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The publication is devoted to a research of an internal picture of disease, nozogeny reactions at patients with chronic kidney disease both at early stages of disease and at statement in the waiting list on renal allotransplantation. The research objective was to prove value of psychological factors in formation of nozogenyat patients with CKD. Authors describe the results of research of an internal picture of a disease and nozogeny at 36 patients presented by two experimental groups. Results of a research allow to assume that formation of nozogenyat patients with chronic kidney disease is complicated by negative dynamics of intraception, increase of a depression, distortion of perception of a disease and prevalence of negative personal sense of disease.

Scientific publications devoted to the contemporary prospective selected and combined extracorporeal modalities to treat complications after renal allotransplantation were analyzed involving pyoseptic processes and viral hepatites.

Guy Alexandre made major contributions to organ transplantation that, in my opinion, have not been sufficiently recognized by the transplant community. To make his contributions better known, I present a brief summary of the innovations for which he was largely responsible. As a research fellow at the Peter Bent Brigham Hospital in Boston in 1962-3, under subsequent Nobelist Joseph Murray, he contributed to the establishment of pharmacologic immunosuppressive therapy (initiated by Roy Calne) in patients undergoing renal allotransplantation. After his return to his native Belgium, he carried out the first clinical kidney transplant there and, controversially, was the first to take kidneys from brain-dead donors (in 1963), a major advance in organ transplantation. He was also the first to carry out an elective series of kidney transplants between ABO blood group-incompatible donors and recipients, using pre-transplant plasmapheresis to deplete anti-A/B antibodies. This led him to explore kidney xenotransplantation, reporting prolongation of function of pig kidneys in baboons in 1989. Finally, in the early 1990s, he investigated the concept of thymic tissue transplantation as a means of inducing tolerance to donor-specific allografts. I hope this summary of his work makes his pioneering contributions better known to the transplant community.

Minimally invasive renal allotransplantation techniques have been recently described; reported benefits include reduced morbidity/complications. These benefits have been successfully adapted for minimally invasive renal autotransplantation, however, in a non-oncological setting. We, here, describe a novel alternative robot-assisted renal autotransplantation technique, utilizing GelPOINT, which by permitting ex vivo graft examination and surgery might allow further broadening of indications for minimally-invasive renal autotransplantation, to include complex oncological renal/ureteral lesions. Future studies are needed to evaluate the utility of these techniques.

Ureteroneocystostomy (UNC) is the implantation of the ureter onto the bladder. The indications for this are: Implantation of a donor ureter during renal allotransplantation Re-implantation of the native ureter during renal autotransplantation (a treatment for complex renal artery aneurysm) Re-implantation of the native or transplant ureter due to disease of the distal ureter (such as vesicoureteral reflux in native kidneys, or ureteric stenosis in transplant kidneys)

Objectives To report a high-volume institution experience with salvage techniques for vascular accidents during live donor renal allotransplantation. Methods Between March 1976 and January 2011, 2208 recipients underwent live donor renal allotransplantation. A retrospective review of recipients with vascular accidents – renal artery thrombosis and renal vein thrombosis – was carried out. Salvage procedures were recorded and their outcomes were assessed. Results A total of 23 (1%) vascular accidents occurred, including renal artery thrombosis and renal vein thrombosis in 19 (0.8%) and four (0.18%) recipients, respectively. All renal artery thrombosis patients were treated by open revascularization and the graft was salvaged in 12 patients (63%). Two renal vein thrombosis events were resolved by percutaneous catheter-directed thrombolytic therapy. Of the other two allografts, one was salvaged by thrombectomy and revascularization, and the other was lost. On univariable analysis, older recipients (P = 0.003), pretransplant hypertension (P = 0.001), more human leukocyte antigen mismatches (≥3; P = 0.036), shorter ischemia time (≤45 min; P = 0.004) and longer time to diagnosis (>3.5 days; P = 0.013) were significantly associated with non-salvage of the graft after vascular accidents. Nevertheless, none of these variables were significant on the multivariable analysis. Over a median follow up of 35 months, the median (range) serum creatinine was 2 mg/dL (range 0.8–8.8 mg/dL), and 11 (79%) recipients were living with functioning grafts. Conclusions Despite the devastating complications, vascular accidents are salvageable and revascularization is crucial for graft salvage. Angiographic percutaneous techniques are viable alternatives for renal vein thrombosis.

