Results of kidney transplantation in patients with end-stage renal disease caused by glomerulonephritis

Aim. To analyze own 3-year results of kidney transplantation after hemodialysis in patients with chronic glomerulonephritis.

Materials and methods. Living-donor kidney transplantation was performed in 49 patients with end-stage kidney disease. All patients were first-time recipients. They received tacrolimus. After induction immunosuppression, 3-component supportive immunosuppressive therapy was used according to the following scheme: calcineurin inhibitors (tacrolimus), antiproliferative drug (mycophenolate mofetil; Cellcept) and glucocorticoids (prednisolone). In 16.3% of patients, the nephrotoxic effect of tacrolimus was seen and they were prescribed an mTOR inhibitor (everolimus). Body mass index (BMI), serum creatinine level before and after transplantation, glomerular filtration rate (GFR), panel-reactive antibodies, as well as donor-specific antibodies were determined. Panel-reactive antibodies were detected using Gen-Probe-Lifecodes and Luminex-200 screening kits (Luminex Corporation, Austin, Texas, USA). Detection of donor-specific antibodies in the recipient (DSA-test) was carried out according to the cross-match test. For statistical processing, the statistical package Statistica 16.0, Excel 2016 was used.

Results. The average age of the recipients was 33.61±7.89 years. The duration of hemodialysis was 23.49±14.23 months, in 12.2% of cases transplantation was performed without prior hemodialysis. The mean fluorescence intensities of HLA classes I and II was 249.96±200.57 and 251.48±282.44, respectively. HLA compatibility was 41.16±16.68. Donor-specific antibodies were absent. The average age of donors was 49.39±7.97 years, and 71.4% of donors were first-degree relatives. After 1 day, the serum creatinine level decreased by 53.6% in comparison with the baseline value (p=0.093). After 3 and 7 days, the difference with the initial creatinine level was 72.8% (p=0.027) and 75.7% (p=0.022). In 53.1% of cases, the HLA compatibility was 50.0%. The panel-reactive antibodies were negative in 2.0% of cases. There were no lethal outcomes. Acute cellular and humoral rejection developed in 1 (2.0%) patient. After transplantation, rejection was observed in 5 (10.2%) recipients.

Conclusion. Analysis of our data indicates satisfactory results of kidney transplantation in the Republican Diagnostic and Treatment Center, which indicates the necessity of continuation of the program of transplantation with the analysis of HLA subclasses.