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Transplantation of the kidney in patients with renal carcinoma is disputable. The article presents the results of kidney transplantation in different cancer lesions of the patient's kidneys. Seven case histories of patients with primary renal tumors are retrospectively analysed. A clinical case of development of the tumor of own kidney in a patient after transplantation is reported. A time factor of kidney transplantation after tumor removal in a recipient is discussed.

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AIM: to assess the role of immunological mechanisms in the development and progression of chronic transplant nephropathy (CTN) and the prognostic value of rapid computer morphometry of lymphocytes in predicting the risk of renal allograft rejection. SUBJECTS AND METHODS: Thirty-seven renal graft recipients (29 males and 8 females; mean age 35.9 +/- 2.2 years; mean time after renal allografting 19.9 +/- 2.7 months). Twenty-three patients had satisfactory renal graft function; 14 patients were diagnosed as having CTN. A control group included 30 apparently healthy individuals. Along with physical examination, vital computer phase morphometry (CPM) of peripheral blood immunocompetent cells was carried out in all the patients. RESULTS: Small and average cells were predominant in the T and B lymphocyte populations. In CTN, there were increases in diameter, perimeter, and area and decreases in the phase height and volume of B lymphocytes, which is indicative of their activation. There was a predominance of average B lymphocytes in CTN. CONCLUSION: Vital CPM of peripheral blood immunocompetent cells may be used for the early diagnosis and prediction of CTN development.

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AIM: To study infectious complications in renal transplant recipients receiving mycophenolate mofetil (MMF) for prevention of acute transplant rejection or treatment of chronic allograft nephropathy (CAN). MATERIAL AND METHODS: A group of renal transplant recipients (n=47) receiving 1.0-2.0 g/day MMF with cyclosporine A (CsA) and steroids as maintaining immunosuppression was compared to a group (n=47) taking triple immunosuppressive therapy which included azathioprine (Aza). Separate group of patients (n=9) received MMF for treatment of CAN. In all groups etiology and incidence of infections were evaluated. RESULTS: During 2 years various posttransplant infections developed in 72.3% patients on MMF and 93.6% on Aza. The incidence of viral infections was 53.2% in MMF and 59.6% in Aza group, the incidence of bacterial infection--55.3 and 70.2%, respectively. Among 9 recipients with CAN the infections occurred in five. There were two cases of active tuberculosis in Aza group, one--in MMF group and one in patients with CAN. CONCLUSION: We suggest that MMF in the dose 1-2 g/day does not increase infection rates in renal transplant recipients comparing Aza.

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In this retrospective study we evaluated incidence of malignancies observed among 718 renal transplant recipients with at least 6 months of follow-up. A total of 461 men and 257 women (mean age at transplantation 36.3 +/- 8.3 years) were included. Thirty three out of 718 recipients (4.6%) developed malignant neoplasia: 45.4% of these were Kaposi's sarcomas, 12.1%--cancers of the uterine cervix, 12.1% cancers of the stomach, 12.1%--basal cell carcinomas, 6.06%--posttransplant lymphoproliferative disorder. There was no significant effect of either cyclosporin A doses or OKT3/ATG on the incidence of the tumors. Mean age of transplant recipients with malignancies was statistically higher as compared to those without malignancies (45.5 +/- 8.2 years versus 36.1 +/- 8.4 years, p < 0.00001). The median time from onset of end-stage renal failure (dialysis start) and from the transplantation to the diagnosis of the tumor make up 32 (16-161) and 23 (5-158) months, respectively. One renal transplant patient suffered from multiple myeloma with aggressive course.

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For many years the treatment of steroid-resistant rejection (SSR) remains a common problem od renal transplantation. We used plasmapheresis (PPH) in the treatment of SRR in 29 renal transplant recipients. All patients had progressive deterioration of renal function and compatible biopsy histology. The first group (15 patients) was administered PPH with methylprednisolone (MP). The second group (14 patients) was treated by intravenous MP. There was no significant difference in the time of beginning and severity of rejection. In the PPH group the results were better: a significant increase in SSR reversion was attained (73.3%) in comparison with the control (42.8%), the number of grafts lost during the first year was less (26.7 versus 57.2%). Better results were observed in patients with high levels of serum anti-HLA antibodies. Their transplants functioned well during 12 months after SSR. Hence, PPH can be used in patients with SSR with high levels of anti-HLA antibodies.

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Causes and mechanisms underlying nephrolithiasis after transplantation of the kidney differ much from known in other urological patients. We have found calculi in transplanted kidney in 5 of 939 surgical patients. Two cases of concrement formation in the transplant in the members of the same family aged 22 and 26 years we report as interesting. Our experience and literature data suggested family nature of the concrements. One of the patients underwent pyelolithotomy, the other impulse lithotripsy. Both the transplants function normally 5 years after kidney transplantation.

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The paper is concerned with the results of 39 transplantations of the kidney. All the patients received two basic immunosuppressants, namely prednisolone in a dose of 30 mg/day and Cy in a dose of 10-12 mg/kg a day. Within 6 to 11 months, the recipients' survival amounted to 82.5%, that of the organs to 84.5%. In 63.1% of the patients, immediate function of the transplant could be observed. It has been demonstrated that delayed function of the transplant was conjugated with reduction of the survival of the organs and recipients as well as with decrease of the quality of transplant functioning. Delayed function of the transplant might be determined not only by ischemic but also by immunologic injuries to the organ.

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The authors analyzed the results of 139 kidney transplantations in 115 patients with chronic renal failure depending on a degree of risk. The most frequent risk factors were poor compatibility, high arterial hypertension, myocardial and valvular lesions and retransplantation. As to the combination of various risk factors 4 types of risk were defined. It was proved that in the 4th type of risk kidney transplantation was inappropriate. In the 2nd and 3rd types of risk sparing immunodepression was indicated.

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