There are more than 3000 patients in our Republic with chronic kidney insufficiency (CKI) of different stages, and 1200 out of them are of terminal stage. 650 of them get programmed haemodialysis, another 500 patients are expecting their chance to get haemodialysis. 140 of these patients have been transplanted the kidney: 116 were operated in Iran, 19 – in Azerbaijan, 2 – in Turkey, 1 – in Russia, and 1 – in Pakistan.After a long time (25 years) first time in Independent Azerbaijan 19 patients with terminal stages of CKI were transplanted kidney from living relatives during last 3 years 2005-2008). In 15 of these cases the CKI was caused by chronic gloumerulonephritis, in 3 cases by chronic pyelonephritis, in 1 case-by polycystosis.The age of patients was 17-58 y/o. 16 out of these patients were male, 3 female. The donors were: in 1 case – father, in 3 – sisters, in 15 – brother and relatives. The age of donors was 22-48 y.o.17 patients received 50-108 session of haemodialysis, 1 patient received 576 haemodialysis, and 1 patient never had taken haemodialysis. In 17 cases was transplanted left kidney of the donor into the right ileac region of the patient, in 2 cases right donor’s kidney was transplanted into the same side of the patient. One female was performed nephrectomy of the right kidney because of polycystosis and large size of this kidney (340x230x170mm), and then the kidney from donor was transplanted into the right ileac. In all these cases the heating ischemia lasted no longer than 2 min, and cooling ischemia - 40-50 min. Cooling perfusion was performed in cuvet with sterile ice and 500,0 Ringer lactate solution, +18ºC.In 17 cases were performed vasal anastomoses between a.ileaca interior and a.renalis, between vena ileaca externa and vena renalis. In two cases there was severe atherosclerosis and after atheromectomy there were performed arterial anastomoses between a.renalis and a.illeaca externa.After setting on the haemocirculation all the transplanted kidneys restored the function of urine excretion. In 17 cases the ureterocystoneostomy was performed by Barry method, and in 2 cases – by Barry-Takoshi method. During first 24 hours after, transplantation the diuresis varied between 14-36 liters. During first 3 days all the patients were injected 500 mg of methylprednisolone, and every next 2 days the dose was being reduced as follows: 250mg -150mg -100mg and then prednisolone administration was in tabs 50mg/day. Supportive dose of prednisolone usually was 10 mg/day. Cyclosporine (Sundymmoon-Neoral) was prescribed as 8 mg/kg and then every 5 days the dose was being reduced for 1 mg/kg. Supportive dose of Cyclosporine was 150-250 mg a day. Azathioprine was prescribed as 1, 5-2 mg/kg and during next period was administered 50-75 mg/day. This drug is prescribed to 10 patients. Cellcept was given in dose of 2000 mg/day (twice 1000 mg). This drug receives 9 patients.In cases on the second day after operation was bleeding and the wound was tamponade, the patient urgently was revised and bleeding was stopped. In 3 cases after one week began the crisis of rejection. There was prescribed puls therapy by means of methylprednisolone. In two cases the crisis was stopped, and only in one case the expected effect was not successed. In this case the haemodialysis was applied during one month. On the background of crisis the level of creatinin has reached 1100 mkmol/l. During two weeks was applied antilymphocitary immunoglobulin and as a result the crisis was discontinued. The level of creatinine reduced till 186 mkmol/l. In this patient a month later was diagnosed paranephric abscess on the dorsolateral surface. The abscess was drained by means of surgical intervention. In two cases – 3 months after and 6 months after transplantation there were found few concernments in the transplant. Complex therapy was applied and the concernments were eliminated. Normalization of creatinine level was successed during 6 days (140 mkmol/l and less). One month later after transplantation the level of plasma creatinine was 100.4±19.4 mkmol/l. Duration of hospitalization of the recipients was 14-20 days, and of the donors – 2 days. There was not ureter stenosis or and fistula formation. The catamnesis duration was 4-39 months. The condition of patients was satisfactory. All the patients receive the immunosupressor drugs free of charge during life in accordance with state law.
Volume : 6
Issue : 4
Pages : 141
Urological Center, Baku, Azerbaijan