The aim: To estimate the protective effect of remote ischemic preconditioning (RIPC) on kidney transplants harvested from living related donors. Materials and methods: To achieve the claimed aim, there were examined 60 donor-recipient couples, where kidney transplant donors were living-related. All donors had the same anaesthetic management. The first group (n = 30) received RIPC which included four procedures of cuff inflations each lasting 5 minutes followed by 5-minute intervals of cuff deflation to measure blood pressure up to 40 mm Hg above systolic blood pressure on the shoulder. Patients of the second group (controls) did not experience RIPC (n = 30) and control group without RIPC. Results: RIPC resulted in a statistically significant (P<0.05) increase in GFR of the transplanted kidney from 66±5 mL /min to 63±4 mL /min after 3 months, from 69±3 mL /min to 61±5 mL /min after 6 months, from 63±2.5 mL /min to 57±3 mL /min after 12 months; a 3-fold reduced partial delay of graft function; a 2-fold decreased incidence of acute kidney transplant rejection times; 1.5-fold decline in the incidence of primary non-function; and 1.4-fold tCr50 acceleration (p = 0.16). The follow-up period lasted for a year after transplantation. Conclusions: RIPC during organ harvesting improved graft ischemic protection and increased functioning efficiency in the recipient.

Objective. Elaboration of method for the intraoperative ischemic-reperfusion trauma softening - distant ischemic preconditioning and investigation of results of its introduction into clinical practice. Materials and methods. The method of distant ischemic preconditioning elaborated have included four procedures the air inflation into the flap for the arterial pressure measuring by 40 mm Hg over the level of systolic arterial pressure, 5 min of duration in every one, with consequent 5-minute intervals for the air release from the flap. The procedure of a distant ischemic preconditioning was conducted after introduction into narcosis, but before the donor's nephrectomy in 30 patients (the main group). The procedure was not conducted in 30 such patients. Results. The procedure elaborated permits to enhance the glomerular filtration significantly in 6 and 12 mo, to reduce the rate of partial delay of the transplant functioning, its acute rejection and primary dysfunction. Conclusion. The procedure of a distant ischemic preconditioning elaborated improves the transplanted kidney function.

The aim. To study the role of NGAL in assessing the recovery of early graft function (GF) and in predicting GF in the first year after kidney transplantation (KT) from a living-related donor (LRD). Materials and methods. For this aim, a total of 60 kidney recipients who underwent KT from LRDs were examined. To study the early GF, NGAL concentrations in urine samples were measured on days 1, 2, 3, 7 after KT. To study the late GF, the glomerular filtration rate (GFR) was calculated at 3, 6, 12 months after KT. To study the prognosis of GF during the first year after KT, the relationship between u-NGAL and GFR levels at 3, 6, 12 months after KT was analyzed. The incidence of acute kidney transplant rejection (AKTR), delay of graft function (DGF), primary non-function was recorded. Results. DGF was observed in 5 (8.33 %) recipients with statistically significantly increased mean NGAL levels (P < 0.05) on days 1, 2, 3, 7 as compared to those in normal GF. AKTR was detected in 10 (16.67 %) recipients with statistically significantly increased mean NGAL levels (P < 0.05) on days 1, 2, 3, 7 compared to those in normal GF. Primary allograft non-function was diagnosed in 8 (13.33 %) recipients with statistically significantly increased mean NGAL levels (P < 0.05) on days 1, 2, 3, 7 compared to those in normal GF. Assessing the relationship between NGAL levels on days 1, 2, 3, 7 and GFR at 3, 6, 12 months after transplantation, it was found that GFR was higher in recipients with NGAL levels on days 1, 2, 3, 7 after transplantation within the reference values (<131.7 ng/ml) than that in recipients with NGAL levels on days 1, 2, 3, 7 after transplantation above 131.7 ng/ml. Conclusions. Evaluation of NGAL after KT informs about the restoration of renal function (rapid decrease in NGAL) or the development of complications (DGF, primary allograft non-function, AKTR) with slow decrease or increase in NGAL levels. Thus, u-NGAL is an early, non-invasive and accurate predictor of the need for dialysis in the first week after KT and the restoration of GF within 12 months.