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.

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 < 45 ml/min/1.73m2 (8±4.1 ng/ml, 5.2±3.5 ng/ml, 3.9±1.5 ng/ml accordingly), p>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.

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.