[Impact of plasmapheresis on intraorgan blood flow of the transplanted kidney in the early postoperative period].

Kidney transplant is inevitably subjected to ischemic and reperfusion injury. In many cases, this is due to a violation of intraorgan hemodynamics. Severity of such damage can be reduced using different methods of extracorporeal hemocorrection. The aim of the study was to examine the intraorgan blood flow of kidney transplant and assess the impact of plasmapheresis on its primary function in the early postoperative period. Plasmapheresis with replacement from 1,25 to 3,5 liters of plasma was applied in 40 recipients of the Group 1; in 40 recipients of Group 2 plasmapheresis was not performed. High resistance index (Ri > 0,9) at low flow velocities in the interlobular arteries at the first day after surgery is an informative criterion for the diagnosis of acute tubular necrosis and indicates the inadequate blood supply of kidney. Plasmapheresis has promoted the normalization of renal hemodynamics. Immediate graft function in patients of Group 1 was observed in 36 patients, whereas only in 19 patients of Group 2. In the Group 1, there were no patients with primary non-functioning graft, while there were three such patients in Group 2. Thus, plasmapheresis in the early postoperative period, no later than 3-5 h after reperfusion of the graft, has a positive effect on the functional status of the transplanted kidney.

[Experimental rationale for possible clinical use of biodialysis].

At biodialysis, the bloods of a patient and a donor simultaneously pass through the individual mass exchangers. The cavities of the dialyzing fluid of both mass exchangers hydraulically interconnected with recurculating transport medium. The metabolites accumulating in the patient's blood pass through the membrane to the transport medium and then the second membrane to the donor's blood and they are eliminated via his/her liver and kidney. At the same time, regression occurs: the substances required for normal vital activity move from the donor's body to the patient's one. Experiments on pigs in one of which both kidneys were removed yielded clearances of major toxic metabolites by approximately 2 times less than that at routine dialysis. Daily sessions of biodialysis ensured a satisfactory state and stable levels of metabolites. At biodialysis, the state did not deteriorate. In the other series of experiments, choledochus was ligated in one of the pigs and sessions of biodialysis were initiated following 24 hours. Daily sessions could achieve stabilization of the level of bilirubin within 135 micromol/l. In the donor pig, the level of bilirubin slightly increased. Its condition remained to be satisfactory.

[Influence of posttransplantation plasmapheresis on results of transplantation of a cadaveric kidney]. / Vliianie posttransplantatsionnogo plazmafereza na rezul'taty peresadki trupnoi pochki.

Plasmapheresis was performed with "Haemonetics" (USA), PCS-Ultralite and MCS+ devices. During one procedure 1750-3550 ml of plasma were removed. Results were evaluated by the following parameters: diuresis within 24 hours after surgery, number of hemodialysis sessions after surgery, period of normalization of creatinine in blood. In patients of the study group oligoanuria was seen 4.5 times more rarely than in the control group, they needed less sessions of hemodialysis. Level of creatinine normalized earlier in the study group. Actually survival of patients with potent transplants was higher in the study group than in the controls. It is concluded that plasmapheresis has positive influence on the course of posttransplantation period.