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Objective: to clarify the indications for the use of nephron-sparing technologies in surgical treatment of patients with retroperitoneal sarcomas. Material and Methods. The study included 64 patients with primary retroperitoneal sarcomas with kidney and renal pedicle invasion, who underwent surgical treatment in the Thoracic-abdominal Department of the P.A. Herzen Moscow Oncology Research Institute from 2010 to 2021. Twenty-one patients underwent nephrectomies, and 43 patients underwent nephron-sparing surgery. The morphological profile of sarcomas, age and gender of the patients, feasibility of using nephron-sparing technologies, postoperative complications, and long-term outcomes in patients of both groups were analyzed. Results. Forty-three patients with primary retroperitoneal sarcomas with invasion of the renal parenchyma, ureter, and renal pedicle underwent nephron-sparing surgery (precision mobilization of the kidney, ureter and vascular structures of the kidney from tumor tissue, kidney resection, ureteral stenting, resection of the renal vein orifices, resection of the ureters, and kidney autotransplantation). Postoperative complications were observed in 19.0 % of nephrectomy group patients (4 pts: II, IIIB, IV and V types according to Clavien–Dindo) and in 30.2 % of nephron-sparing group patients (15 pts: types II – 8, IIIA – 1, IIIB – 3, IV – 1). No statistical differences in the relapse-free period and survival time between two groups were observed. The 1-, 3- and 5-year survival rates were 84.1 %, 65.9 %, and 51.4 %, respectively. Multifactorial analysis showed that mortality increased significantly in patients over 64 years of age and was associated with both disease recurrence and concomitant pathology (p=0.009). There was also a trend toward decreased survival in patients with leiomyosarcoma (p=0.066). Conclusion. In retroperitoneal sarcomas, tumor resection with preservation of organs and structures not directly invaded by the tumor is the optimal surgical strategy. Nephron-sparing technologies do not worsen both immediate and long-term treatment outcomes. For leiomyosarcoma, tumor resection with nephrectomy is the most suitable approach.

The first successful kidney autotransplantation was performed in 1902. The technique has undergone several changes since then. The indications and surgical technique are presented in this literature review. Kidney autotransplantation is the treatment of choice for preserving renal function. Three clinical observations on the use of kidney autotransplantation in urological and oncological practice are described: a patient after iatrogenic ureteral injury and two patients with primary retroperitoneal tumor. Literature analysis and clinical observations from urological and oncological practice show that kidney autotransplantation could be safely used for strictly selected indications.

Simultaneous pancreas-kidney transplantation (SPKT) is the most promising treatment option for patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) due to diabetic nephropathy (DN). Successful SPKT eliminates uremic intoxication and hyperglycemia – the leading trigger of vascular diabetic complications. Therefore, euglycemia is an important metabolic change in patients after surgery and remains only one of the factors for the saved renal allograft functioning. In the case of resuming renal replacement therapy by dialysis after SPKT, the management and monitoring of the pancreatic graft remains open. Special attention to the pancreatic graft’s function is due to both the potential risk of surgical complications, and some probability of T1DM relapse with the need to resume insulin therapy. In patients with saved function of both transplants, the assessment of the dynamics of diabetic complications in general becomes more important. The results of few studies in this regard remain contradictory. Thus, clinical options can be unpredictably diverse and require not only search for the root cause, but also optimization of rehabilitation tactics, even if the expected results are achieved.

We present a case of simultaneous laparoscopic bilateral nephroureterectomy, cadaveric kidney allotransplantation and performance of vesicostomy. This observation shows that patients with end-stage kidney disease, primarily caused by neurogenic bladder dysfunction, can be successfully treated via surgery. The course of early postoperative period and further rehabilitation did not differ significantly from that obtainable after standard kidney allotransplantation.

