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.

АЛЛОТРАНСПЛАНТАЦИЯ АВО-НЕСОВМЕСТИМЫХ ПОЧЕК У ДЕТЕЙ

At present the problem of donor organs for transplantation shortage remains unsolved. Cautious and mixed attitude towards the transplantation of incompatible kidneys remains, while it could considerably reduce the donor organ waiting time for a recipient. Experience of 19 allotransplantations of ABO-incompatible kidneys in children is analyzed in the article. A group of 14 patients who received ABOcompatible kidneys was chosen for the comparative analysis. Such parameters as the assessment of function of allotransplanted kidneys, morphology character comparison of biopsy materials of allo-kidneys in both groups, actuarial survival rate of the recipients with functioning allografts are used to assess the results. Comparison of the aforementioned parameters showed practically the same results, and that enables us to assert that transplantations of kidneys of ABO-incompatible donors have the right to exist.В настоящее время остается нерешенной проблема нехватки донорских органов для трансплантации. Сохраняется настороженное, неоднозначное отношение к пересадке несовместимых почек, применение которых могло бы значительно сократить время ожидания реципиентом донорского органа. В статье проанализирован опыт 19 аллотрансплантаций АВ0-несовместимых почек у детей. Для сравнительного анализа выбрана группа из 14 больных, которым выполнены пересадки АВ0-совместимых почек. Для оценки результатов использованы такие параметры, как оценка функции аллотрансплантированных почек, сравнение характера морфологии биоптатов аллопочек в обеих группах, оценка актуарной выживаемости реципиентов с функционирующими аллотрансплантатами. Сравнение вышеперечисленных параметров показало практически одинаковые результаты, что дает нам право утверждать: пересадки почек от АВ0-несовместимых доноров имеют право на существование

Anemia in renal allograft recipients

The review deals with anemia, one of the posttransplantation complications. To define the ways of preventing this complication in the posttransplantation period, the factors favors its development are analyzed. Anemia is shown to negatively affect autografted kidney function and actuarial survival in allokidney graft recipients. The current principles in the treatment of posttransplantation anemia are reflected

Generation of donor-specific immunotolerance in renal-allograft recipients

The kidney cannot be successfully grafted without immunosuppressive therapy. A unicenter retrospective study has evaluated the efficiency of immunosuppression with daclizumab (Zenapax) versus alemtuzumab (Campath).Subjects and methods. After renal allotransplantation, 64 patients, including 34 and 30 patients, were treated with daclizumab and alemtuzumab, respectively. The absolute count of peripheral blood lymphocytes was measured. Renal grafts were morphologically assessed as described by Banff.Results. After administration of alemtuzumab, there was a more pronounced decrease in the absolute count of peripheral blood lymphocytes and the rate of acute rejection crisis was 1.5 times lower than that after use of daclizumab.Conclusion. During the study, alemtuzumab demonstrated a more marked immunosuppressive activity than did daclizumab and the ability of the former to generate donor-specific immunotolerance in renal-allograft recipients

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

ВАКЦИНАЦИЯ ДЕТЕЙ С ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ В ПРЕД- И ПОСТТРАНСПЛАНТАЦИОННЫЙ ПЕРИОД

The article is dedicated to an extremely important issue of pediatric nephrology and pediatric transplantology – vaccination of children with chronic kidney disease for prevention of vaccine-manageable infections. Commonplace and often mild (in healthy children) viral and bacterial infections in the patients on immunosuppressive therapy may cause development of life-threatening conditions and loss of a transplant in children with transplanted kidneys. There are no common vaccination protocols for such children neither in Russia nor in any other country. Moreover, it is presumed that vaccination should not take place in children with chronic renal diseases, especially in the stage of renal failure; however, in many cases it is unreasonable. The authors present personal experience of children’s vaccination before and after kidney transplantation.Статья посвящена крайне важной проблеме детской нефрологии и детской трансплантологии — вакцинации детей с хронической почечной недостаточностью с целью профилактики вакциноуправляемых инфекций. Банальные, часто легко протекающие для здоровых детей вирусные и бактериальные инфекции у пациентов, получающих иммуносупрессивную терапию, могут привести к развитию жизнеугрожающих состояний, а также к потере трансплантата у детей с пересаженной почкой. В нашей стране так же, как и во всем мире, нет единых протоколов вакцинации этих детей. Кроме того, считается, что детям с хроническими болезнями почек, и особенно в стадии почечной недостаточности, вакцинацию проводить не следует, что во многих случаях необоснованно. Авторы представляют собственныйопыт вакцинации детей до и после пересадки почек.