preclude ABOi-LDLT have not yet been determined. In this study, the highest preoperative antibody titer was 1:4096, and the recipient had good outcomes. There has been only one report of good outcomes with a preoperative antibody titer of more than 1:4096. We hypothesized that high preoperative antibody titers in ABOi-LDLT may not be associated with AMR in protocols involving rituximab.Case presentationThe recipient was a 22-year-old man with biliary atresia and underwent ABOi-LDLT (B to O). We administered 500 mg of rituximab 14 days prior and then 300 mg of rituximab one day prior to ABOi-LDLT. The recipients preoperative IgG antibody titer was 1:4096. Postoperative immunosuppressive protocol involved steroids, tacrolimus, and mycophenolate mofetil. The patient had satisfactory graft function three years following ABOi-LDLT.Clinical discussionThe antibody that is responsible for posttransplant AMR should be newly synthesized after transplantation as a result of sensitization by antigens on the vascular endothelial cells of the graft. In ABOi-LDLT, natural antibodies may not cause AMR.ConclusionsThe most important factor for preventing AMR in recipients undergoing ABOi-LDLT is the suppression of de novo antibodies. High preoperative antibody titers may not necessarily preclude ABOi-LDLT, provided that rituximab is used in desensitization.

Urgent liver retransplantation in patient with sepsis, multiple organ failure and unstable hemodynamics

In the presented case, the patient after orthotopic liver transplantation from an optimal cadaveric donor against the background of a smooth postoperative period and satisfactory graft function was followed by a series of biliary complications in the form of ongoing necrosis of the bile ducts of the graft, which required repeated surgical interventions, which led to the formation of a separate bicholangiostomy. The patient was put on the waiting list for a repeated liver transplantation. The developed complications led to sepsis, multiple organ failure and unstable hemodynamics, that required using of substitution therapy and high doses of inotropic, vasopressor drugs. A decision was made to assign the patient a «high-urgency» status with priority graft obtaining, and the coordination centers of St. Petersburg, Moscow, Leningrad and Moscow Regions and FMBA were notified. From the assignment of the «high urgency» status to receiving an organ has passed 10 hours. Hepatectomy with the formation of a temporary portocaval shunt began in advance of the donor liver’s admission to the clinic, which made it possible to stabilize the hemodynamic parameters and the recipient’s condition. However, against the background of massive blood loss, at the stage of graft revascularization, two episodes of cardiac arrest occurred, requiring indirect heart massage with chest and diaphragm compressions. Due to severe peripheral circulatory insufficiency, dry gangrene of the nail phalanx of the right forefinger was developed. Nevertheless, from the first postoperative day and thereafter, the graft demonstrated satisfactory function. Two months after the repeated transplantation, the patient was discharged in satisfactory condition. Subsequently, the index finger was amputated. Six months after the second operation, the patient returned to the work of a teacher.

ОСОБЕННОСТИ ДИНАМИКИ CD4+CD25+ СУБПОПУЛЯЦИЙ Т-ЛИМФОЦИТОВ ПАЦИЕНТОВ С УДОВЛЕТВОРИТЕЛЬНОЙ РАННЕЙ ФУНКЦИЕЙ ПОЧЕЧНОГО ТРАНСПЛАНТАТА

Background. Experimental models indicate a certain role of T-regulatory lymphocytes in the induction of immunological tolerance. However, it is necessary to study their function and phenotype in more detail for the purposes of applying the mechanisms of tolerance induction. Objective. To assess the dynamics of CD3+CD4+CD25+ and CD3+CD4+CD25+highCD127+low indicators in renal transplant recipients with satisfactory early allograft function. Material and Methods. Kidney transplantation was performed in 197 recipients. We assessed CD3+CD4+CD25+ and CD3+CD4+CD25+highCD127+low level before the transplantation and on the 1st, 3rd, 7th, 30th and 90th days after the transplantation. The following groups of recipients were identified: PGF – those with satisfactory primary graft function, PGD – those with primary graft dysfunction, TR – those with transplant rejection in the early postoperative period. The comparison group (CG) consisted of healthy volunteers. Results. A significant increase in the relative and absolute level of CD3+CD4+CD25+highCD127+low from day 30 to 90 after surgery was revealed in recipients with a primary functioning graft. At the same time, CD3+CD4+CD25+ indicators in the recipients of the studied groups did not have significant differences throughout the study. Conclusions. CD3+CD4+CD25+highCD127+low monitoring can be used to identify patients with high tolerogenic potential.

