Предикторы результатов пересадки почек от живых родственных доноров у детей

Relevance. Successful living relative donor (LRD) kidney transplantation is the most effective method of treating children with terminal chronic renal failure. Materials and methods. 148 living relative donor kidney transplantations to children were performed at the department of kidney transplantation of the Federal State Budgetary Research Institution “Academician Petrovskiy Russian Surgical Research Center” from December 2012 to March 2015. We used the following parameters to evaluate the factors affecting results of such an operation: recipient’s age and sex; living relative donor’s age and sex; antigen donor/recipient compatibility (system HLA-A, -B, -DR); type of induced immunosuppression; donor/recipient degree of kindred; presence or absence of rejection episodes throughout the whole observation period. Student’s test, Fisher’s test and Kaplan–Meier’s cumulative survival analysis of recipients and transplants were used for statistical processing. Results. 4 allokidneys out of 71 were rejected in group 1 (5.63%), in group 2 — 4 out of 77 (5.19%). The relative rates of transplant and patient survival were higher if LRD were 24–40 years of age than if LRD were 41–68 years of age. 12 patients out of 77 died in group 1 (15.58%), in group 2 — 3 out of 65 (4.62%). 7 allokidneys out of 67 were rejected in girls (7 fatal outcomes), in boys — 6 out of 81 (8 fatal outcomes). The highest rates of fatal outcomes and transplant rejection were observed in the group of patients prescribed daclizumab for induced immunosuppression, the lowest — in the group of patients prescribed methyl prednisolone. Conclusion. The conducted clinical material analysis led us to a conclusion that only two factors affect results of relative donor kidney transplantation in children — antigen donor/recipient compatibility (system HLA-A, -B, -DR) and presence of rejection episodes in the posttransplantation period. Актуальность. Успешная трансплантация почки от живого родственного донора (ЖРД) — самый эффективный метод лечения детей с терминальной стадией хронической почечной недостаточности. Материалы и методы. В отделении трансплантации почки ФГБНУ «РНЦХ им. академика Б. В. Петровского» с декабря 2012 по март 2015 г. были выполнены 148 пересадок почек от живых родственных доноров детям. Для оценки факторов, влияющих на результаты данной операции, были использованы следующие параметры: возраст и пол реципиента; возраст и пол живых родственных доноров; степень совместимости между донором и реципиентом по антигенам системы HLA-A, -B, -DR; характер индукционной иммуносупрессии; степень родства между донором и реципиентом; наличие или отсутствие эпизодов отторжения на протяжении всего периода наблюдения. Было сформировано две группы сравнения (в зависимости от возраста пациентов): группа 1 — дети 1–11 лет и группа 2 — 12–18 лет. Для проведения статистической обработки были использованы критерий Стьюдента, критерий Фишера, кумулятивная выживаемость реципиентов и трансплантатов по Каплану–Мейеру. Результаты. В группе 1 потеряны 4 аллопочки из 71 (5,63%), в группе 2 — 4 из 77 (5,19%). При возрасте ЖРД 24–40 лет процент потерь трансплантатов и пациентов ниже, чем при возрасте ЖРД 41–68 лет. В группе 1 умерли 12 больных из 77 (15,58%), в группе 2 — 3 из 65 (4,62%). У девочек были потеряны 7 аллопочек из 67 и наступило 7 летальных исходов, у мальчиков — 6 и 8 из 81, соответственно. Наибольший процент летальных исходов и потери трансплантатов наблюдались в группе больных, получавших для индукционной иммуносупрессии даклизумаб, наименьший — у использующих метилпреднизолон. Заключение. Проведенный анализ клинического материала привел нас к заключению, что только два фактора оказались влияющими на результаты пересадки родственных почек у детей — степень совместимости между донором и реципиентом по антигенам системы HLA-A, -В, -DR и наличие эпизодов отторжения в посттрансплантационном периоде.

CLINICAL PERSPECTIVES FOR STUDYING THE NUCLEAR TRANSCRIPTION FACTOR NF-κB IN BREAST CANCER

The paper describes a role of the nuclear transcription factor NF-κB in oncogenesis and presents studies of this factor in breast can- cer (BC). It also shows it promising to use the values of the transcription factor NF-κB activity to identify a hormone-resistant sub- group among the patients with receptor-positive BC, in its early stages in particular

