Pub Date : 2023-04-08DOI: 10.15825/1995-1191-2023-1-68-76
V. L. Korobka, V. Pasechnikov, R. V. Korobka, E. Pak, A. M. Shapovalov, D. Pasechnikov
Objective: to determine the efficacy of non-selective beta-blockers (NSBBs) in the primary prevention of bleeding esophageal varices and to assess their impact on the survival of patients with ascites enrolled in the liver transplant waiting list (LTWL).Materials and methods. We carried out a retrospective comparative study of cirrhotic patients with severe ascites and esophageal varices without bleeding before enrollment in the LTWL. Primary prophylaxis of variceal bleeding included the use of NSBBs (n = 97, group 1). These drugs were not used in the other patients (n = 91, group 2).Results. There were no significant differences between the groups in terms of clinical, laboratory and demographic parameters, MELD scores and Child-Turcotte-Pugh (CTP) classes for cirrhosis. Patient groups included in the study had no significant differences with respect to incidence of medium- and large-sized varices and incidence of severe ascites. Bleeding incidence was significantly lower in the NSBBs group than in the non-NSBBs group (52.6% and 95.6%, respectively, p = 0.0001).Conclusion. NSBBs constitute an efficacious therapy in primary prophylaxis of esophageal variceal bleeding, thereby saving life and preventing delisting of patients with ascites from the LTWL.
{"title":"Nonselective beta-blockers in primary prophylaxis of esophageal variceal bleeding in patients with ascites waitlisted for liver transplantation","authors":"V. L. Korobka, V. Pasechnikov, R. V. Korobka, E. Pak, A. M. Shapovalov, D. Pasechnikov","doi":"10.15825/1995-1191-2023-1-68-76","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-68-76","url":null,"abstract":"Objective: to determine the efficacy of non-selective beta-blockers (NSBBs) in the primary prevention of bleeding esophageal varices and to assess their impact on the survival of patients with ascites enrolled in the liver transplant waiting list (LTWL).Materials and methods. We carried out a retrospective comparative study of cirrhotic patients with severe ascites and esophageal varices without bleeding before enrollment in the LTWL. Primary prophylaxis of variceal bleeding included the use of NSBBs (n = 97, group 1). These drugs were not used in the other patients (n = 91, group 2).Results. There were no significant differences between the groups in terms of clinical, laboratory and demographic parameters, MELD scores and Child-Turcotte-Pugh (CTP) classes for cirrhosis. Patient groups included in the study had no significant differences with respect to incidence of medium- and large-sized varices and incidence of severe ascites. Bleeding incidence was significantly lower in the NSBBs group than in the non-NSBBs group (52.6% and 95.6%, respectively, p = 0.0001).Conclusion. NSBBs constitute an efficacious therapy in primary prophylaxis of esophageal variceal bleeding, thereby saving life and preventing delisting of patients with ascites from the LTWL.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89802942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-08DOI: 10.15825/1995-1191-2023-1-43-46
R. Trushkin, L. Artyukhina, T. K. Isaev, P. E. Medvedev, O. S. Shevcov, T. M. Klementeva
This paper presents a clinical case of laparoscopic nephrectomy for a large (10 cm) renal sinus mass in an allograft kidney, followed by intrarenal urinary tract reconstruction with ureteral reimplantation. The surgery had an acceptable oncological outcome, without loss of kidney function. Regardless of the volume and extent of the tumor process, the use of minimally invasive, nephron-sparing treatment techniques takes a leading position in the treatment of renal cancer in kidney recipients. Intrarenal urinary tract reconstruction allows a kidney to be saved even if the tumor is significantly large and/or inoperable.
