Pub Date : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-121-129
V. Syutkin, A. Salienko, O. Olisov, S. Zhuravel, M. Novruzbekov
Introduction. The lifelong use of calcineurin inhibitors in liver transplant recipients leads to an increased incidence of chronic kidney disease.Objective. To compare the changes in glomerular filtration rate over five years in liver transplant recipients between those on everolimus with a reduced exposure to calcineurin inhibitors and those on standard doses of calcineurin inhibitors.Material and methods. Fourteen liver transplant recipient switched to everolimus with a minimization of calcineurin inhibitors exposure in the first months after liver transplantation from February 2009 to February 2015 who had received that therapy continuously for at least 60 months were included in the case-control study. Twenty eight liver transplant recipients (matched by sex, etiology of the underlying disease, calcineurin inhibitors) who were followed-up for at least 60 months after liver transplantation, who had received no dose of everolimus, in whom the glomerular filtration rate could be calculated at all points of analysis were selected as a comparison group (1:2). Glomerular filtration rate was calculated immediately before liver transplantation; 12, 24, 36, 48, and 60 months after liver transplantation. The glomerular filtration rate after liver transplantation was also calculated for liver transplant recipients from the main group immediately before the conversion to everolimus.Results. Before liver transplantation, the median of glomerular filtration rate in the main group of liver transplant recipients was lower (81.2 ml/min) than in the comparison group (97.5 ml/min, p=0.01). After liver transplantation, the renal function worsened in both groups of patients. In a pairwise comparison, the medians of glomerular filtration rate were statistically significantly lower after 12 months, 24 months, 36 months, 48 months after liver transplantation, than before liver transplantation. The median of glomerular filtration rate at the time of immunosuppression conversion was 44.3 ml/min. After the conversion of immunosuppression, the median of glomerular filtration rate gradually increased, and after 36 months the differences in glomerular filtration rate reached statistical significance compared with the level before conversion (69.4 ml/min;p=0.048). These differences still increased after 60 months after conversion (72.3 ml/min; p=0.041).Conclusion. Long-term administration of everolimus with minimization of calcineurin inhibitors exposure with the early conversion to this immunosuppression regime provides a steady improvement in renal function in liver transplant recipients with a low glomerular filtration rate in the preoperative and early post-transplant period.
介绍。肝移植受者终身使用钙调磷酸酶抑制剂可导致慢性肾脏疾病的发病率增加。比较使用依维莫司减少钙调磷酸酶抑制剂和使用标准剂量钙调磷酸酶抑制剂的肝移植受者在5年内肾小球滤过率的变化。材料和方法。从2009年2月至2015年2月，14名肝移植受者在肝移植后的第一个月内改用依维莫司，并将钙调磷酸酶抑制剂暴露量降至最低，这些患者连续接受依维莫司治疗至少60个月，纳入病例对照研究。选择28名肝移植受者(按性别、基础疾病病因、钙调磷酸酶抑制剂匹配)，在肝移植后随访至少60个月，未接受依维莫司剂量，在所有分析点均可计算肾小球滤过率的患者作为对照组(1:2)。肝移植前立即计算肾小球滤过率;肝移植后12、24、36、48和60个月。在转入依维莫司前，计算主组肝移植术后的肾小球滤过率。肝移植前，肝移植受者主组肾小球滤过率中位数(81.2 ml/min)低于对照组(97.5 ml/min, p=0.01)。肝移植后两组患者肾功能均恶化。两两比较，肝移植后12个月、24个月、36个月、48个月肾小球滤过率中位数均低于肝移植前。免疫抑制转化时肾小球滤过率中位数为44.3 ml/min。免疫抑制转化后，肾小球滤过率中位数逐渐升高，36个月后肾小球滤过率与转化前比较差异有统计学意义(69.4 ml/min;p=0.048)。转换后60个月，这些差异仍在增加(72.3 ml/min;.Conclusion p = 0.041)。长期服用依维莫司，尽量减少钙调磷酸酶抑制剂的暴露，并早期转换到这种免疫抑制方案，可以稳定地改善术前和移植后早期肾小球滤过率低的肝移植受者的肾功能。
{"title":"The effect of early everolimus administration on the renal function while reducing the dosage of calcineurin inhibitors in liver transplant recipients in a long-term follow-up","authors":"V. Syutkin, A. Salienko, O. Olisov, S. Zhuravel, M. Novruzbekov","doi":"10.23873/2074-0506-2021-13-2-121-129","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-121-129","url":null,"abstract":"Introduction. The lifelong use of calcineurin inhibitors in liver transplant recipients leads to an increased incidence of chronic kidney disease.Objective. To compare the changes in glomerular filtration rate over five years in liver transplant recipients between those on everolimus with a reduced exposure to calcineurin inhibitors and those on standard doses of calcineurin inhibitors.Material and methods. Fourteen liver transplant recipient switched to everolimus with a minimization of calcineurin inhibitors exposure in the first months after liver transplantation from February 2009 to February 2015 who had received that therapy continuously for at least 60 months were included in the case-control study. Twenty eight liver transplant recipients (matched by sex, etiology of the underlying disease, calcineurin inhibitors) who were followed-up for at least 60 months after liver transplantation, who had received no dose of everolimus, in whom the glomerular filtration rate could be calculated at all points of analysis were selected as a comparison group (1:2). Glomerular filtration rate was calculated immediately before liver transplantation; 12, 24, 36, 48, and 60 months after liver transplantation. The glomerular filtration rate after liver transplantation was also calculated for liver transplant recipients from the main group immediately before the conversion to everolimus.Results. Before liver transplantation, the median of glomerular filtration rate in the main group of liver transplant recipients was lower (81.2 ml/min) than in the comparison group (97.5 ml/min, p=0.01). After liver transplantation, the renal function worsened in both groups of patients. In a pairwise comparison, the medians of glomerular filtration rate were statistically significantly lower after 12 months, 24 months, 36 months, 48 months after liver transplantation, than before liver transplantation. The median of glomerular filtration rate at the time of immunosuppression conversion was 44.3 ml/min. After the conversion of immunosuppression, the median of glomerular filtration rate gradually increased, and after 36 months the differences in glomerular filtration rate reached statistical significance compared with the level before conversion (69.4 ml/min;p=0.048). These differences still increased after 60 months after conversion (72.3 ml/min; p=0.041).Conclusion. Long-term administration of everolimus with minimization of calcineurin inhibitors exposure with the early conversion to this immunosuppression regime provides a steady improvement in renal function in liver transplant recipients with a low glomerular filtration rate in the preoperative and early post-transplant period.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91013275","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 : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-165-178
B. Z. Khubutiya, O. Rzhevskaya, A. A. Lisenok
Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.
{"title":"Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history","authors":"B. Z. Khubutiya, O. Rzhevskaya, A. A. Lisenok","doi":"10.23873/2074-0506-2021-13-2-165-178","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-165-178","url":null,"abstract":"Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84137461","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 : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-158-164
A. Shabunin, S. Loginov, P. Drozdov, I. Nesterenko, D. A. Makeev, O. S. Zhuravel, L. Karapetyan
Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.
{"title":"A case of rhabdomyolysis after atorvastatin therapy of a liver transplant recipient receiving immunosuppressive therapy with cyclosporine","authors":"A. Shabunin, S. Loginov, P. Drozdov, I. Nesterenko, D. A. Makeev, O. S. Zhuravel, L. Karapetyan","doi":"10.23873/2074-0506-2021-13-2-158-164","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-158-164","url":null,"abstract":"Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80149725","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 : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-112-120
A. Pinchuk, N. Shmarina, E. V. Migunova, A. Rustambek Uulu, N. E. Kudryashova, I. Dmitriev, D. V. Lonshakov, A. Balkarov
Introduction. The urinary tract incompetence ("extravasation of urine") of the renal allograft is the most common urological complication in the early postoperative period.The purpose was to evaluate the efficacy of the dynamic angionephroscintigraphy technique in diagnosing the extravasation of urine after kidney transplantation.Material and methods. The results of dynamic angionephroscintigraphy were analyzed for the purpose of verifying/ diagnosing the extravasation of urine in 63 patients who underwent kidney transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019. Dynamic angionephroscintigraphy of the renal allograft was performed with the glomerulotropic 99mTc-pentatech radiopharmaceutical on a two-detector single-photon emission tomography "Infinia II" and a combined CT SPECT / CT system "Discovery NM/CT670".Results. The sensitivity of dynamic angionephroscintigraphy in detecting the extravasation of urine was 100%, the specificity was 88%, and the accuracy of the method was 89%.Conclusion. Dynamic angionephroscintigraphy is a highly sensitive and specific method for diagnosing the extravasation of urine after kidney transplantation.