Outcomes of Kidney Transplantation in the Elderly Recipients.

Introduction:In a developing country with a predominantly young population, the valid assumption is directed toward medical care toward the young. However, as medical technology has advanced, quality care has ensured better survival for the elderly population also. The aim of this study was to determine the clinical outcomes in elderly patients undergoing kidney transplantation.Materials and Methods:A retrospective analysis of 1150 patients who had undergone live related renal transplantation was done from January 2006 to December 2014. These patients were divided into two groups; Group 1: age >60 years (N = 150), Group 2: age 18–60 years (N = 1000). The clinical outcomes were compared.Results:The mean age in Group 1 was 69 ± 7.5 years (SD ± 7.5), and group 2 was 41 ± 8 years. In groups 1 and 2, males were 80% and 82%; death censored graft survival at 5 years was 82% and 87%; patient survival at 5 years was 86% and 94%, respectively. The incidence of biopsy-proven acute rejection was similar in both groups (11.3 vs. 10.2%, P = 0.12). Urinary tract infection was the most common infectious complication. Sepsis was the primary cause of death in both groups.Conclusion:In the elderly patients who underwent kidney transplantation, satisfactory graft function, and patient survival were maintained over a period of 60 months. Urinary tract infections were common, and sepsis was the most common cause of death with a surviving allograft. The acute rejection and mortality rates were comparable to the literature published from India so far.

Normothermic Machine Preservation of Marginal Livers in Australasia - Initial Brisbane Experience Using a “Back-to-Base” Approach

Introduction: The assessment of marginal liver suitability using empirical criteria remains imprecise. Ex-vivo normothermic machine perfusion (NMP) allows for a period of graft assessment under near-physiological conditions, which might improve the selection of such livers for transplantation. We describe the first 11 clinical applications of NMP in Australasia using a “back-to-base” approach. Methods: Eleven marginal livers were accepted for preservation and assessment on the OrganOx metra device following a period of static cold storage (post-SCS-NMP). Average donor risk index was 1.53 (1.08-1.93), with five grafts donated after brain death (DBD) and six donated after circulatory death (DCD). All DCD grafts were outside of established local criteria. Average cold ischaemic time and NMP time was 5.2 (4.2-6.5) hours and 12.0 (9.1-17.6) hours respectively. Recipient MELD score was 17 (11-20), including one combined liver-kidney transplant and one re-transplant. Results: All livers met pre-established viability criteria and were successfully transplanted. Five (45%) recipients developed early allograft dysfunction based solely on peak AST >2000 U/L (average 1860 (629-8910) U/L, Figure 1). Two patients (18%) required revisional surgery for biliary anastomotic complications following initial Roux-en-Y hepaticojejunostomy. No clinically significant biliary problems were observed in the nine patients receiving duct-to-duct anastomosis. All cases have satisfactory graft function to date. Conclusions: Post-SCS NMP was successfully implemented in 11 cases, enabling the safe utilisation of grafts deemed non-transplantable using static cold storage preservation alone. The technique was user friendly, improved transplant logistics and surgeon confidence, and increased local transplant activity by 10%.