{"title":"Laparoscopic partial nephrectomy in allograft kidney followed by intrarenal urinary tract reconstruction and ureteral reimplantation (clinical report)","authors":"R. Trushkin, L. Artyukhina, T. K. Isaev, P. E. Medvedev, O. S. Shevcov, T. M. Klementeva","doi":"10.15825/1995-1191-2023-1-43-46","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-43-46","url":null,"abstract":"This paper presents a clinical case of laparoscopic nephrectomy for a large (10 cm) renal sinus mass in an allograft kidney, followed by intrarenal urinary tract reconstruction with ureteral reimplantation. The surgery had an acceptable oncological outcome, without loss of kidney function. Regardless of the volume and extent of the tumor process, the use of minimally invasive, nephron-sparing treatment techniques takes a leading position in the treatment of renal cancer in kidney recipients. Intrarenal urinary tract reconstruction allows a kidney to be saved even if the tumor is significantly large and/or inoperable.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83122799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-08DOI: 10.15825/1995-1191-2023-1-47-51
K. Tayler, S. R. Galeev
The paper presents a clinical case of successful kidney transplantation (KTx) in a patient with end-stage chronic kidney disease (ESKD) resulting from familial Mediterranean fever (FMF). Pre-transplant preparation and posttransplant management tactics are presented. The authors conclude that ESKD can be effectively treated by KTx in a patient with FMF against the background of ongoing pathogenetic therapy in autoinflammation.
{"title":"Kidney transplantation in a patient with familial mediterranean fever complicated by secondary amyloidosis (clinical report)","authors":"K. Tayler, S. R. Galeev","doi":"10.15825/1995-1191-2023-1-47-51","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-47-51","url":null,"abstract":"The paper presents a clinical case of successful kidney transplantation (KTx) in a patient with end-stage chronic kidney disease (ESKD) resulting from familial Mediterranean fever (FMF). Pre-transplant preparation and posttransplant management tactics are presented. The authors conclude that ESKD can be effectively treated by KTx in a patient with FMF against the background of ongoing pathogenetic therapy in autoinflammation.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77436842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-08DOI: 10.15825/1995-1191-2023-1-106-112
A. Buchnev, A. P. Kuleshov, O. Y. Esipova, A. Drobyshev, N. V. Grudinin
Objective: to investigate the efficiency of a device that generates pulsatile flow during constant-speed axial-flow pump operation for use in left ventricular assist devices.Materials and methods. The pulsatile flow-generating device, hereinafter referred to as «pulsator», consists of a variable hydraulic resistance made in the form of a hull. A tube of elastic biocompatible material featuring an inner diameter of 11 mm is installed inside it. In the systolic phase of the left ventricle, due to systolic pressure, the elastic tube is fully opened, minimizing resistance to blood ejection. In the diastolic phase, due to suction action of the flow pump operating in constant revolutions, the elastic tube partially closes, creating additional hydraulic resistance to blood flow, which leads to reduced diastolic aortic pressure. Comparative assessment of axial-flow pump operation in pulsating and non-pulsating modes was carried out on a hydrodynamic stand that simulated the cardiovascular system. The following indices were calculated: arterial pressure pulsation (Ip), in-pump flow pulsation (AQ), energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE).Results. When comparing axial-flow pump operation in pulsatile and continuous mode, arterial pressure pulsation index, in-pump pulsation index, and SHE index increased by 2.13 ± 0.2, 3.2 ± 0.2, and 2.7 ± 0.15 times, respectively, while EER index remained unchanged.