{"title":"The role of dynamic angionephroscintigraphy in the diagnosis of urinary tract incompetence after kidney transplantation","authors":"A. Pinchuk, N. Shmarina, E. V. Migunova, A. Rustambek Uulu, N. E. Kudryashova, I. Dmitriev, D. V. Lonshakov, A. Balkarov","doi":"10.23873/2074-0506-2021-13-2-112-120","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-112-120","url":null,"abstract":"Introduction. The urinary tract incompetence (\"extravasation of urine\") of the renal allograft is the most common urological complication in the early postoperative period.The purpose was to evaluate the efficacy of the dynamic angionephroscintigraphy technique in diagnosing the extravasation of urine after kidney transplantation.Material and methods. The results of dynamic angionephroscintigraphy were analyzed for the purpose of verifying/ diagnosing the extravasation of urine in 63 patients who underwent kidney transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019. Dynamic angionephroscintigraphy of the renal allograft was performed with the glomerulotropic 99mTc-pentatech radiopharmaceutical on a two-detector single-photon emission tomography \"Infinia II\" and a combined CT SPECT / CT system \"Discovery NM/CT670\".Results. The sensitivity of dynamic angionephroscintigraphy in detecting the extravasation of urine was 100%, the specificity was 88%, and the accuracy of the method was 89%.Conclusion. Dynamic angionephroscintigraphy is a highly sensitive and specific method for diagnosing the extravasation of urine after kidney transplantation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90249353","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 : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-141-150
S. V. Zybleva, S. L. Zyblev
Introduction. The presence of multiple subsets of B-cells with specific regulatory functions capable of modulating inflammatory responses havebeen detected. Most of the studies of Bregs function were carried out in the context of autoimmune and infectious diseases, whereas the objective of this research was to study the characteristics of the main, activated and tolerogenic subpopulations of B lymphocytes in patients who underwent kidney transplantation. Objective. To study the indices of B-lymphocyte subpopulations and determine their role in the development of immunological tolerance after kidney transplantation.Material and methods. We have examined 197 recipients who underwent kidney transplantation. We determined B lymphocyte subpopulation levels (CD19+IgD+CD27+ and CD19+IgD-CD27+) before transplantation, on the 1st, 3rd, 7th and 30th days after the transplantation. Allograft function was assessed on day 7 with the division of patients into two groups: with primary graft function and graft dysfunction.Results and discussion. Significant differences were revealed between the groups of recipients over three months in the following cell subpopulation levels CD19+IgD+CD27+ and CD19+IgD-CD27+. During the first 7 days, lower levels of these subpopulations were associated with satisfactory allograft function. However, by the 90th day after surgery, an increase in CD19+IgD+CD27+ B lymphocytes was noted in the group of patients with graft dysfunction.Conclusions. Low levels of not-switched (CD19+IgD+CD27+) and switched (CD19+IgD-CD27+) memory В lymphocytes in the peripheral blood of kidney transplant recipients are associated with a favorable postoperative course. We have found that on the 3rd post-transplant day, the relative level of non-switched memory B lymphocytes (CD19+IgD+CD27+) exceeding or equal to 11.47%, and the level of switched memory B lymphocytes (CD19+IgD-CD27+) exceeding or equal to 20.74% might predict the development of early renal graft dysfunction with a sensitivity and specificity of 88.40% and 84.30% for the former parameter and of 88.70% and 82.40% for the latter one, respectively.