Dynamics of minor T-lymphocyte subpopulations in patients undergoing kidney transplantation

Objective: to study the dynamics of the indicators of CD3+CD4+CD8+double-positive and CD3+CD4-CD8- double-negative T-lymphocytes in patients who underwent kidney transplantation. Material and methods. Three groups were formed out of 197 allograft recipients. PGF group consisted of patients with primary satisfactory graft function. PGD group - with primary graft dysfunction. GR group - with primary graft dysfunction and histologically confirmed graft rejection. We studied the CD3+CD4+CD8+ (DP) and CD3+CD4-CD8- (DN) T-lymphocyte levels before the transplantation, and on the 1st, 3rd, 7th, 30th, and 90th days after the transplantation. Results. Within a month after the transplantation we noted a decrease in the relative DN T-lymphocyte level in the PGF group, while in the PGD and GR groups this indicator significantly increased. By the 90th day, the count of DN T-lymphocytes had remained unchanged in the PGD group, while there had been a statistically significant increase of this subpopulation in the PGF group. The absolute counts of DN T-lymphocytes in the PGF group on the 1st and 7th days were lower than in the GR group. On the 90th day, there was no statistically significant difference in the absolute number of DN T-lymphocytes in the recipient groups. In all the groups, there was a decrease in the number of DP T-lymphocytes on the 1st day, however, in the PGF group, the relative level was significantly higher. This tendency retained for 3 months. There were no statistically significant differences between the PGD and GR groups. The absolute number of DP T-lymphocytes in the PGF group during the entire observation period was significantly higher than in the PGD and GR groups. Conclusion. We noted a decrease in the indicators of DN T-lymphocytes in the PGF group associated with the increase in the DP T-lymphocyte level within the first three months. In the PGD and GR groups, an increase in the DN T-lymphocyte level was revealed due to a decrease in the indicators of DP T-lymphocytes within 90 days after transplantation.

Indicators of monocyte-derived component of the immune system in patients with satisfactory renal graft function

Objective: to study the indicators of the monocyte-derived component of the immune system in kidney transplant recipients with satisfactory early and delayed renal transplant function. Materials and methods. The study involved 76 kidney transplant recipients. Concentrations of serum creatinine (sCr), serum urea (sUr) and serum cystatin C (sCysC) were measured. CD14+mid/high and CD14+low were isolated from CD14+ monocytes. CD64- and CD86-expressing cell counts were determined for each subpopulation. Immunological examination was performed before surgery, as well as at days 1, 3, 7, 30, 90, 180 and 360 after surgery. Results. There was significant imbalance between the two monocyte subpopulations before transplantation and in the early post-transplant period (first 3 months). By the end of a 6-month follow-up period, the percentage of CD14+ cells had normalized. The dynamics of the subclasses of CD86-expressing monocytes in the post-transplant period is somewhat different from the dynamics of the total count for these monocytes. However, by the end of a 6-month follow-up period, these biomarkers returned to normal for the group of healthy individuals (CD14+mid/highCD86+ p180 = 0.079; CD14+lowCD86+ p180 = 0.789). CD14+lowCD64+ level was significantly higher in the kidney transplant group than in the control group during the entire follow-up period (p0 = 0.0006, p1 = 0.0001, p7 = 0.005, p30 = 0.005, p90 = 0.007, p180 = 0.0002, p360 = 0.001). On the other hand, CD14+mid/highCD64+ count for up to 180 days was not significantly different from that of the control group (p0 = 0.561, p1 = 0.632, p7 = 0.874, p30 = 0.926, p90 = 0.912), with subsequent significant increase by day 360 of follow-up (p180 = 0.01, p360 = 0.003). We observed a negative correlation between CD14+lowCD86+ level at day 0 and sCr levels at day 7 (r = –0.4; p = 0.008) and day 360 (r = –0.34; p = 0.042) and sCysC level at day 7 (r = –0.57; p = 0.014). A negative correlation was also found between CD14+lowCD86+ at day 1 and sCr levels at day 7 (r = –0.4; p = 0.005) and day 360 (r = –0.39; p = 0.02). There was positive correlation between the CD14+lowCD64+ subpopulation index at day 0 and sCr (r = 0.54; p = 0.008) and sCysC (r = 0.6; p = 0.008) levels at day 7, and also between the CD14+lowCD64+ count at day 1 and sCr (r = 0.55; p < 0.0001) and sCysC (r = 0.58; p = 0.004) levels at day 7. CD14+mid/highCD64+ at day 0 negatively correlated with sCysC level at day 360 (r = –0.85; p = 0.015), while CD14+mid/highCD64+ at day 7 positively correlated with sCysC level at day 360 (r = 0.50; p = 0.016). Conclusion. Before transplant surgery, CD14+mid/high, CD14+mid/highCD86+ , and CD14+lowCD86+ counts were reduced, while those of CD14+low, CD14+mid/highCD64+ and CD14+lowCD64+ were increased. By the 6-month follow-up, all these subpopulations except CD14+mid/highCD64+ had reached values for healthy people. Positive correlation between CD14+mid/high, CD14+lowCD64+ , CD14+mid/highCD86+ , CD14+mid/highCD64+ counts in the early post-transplant period and sCr/sCysC levels in long-term follow-up, as well as negative correlation between CD14+low, CD14+lowCD86+ counts in the early post-transplant period and sCr/sCysC levels in long-term follow-up can serve as a predictor of renal graft function.