{"title":"Hemodynamic evaluation of pulsatile-flow generating device in left ventricular assist devices","authors":"A. Buchnev, A. P. Kuleshov, O. Y. Esipova, A. Drobyshev, N. V. Grudinin","doi":"10.15825/1995-1191-2023-1-106-112","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-106-112","url":null,"abstract":"Objective: to investigate the efficiency of a device that generates pulsatile flow during constant-speed axial-flow pump operation for use in left ventricular assist devices.Materials and methods. The pulsatile flow-generating device, hereinafter referred to as «pulsator», consists of a variable hydraulic resistance made in the form of a hull. A tube of elastic biocompatible material featuring an inner diameter of 11 mm is installed inside it. In the systolic phase of the left ventricle, due to systolic pressure, the elastic tube is fully opened, minimizing resistance to blood ejection. In the diastolic phase, due to suction action of the flow pump operating in constant revolutions, the elastic tube partially closes, creating additional hydraulic resistance to blood flow, which leads to reduced diastolic aortic pressure. Comparative assessment of axial-flow pump operation in pulsating and non-pulsating modes was carried out on a hydrodynamic stand that simulated the cardiovascular system. The following indices were calculated: arterial pressure pulsation (Ip), in-pump flow pulsation (AQ), energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE).Results. When comparing axial-flow pump operation in pulsatile and continuous mode, arterial pressure pulsation index, in-pump pulsation index, and SHE index increased by 2.13 ± 0.2, 3.2 ± 0.2, and 2.7 ± 0.15 times, respectively, while EER index remained unchanged.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79191033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-08DOI: 10.15825/1995-1191-2023-1-52-61
Objective: to develop a personalized algorithm for extended-release tacrolimus in kidney recipients and to analyze its early outcomes in comparison with a retrospective control group.Materials and methods. The first (I) control group «Standard Protocol» included 228 patients operated on at Botkin City Clinical Hospital from June 2018 to November 2021; tacrolimus was administered postoperatively in a starting standard dosage of 0.2 mg/kg. The second group (II) consisted of 75 patients operated from December 2021 to November 2022, whose postoperative treatment involved a personalized extended-release tacrolimus dosing protocol. Induction immunosuppression was similar in both groups. The target tacrolimus level in the early postoperative period was considered to be 10-12 ng/ml for all patients. The comparison criteria included incidence of Over-immunosuppression (tacrolimus C0 >15 ng/ml), incidence of acute rejection and infectious complications in the first month after surgery, incidence and duration of delayed graft function (DGF), and length of stay at the hospital.Results. Over-immunosuppression was statistically significantly lower in the personalized protocol group, with 36.7% in group I and 87.5% in group II (p < 0.001). There was also a lower incidence of early infectious complications in group II: 5.4% vs. 13.2%, however, without reaching a level of statistical significance (p = 0.088). DGF incidence in group I and group II were 25.4% (58/228) and 22.7% (17/75), respectively. The length of stay at the hospital in group II was also statistically significantly lower: 13 versus 19 bed days (p = 0.033). In both subgroups, no patient developed acute rejection in the first month after surgery (p = 1).Conclusion. The personalized dosing protocol that was developed for extended-release tacrolimus in kidney recipients achieves the target levels of the drug recommended for the early postoperative period with low risk of under-immunosuppression and associated acute graft rejection, with a significantly lower incidence of over-immunosuppression.
