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.

Simultaneous laparoscopic bilateral nephroureterectomy, cadaveric kidney allotransplantation and performance of vesicostomy in a patient with neurogenic bladder

We present a case of simultaneous laparoscopic bilateral nephroureterectomy, cadaveric kidney allotransplantation and performance of vesicostomy. This observation shows that patients with end-stage kidney disease, primarily caused by neurogenic bladder dysfunction, can be successfully treated via surgery. The course of early postoperative period and further rehabilitation did not differ significantly from that obtainable after standard kidney allotransplantation.

Analytical review of 10-year work of intensive care unit of Moscow’s Municipal Clinical Hospital No. 52

The intensive care unit for nephrological patients is the first such intensive care unit in the Russian Federation and is unique in its specificity. The main task of the ICU department No. 2 is to provide an intensive care complex aimed at restoring and maintaining the vital functions of organs and systems in patients with kidney diseases of various origins, as well as in patients after kidney allotransplantation. The department is equipped with the most advanced equipment for the treatment of multi-organ pathology, including therapeutic plasma exchange, therapeutic plasmapheresis and double cascade plasma filtration.

MANAGEMENT OF PREGNANCY AND LABOUR AFTER KIDNEY TRANSPLANTATION: CLINICAL CASE

Aim. To present a clinical case of pregnancy and childbirth in a woman with a kidney transplant with a favourable outcome for the mother and the fetus. Materials and methods. We studied all medical documents — the pregnancy record, observations and delivery record — of a woman with a transplanted kidney. Clinical case. The article describes the clinical observation of a pregnant woman, who is intended for continuous immunosuppressive therapy after the operation on cadaveric kidney allotransplantation. Conclusion. Pregnancy management in patients with a transplanted kidney should be carried out under the supervision of an obstetrician-gynecologist, nephrologist and urologist, as well as under the permanent clinical and laboratory monitoring of all indicators of the mother’s body (blood and urine tests, blood pressure control) and the fetus (ultrasound, Doppler). This category of patients belongs to a high-risk group in terms of complications for the mother and fetus.