Long-term Results of Kidney Transplantation: Analysis of Selected Factors

BackgroundKidney transplantation is considered the most effective method of treating patients with end-stage renal disease. Despite continuous improvement of short-term outcomes, progression of long-term results is minimal. MethodsThe retrospective cohort study included 45 patients (24 women and 21 men). Terms of qualification for the study were time after kidney transplantation: minimum 25 years and satisfactory graft function. Medical documentation was analyzed from which specific laboratory parameters, information about transplantation procedure, and clinical data were selected. ResultsThe average time since transplantation in the study group was 30 years. Chronic glomerulonephritis was a major cause that led to end-stage renal disease among the study group. The average age of the respondents was 62 years ± 8.5 years. The average time patients had hemodialysis procedures lasted 30 months. Current estimated glomerular filtration rate (eGFR) concentration was correlated with level of creatinine measured 10 years after transplantation and current hemoglobin level (r = 0.447, P = .003, r = 0.586 P < .001). No statistically significant differences were noted in the eGFR level, depending on the current age of recipients (t = 0.511, P = .612), total ischemia time (Z = 0.334, P = .729), or hemodialysis duration (t = -1.944, P = .058). ConclusionsThe presented study emphasizes the impact of graft function on hemoglobin level and the predictive role of the creatinine measured 10 years after transplantation for long-term renal outcomes. Continuing research will enrich the knowledge about long-term care and treatment for patients after kidney transplantation.

Fatal progression of squamous cell carcinoma 10 years after cadaveric kidney transplantation

Various research has shown that non-melanocytic malignant skin lesion is one of the most common post-kidney transplant neoplasms. Multiple lesions and a more aggressive clinical course are more common in kidney transplant patients than in the general population. This paper presents a case of malignant skin neoplasms in a patient 10 years after cadaveric kidney transplantation. The patient received standard 3-component immunosuppression with satisfactory graft function (serum creatinine level remained at 157–178 μmol/L). Scalp neoplasm was removed. Histological examination revealed a morphological picture characteristic of basal cell carcinoma with squamous differentiation. Subsequently, a relapse of the skin neoplasm of the temporal region, as well as new lesions in the frontal region and the skin of the anterior chest wall, were discovered. Despite surgical treatment and close-focus x-ray radiation, the disease rapidly progressed and eventually led to death. Squamous cell carcinoma can progress very rapidly in patients after solid organ transplantation, despite ongoing combination treatment. Perhaps in such cases, it is worth cancelling immunosuppressive therapy completely and removing the kidney graft in order to control progression of the malignant tumor process.