{"title":"Characteristics of B-lymphocyte subpopulations in renal transplant recipients","authors":"S. V. Zybleva, S. L. Zyblev","doi":"10.23873/2074-0506-2021-13-2-141-150","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-141-150","url":null,"abstract":"Introduction. The presence of multiple subsets of B-cells with specific regulatory functions capable of modulating inflammatory responses havebeen detected. Most of the studies of Bregs function were carried out in the context of autoimmune and infectious diseases, whereas the objective of this research was to study the characteristics of the main, activated and tolerogenic subpopulations of B lymphocytes in patients who underwent kidney transplantation. Objective. To study the indices of B-lymphocyte subpopulations and determine their role in the development of immunological tolerance after kidney transplantation.Material and methods. We have examined 197 recipients who underwent kidney transplantation. We determined B lymphocyte subpopulation levels (CD19+IgD+CD27+ and CD19+IgD-CD27+) before transplantation, on the 1st, 3rd, 7th and 30th days after the transplantation. Allograft function was assessed on day 7 with the division of patients into two groups: with primary graft function and graft dysfunction.Results and discussion. Significant differences were revealed between the groups of recipients over three months in the following cell subpopulation levels CD19+IgD+CD27+ and CD19+IgD-CD27+. During the first 7 days, lower levels of these subpopulations were associated with satisfactory allograft function. However, by the 90th day after surgery, an increase in CD19+IgD+CD27+ B lymphocytes was noted in the group of patients with graft dysfunction.Conclusions. Low levels of not-switched (CD19+IgD+CD27+) and switched (CD19+IgD-CD27+) memory В lymphocytes in the peripheral blood of kidney transplant recipients are associated with a favorable postoperative course. We have found that on the 3rd post-transplant day, the relative level of non-switched memory B lymphocytes (CD19+IgD+CD27+) exceeding or equal to 11.47%, and the level of switched memory B lymphocytes (CD19+IgD-CD27+) exceeding or equal to 20.74% might predict the development of early renal graft dysfunction with a sensitivity and specificity of 88.40% and 84.30% for the former parameter and of 88.70% and 82.40% for the latter one, respectively.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90358329","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 : 2021-06-19DOI: 10.23873/2074-0506-2021-13-2-179-197
S. Glyantsev
Analysis of the materials of the 2nd All-Union conference on the problem of tissue incompatibility, conservation and transplantation of tissues and organs (Odessa, 1967) showed that Soviet and foreign scientists had similar approaches to solving the problem of organ and tissue transplantation. Soviet scientists spoke about overcoming tissue incompatibility by hybridization of plants and chimerization of animals, about the effect of drug sleep on transplant immunity, about neurohumoral immunological shifts and the role of the central and peripheral nervous systems in the engraftment of grafts, about the influence of external factors on immunity. They also discussed the characterization of the antigenic structure of grafts, the role of DNA in immunity, the genetic transformation of homomaterial, the use of pharmacological agents to suppress immunogenesis, the cryopreservation of auto- and homo-organs and tissues with perfusion of their vascular bed, and the study of immunogenesis at the molecular level. A year earlier, the Americans discussed immunological paralysis, the effect on the recipient's immunity of the donor's blood transfused to him and its components, and biochemical studies of immunity. At the same time, without any ethical doubts, American scientists conducted experiments, including clinical ones, with multiple passages of homosexual skin, with exchange transfusion of blood to newborns and subsequent transplantation of homosexual donors to them, with irradiation of recipients with powerful doses of X-rays. It is shown that most of the trends that had been developed by V.P. Demikhov, were approved by the 2nd All-Union Conference. But what he lacked was close and comprehensive integration with morphologists, physiologists, immunologists, biochemists, pharmacologists and, sadly, with clinical surgeons. Based on the research conducted, an unambiguous conclusion can be drawn: Soviet scientists should not have criticized V.P. Demikhov for his "misunderstanding" of immunology, and to help him in every possible way, directing his energy in the right direction.
