No abstract

0,65 (0,36-0,73) vs 1,05 (0,67-1,4) % и 0,039 (0,028-0,056) vs 0,063 (0,049-0,076) × 10 9 кл./л соответственно (р = 0,0009, р = 0,003), а также относительной и абсолютной численности плазмоцитоидных дендритных клеток -0,055 (0,04-0,085) vs 0,09 (0,05-0,12) % и 0,0038 (0,0021-0,0054) vs 0,005 (0,0035-0,007) × 10 9 кл./л соответственно (р = 0,0197, р = 0,0414 Introduction. Diagnosis of the kidney transplant cellular rejection in the long-term after transplantation remains a challenge. Usual surrogate markers are not enough sensitive and specific. Rejection is an immune reaction to donor alloantigens. The kidney transplant biopsy to diagnose a dysfunction is an invasive procedure with the incidence of complications about 12.6% and can lead to transplant loss. In this regard, the search of immunological biomarkers for early noninvasive and accurate diagnosis of kidney transplant rejection is an actual task. Material and methods. This is a report of the observational retrospective single-center, comparative case-control study in two groups involving 44 patients who underwent kidney transplantation. The first group (REJ) included the patients with the chronic graft dysfunction caused by a biopsy-confirmed late cellular rejection (22 patients). The second group (STA) included the recipients who had no dysfunction in the posttransplant period (22 patients). Flow cytometry of peripheral blood cells was performed to identify immunophenotyping markers of late cellular rejection after kidney transplantation (we determined subpopulations of T, B lymphocytes, and dendritic cells).Results. As a result of our work, we found significant differences in the absolute count of effector memory T cells making (0.36-0.73) vs. 1.05 (0.67-1.4) % and 0.039 (0.028-0.056) vs. 0.063 (0.049-0.076 , respectively (р = 0.0009, р = 0.003). The numbers of plasmacytoid dendritic cells were also different between the study groups: 0.0038 (0.0021-0.0054) vs. 0.005 (0.0035-0.007) × 10 9 cell/L for an absolute count (р = 0.0414), and 0.055 (0.04-0.085) vs. 0.09 (0.05-0.12

Background and Aims Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI), especially recurrent UTI, is a common problem, with the prevalence up to 75% among kidney transplant (KTx) recipients. Older age, female gender and delayed graft function are among the independent risk factors for recurrent UTIs in renal transplant recipients*. Postmenopausal women with recurrent UTI after KTx especially caused by bacteria with multidrug antibiotic resistance (MDR) form a large and growing up group of patients with almost unachievable remission. The aim of the study was to assess the efficiency of different treatment schemes of recurrent UTI in postmenopausal female transplant recipients. *prospective study presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy Method The randomized prospective pilot study was conducted to assess the efficiency of 3 different therapy schemes, study period: 2017-2019. Recurrent UTIs were defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A UTI was diagnosed based upon the presence of pyuria defined as >5 WBCs/high-power field and a urine culture of >100,000 colonies/mL. All consecutive female patients with postmenopausal history who presented to the transplant clinic for follow-up over the study period of six months were prospectively randomized into 3 groups. The primary outcome was occurrence of UTI at 6 months. Results Escherichia coli was the responsible pathogen for recurrent UTI in 55% of cases. Other causative organisms include Klebsiella pneumoniae (35%) as well as Enterobacter spp (10%). The rate of resistance to all tested antibiotics was the highest in Klebsiella pneumoniae. The first episode of UTI occurred at 16 (8,5;42) week after KTx. The total number of UTI episodes (per year) after treatment varies from 7 [5;8] in the 1st Group to 0 [0;0] at the 3rd Group (p<0,001), in which 13 out of 15 patients achieved long-term remission during the observation period. Clinical data on the 1st check-up after treatment course and about UTI episodes are given bellow. Conclusion Frequent antibiotic usage often causes MDR as well as result in intestinal dysbacteriosis. Immunosuppression state, frequent antibiotic usage, intestinal disbiosis and also vaginal Ph decline form pathogenic vicious circle. Complex usage of fosfomycin that remains active against a considerable proportion of MDR gram-negative bacteria with bacteriophages, estrogen treatment and long-term probiotic supplement may reduce the UTI frequency in postmenopausal women after KTx.

