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Transplantation in elderly patients is obviously more challenging due to existing underlying diseases, changes in pharmacokinetics of immunosuppressive drugs, polypragmasy, and transformation of immunoreactivity (immunosenescence). Our review presents data on modification of adaptive and innate immunity during aging. It also considers the possibility of both reduced and adapted immunosuppressive therapy in elderly renal transplant recipients in achieving an optimal balance between efficacy and complications.

Aim. To analyze the relationship between the peak panel-reactive antibodies (peak-PRA), the value at the time of transplantation (Tx-PRA) and the results of kidney transplantation.Materials and methods. The study included 287 patients from the waiting list with anti-HLA antibodies of I and/or II classes. 142 patients underwent transplantation of a cadaveric kidney. All patients received standard immunosuppression: a calcineurin inhibitor, mycophenolate and steroids. Desensitization in the preoperative period was carried out in 11 patients. Screening and identification of antibodies was performed using multiplex technology on Luminex platform.Results. The median PRA was 47% (interquartile range – 29%; 65%). Depending on the dynamics of PRA, we identified several groups of patients: stable PRA (83 patients), increasing (77 patients) or decreasing value (96 patients), or variable dynamics (31 patients). The change in PRA was accompanied by a change in the mean fluorescence intensity (r = 0.787, r2 = 0.59, p < 0.0001). In the univariate analysis, each 5% of peak-PRA and Tx-PRA increased the relative risk (RR) of humoral graft rejection (1.09 (95%CI 1.06; 1.17), p < 0.001; 1.17 (95%CI 1.09; 1.26), p < 0.001 respectively), and ΔPRA decreased a RR (0.932 (95% CI 0.861; 0.967), p = 0.009). In multivariate analysis (adjusted for sex and age of recipient, duration of dialysis, number of HLA mismatches), we observed a similar scenario: peak-PRA 1.14 (95% CI 1.07; 1.19), p < 0.001; Tx-PRA 1.13 (95% CI 1.09; 1.22), p < 0.001; ΔPRA 0.949 (95% CI 0.871; 0.981), p = 0.017. In the univariate analysis increases in peak- PRA and Tx-PRA increased aRR of graft loss (1.1 (95% CI 1.05; 1.14), p

Aim – to perform a comparative study of the long-term results of the combined use of extracorporeal photochemotherapy (photopheresis) and drug immunosuppression and standard immunosuppressive therapy in patients after kidney transplantation.Materials and methods. An open cohort randomized study was conducted, including 60 patients with chronic kidney disease stage 5D. All patients underwent single-group cadaveric kidney transplantation. Patients were randomly divided into two groups. All transplants were paired, the fi rst kidney transplant was received by the patient of the main group, the second – by comparison group. 30 patients of the main group received standard protocol of immunosuppression and 10–15 sessions of photopheresis during the fi rst six months after transplantation. All patients of the comparison group received standard immunosuppressive therapy only. End points: primary – graft loss, surrogate – the number of acute rejection episodes and infectious complications, the dynamics of creatinine blood concentration, the glomerular fi ltration rate and daily proteinuria, the dynamics of tacrolimus C0 blood concentration. To study the mechanism of photopheresis action in the late postoperative period, we evaluated the immunological parameters: subpopulation of naive T-cells (CD3+CD4+CD45RO–CD28+), the level of CD28 molecule expression (MFI) on these cells and also – subpopulation of T-regulatory cells (CD3+CD4+CD25 (Hi)CD127–).Results. The use of photopheresis leads to the graft function improvement in the late postoperative period: the creatinine concentration (p = 0.017) in the blood and daily proteinuria (p = 0.011) were lower in patients of the main group, the glomerular fi ltration rate was higher (p = 0.027). The incidence rate ratio (IRR) of rejection in the main group was signifi cantly lower than in the comparison group: 0.2509 (95% CI 0.05386, 0.9167), p = 0.0358. The risk of graft loss was also lower in the main group: IRR 0.2782 (95% CI 0.07562, 0.8657), p = 0.026, as well as the risk of infectious complications: IRR 0.3888 (95% CI 0.2754; 0, 5445), p < 0.0001. Survival rate of transplants was higher in the main group (Log Rank p = 0.009; Breslow p = 0.005). The use of photopheresis made it possible to reduce the concentration of tacrolimus in the late postoperative period (p = 0.0017) without increasing the risk of graft rejection. The photopheresis tolerogenic effect in the late postoperative period may be due to an increase in the population of T-regulatory cells with the CD3+CD4+CD25(Hi)+CD127– phenotype compared to the patients which received only standard immunosuppressive therapy (p = 0.024).Conclusion. The preventive use of photopheresis contributes to improvement of the kidney transplantation long-term outcomes. Further studies are needed to study the mechanisms of photopheresis action and markers of partial immunological tolerance to the allograft.