{"title":"Personalized dosing protocol for extended-release tacrolimus in kidney transplant recipients in the early postoperative period","authors":"","doi":"10.15825/1995-1191-2023-1-52-61","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-52-61","url":null,"abstract":"Objective: to develop a personalized algorithm for extended-release tacrolimus in kidney recipients and to analyze its early outcomes in comparison with a retrospective control group.Materials and methods. The first (I) control group «Standard Protocol» included 228 patients operated on at Botkin City Clinical Hospital from June 2018 to November 2021; tacrolimus was administered postoperatively in a starting standard dosage of 0.2 mg/kg. The second group (II) consisted of 75 patients operated from December 2021 to November 2022, whose postoperative treatment involved a personalized extended-release tacrolimus dosing protocol. Induction immunosuppression was similar in both groups. The target tacrolimus level in the early postoperative period was considered to be 10-12 ng/ml for all patients. The comparison criteria included incidence of Over-immunosuppression (tacrolimus C0 >15 ng/ml), incidence of acute rejection and infectious complications in the first month after surgery, incidence and duration of delayed graft function (DGF), and length of stay at the hospital.Results. Over-immunosuppression was statistically significantly lower in the personalized protocol group, with 36.7% in group I and 87.5% in group II (p < 0.001). There was also a lower incidence of early infectious complications in group II: 5.4% vs. 13.2%, however, without reaching a level of statistical significance (p = 0.088). DGF incidence in group I and group II were 25.4% (58/228) and 22.7% (17/75), respectively. The length of stay at the hospital in group II was also statistically significantly lower: 13 versus 19 bed days (p = 0.033). In both subgroups, no patient developed acute rejection in the first month after surgery (p = 1).Conclusion. The personalized dosing protocol that was developed for extended-release tacrolimus in kidney recipients achieves the target levels of the drug recommended for the early postoperative period with low risk of under-immunosuppression and associated acute graft rejection, with a significantly lower incidence of over-immunosuppression.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90058825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.15825/1995-1191-2023-1-31-37
V. S. Dayneko, A. V. Osipov, O. Reznik, S. A. Platonov, M. A. Kiselev, M. I. Safoev, A. V. Sviatnenko, I. V. Ulyankina, I. Loginov, D. Kuzmin, V. Savello, V. Kravchuk, A. Demko, D. Kandyba, V. Manukovsky
Hepatic artery thrombosis (HAT) following liver transplantation (LT) is a severe life-threatening complication that can lead to graft loss and mortality after LT. According to different reports, HAT incidence ranges from 2% to 9%. Modern endovascular and radiosurgical techniques allow for minimally invasive liver graft revascularization. Nonetheless, a major consequence of even a successful revascularization is ischemic cholangiopathy, which can lead to ischemic biliary strictures and anastomotic leak. The paper presents a clinical case of long-term complex treatment of combined complications of LT using minimally invasive endovascular and endoscopic techniques.
{"title":"Clinical case of staged treatment of combined complications of orthotopic liver transplantation","authors":"V. S. Dayneko, A. V. Osipov, O. Reznik, S. A. Platonov, M. A. Kiselev, M. I. Safoev, A. V. Sviatnenko, I. V. Ulyankina, I. Loginov, D. Kuzmin, V. Savello, V. Kravchuk, A. Demko, D. Kandyba, V. Manukovsky","doi":"10.15825/1995-1191-2023-1-31-37","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-31-37","url":null,"abstract":"Hepatic artery thrombosis (HAT) following liver transplantation (LT) is a severe life-threatening complication that can lead to graft loss and mortality after LT. According to different reports, HAT incidence ranges from 2% to 9%. Modern endovascular and radiosurgical techniques allow for minimally invasive liver graft revascularization. Nonetheless, a major consequence of even a successful revascularization is ischemic cholangiopathy, which can lead to ischemic biliary strictures and anastomotic leak. The paper presents a clinical case of long-term complex treatment of combined complications of LT using minimally invasive endovascular and endoscopic techniques.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83421304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.15825/1995-1191-2023-1-38-42
Kidney transplantation (KT) is regarded as the most effective therapeutic approach for people with end-stage renal disease. However, for a number of reasons - constant increase in the incidence of diseases contributing to formation and development of chronic kidney disease, as well as continuing shortage of donor organs - 78-95% of patients in need of a kidney transplant do not receive the necessary treatment, and the waiting list stretches for several years. This paper presents the first outcomes of KT for chronic glomerulonephritis performed at St. Luke’s Clinical Hospital in St. Petersburg, in collaboration with the staff of Shumakov National Medical Research Center of Transplantology and Artificial Organs.