CLINICAL SIGNIFICANCE OF THE VEGFR-2 IN THE TUMORS AND BLOOD SERA OF THE BREAST CANCER PATIENTS

The analysis of the changes of the content of the angiogenic factor VEGFR-2 in the cytosol of the tumor and blood sera of the 30 breast can- cer patients determined by immunoenzyme method during neoadjuvant therapy is given. Likewise the correlation of this index with the main clinicomorphological characteristics of the disease is assessed. The obtained results suggest on the possibility of the use of VEGFR-2 as the one of the diagnostic markers of the breast cancer. The index dynamics didn’t depend on the given therapy type but nonetheless the correlation of the VEGFR-2 content in the residual tumor after preoperative therapy with the grade of the treatment pathomorphosis is determined

The effect of the applied induction immunosuppressive therapy protocol on the allografted kidney condition

Aim: To assess the Eculizumab effect on the allografted kidney function in the immediate and early postoperative period.Materials and methods: In kidney transplantation, 33 patients received Eculizumab in combination with Alemtuzumab (group 1). Other 38 patients (group 2) were enrolled for a comparative analysis. They received their induction immunosuppressive therapy with Alemtuzumab and plasmapheresis sessions. The following parameters were used for analysis: the urine output in the first 24 hours after surgery, the period of creatinine level drop to 3 mg/dL, a 24-hour protein excretion at day 30 after surgery, a glomerular filtration rate at day 30 after transplantation, histology of kidney allograft biopsy at 1 month post surgery.Results: A comparative analysis has demonstrated much lower values of 24 hour proteinuria in group 1 than in group 2. As to the glomerular filtration rate, it was 1.9 times higher in group 1 than in group 2. The period of blood creatinine subnormalization was significantly shorter in group 1. The differences were statistically significant in all studied parameters (p=0.002–0.003).Conclusion: The allografted kidney function was much better in group 1 than in group 2. Thus, the combination of Eculizumab + Alemtuzumab had a more favorable effect on the function and morphology of allografted kidneys in the immediate and early postoperative periods compared to that of Alemtuzumab + plasmapheresis combination

The impact of С4d deposits in peritubular capillars on living related donor kidney transplantation outcome

In the Department of Kidney Transplantation of Petrovsky National Research Centre of Surgery, the investigations of kidney biopsy specimens for С4d started in 2009. The study was performed in 119 patients with impaired function of kidneys allografted from living related donors. The staining for C4d was negative in 85 cases, and positive in 34 cases. The groups were compared on the following parameters: the patient mortality, and allograft loss. Besides, morphologic findings in the biopsy were compared by nature between the groups. There were 6 deaths among 85 patients in Group 1, and 16 deaths among 34 patients in Group 2. Comparative analysis of results, using Fischer's criterion, demonstrated a statistically significant difference in mortality between the groups ( 2 = 4,86, p = 0,0275). As for graft losses, and the nature of assessed morphology findings, they were nearly similar in both groups. Therefore, according to our data, the presence of C4d protein was associated with increased mortality. The differences between the groups in all other parameters were not statistically significant

Predictors of Results of Living Relative Donor Kidney Transplantation in Children

Relevance. Successful living relative donor (LRD) kidney transplantation is the most effective method of treating children with terminal chronic renal failure. Materials and methods. 148 living relative donor kidney transplantations to children were performed at the department of kidney transplantation of the Federal State Budgetary Research Institution “Academician Petrovskiy Russian Surgical Research Center” from December 2012 to March 2015. We used the following parameters to evaluate the factors affecting results of such an operation: recipient’s age and sex; living relative donor’s age and sex; antigen donor/recipient compatibility (system HLA-A, -B, -DR); type of induced immunosuppression; donor/recipient degree of kindred; presence or absence of rejection episodes throughout the whole observation period. Student’s test, Fisher’s test and Kaplan–Meier’s cumulative survival analysis of recipients and transplants were used for statistical processing. Results. 4 allokidneys out of 71 were rejected in group 1 (5.63%), in group 2 — 4 out of 77 (5.19%). The relative rates of transplant and patient survival were higher if LRD were 24–40 years of age than if LRD were 41–68 years of age. 12 patients out of 77 died in group 1 (15.58%), in group 2 — 3 out of 65 (4.62%). 7 allokidneys out of 67 were rejected in girls (7 fatal outcomes), in boys — 6 out of 81 (8 fatal outcomes). The highest rates of fatal outcomes and transplant rejection were observed in the group of patients prescribed daclizumab for induced immunosuppression, the lowest — in the group of patients prescribed methyl prednisolone. Conclusion. The conducted clinical material analysis led us to a conclusion that only two factors affect results of relative donor kidney transplantation in children — antigen donor/recipient compatibility (system HLA-A, -B, -DR) and presence of rejection episodes in the posttransplantation period