Introduction. Expanding donation criteria is one way of solving the problem of the increasing need of transplantation. The article is dedicated to comparison of the outcomes of first and second repeated kidney transplantation using grafts from standard criteria and expanded criteria donors.Aim. To evaluate 1-year and 5-year recipient and kidney graft survival rates after first and second kidney transplantation according to the donor type – standard criteria or expanded criteria donors.Material and methods. From 2007 till 2019 we performed 1459 kidney transplantations. The comparison study of outcomes of first (n=196) and second (n=143) kidney transplantations from standard criteria (n=245) and expanded criteria (n=94) donors was made.Results. There were no significant differences in a 1-year patient survival according to the donor type (98% and 95%, p=0.13). A 5-year recipient survival was significantly poorer after kidney transplantation from expanded criteria donors (97.6% and 88%, p=0.01). There were no significant differences in 1-year and 5-year graft survival rates according to the order of transplantation (p=0.21 and p=0.36). We found no significant difference in 1-year recipient survival after kidney transplantation from expanded criteria donors according to the order of transplantation (p=0.50). A 5-year recipient survival was significantly difference poorer after second kidney transplantation from expanded criteria donors (p=0.04). One-year and 5-year graft survival rates were significantly lower after kidney transplantation from expanded criteria donors (94%, 88% vs 86%, 65%, p=0.0025 and p=0.0011, respectively). One-year and 5-year survival rates were higher after first kidney transplantation from standard criteria donors in comparison with second kidney transplantation (p=0.052 and p=0.02, statistically significant in both cases). Analyzing outcomes of kidney transplantation from expanded criteria donors we found 1-year and 5-year graft survivals to be higher after first kidney transplantation comparing with second kidney transplantation (p=0.030 and p=0.018, statistically significant in both cases).Conclusion. In case of second organ transplantation, it is reasonable to use organs from standard criteria donors.
Introduction:The expansion of the criteria for donor organ retrieval contributes to an increase in the number of kidney transplantations to elderly recipients; but in view of reduced requirements to donor organ quality, a further analysis of transplantation outcomes is needed. The aim was to analyze and compare the outcomes of kidney transplantation to elderly patients depending on the donor organ quality.Material and methods.The study was based on the analysis of the kidney transplantation outcomes in 61 elderly recipients, including 51 transplantations performed from expanded criteria donors (group 1), and other 10 from standard donors (group 2). Based on clinical, laboratory, histological, and instrumental diagnostic data, we compared the graft function recovery rates, graft/recipient survival rates, the causes of graft loss in the early posttransplant period.Results:Patients of group I had significantly higher delayed graft function rates (37.3% vs. 10%), graft non-function rates (15.7% vs. 0%), and lower early posttransplant survival rates (72.5% vs. 100%). Graft function recovery rate was 58.8% in group I, and 100% in the patients of group II. The most common cause of the graft loss and the renal graft removals performed in the early posttransplant period was the poor graft quality due to the donor's existing pathology.Conclusion.The study demonstrated a statistically significant deterioration of the initial graft function, significantly increased graft non-function rates, and decreased graft survival rates in the early posttransplant period in the elderly recipients after kidney transplantation from expanded criteria donors.
Introduction.In spite of improvements in quality of life and lifetime of kidney transplant recipients the limited time of kidney transplant survival dictate the need for returning back to dialysis or repeat kidney transplantation. In respect that the need of repeat kidney transplantation usually observed in elderly recipients we attach importance in the analysis of outcomes of kidney retransplantation in patients over 60-s. Aim: to analyse the early outcomes of kidney re-transplantations in middle-aged and elderly recipients. Material and methods: the retrospective analysis of outcomes of 124 repeat kidney transplantations was made (16 transplantations in elderly recipients -Group I; 108 transplantations in recipients aged 20-59 yrs -Group II). The recovery of kidney transplants, acute rejection rates, the causes and the rate of kidney transplant dysfunction and failure, early patient's and kidney transplant' survival rates were analyzed. We used clinical, laboratory, histological and instrumental diagnostics. Results: in both groups there were no differences in kidney transplant recovery rates (p = 0,546), kidney transplant function (normal function 81,2% vs 86,1%, dysfunction 6,3% vs 4,3%, graft failure 12,5% vs 9,3% (p = 0,876), recipient 100% vs 99,1% (p = 0,34) and graft survival rates 87,5% vs 90,7% (p = 0,30). There were no episodes of acute rejection in patients of group I (0% vs 30,6% (p = 0,006). The reason of graft failure in group I -the graft's pathology (nephroangiosclerosis (12,5%), group II -intractable acute rejection (4,6%), graft's pathology (3,7%), patient's death with functioning graft (0,9%). Conclusion: there were similar recipient and graft survival rates in both groups. We observed lower acute rejection rate in patients of group I using sufficient immunosuppressive regimens.
The origin of the recipient is one of the recipient-related factors that statistically significantly affects the outcomes of kidney transplantation, but this factor is not so relevant in our country. The article presents the first experience of kidney transplantation in a patient of African descent at the N.I. N.V. Sklifosovsky.Material and methods. Allogeneic renal graft transplantation from a post-mortem donor was performed in a 60-year-old African male patient with stage 5 chronic kidney disease as a result of hypertensive nephroangiosclerosis.Results. The early postoperative period was complicated by the development of acute cellular graft rejection grade 1a-b according to Banff. Anti-crisis therapy was performed with some positive effect, however, in the late postoperative period, a loss of renal graft function was noted, and the patient was returned to renal replacement therapy with program hemodialysis.Conclusion. Patients of African ancestry are at increased risk of adverse outcomes due to immunological causes and require more careful immunological selection of a donor organ, an enhanced immunosuppressive regimen, and close monitoring after transplantation.
Introduction. Currently, the type 2 diabetes mellitus is in the nature of an epidemic of non-infectious etiology. In this regard, the incidence of diabetes mellitus complications, including diabetic nephropathy, which lead to end-stage chronic renal disease, is also increasing. The treatment of type 2 diabetic patients with end-stage chronic renal disease presents significant difficulties, which is associated with an additional risk of developing infectious complications and, as a rule, the presence of concomitant pathology of the cardiovascular system.Objective. To analyze the results of kidney transplantation in elderly patients with diabetes mellitus in the early postoperative period.Material and methods. The study is based on a retrospective analysis of the results of 77 kidney transplants ations performed to elderly recipients at N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2015 to 2019. The study group included 22 recipients over 60 years old with type 2 diabetes mellitus, as main or concomitant disease. The comparison group consisted of 55 recipients over 60 years without diabetes.Results. Survival of recipients with type 2 diabetes mellitus was significantly lower (p = 0.026). So, there were 20 surviving recipients (90.9%) in the group of patients with type 2 diabetes mellitus, and 55 (100%) surviving recipients in the group without diabetes. When comparing the kidney graft survival rates in the recipients between the two groups, no statistically significant difference (p = 0.29) was found. The overall graft survival was 77.3% (n = 17) in the group of recipients with type 2 diabetes mellitus, and 89.1% (n = 49) in the comparison group.Conclusions. It has been proven that kidney transplant recipients with type 2 diabetes mellitus have a significantly lower survival rate after transplantation than recipients without diabetes; and the kidney graft survivals were not significantly different early after transplantation. The recipients did not show differences in the recovery of the transplanted kidney function depending on the presence of type 2 diabetes mellitus.Authors declare no conflict of interest.
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