Research of subpopulation CD3+ CD4- CD8- double-negative T lymphocytes in kidney transplant recipients

Introduction. CD3+CD4- CD8- cells represent one of the subpopulations of T-regulatory lymphocytes. According to literature reports, an increase in the content of graft-infiltrating CD3+CD4- CD8- T cells was detected in the heart xenograft tissues of an experimental model with a long-term graft survival. The efficacy of CD3+CD4- CD8- infusion to induce skin graft tolerance was described. Some studies have shown that a decrease in CD3+CD4- CD8- content in peripheral blood of patients undergoing to hematopoietic stem cell transplantation was associated with the development of a graft-versus-host reaction.Objectives. To study changes in the values of CD3+CD4- CD8- double-negative T lymphocytes in peripheral blood in kidney transplant recipients.Material and methods. The study included 165 recipients who underwent kidney transplantation. The creatinine and urea concentrations in blood were determined before surgery, on day 7, and day 360 after transplantation. The content of CD3+CD4- CD8- lymphocytes was studied before surgery, on the 3rd, 7th, 30th, 90th, 180th and 360th days after surgery. Early graft function was assessed on day 7 after transplantation. The function was defined as a primary one at creatinine levels below 300 μmol/L. The graft dysfunction was defined as creatinine values equal to or greater than 300 μmol/L and the need for dialysis in the first week after surgery. The satisfactory graft function after a year was characterized by the blood creatinine level below 150 μmol/L, absent episodes of graft rejection, and no need for dialysis in the first year of follow-up. There were 4 groups of recipients formed. The first group included patients with the primary graft function and satisfactory late graft function. The second group included patients with the primary function and late graft dysfunction. The third group included patients with the primary dysfunction and late satisfactory function. The fourth group included patients with the primary and late graft dysfunction.Results. In the first and second groups, there were no significant differences in the blood level of CD3+CD4- CD8- during the year. After a year, a significant CD3+CD4- CD8- decrease was noted in the group with late graft dysfunction. A similar tendency was revealed in the third and fourth groups. In the fourth group (with late graft dysfunction), the level of CD3+CD4- CD8- was significantly lower only after a year of observation compared with the levels in the third group. A negative correlation was noted between the CD3+CD4- CD8- values and the creatinine and urea levels. Thus, high CD3+CD4- CD8- values in kidney transplant recipients after a year were associated with a satisfactory graft function.Conclusions. 1. A stable 1-year satisfactory kidney graft function is characterized by an increase in the blood level of CD3+CD4- CD8- T lymphocytes. 2. A kidney graft dysfunction in the late post-transplant period is characterized by a decrease in the blood level of CD3+CD4- CD8- T lymphocytes.Authors declare no conflict of interest.

УРОВЕНЬ ДЕНДРИТНЫХ КЛЕТОК У РЕЦИПИЕНТОВ ПОЧЕЧНОГО ТРАНСПЛАНТАТА В РАННЕМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ

Background. Dendritic cells (DC) regulate innate and adaptive immunity and play an important role in the development of tolerance or rejection of the donor organ. Objective. To study the level of dendritic cells in patients after kidney transplantation in the early postoperative period, depending on the functional activity of the donor organ. Material and Methods. Kidney transplantation was performed in 197 recipients. The level of dendritic cells was determined on days 0, 1, 3 and 7 after transplantation. The patients were divided into groups: PGF – those with satisfactory primary graft function, PGD – those with primary graft dysfunction, TR – those with transplant rejection in the postoperative period. The comparison group (CG) consisted of healthy volunteers. Results. Before transplantation, the relative DC level in the PGF group significantly exceeded this indicator in the comparison group. DC level in the PGD and TR groups didn’t differ from the value in the comparison group. The absolute amount of DC in the comparison group was significantly higher than in the PGF group, and there were no differences with the PGD and TR groups. On day 3, the relative amount of DC decreased significantly in the PGF and PGD groups, but there was noted an increase in the TR group. On day 7 in the PGF group there was a significant increase in the DC level, in the PGD group there were no changes, in the TR group there was a significant decrease compared with the PGF and PGD groups. The absolute DC values in the TR and PGD groups were gradually decreasing during 7 days, but in the TR group the decrease was more pronounced. Conclusions. Studying the level of dendritic cells in patients after kidney transplantation makes it possible to predict the nature of the course of the early postoperative period.