It was shown that Tacrolimus (TAC) can suppress inflammation and immune response involved in liver ischemic reperfusion injury (IRI) (Kristo I., Transpl Int. 2011). The aim: We hypothesize that back-table arterial and portal liver perfusion with TAC can influence the incidence and severity of EAD. A prospective randomized study was conducted (ClinicalTrials.gov Identifier: NCT01887171). Materials and methods: Including criteria: 1 st liver transplantation from DBD donor with sequential portal-arterial reperfusion. At back-table portal vein and hepatic artery were perfused each by 500 ml of HTK solution containing 20 ng/ml TAC during 10-15 min followed by portal flushing with 200 ml 5% solution of Albumin containing 20 ng/ml TAC and by resting of liver in effluent. No Tac was added in the control group. Primary Outcome: EAD (Olthoff KM, et al. Liver Transpl. 2010) and severe EAD (P.R. Salvalaggio, et al. Transpl. Proceedings, 2012). Results: No difference was found between groups (main vs. control) in terms of MELD (16 vs. 16), steatosis (10 vs. 10%), ballooning (45 vs. 40%) of liver grafts, recipient's age (50 vs. 50y), warm ischemia time (50 vs. 50 min) and total ischemia time (482.5 vs. 485.0 min). Median donor age was higher in the main group (44.5 vs. 39.0y). The overall rate of EAD was 27.9%. EAD rate was significantly lower in the main group (6/43 vs. 18/43; p=0.003). The rate of moderate-to-severe EAD was lower in the main group (1/43 vs. 10/43; p=0.009). The median level of AST and ALT 24 h after reperfusion were significantly lower in the intervention group (1004 vs. 1596; p=0.03 and 449 vs. 759; p=0.057). Conclusion: Portal and arterial back-table liver perfusion by HTK solution with Tacrolimus may contribute to lower EAD incidence and severity.

РНПЦ трансплантации органов и тканей УЗ «9-я городская клиническая больница», Минск, Республика Беларусь В предыдущих исследованиях было показано, что такролимус может подавлять воспаление и иммунный ответ во время ишемически-реперфузионного повреждения трансплантата печени (Kristo I., Transpl Int., 2011). Цель исследования. Оценить влияние back-table портальной и артериальной перфузии раствором HTK и альбумина, содержащим такролимус, на частоту и выраженность ранней дисфункции трансплан-тата печени. Материалы и методы. Для достижения поставленной цели было организовано интервен-ционное проспективное рандомизированное исследование (ClinicalTrials.gov Identifi er: NCT01887171) в двух параллельных группах по 43 пациента. Критерии включения: первичная ортотопическая трансплан-тация печени от донора со смертью мозга с последовательной портально-артериальной реперфузией. В основной группе на операции back-table выполняли перфузию воротной вены под давлением 40-60 см водяного столба раствором HTK в объеме 500 мл c содержанием такролимуса 20 нг/мл, а затем перфузию печеночной артерии 500 мл такого же раствора под давлением 40-50 мм рт. ст., перед имплантацией граф-та в воротную вену вводили 200 мл 5% раствора альбумина c содержанием такролимуса 20 нг/мл. В конт-рольной группе такролимус не был добавлен. Результаты. Группы были сопоставимы (основная против контрольной соответственно) по баллу MELD, стеатозу, баллонной дистрофии трансплантатов печени, возрасту реципиента, времени тепловой ишемии и общему времени ишемии. Средний возраст донора был выше в основной группе (44,5 против 39 лет). Общая частота ранней дисфункции аллографта (РДА) была 27,9%. Частота РДА была значительно ниже в основной группе (6/43 против 18/43, р = 0,003), также частота тяжелой РДА была значимо ниже в основной группе (1/43 против 10/43; р = 0,009). Средний уро-вень АСТ и АЛТ через 24 ч после реперфузии были значительно ниже в основной группе (1004 против 1596; р = 0,03 и 449 против 759, р = 0,057). Заключение. Применение инфузии раствора HTK и альбу-мина с такролимусом в воротную вену и печеночную артерию во время подготовки донорской печени к имплантации позволяет уменьшить частоту и выраженность ранней дифункции трансплантата печени. Ключевые слова: дисфункция трансплантата печени, портально-артериальная перфузия.