The aim of the study was to determine the value of extracorporeal photochemotherapy (EPCT) in the induction of tissue tolerance in renal transplantation. EPCT was applied to 24 renal transplant recipients in early postoperative period, the control group consisted of paired transplant recipients. In the group using EPCT over a three-year period of observation no clinical or histological signs of rejection were observed. In the control group, histologically confirmed rejection was observed in 4 cases, in 2 cases transplantectomy due to acute rejection. The reducing incidence of infectious complications in the study group compared with the control one (4 and 19 cases, respectively) and decreasing number of hospitalizations on various reasons (8 and 47 cases in the study and control groups, respectively) were also noted. Three-year graft survival was 100% and 83.3% in the study and the control groups, respectively. Using immunological tests in 30 days after transplantation the stable number of cells expressing coactivation molecules (57.7 ± 18.2 and 52.7 ± 23.2%, respectively, p > 0.05) and the density of their co-expression (22.7 ± 6.0 and 19.6 ± 7.0 units, respectively, p > 0.05) were demonstrated, while in the study group, the pronounced and statistically significant reduction both in the amount of cells expressing co-activation receptors (from 57.7 ± 18.2 to 34.5 ± 11.4%, p < 0.05) and in the density of these receptors on naive helper T-lymphocytes (from 22.7 ± 6.0 to 16.8 ± 5.1 units, p < 0.05) was revealed. Thus, it is noted that EPCT provides induction of tolerance to MHC antigens in kidney transplantation due to reducing expression of coactivation molecules which promote the second signaling pathway to T-cell receptor activation.

Currently, an organ rejection is a leading cause of kidney transplants loss. Effective therapy is impossible without a clear understanding of the rejection mechanisms. In this paper, we summarize the views of domestic and foreign authors on the role of T cell activation in kidney transplant rejection.

The paper presents a contemporary view on organization of genes in the major histocompatibility complex, their protein products, and nomenclature of human leukocyte antigens.

The new immunotherapeutic method is presented in the review - an extracorporeal photochemotherapy. The questions concerning its application in the T-cellular lymphoma of skin and transplantation of solid bodies are discussed. The special attention is paid to the mechanism of its therapeutic action.

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.

It is known that the number of matches of the major histocompatibility complex antigens has a direct relationship with the duration of a renal transplant functioning. The lecture examines the role of HLA matching in presensitization of renal transplant recipients and de novo production of antibodies. Attention is also paid to non-HLA antibodies.

The first domestic experience of translational cellular immunotherapy application in recipients of cadaveric renal allograft is presented. We present the analysis of the clinical, laboratory and immunological data and also the results of transplant protocol biopsy on the 30th and 180th days after transplantation. Clinical, laboratory, immunological, and histological benefits in patients of the main group were revealed. As а result, some mechanisms that explain the possibility to form immunological tolerance were established.

Reducing the risk of kidney transplant rejection is a perspective trend in modern medical science. One of the promising methods for reducing the activity of immune conflict between the recipient and the donor organ and the achievement of partial immunological tolerance is photochemotherapy. This method is widely used in over- seas heart and lung Transplantation. Domestic experience of applying this method in renal transplant recipients is extremely small. In this review of literature a modern representation of the scientists on the mechanism of action of this method is presented.

Aim. To evaluate the clinical efficiency of extracorporeal photochemotherapy (EPCT) in the treatment of psoriasis (Ps) and Ps associated with psoriatic arthritis (PsA). Subjects and methods. Ninety-three patients with different forms of psoriasis were examined. A study group (SG) comprised 52 patients who were treated with EPCT; a control group (CG) included 41 patients. All the patients received pharmacotherapy generally accepted for these diseases. The SG patients were given additionally EPCT (the patient took 8-methoxypsoralen in a dose of 0.6 mg/kg 1.5-2 hours before the procedure). Mononuclear cells were isolated from the patients' blood in the intermittent-line mode on a Haemonetics MCS+ cell separator. The cell suspension was irradiated with ultraviolet light A (λ=320-400 nm) on a JULIA irradiator at 10-15 ml/min for 30 min and reinfused in the patient. The course of therapy consisted of 4 sessions performed on alternate days. Results. A varying positive effect was obtained in 49 (94%) SG patients; the mean PASI scores fell from 19.7±3.4 to 6.7±2.1 (p