Purpose To analyse the long-term outcome in relation to multiple graft arteries (MGA) in live-donor renal transplantation, and assess its effect on graft and patient survival. Patients and methods Between March 1976 and November 2009, a total of 2100 live-donor renal transplants were carried out at our centre. Patients were stratified according to the number of graft arteries into two groups, i.e. MGA (two or more arteries; 237 patients) and single-graft artery (SGA; 1863 patients). Variables assessed included patient demographics, site of vascular anastomosis, ischaemia time, onset of diuresis, delayed graft function, acute tubular necrosis (ATN), acute rejection, vascular and urological complications. Moreover, long-term patient and graft survival were compared among both groups. Patients were followed up for a mean (SD) of 112 (63) months. Results Grafts with MGA were associated with a prolonged ischaemia time (P = 0.001) and ATN (P = 0.005). Vascular thrombosis (arterial and venous) had a higher incidence in MGA (2.5%) than SGA (0.6%) (P = 0.01). Both groups were not significantly different for the onset of diuresis, acute rejection and urological complications (P = 0.16, 0.23 and 0.85, respectively). Graft and patient survival were comparable in both groups. The mean (SD) 1-, 5-, 10- and 20-year graft survival rates (%) for MGA were 96.1 (1.26), 86.6 (2.39), 61.3 (4.42) and 33.8 (7.23), and 97.5 (0.36), 86.8 (0.84), 66.0 (1.35) and 37.3 (2.76) for SGA (P = 0.54). Conclusions Although there was a higher incidence of prolonged ischaemia time, ATN and vascular thrombosis in live-donor renal transplants with MGA, it did not adversely affect patient or graft survival. The early, intermediate- and long-term follow-up showed an outcome comparable to that in patients with SGA.

Gastrointestinal iron absorption has been measured by means of whole body counting in 13 patients after renal allotransplantation. Whole body retention 14 days after oral administration of 10 muCi 59Fe together with a carrier dose of 9.9 mg Fe2+ was used as an expression of absorption. The percentage incorporation in the total erythrocyte mass of administered 59Fe (erythrocyte incorporation) and absorbed 59Fe (red cell utilization) was estimated as well. Geometric mean iron absorption was 12.4 +/- 2.5 (S.D.)% and geometric mean erythrocyte incorporation 11.1 +/- 3.0 (S.D.)% while arithmetic mean red cell utilization was 95.6 +/- 8.6 (S.E.M.)%. None of these parameters differed significantly from those obtained in normal subjects (p greater than 0.2, p greater than 0.1, pgreater than 0.3, respectively). Iron absorption and erythrocyte incorporation in renal transplanted patients did not differ significantly from the values measured in non-dialysed and dialysed patients with chronic renal failure (p greather than 0.1). The correlation between iron absorption and erythrocyte incorporation was highly significant (r = 0.96, p less than 0.001).

Tolerance is the so-called "Holy Grail" of transplantation, but achieving this state is proving a major challenge, particularly in the clinical setting. Even in rodents, the definition of true transplant tolerance is not applicable to many models, with late graft damage often occurring despite long-term graft survival. Hence the term "operational tolerance," based more on graft function and absence of exogenous immunosuppression, is being adopted. Although the most sought-after goal in this field is to intentionally induce this state in a controlled manner, translating protocols across species from rodents to the clinic, the current literature demonstrates that this is proving a formidable task. A complementary approach is to address transplant tolerance from a different angle, by studying tolerance-like phenomena that occur "unintentionally" in transplant patients after immunosuppressive drug weaning. Such spontaneous operational tolerance, which can take place after years of immunosuppression, is rare in kidney transplant recipients. However, determining exactly how this state arises and how it can be detected may make it possible to induce it in a greater number of patients and then to return to the drawing board to rationally design protocols that have a greater chance of clinical success. Moreover, the study of such patients should help in the identification of biomarkers of low immunological risk that could be used to select patients for potential weaning. Collaborative efforts through international networks, together with the application of newer and more powerful technologies to diagnostic, prognostic, and mechanistic research, may help transplanters to achieve this goal.