Diabetes mellitus is a significant social problem. In the Russian Federation, the prevalence of diabetes type 1 is 340.000 people, 21% of them having diabetic nephropathy, as well as other secondary complications leading to disability and high mortality. There are several options for diabetic patients with chronic kidney disease dialysis: kidney transplantation with insulin therapy, simultaneous kidney-pancreas transplant or islet transplant. Good long-term results could be obtained by the whole pancreas and kidney combined transplantation through maximum metabolism recovery comparing to other replacement therapy options. The recipientselection with special attention to the cardiovascular system evaluation is essential to successful transplantation. The proper pancreatic graft assessment needs a wide range of criteria to be analyzed. Integral scores can simplify and systematize the assessment. The choice of preservation technique is important to pancreatic graft ischemia-reperfusion injury minimization. Despite the progress in graft preservation methods, cold storage using University of Wisconsin (UW) solution remains to be the gold standard. The evolution of surgical technique has resulted in utilizing the most physiologic variations of exocrine drainage and venous outflow of the pancreas, so-called portoenteric drainages, which were designed to improve remote metabolic effects and to reduce complications probability.

Aim. To analyze the efficacy and safety of different induction therapy protocols experience based on depleting antibodies for kidney transplantation (ATGAM, Timoglobulin).Material and methods. The study included 107 non-sensitized patients who underwent primary kidney allotransplantation in the period from January 2012 to March 2014. Patients were divided into 3 groups according to the ongoing induction immunosuppressive therapy. Group I, patients receiving the drug ATGAM (n = 67). Group II – Timoglobulin (n = 30). Group III, patients received a combination of the introduction of basiliximab and ATGAM (n = 10). All patients received basic triple immunosuppressive therapy: tacrolimus, mycophenolic acid, methylprednisolone tapering.Results. The incidence of acute rejection in group I – 7,5% , in group II – 0%, in group III – 0% (p = 0,15). The incidence of severe thrombocytopenia in group I – 2,7%, in group II – 0% (p < 0,05), in group III – 10%. Incidence of CMV viremia in group I – 6,16%, in group II – 6,6%, in the group III – 10%, respectively (p > 0,05). In the 2-nd and 3-rd group registered one case of CMV pneumonia in the early postoperative period.Conclusion. Use of exhaustible polyclonal antibodies as drugs of choice for renal transplantation induction therapy in primary unsensitized patients is warranted. Further research is needed for evaluation of 5- and 10-year results.

AAim. To identify factors influencing upon decision on pancreas allograft suitability for transplant and their clinical significance. Materials and methods. We reviewed 95 multiorgan donors under the age of 45, who were considered as pancreas donor between January 2010 and December 2013. 28 pancreata were procured (Group I), 67 pancreata were refused (Group II). Demographic, clinical and laboratory data, anatomical hepatopancreatoduodenal varieties were taken into account. Results. We found that only three factors have an effect on pancreas allograft refusal probability. According to our data, non-transplantation of the liver from the same donor increases the pancreas graft refusal in 4 times. Elevated donor’s sodium and urea blood levels also increase the probability of donor pancreas denial for transplantation. For example, the probability of pancreas graft refusal from the donor with sodium level 145 mmol/l and urea level 6.0 mol/l is only 32%. As compared to the donor with sodium level 160 mmol/l and urea 12.0 mol/l where probability reaches 85%. Other factors: demographic, laboratory, clinical indicators, gepatopancreatoduodenal blood supply variations were not predictive for the procurement decision. Conclusion. Main predictors of pancreas allograft refusal to be taken into account, appropriate correction of donor metabolic disturbances and sufficient experience of the surgeon performing the procurement can increase the availability of pancreas transplantation.

Combined liver-pancreas transplantation is considered to be a reasonable treatment of patients with end-stage liver disease and concomitant insulin-dependent diabetes mellitus, so it may become a standard treatment of this category of patients. As known, diabetes mellitus negatively affects the long-term results of isolated liver transplantation and increases a risk of posttransplant complications. Notwithstanding the widening range of indi- cations for simultaneous liver-pancreas transplantation and advances of transplantology, this operation continues to be a rare event in world medical practice. In May 2010 in Academician V.I. Shumakov Federal Research Cen- ter of Transplantology and Artificial Organs there was performed a first in Russia simultaneous liver-pancreas transplantation to 17-years old recipient, suffering with liver cirrhosis (as a result of autoimmune hepatitis) and concomitant insulin-dependent diabetes mellitus. In this article we give an overview of indications for simultaneous liver-pancreas transplantation, different ope- rative techniques, immunological aspects and immunosuppression regimes, as well as we describe the first in Russian experience of such transplantation.