{"title":"PHENOMENON OF DEMIKHOV. In the Sklifosovsky Institute (1960–1986). Approaches to solving the problem of organ and tissue transplantation in the USSR and abroad (1967)","authors":"S. Glyantsev","doi":"10.23873/2074-0506-2021-13-2-179-197","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-179-197","url":null,"abstract":"Analysis of the materials of the 2nd All-Union conference on the problem of tissue incompatibility, conservation and transplantation of tissues and organs (Odessa, 1967) showed that Soviet and foreign scientists had similar approaches to solving the problem of organ and tissue transplantation. Soviet scientists spoke about overcoming tissue incompatibility by hybridization of plants and chimerization of animals, about the effect of drug sleep on transplant immunity, about neurohumoral immunological shifts and the role of the central and peripheral nervous systems in the engraftment of grafts, about the influence of external factors on immunity. They also discussed the characterization of the antigenic structure of grafts, the role of DNA in immunity, the genetic transformation of homomaterial, the use of pharmacological agents to suppress immunogenesis, the cryopreservation of auto- and homo-organs and tissues with perfusion of their vascular bed, and the study of immunogenesis at the molecular level. A year earlier, the Americans discussed immunological paralysis, the effect on the recipient's immunity of the donor's blood transfused to him and its components, and biochemical studies of immunity. At the same time, without any ethical doubts, American scientists conducted experiments, including clinical ones, with multiple passages of homosexual skin, with exchange transfusion of blood to newborns and subsequent transplantation of homosexual donors to them, with irradiation of recipients with powerful doses of X-rays. It is shown that most of the trends that had been developed by V.P. Demikhov, were approved by the 2nd All-Union Conference. But what he lacked was close and comprehensive integration with morphologists, physiologists, immunologists, biochemists, pharmacologists and, sadly, with clinical surgeons. Based on the research conducted, an unambiguous conclusion can be drawn: Soviet scientists should not have criticized V.P. Demikhov for his \"misunderstanding\" of immunology, and to help him in every possible way, directing his energy in the right direction.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78501809","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 : 2021-03-24DOI: 10.23873/2074-0506-2021-13-1-49-62
A. Mironov, N. Borovkova, M. Makarov, I. N. Ponomarev, Y. Andreev
The article outlines the main stages of the formation, development and specialization of medical institutions associated with the harvesting and procurement of allogeneic tissues, considers the global practice in the field of tissue institutions, taking into account medical and legal aspects. In the second half of the XX century, the tendency has developed towards the consolidation of tissue banks and the expansion of their functional capabilities within individual states. The development of this trend in the late XX - early XXI centuries led to the establishment of international tissue banking associations. The goal of international associations of tissue banks has been to develop cooperation, standardize procedures at all stages of tissue harvesting and procurement, and form an effective legislative framework. In the Soviet Union, the procurement of donor tissues was widely developing, but in the 90s, in our country there was an abrupt decline in this field. To date, in Russia, the harvesting and procurement of allogeneic tissues is carried out in only a few institutions; the development of tissue institutions is difficult due to the lack of an adequate legal framework. The article proposes to legally differentiate the concepts of "organ transplantation" and "tissue transplantation"; as an example, the US experience in this area is discussed.
{"title":"Tissue banks. World experience. The history of development and current approaches","authors":"A. Mironov, N. Borovkova, M. Makarov, I. N. Ponomarev, Y. Andreev","doi":"10.23873/2074-0506-2021-13-1-49-62","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-1-49-62","url":null,"abstract":"The article outlines the main stages of the formation, development and specialization of medical institutions associated with the harvesting and procurement of allogeneic tissues, considers the global practice in the field of tissue institutions, taking into account medical and legal aspects. In the second half of the XX century, the tendency has developed towards the consolidation of tissue banks and the expansion of their functional capabilities within individual states. The development of this trend in the late XX - early XXI centuries led to the establishment of international tissue banking associations. The goal of international associations of tissue banks has been to develop cooperation, standardize procedures at all stages of tissue harvesting and procurement, and form an effective legislative framework. In the Soviet Union, the procurement of donor tissues was widely developing, but in the 90s, in our country there was an abrupt decline in this field. To date, in Russia, the harvesting and procurement of allogeneic tissues is carried out in only a few institutions; the development of tissue institutions is difficult due to the lack of an adequate legal framework. The article proposes to legally differentiate the concepts of \"organ transplantation\" and \"tissue transplantation\"; as an example, the US experience in this area is discussed.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89286804","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 : 2021-03-24DOI: 10.23873/2074-0506-2021-13-1-33-40