Aim: To evaluate the effect of multiple renal artery (MRA) presence on the success and complication rate of renal allotransplantation. Patients and Methods: We retrospectively analyzed 187 cases (128 men and 59 women) who were transplanted in our department from 1997 to 2005. 28 of these cases had MRA. Of MRA kidneys, 6 were obtained from cadavers and 22 from live donors. When the types of anastomoses for MRA cases were examined, 4 cases were anastomosed after being connected to the main polar artery with ex vivo bench surgery; the others had in vivo anastomosis. The patients were divided into two groups as single (group 1) and MRA (group 2) groups. Following the transplantation, creatinine levels, ATN ratios, development of hypertension, patient and graft survivals and vascular and urological complications were compared between the two groups. Results: Patient and graft survival rates were compared between the two groups in the first and third post-operative years. In the first year, graft survival rates for groups 1 and 2 were 94.9 and 92.9% respectively, whereas in the third year these were calculated as 88 and 85.7%. Concerning patient survival, first year results for groups 1 and 2 were 92.5 and 89.2%, for the third year these were found to be 84.9 and 82.1%. Mean creatinine levels of both groups were compared in the first and third years. The results for groups 1 and 2 were 1.41 ± 0.37 and 1.46 ± 0.46 mg/dl respectively for the first year. In the third year these were found to be 1.60 ± 0.43 and 1.69 ± 0.49 mg/dl and there was no statistically significant difference between the groups. Vascular and urological complications were observed in only 6 out of 187 cases (3.2%). Conclusions: No significant difference has been observed between single and MRA kidneys considering the success and complication rates of renal allotransplantation.

The development (in 1981) of a protocol for successful renal allotransplantation across ABO barriers is outlined. From this experience, the concept of "adaptation", subsequently termed "accommodation", was defined. It was then hypothesized that a similar approach might allow pig-to-human organ xenotransplantation. This hypothesis was explored in the pig-to-baboon renal transplantation model, with graft survival for a maximum of 23 days. Rejection episodes were temporarily reversed, providing encouragement that discordant xenotransplantation would one day prove successful. Finally, the preparation of the thymokidney, developed as a means of inducing xenotolerance, is briefly reviewed.

Static cold storage (CS) is the most widely used organ preservation method for deceased donor kidney grafts but there is increasing evidence that hypothermic machine perfusion (MP) may result in better outcome after transplantation. We performed an economic evaluation of MP versus CS alongside a multicenter RCT investigating short- and long-term cost-effectiveness. Three hundred thirty-six consecutive kidney pairswere included, one of which was assigned to MP and one to CS. The economic evaluation combined the short-term results based on the empirical data from the study with a Markov model with a 10-year time horizon. Direct medical costs of hospital stay, dialysis treatment, and complications were included. Data regarding long-term survival, quality of life, and long-term costswere derived from literature. The short-termevaluation showed that MP reduced the risk of delayed graft function and graft failure at lower costs than CS. The Markov model revealed cost savings of $86 750 per life-year gained in favor of MP. The corresponding incremental cost-utility ratio was minus $496 223 per quality-adjusted life-year (QALY) gained. We conclude that life-years and QALYs can be gained while reducing costs at the same time, when kidneys are preserved by MP instead of CS. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

In order to assess the immunosuppressive potentials of 15-deoxyspergualin (15-DS) in a preclinical experiment, heterotopic cardiac (n = 27, group I) and classic renal (n = 25, group II) allotransplantations were performed in Chacma baboons. The following immunosuppressive regimens were applied: Groups IB and IIB were treated with 15-DS alone (4 mg/kg/day) for p.o. days 0-9. Groups IC and IIC were treated with cyclosporine A (10-40 mg/kg/day) for p.o. days 0-30. Groups ID and IID received a combination of 15-DS (for p.o. days 0-9) and CsA (for p.o. days 0-30). Groups IA and IIA served as control and received no medication. The mean graft survival was 11.0 days for group IA, 28.2 days for group IB (P less than 0.05; IB vs. IA), 32.4 days for group IC, and 43.1 days for group ID (P less than 0.025; ID vs. IA). After renal transplantation, the corresponding figures were 12.3 days for group IIA, 8.5 days for group IIB, 30.4 days for group IIC and 148.9 days for group IID (P less than 0.025; IID vs. IIA). After cardiac and renal transplantation, acute rejection was the main cause of graft failure. Treatment-related side effects, mainly gastrointestinal complications, were observed only in primates, who were treated with 15-DS alone. After cardiac transplantation, permanent graft non-reactivity was not achieved, but a delayed rejection occurred within a mean of 21.8 days after immunosuppression had been stopped. Following renal transplantation, graft nonreactivity was also not achieved in groups IIB and IIC. In group IID, however, 4 of 8 animals (50%) were graft-tolerant 340, 256, 244, and 164 days after treatment discontinuation. Thus, the combination of 15-DS and CsA led to a significant prolongation of graft survival in both groups. Long-term nonreactivity was achieved only after renal transplantation, when initially treated with 15-DS and CsA.

