Первые 100 трансплантаций почки от родственного донора: Опыт центра экстренной медицинской помощи

Ф.А. ХАДЖИБАЕВ, В.Х. ШАРИПОВА, П.К. СУЛТАНОВ

Abstract

Topicality. The advances achieved in the field of transplantation make it possible to make this type of renal
therapy routine and define it as the “gold standard” in the treatment of patients with chronic renal failure
with the best indicators in comparison with other methods of substitution therapy. At the present stage,
transplantologists are faced with achieving 95% graft survival within 5 years. Currently, the graft survival rate
in the first year has significantly increased to 93.4% with LT from cadaveric donors and 97.2% from living
22 Вестник экстренной медицины, 2021, том 14, № 4
donors. An improvement in this indicator is possible due to the improvement of immunosuppression protocols
and the prevention of surgical complications.
Aim. To analyze the results of the first 100 kidney transplants from related donors at the Republican Research
Center of Emergency Medicine.
Material and methods. The work included 100 patients who underwent kidney transplantation from a living
donor at the Republican Research Center of Emergency Medicine from March 2018 to January 2021.
Results. Immediate graft function was noted in 84 (84%) cases, and DGF - in 16 (16%). SPT took place mainly
in the presence of multiple vessels of the donor kidney (35.5%) compared with a single renal artery and vein
(12.1%), which was influenced by the average duration of warm ischemia - 80.26 ± 38.35 minutes with multiple
arteries and 50.44 ± 14.44 with a single renal artery and vein (p = 0.001). In 3 (3%) cases, there was an acute
cellular rejection of the graft, which was successfully treated with pulse therapy with methylprednisolone, in
1 (1%) - hyperacute rejection, which resulted in the removal of the graft. Urological complications in the form
of ureteral stenosis were observed in 2 (2%) cases and ureteral necrosis with anastomotic insufficiency - in
1 (1%). Urological complications were mainly observed with ureteral-vesical anastomosis without stenting
(50%) than with stenting (4.5%), RR = 21.5 (95% CI = 3.84 - 117.57) (p˂0.001) . Graft artery thrombosis was
detected in 1 (1%) case, vein thrombosis of the transplanted kidney and external iliac vein was detected in 1
(1%) case, bleeding was noted in 8 (8%) cases. In 13 (13%) recipients, purulent-infectious processes were
observed, of which in 9 (9.3%) cases, wound infection developed. Two recipients (2%) underwent renal graft
nephrectomy. In our short-term study, the one-year survival rate for patients with LT was 93% and the graft
survival rate was 91%.
Conclusions. Delayed graft function often develops with a long stay of the recipient on hemodialysis, as well as
an increase in the time of thermal ischemia, which is influenced by the number of vessels in the donor kidney
and is an important prognostic factor for the development of acute rejection. Due to postoperative hemodialysis
due to the development of delayed graft function, the risk of developing vascular complications increases.
The risk of developing urological complications is high with the imposition of a ureteral-vesical anastomosis
without stenting. Hyperacute rejection and the development of a purulent infection leading to arrosive arterial
bleeding may result from the loss of a kidney transplant. The cause of the death of the recipient in the first year
after KT is mainly: pulmonary embolism, infection and sepsis as a result of immunosuppression, hypovolemic
shock and acute ischemic stroke.