A. Maksimova, E. Bessonova, V. Bazarnyy
Introduction. One of the urgent tasks in modern transplantology is the search of biomarkers for predicting and early diagnosis of graft dysfunction.Objective. The study objective was to determine the biomarkers of liver graft dysfunction.Material and methods. We have examined 19 recipients who underwent liver transplantation and 36 healthy blood donors. Levels of 7 serum cytokines were measured by multiparametric fluorescence analysis with magnetic microspheres (xMAP technology, Luminex 200, USA). Statistical analysis was carried out by methods of nonparametric statistics. To determine the predictive value of the test, a ROC-analysis was performed.Results and discussion. We found that the interleukin-8 level was 3.6 times higher in recipients with liver graft dysfunction compared to those who had an uneventful postoperative course. The diagnostic sensitivity of the test was 75%, the specificity was 91%, and negative predictive value was 84.6.Conclusion. Serum interleukin-8 measurement provides a biomarker for early predicting a post-transplant liver graft dysfunction development
{"title":"Predictive value of serum cytokine level in the assessment of complications after liver transplantation","authors":"A. Maksimova, E. Bessonova, V. Bazarnyy","doi":"10.23873/2074-0506-2021-13-1-33-40","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-1-33-40","url":null,"abstract":"Introduction. One of the urgent tasks in modern transplantology is the search of biomarkers for predicting and early diagnosis of graft dysfunction.Objective. The study objective was to determine the biomarkers of liver graft dysfunction.Material and methods. We have examined 19 recipients who underwent liver transplantation and 36 healthy blood donors. Levels of 7 serum cytokines were measured by multiparametric fluorescence analysis with magnetic microspheres (xMAP technology, Luminex 200, USA). Statistical analysis was carried out by methods of nonparametric statistics. To determine the predictive value of the test, a ROC-analysis was performed.Results and discussion. We found that the interleukin-8 level was 3.6 times higher in recipients with liver graft dysfunction compared to those who had an uneventful postoperative course. The diagnostic sensitivity of the test was 75%, the specificity was 91%, and negative predictive value was 84.6.Conclusion. Serum interleukin-8 measurement provides a biomarker for early predicting a post-transplant liver graft dysfunction development","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76675708","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 : 2021-03-24DOI: 10.23873/2074-0506-2021-13-1-10-24
A. Sushkov, K. Gubarev, V. L. Vinogradov, V. Rudakov, D. Svetlakova, A. Fedyunin, M. Krstich, A. I. Zakhlevnyy, A. Artemiev, S. Voskanyan
Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task.The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes.Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed.Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p<0.001; transportation time was 3.5 h (interquartile range : 2.5–4.7 h) and 3.5 h (interquartile range: 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p <0.001, in group 1 and group 2, respectively, the difference being statistically significant for all parameters. Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance.Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.
基本原理。目前，在俄罗斯的移植中心，远距离运送已故捐赠者的肝脏并不是常规做法;因此，即使是相对较小的单中心体验，基于研究的分析似乎也是一项主题任务。本研究旨在评估远距离供肝运输对冷缺血时间、移植物初始功能以及近期和远期移植结果的影响。材料和方法。回顾性单中心研究包括了72例连续死亡供肝移植的具体特征和结果的数据。根据冷缺血时间将患者分为两组:1组冷缺血时间小于9小时;N = 41)和9小时或更长时间(第二组;N = 31)。比较两组间供体器官运输参数、供体和受体特征、手术特点及术后早期、近期和远期预后。对于整个样本量，评估供体医院到移植中心的距离、运输方式和运输时间与冷缺血时间的关系。捐献的肝脏是从距离移植中心40-3500公里的医院运送的，其中67%的病例是通过定期航班运送的。运输时间为1 ~ 8 h(中位数为3.5 h)，占冷缺血时间的41%(四分位数间距为35 ~ 54%)。两组间供体、受体及手术特征无统计学差异。组1的中位距离为509 km(四分位间距130 ~ 1321 km)，组2的中位距离为1321 km(四分位间距897 ~ 3441 km)， p<0.001;1组和2组的输运时间分别为3.5 h (2.5 ~ 4.7 h)和3.5 h (3.3 ~ 7.0 h)， p = 0.022;冷缺血时间分别为8 h (7 ~ 9.5 h)和10 h (9 ~ 10.5 h)， p <0.001，各参数差异均有统计学意义。尽管早期同种异体移植物功能障碍的发生率有增加的趋势(1组6/41,2组9/31;P = 0.155)，原发性移植物无功能(1组1/41,2组3/31;P = 0.308)，前6周移植物丢失发生率(1组4/41;第2组7/31;p = 0.189)，差异无统计学意义。本回顾性研究结果证实了长途运输后供肝移植的可行性和临床疗效。然而，冷缺血时间超过9小时是导致移植物初始功能差的危险因素。
