Abstract. The occurrence of an emergency situation (ES) forced international (ISN, EDTA/ERA) and national (Turkey) nephrological associations to establish the Renal Disaster Relief Task Force, which is primarily concerned with the treatment of patients with acute kidney injury and end-stage renal disease requiring dialysis. The war started by the RF is putting the Ukrainian state, Ukrainian society, and the healthcare system in the catastrophic ES. Under these circumstances, all nephrological patients became one of the most vulnerable categories of patients. To provide immediate support in solving problems within the Ukrainian Association of Nephrologists and Kidney Transplant Specialists (UAN&KTS), the Ukrainian Renal Disaster Relief Committee (URDRC) has been established. One of the most important tasks was to form a group of experts to develop recommendations for specialized medical care for kidney patients in wartime.  According to the experts, the key person for this type of medical care is the leading nephrologist in the region or city. He/she establishes a local Renal Disaster Relief Committee (LRDRC) and decides through horizontal (with other LRDRC) or vertical (with UAN &KTS) collaboration, using available communication tools, on the problems that arise; the most appropriate tool is the Viber platform "Nephrology. Dialysis. Transplantation". In this way, a network without administrative subordination and a non-hierarchical functional system was created, which, on the one hand, functions according to similar working principles, but, on the other hand, may differ in terms of LRDRC composition, communication methods, and more. The LRDRC divides all patients into three groups and provides work preparation measures before, during and after the cancellation of ES.

ВступОстаннім десятиріччям трансплантація нирки є методом вибору в лікуванні пацієнтів із термі-нальною хронічною нирковою недостатністю (ТХНН). Особливо це стосується пацієнтів дитя-чого віку, оскільки, на відміну від інших методів замісної ниркової терапії, успішна транспланта-ція в дітей і підлітків не тільки ліквідовує уремію, але й суттєво стимулює наявні резерви росту та фізичного розвитку, сприяє покращенню стате-вого дозрівання, психоемоційного й соціально-го розвитку. Проте, незважаючи на досягнення імуносупресивної терапії, реакція відторгнення трансплантованого органа залишається осно-вною причиною незадовільних результатів опера-ції. Виникнення цього ускладнення багато в чому залежить від стану імунної системи, тому вивчен-ня її в потенційних реципієнтів перед операцією становить великий інтерес для трансплантологів. Це також важливо для вибору оптимальної схеми імуносупресивної терапії.Відомо, що розвиток хронічної ниркової не-достатності (ХНН) супроводжується порушен-нями імунної відповіді [1]. Крім того, за даними літератури, є різниця між імунологічними пара-метрами в дітей та дорослих, але це питання зали-УДК 616. 61-053.2-089.843:612.017

Abstract. Kidney transplantation is recognized as the optimal method of end-stage kidney disease treatment, but chronic renal allograft rejection remains an unresolved issue and leads to transplanted organ function loss. Recent studies show positive effects of stem cell injections in a variety of diseases, including kidney transplantation. The present study aimed to analyze the first experience of umbilical cord blood stem cells application in living-related kidney transplantation in Shalimov’s National Institute of Surgery and Transplantation, give a preliminary assessment of their effectiveness and safety, evaluate the clinical course and especially the dynamics of laboratory parameters in the recipient’s postoperative period. Methods. The study group included 6 male, adult recipients of kidney transplants, who performed the first kidney allotransplantation from a living family donor in the Shalimov’s National Institute of Surgery and Transplantology in 2020 – 2021. Before surgery, all patients received intravenous administration of a fraction of nuclear cells from human umbilical cord blood at a dose of 2-3 x 106/kg body weight in combination with standard three-component immunosuppressive therapy. Immune system studies were performed before kidney transplantation, on the first and third days of the postoperative period, at the end of the first and second week, as well as on the first, third, sixth, and twelfth months, following kidney transplantation. Renal graft function was assessed by serum creatinine and glomerular filtration rate. Monitoring of clinical and laboratory parameters of blood and urine, the concentration of calcineurin inhibitors (C0) was carried out regularly three times a week for the first month, twice a month for 2-3 months, and once a month until the end of the year. Puncture biopsy of the transplanted kidney was performed three months after surgery to diagnose the pathology of the graft, namely the manifestations of acute and chronic rejection, the nature and degree of which were determined according to the Banff classification. The state of the immune system of the recipients was characterized by indicators of cellular and humoral immunity. Statistical processing of research results was performed using the statistical package StatSoft (2010) STATISTICA 9.1 for Windows StatSoft Inc, Tusla. Results. All patients received cord blood stem cells without complications. On the first day after surgery, an average diuresis was 9415 ± 928.1 ml. Normalization of graft function was observed on the second or third day (GFR more than 90 ml/ min/1.73 m2). There were no rejections of grafts and signs of opportunistic infections in the patients during 1 year follow-up period. Morphological studies did not reveal signs of significant pathological changes in transplanted kidneys in patients who received stem cells as induction therapy. The study of the state of the immune system of recipients in the dynamics, given the insufficient number of patients, requires further research. Conclusions. The administration of cord blood stem cells to recipients prior to kidney transplantation is safe and promotes rapid recovery of renal allograft function. There were no signs of morphological proven chronic graft rejection, which allows us to predict its long-term functioning in the future. To assess the response of the recipient's immune system to the application of cord blood stem cells requires the accumulation of additional data.

Kidney transplantation is considered the gold standard in the treatment of end-stage renal disease and can be performed if cadaveric or living related donor organ is available. AB0 incompatible kidney transplantation can lead to antibody-mediated rejection. There are a number of methods in the world for the elimination of anti-A/B antibodies to prepare for AB0 incompa­tible kidney transplantation, each of which has its advantages and disadvantages. Therefore, further researches are needed in this direction to determine the optimal method in each case. Particular attention is paid to modern methods of anti-A/B antibodies elimination, protocols for managing such patients, and their comparison. The possibilities of using these methods in Ukraine are analyzed.

Kidney transplantation is the gold standard for treating end - stage kidney disease. But the lack of cadaveric organ donation in Ukraine makes this operation available only for patients with living related donor. The absence of ABO - compatible living donor in the family is found in 20 - 30% of cases. This is the case for ABO - incompatible transplantation, but it is associated with an increased risk of acute rejection and requires special pre - transplant management. The article describes the first in Ukraine successful case of ABO - incompatible kidney transplantation in A.A. Shalimov’s National Institute of Surgery and Transplantology.