{"title":"Living-related kidney transplantation: first experience at St. Luke’s Clinical Hospital","authors":"","doi":"10.15825/1995-1191-2023-1-38-42","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-38-42","url":null,"abstract":"Kidney transplantation (KT) is regarded as the most effective therapeutic approach for people with end-stage renal disease. However, for a number of reasons - constant increase in the incidence of diseases contributing to formation and development of chronic kidney disease, as well as continuing shortage of donor organs - 78-95% of patients in need of a kidney transplant do not receive the necessary treatment, and the waiting list stretches for several years. This paper presents the first outcomes of KT for chronic glomerulonephritis performed at St. Luke’s Clinical Hospital in St. Petersburg, in collaboration with the staff of Shumakov National Medical Research Center of Transplantology and Artificial Organs.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72794755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.15825/1995-1191-2023-1-15-23
V. V. Borovik, I. I. Tileubergenov, O. Gerasimova, D. Granov
Objective: to study the causes of graft loss and indications for repeat liver transplantation (rLT).Materials and Methods. We studied the experience garnered from 250 orthotopic full-size cadaveric liver transplantations in 228 patients from 1998 to 2021. The severity of the patient’s condition at the time of intervention was estimated according to the MELD scale. Repeat surgeries were performed in 22 cases in 19 patients (analyzed group).Results. Organ preservation parameters, length of stay in intensive care unit (ICU), severity of postoperative complications in primary transplantations in general and in the analyzed group did not differ significantly. The main causes of graft loss were graft arterial insufficiency (57.9%) and hepatic artery thrombosis (21%). Severe early allograft dysfunction (EAD) and primary nonfunction accounted for 10.5%, portal vein thrombosis occurred in 5%, and chronic graft rejection was noted in 5% of cases.Conclusion. Arterial insufficiency is one of the leading causes of graft loss after liver transplantation. Early correction of arterial and biliary complications help in preserving graft viability.
{"title":"On indications for repeat liver transplantation","authors":"V. V. Borovik, I. I. Tileubergenov, O. Gerasimova, D. Granov","doi":"10.15825/1995-1191-2023-1-15-23","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-15-23","url":null,"abstract":"Objective: to study the causes of graft loss and indications for repeat liver transplantation (rLT).Materials and Methods. We studied the experience garnered from 250 orthotopic full-size cadaveric liver transplantations in 228 patients from 1998 to 2021. The severity of the patient’s condition at the time of intervention was estimated according to the MELD scale. Repeat surgeries were performed in 22 cases in 19 patients (analyzed group).Results. Organ preservation parameters, length of stay in intensive care unit (ICU), severity of postoperative complications in primary transplantations in general and in the analyzed group did not differ significantly. The main causes of graft loss were graft arterial insufficiency (57.9%) and hepatic artery thrombosis (21%). Severe early allograft dysfunction (EAD) and primary nonfunction accounted for 10.5%, portal vein thrombosis occurred in 5%, and chronic graft rejection was noted in 5% of cases.Conclusion. Arterial insufficiency is one of the leading causes of graft loss after liver transplantation. Early correction of arterial and biliary complications help in preserving graft viability.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86727528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.15825/1995-1191-2023-1-24-30
V. L. Korobka, R. V. Korobka, A. M. Shapovalov, M. Kostrykin, E. Pak
A clinical case of pancreas transplantation (PTx) based on an original technique is presented. The applied technique made it possible to prevent the spread and involvement of the abdominal organs in an inflammatory process caused by postoperative graft pancreatitis, and to preserve the pancreas graft.