The role of mineral and bone disorders in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus of long duration

AimsThe objective of our study was to evaluate the role of mineral and bone metabolism disorders associated with chronic kidney disease (MBD-CKD) in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus (T1DM) of long duration. MethodsWe investigated 96 patients with T1DM of long duration, with CKD at different stages (0–5), including patients on hemodialysis (HD) and with kidney transplantation (KT). Along with overall clinical examination, we assessed markers of MBD (calcium, phosphorus, parathormone, vitamin D, fibroblast growth factor (FGF) 23) and levels of cardiac injury marker (atrial natriuretic peptide, NT-proBNP). Multispiral computer tomography with Agatston index calculation was also included. ResultsDecreased kidney function was associated with increased of levels phosphorus, parathormone, FGF 23, and vitamin D deficiency, with the highest deviation from the reference ranges seen in patients on HD with a very high risk of cardiovascular events. In KT patients with satisfactory graft function, these parameters were at the same levels as in patients with CKD stages 0–4. Progression of cardiovascular pathology was accompanied by elevation of NT-proBNP levels as CKD duration increased, decreased glomerular filtration rate, and were correlated with the main parameters of mineral homeostasis. The severity of coronary arteries calcification was associated with patient age and duration of T1DM and arterial hypertension. ConclusionsDevelopment and progression of kidney dysfunction is accompanied by MBD, a significant factor in progression of cardiac pathology, which remains a major cause of mortality in this patient population.

Preservation Solution Effluent Osmolality as a Predictor of Initial Kidney Transplant Dysfunction.

The aim of this study was to identify new predictors of kidney graft primary dysfunction from results of metabolic, electrolyte composition, and preservation solution effluent osmolality analyses of kidneys from deceased donors. Samples of left renal veins in Custodiol preservation solution (produced by Dr. F. Kohler, Chemie, Bensheim, Germany) from kidney explants and from back table surgical procedures were obtained from 55 deceased donors. We compared metabolic parameters (glucose and lactate levels), electrolyte composition (potassium, sodium, calcium, chlorine), and effluent osmolality of kidney samples from donors whose recipients had satisfactory initial graft function (n = 44) and dysfunction (n = 22). Values are shown as median and interquartile ranges between the 25th and 75th percentiles. We used the Mann-Whitney U test to compare quantitative variables. Statistically significant differences were observed in effluent osmolality results between kidneys that resulted in satisfactory graft function (median, 85; interquartile range, 65.5-97.1) and those that did not result in satisfactory graft function (median, 103.25; interquartile range, 78.7-125.75) (P = .045). We also observed a trend toward significance in sodium ion levels (P = .073) and lactate levels (P = .09). No statistically significant differences were shown in samples obtained from the back table surgical procedure. As a predictor of an initially satisfactory functioning deceased-donor kidney graft, it is possible to use the level of osmolality in Custodiol solution effluent obtained at explant.

Donor kidney glomerular filtration rate and donor/recipient body surface area ratio influence graft function in living related kidney transplantation