A microsurgical method of orthotopic renal allotransplantation in the rabbit is described, and the result of 179 consecutive procedures are presented. There were 10 (5.5%) deaths within I week of transplantation. Earlp complications included vascular thrombosis (4.4%), and obstruction (6.7%) and fistula formation (0.6%) at the uretero-ureteric anastomosis. This method of end-to-end vascular and ureteric anastomoses is straightforward and, in contrast to other models, does not require occlusion of the recipient inferior vena cava or aorta. use of a lone segment of donor ureter, or operation on the recipient bladder.

The different starting points and uneven emphasis of historical accounts of transplantation [1] have tended to obscure the contributions to this field of some of the grand figures of French medicine and science. Clinical transplantation activity began in France within the first few years of the twentieth century when Jaboulay in Lyon [2] and others in France and Germany performed subhuman-primate-to-human kidney heterotransplantation [3–5]. In 1936, The Russian Yu Yu Voronoy of Kiev made the first known attempt at renal allotransplantation [6].

In human renal allotransplantation two functionally different types of rejection crisis were detected. Type I was characterised by an early, abrupt decrease in urine output and an initially reduced fractional sodium and low molecular weight (LMW) protein excretion. Type II was characterised by a later and more insidious onset without oliguria, with no reduction of fractional sodium excretion and with an increased LMW protein excretion.

Ten patients have undergone renal vascular reconstruction with an aortorenal bypass using a polytetrafluoroethylene (PTFE) graft. These operations were indicated as treatment for renovascular hypertension in 9 patients and for renal allotransplantation in 1. Vascular reconstruction was technically successful in all patients with no perioperative complications. Blood pressure control was improved in all patients, and in all those with renal insufficiency preoperatively, renal function was improved or stabilized. Renal revascularization with PTFE grafts has yielded excellent results and offers acceptable surgical management for renovascular disease in selected patients.

Seventy-four recipients of related donor renal allografts were tested for the presence of cellular immunity to specific donor lymphocyte antigens using the direct migration inhibition factor (MIF) assay. Responses on the assay fell into one of the following three statistically distinct groups: (1) greater than 20% inhibition of macrophage migration, (2) nonresponsiveness, +/- 10% of control migration, and (3) greater than 12% stimulation of macrophage migration. Migration stimulation was shown to be reproducible and to correlate well with a very benign post-transplant clinical course. The production of migration stimulatory factor appears to be an immunological response analagous to the production of migration inhibition factor.

Graft biopsy was performed in 49 cases of acute rejection in which plasma creatinine levels had not decreased after a first course of high-dose intravenous methylprednisolone. The severity of the hist

The development of microangiopathic hemolytic anemia after renal transplantation in a 17 year old white boy is reported, and the literature is reviewed. In this patient microangiopathic hemolytic anemia developed 6 weeks after renal transplantation during a second episode of rejection. Light, fluorescence and electron microscopy demonstrated the renal vascular lesion associated with this syndrome. In contrast to the other four previously reported cases of microangiopathic hemolytic anemia associated with renal allotransplantation, this patient had complete resolution of the microangiopathic hemolytic anemia with heparin therapy and improved allograft function, presumably with diminution of the vascular lesion. He survived a complicated early period after renal transplantation and has shown no recurrence of microangiopathic hemolytic anemia in the 18 months since transplantation. Special red blood cell and fibrinogen studies are discussed.