{"title":"Impact of long-distance (up to 3.500 km) deceased donor liver transportation on cold ischemia time, initial graft function and transplant outcomes","authors":"A. Sushkov, K. Gubarev, V. L. Vinogradov, V. Rudakov, D. Svetlakova, A. Fedyunin, M. Krstich, A. I. Zakhlevnyy, A. Artemiev, S. Voskanyan","doi":"10.23873/2074-0506-2021-13-1-10-24","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-1-10-24","url":null,"abstract":"Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task.The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes.Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed.Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p<0.001; transportation time was 3.5 h (interquartile range : 2.5–4.7 h) and 3.5 h (interquartile range: 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p <0.001, in group 1 and group 2, respectively, the difference being statistically significant for all parameters. Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance.Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88978654","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 : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-286-294
M. Gurin, A. Venediktov
Introduction. Ligaments play a critical role in the body, linking bones together. Ligament ruptures are the most common manifestations of serious musculoskeletal injuries. This is especially true for the anterior cruciate ligament of the knee joint. In trauma surgery, orthopedics, the ligament functional recovery can be achieved by using tissue autografting, synthetic and biological prostheses. Of great interest to surgeons is the use of prostheses made of biological tissues of animal origin, since they are easily available and, when high-quality processing is achieved, they are safe, retaining their natural structure and strength. Purpose of the study. To decellularize the bovine tendon according to our originally developed technique and to investigate its efficacy in terms of the presence of cellular elements and physical and mechanical parameters of the material. Material and methods. To manufacture the prototype of the ligament prosthesis product, we developed the technique for processing the bovine tendon, as the most similar material by structure, including its mechanical processing, chemical and physical processing methods and a special treatment with supercritical carbon dioxide fluid containing nonionic surfactant Tween-80 for decellularization and extraction of organic components in addition to collagen framework, while maintaining strength properties. Histological studies were performed to check for the residues of cellular elements, and the measurements of the physical and mechanical properties of the material were made. Results. Histological examination of the material showed that after processing, 0–2 cells in the field of view were found in the material. The strength properties of the material were 503 kgf/mm2 before processing and 605 kgf/mm2 after processing. Conclusion. The data obtained in the study confirmed that the processing performed qualitatively affected the elimination of cells, did not worsen but even increased the mechanical strength of the material. Further study of the biocompatible properties of the material is required.
{"title":"Evaluation of the bovine tendon decellularization method in the development of a cruciate ligament prosthesis","authors":"M. Gurin, A. Venediktov","doi":"10.23873/2074-0506-2020-12-4-286-294","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-286-294","url":null,"abstract":"Introduction. Ligaments play a critical role in the body, linking bones together. Ligament ruptures are the most common manifestations of serious musculoskeletal injuries. This is especially true for the anterior cruciate ligament of the knee joint. In trauma surgery, orthopedics, the ligament functional recovery can be achieved by using tissue autografting, synthetic and biological prostheses. Of great interest to surgeons is the use of prostheses made of biological tissues of animal origin, since they are easily available and, when high-quality processing is achieved, they are safe, retaining their natural structure and strength. Purpose of the study. To decellularize the bovine tendon according to our originally developed technique and to investigate its efficacy in terms of the presence of cellular elements and physical and mechanical parameters of the material. Material and methods. To manufacture the prototype of the ligament prosthesis product, we developed the technique for processing the bovine tendon, as the most similar material by structure, including its mechanical processing, chemical and physical processing methods and a special treatment with supercritical carbon dioxide fluid containing nonionic surfactant Tween-80 for decellularization and extraction of organic components in addition to collagen framework, while maintaining strength properties. Histological studies were performed to check for the residues of cellular elements, and the measurements of the physical and mechanical properties of the material were made. Results. Histological examination of the material showed that after processing, 0–2 cells in the field of view were found in the material. The strength properties of the material were 503 kgf/mm2 before processing and 605 kgf/mm2 after processing. Conclusion. The data obtained in the study confirmed that the processing performed qualitatively affected the elimination of cells, did not worsen but even increased the mechanical strength of the material. Further study of the biocompatible properties of the material is required.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84576598","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}
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