{"title":"Original pancreas transplant teohnique in terms of prevention of intra-abdominal purulent complications","authors":"V. L. Korobka, R. V. Korobka, A. M. Shapovalov, M. Kostrykin, E. Pak","doi":"10.15825/1995-1191-2023-1-24-30","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-1-24-30","url":null,"abstract":"A clinical case of pancreas transplantation (PTx) based on an original technique is presented. The applied technique made it possible to prevent the spread and involvement of the abdominal organs in an inflammatory process caused by postoperative graft pancreatitis, and to preserve the pancreas graft.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84757491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.15825/1995-1191-2023-1-7-14
I. G. Kim, M. Lysenko, N. Frolova, L. Artyukhina, T. Buruleva, A. Nikitina, V. Vinogradov, E. Volodina, V. I. Chervinko, E. Kryukov, M. Zubkin
Therapy with neutralizing monoclonal antibodies (mAbs) is particularly relevant during COVID-19 outbreaks in patients at high risk of severe disease, including kidney transplant recipients (KTRs).Objective: to evaluate the efficacy and safety of neutralizing mAbs in KTRs with mild to moderate COVID-19.Materials and methods. The retrospective study included 99 KTRs who received inpatient treatment for COVID-19 between September 1 and December 31, 2021. Patients were 52.0 ± 11.5 years old (M, 47.5%). Bamlanivimab/etesevimab combination drug at a dose of 700/1400 mg was used as mAbs. To evaluate the efficacy of mAbs therapy, two groups of patients were identified. Group 1 consisted of 33 KTRs who received mAbs as one of the therapy components, while group 2 consisted of 66 patients who received no mAbs. Discharge from the hospital or death was considered as the endpoint of follow-up.Results. In group 1, after the use of mAb, progression of pulmonary process was observed less frequently than in the control group with CT1-2 transformation to CT3-4 (9.1% vs. 30.3%, respectively, p < 0.01). Group 1 KTRs differed significantly from group 2 - lower need for ICU and ventilator care (6.1% vs. 27.3% and 3% vs. 19.8%, respectively). The groups were comparable by sex, age, body mass index, Charlson Comorbidity Index (CCI) and time after kidney transplant (KTx) at the onset of the disease and by rnseline blood biochemistry parameter values at the time of hospitalization. Only C-reactive protein (CRP) and fibrinogen values were higher in the non-mAbs patients who were hospitalized later in the course of the disease (7.7 ± 3.2 days versus 4.6 ± 1.6 days in group 1, p < 0 .001). The frequency of prescription of other therapies did not differ between the compared groups. Use of mAbs significantly reduced mortality from 19.7% in KTRs in group 2 to 3% in group 1 without adverse effect on graft function. Conclusion. The use of mAbs therapy in the early stages of COVID-19 in KTRs is safe, it prevents severe COVID-19, and reduces the incidence of adverse outcomes.
在COVID-19暴发期间，对包括肾移植受者在内的严重疾病高风险患者，使用中和性单克隆抗体(mab)治疗尤为重要。目的:评价中和单克隆抗体治疗轻、中度新冠肺炎KTRs的疗效和安全性。材料和方法。这项回顾性研究包括了99名在2021年9月1日至12月31日期间因COVID-19住院治疗的ktr患者。年龄52.0±11.5岁(M, 47.5%)。单抗采用巴兰尼维单抗/依替西维单抗联合用药，剂量为700/1400 mg。为了评估单克隆抗体治疗的疗效，我们确定了两组患者。组1包括33名接受单克隆抗体作为治疗成分之一的ktr患者，而组2包括66名未接受单克隆抗体的患者。出院或死亡被视为随访的终点。在第1组，使用单克隆抗体后，肺过程进展的频率低于对照组，CT1-2转化为CT3-4(分别为9.1%和30.3%，p < 0.01)。1组ktr与2组有显著差异，ICU和呼吸机护理需求降低(分别为6.1% vs. 27.3%和3% vs. 19.8%)。两组在性别、年龄、体重指数、Charlson合并症指数(CCI)和发病时肾移植后时间(KTx)以及住院时的rnseline血液生化参数值方面具有可比性。在病程较晚住院的非单克隆抗体患者中，只有c反应蛋白(CRP)和纤维蛋白原值较高(组1为7.7±3.2天，组1为4.6±1.6天，p < 0.001)。其他治疗的处方频率在对照组之间没有差异。单克隆抗体的使用显著降低了KTRs的死亡率，从第2组的19.7%降至第1组的3%，而对移植物功能没有不良影响。结论。在KTRs的COVID-19早期阶段使用单克隆抗体治疗是安全的，它可以预防严重的COVID-19，并减少不良后果的发生率。
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