Three urinary lysosomal enzymes, beta-glucuronidase (beta-Gluc), beta-galactosidase (beta-Gal) and N-acetyl-beta-D-glucosaminidase (NAG), were measured in twenty-one renal allograft recipients to evaluate their role in the diagnosis and prediction of rejection episodes, and in the prediction of eventual graft outcome. A fluorometric assay using methylumbelliferone substrates was used to measure the three enzymes in morning urine samples and enzyme activity was defined in terms of urine creatinine concentration. Urinary NAG levels increased significantly in 13/16 first rejection episodes and 4/4 instances of acute tubular necrosis and graft infarction. In 5 of the 16 first rejection episodes the NAG was predictive of the rejection. NAG was not useful in diagnosing second or subsequent rejections and beta-Gluc and beta-Gal were of little value in assessing any component of renal transplant pathology. As a prognostic index of eventual graft outcome, the peak urinary NAG was particularly encouraging. It correlated strongly with deterioration in graft function as time passed such that only 2/10 patients with peak NAG greater than 1400 Units had normal serum creatinines at 6 months post transplantation. Conversely 4/4 patients with peak NAG levels less than 700 Units had normal serum creatinine at that time. In our series the measurement of urinary NAG was a useful adjunct to the diagnosis of first rejections but appears to be more valuable in predicting graft outcome.

Serial measurements of the neutral glycosphingolipids in the plasma and urine of a man who underwent renal allotransplantation because of renal failure due to Fabry's disease were done to evaluate the contribution of the donor organ to the correction of the basic metabolic defect. The concentration of galactosylgalactosylglucosylceramide in the plasma transiently decreased after the renal transplantation (from 0.76 to 0.48 μmoles per 100 ml). The variations in concentration of this lipid closely paralleled similar changes in the concentration of its precursor, N-acetylgalactosaminylgalactosylgalactosylglucosylceramide (from 0.23 to 0.07 μmoles per 100 ml), suggesting that the alterations in galactosylgalactosylglucosylceramide were the result of changes in the rate of formation of the lipid rather than increased catabolism by the graft. The data do not support the hypothesis that enzyme replacement by renal transplantation is effective in correcting the basic metabolic defect in patients with Fab...

The detection of lymphoid cells by routine examination of the urine after renal allotransplantation has proved to be a useful early indication of rejection. In a study of 36 rejection episodes, 20 (56%) were associated with a significant number of lymphocytes in the urine. The incidence was much higher when rejection occurred during the first month after operation (76%); lymphocytes were rarely found when rejection occurred after three months. The appearance of lymphocytes in the urine was of particular value for detecting rejection in patients with prolonged oliguria after transplantation.

Preoperative lymph lymphocyte depletion in cadaveric renal allotransplantation as the sole means of immunosuppression in the early posttransplant period was utilized in 19 patients. It was carried out in four children, one of whom weighed 13 Kg. and another who weighed 18 Kg. Tentative criteria with which to gauge the minimal acceptable time for transplantation utilizing this method of immunosuppression have been established. Of the 15 patients who met the criteria, eight have good to excellent transplant function from two to 30 months posttransplantation.

The course of 5 patients were studied after renal allotransplantation from related donors. Transcervical thymectomy was performed after transplantation in 2 patients and before transplantation fir the other 3 recipients.

Renal blood-flow was monitored by an ultasonic Doppler flow-meter in eleven patients after renal allotransplantation. During the period of observation there were 13 occasions on which the ultrasonic signal fell. 10 of these falls were associated with an acute rejection process. The fall in ultrasonic signal is consistent with a fall in blood-flow and, after successful treatment of rejection, the signal rises consistent with an increase of blood-flow. In early rejection, the ultrasonic signal from the renal artery may fall even when renal function is recovering from acute tubular necrosis, indicating the blood-flow

The blood-pressure in a group of forty patients on a renal replacement programme for at least 5 months (mean period 17 months) has been investigated. Sixteen had been on regular intermittent haemodialysis and twenty-four had been treated by renal allotransplantation. Transplantation provided better results in respect of the blood-pressure. Bilateral nephrectomy in patients on dialysis and after transplantation is recommended for patients with persistent hypertension. In cases where hypertension persists in patients after transplantation and nephrectomy, chronic rejection or stenosis of the arterial anastomosis are usually responsible.