Objective: This study seeks to account for the possibility that single kidney glomerular filtration rate (SKGFR) and donor/recipient (D/R) body surface area (BSA) ratio could act as cofactors for evaluating potential living related donors. Methods: The study population included 204 cases of LKRs with a functional graft that were regularly followed up for more than 2 years. Based on SKGFR and D/R BSA ratio, the recipients were divided into six groups: group A (SKGFR < 40 mL/min, D/R BSA ratio ≤ 0.8), group B (SKGFR < 40 mL/min, 0.8 < D/R BSA ratio < 1.2), group C (SKGFR < 40 mL/min, D/R BSA ratio ≥ 1.2), group D (SKGFR ≥ 40 mL/min, D/R BSA ratio ≤ 0.8), group E (SKGFR ≥ 40 mL/min, 0.8 < D/R BSA ratio < 1.2), and group F (SKGFR ≥ 40 mL/min, D/R BSA ratio ≥ 1.2). The database included donor, recipient, and transplant variables. Renal function of the recipients was recorded at 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, and 24 months post-transplantation, respectively. Results: The declining rate of SCr and graft eGFR in stable periods post-transplantation in group A were always worse than the other five groups, and the difference was statistically significant (p < 0.05). The declining rate of SCr and graft eGFR in stable periods post-transplantation in groups C and F were always better than the other four groups, and the difference was statistically significant (p < 0.05). Conclusions: Both SKGFR and D/R BSA ratio should be considered for choosing potential living related donors. Donors with SKGFR < 40 mL/min and D/R BSA ratio ≤ 0.8 should be carefully selected. Satisfactory graft function in donors with SKGFR < 40 ml could be achieved if their D/R BSA ratio is >0.8.

High Serum Level of β2-Microglobulin in Late Posttransplant Period Predicts Subsequent Decline in Kidney Allograft Function: A Preliminary Study.

Background. Identification of patients at risk for kidney allograft (KAG) failure beyond the first posttransplant year is an unmet need. We aimed to determine whether serum beta-2-microglobulin (β2MG) in the late posttransplant period could predict a decline in KAG function. Methods. We assessed a value of single measurement of serum β2MG at one to seventeen years after transplantation in predicting the estimated glomerular filtration rate (eGFR) and the decline in eGFR over a period of two years in 79 recipients of KAG. Results. At baseline serum β2MG concentration was higher (P = 0.011) in patients with allograft dysfunction: 8.67 ± 2.48 µg/mL versus those with satisfactory graft function: 6.67 ± 2.13 µg/mL. Higher β2MG independently predicted the lower eGFR, the drop in eGFR by ≥25% after one and two years, and the value of negative eGFR slope. When combined with proteinuria and acute rejection, serum β2MG had excellent power in predicting certain drop in eGFR after one year (AUC = 0.910). In conjunction with posttransplant time serum β2MG had good accuracy in predicting certain eGFR drop after two years (AUC = 0.821). Conclusions. Elevated serum β2MG in the late posttransplant period is useful in identifying patients at risk for rapid loss of graft function.

Multivisceral Transplantation for Abdominal Malignancy: A Single Center Experience.

Introduction: Standard management of intra-abdominal pediatric solid tumors requires complete resection. However, tumors with multiple organ and vascular involvement present a unique surgical challenge. We present four cases of multivisceral transplantation (MVT) for intra-abdominal malignancies with significant involvement of the visceral arteries and/or portomesenteric venous system. Methods: We conducted a retrospective chart review of patients undergoing MVT for intraabdominal malignancies at our institution. Results: We identified four patients who underwent MVT for unresectable intra-abdominal malignancies at our center. Oncologic indications for MVT included hepatocellular carcinoma (HCC), inflammatory myofibroblastic tumor, and two cases of hepatoblastoma (HB). Grafts included liver, stomach, small bowel, and pancreas in all patients, with two patients also receiving spleens, and one undergoing partial esophageal transplantation. Median age at transplantation was 5.5yrs (range 1 to 14yrs), with additional patient characteristics listed in Table 1. Median hospital stay was 81.5 days. Postoperative complications included abdominal hematoma and bowel obstruction resulting in reoperation in 2 patients, steroid responsive intestinal rejection, wound dehiscence and infection requiring washout, fungemia, seizures, chyle leak with pleural effusion, and post-transplant lymphoproliferative disease (PTLD). Time to follow-up ranges from 6 months to 6 years, with all patients having satisfactory graft function and no evidence of recurrent disease. Conclusion: Multivisceral transplantation is an effective means of providing complete resection of intra-abdominal malignancies found to have multiple organ and vascular involvement.Table: No Caption available.