[Five-year analysis of microbial landscape of transplantation and dialysis center (20112015)].

INTRODUCTION: Treatment of bacterial infections is pressing and difficult task of modern transplantology. AIM: To analyze the spectrum of bacterial microflora and bacterial sensitivity to antibiotics in patients of the transplantation and dialysis center. RESULTS: The study analyzed the results of bacteriological tests performed in 534 patients with chronic kidney disease stage 5 in 2011-2015. Biomaterials for the examination included urine, blood, wound discharge and sputum. Gram-positive bacteria, Gram-negative bacteria, fungi and mixed flora were found in 42%, 39%, 4% and 15%, respectively. Among observed associations 51% were presented by a combination of Gram-positive and Gram-negative bacteria and the others were different combinations of fungi. The most often detected bacteria were Enterococcus spp. (37%), Klebsiella pneumoniae (25%), Staphylococcus spp. (19%), E. coli (13%), Streptococcus spp. (6%), P. aeruginosa (5%). Fungi of the genus Candida were isolated from 11% of all cultures. Enterococci and Klebsiella had pronounced resistance to most antibiotics. All gram-positive bacteria were highly sensitive to vancomycin and linezolid. DISCUSSION: The findings suggest that the percentage of Gram-negative bacteria that are resistant to antibiotics is increasing. CONCLUSION: Significant changes in the microbial landscape and the growing antibiotic resistance dictate the need for periodic analysis of the bacterial flora in the transplantation and dialysis center.

[Infectious complications in using mofetil micofenolate in patients with renal allotransplant].

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.

[Use of ureteral stents in patients with kidney transplantation]. / Primenenie mochetochnikovykh stentov u bol'nykh s transplantatsiei pochki.

The aim of the study was to determine indications for application of ureteral stents for draining urinary tracts of the renal transplant, after low-invasive surgical interventions, for timing drainage, prevention and correction of complications. Ureteral stent insertion for management of urological complications after transplantation of the kidney was made in 36 patients (25 of them have ureteral stricture, 11 had ureteral necrosis). Low-invasive operations were made in 28 patients, open reconstructive plastic operations were conducted in 12 patients. According to 6-12 follow-up of the stented patients, recurrent ureteral stricture was detected only in 4 patients (11.1%). The stricture was corrected transcutaneously by antegrade ureteral stenting. It is concluded that stenting of the urinary tracts of the transplanted kidney in the treatment of urological complications--necrosis and ureteral stricture--in the course of low-invasive roentgenoendoscopic and open reconstructive-plastic operations raises treatment efficacy and prevents recurrent stricture.

[Malignant tumors in patients with kidney transplants ]. / Zlokachestvennye opukholi u bol'nykh s peresazhennoi pochkoi..

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.