Keyword: Kidney Transplantation

ABSTRACT: Background: Long-term graft survival in solid organ transplantation directly depends on the degree of human leukocyte antigen (HLA) compatibility between the donor and the recipient. Along with the cellular immune response, the humoral component—specifically, the presence of pre-existing circulating HLA antibodies—plays a critical role in the pathogenesis of both acute and chronic rejection. Monitoring the level of allosensitization in patients on the transplant waiting list is essential to mitigate the risk of post-transplant immunological complications.
Objective: To evaluate the structure and level of sensitization to HLA Class I and Class II antigens in potential kidney transplant recipients using high-sensitivity Luminex multiplex bead array technology.
Materials and Methods: A retrospective analysis of 1043 serum samples from patients on the kidney transplant waiting list for one year was performed. The mean age of the cohort was 53 years. HLA antibody screening was conducted via solid-phase bead-based immunoassay (Luminex technology) using commercial LabScreen Mixed (LSM12) detection kits (One Lambda, USA). The level of sensitization and antibody specificity were evaluated based on Mean Fluorescence Intensity (MFI).
Results: Screening revealed that 69.3% of the samples (n = 723) were negative for HLA antibodies. Reactive HLA antibodies (positive results) were verified in 30.7% of the patients (n = 320). Among the positive samples, isolated sensitization to HLA Class I antigens was detected in 143 recipients (44.7%), isolated sensitization to HLA Class II antigens in 36 recipients (11.2%), and combined sensitization to both classes (I and II) was identified in 113 cases (35.3%). The panel-reactive antibody (PRA) levels within the cohort ranged from 11% to 97%, with MFI values varying from 399.06 to 175,982.52.
Conclusion: Screening on the Luminex platform serves as a highly sensitive tool for pre-transplant monitoring. Assessing HLA status allows for the timely stratification of waitlist patients into specific immunological risk groups. Detecting high levels of allosensitization (MFI) justifies the need for tailored, selective donor matching, as well as the preemptive implementation of desensitization protocols including extracorporeal hemocorrection and targeted immunosuppressive therapy.

ABSTRACT: Introduction: Kidney transplantation has been actively developing in Kazakhstan, data on outcomes remain limited. This study aimed to evaluate recipient characteristics, patient survival, causes of ESKD, and renal graft function after KT.
Methods: We retrospectively analyzed 37 consecutive kidney transplant recipients who underwent KT between January 2020 and July 2025. Body mass index (BMI), etiology of ESKD, donor type, pre-transplant hemodialysis, mortality, and renal graft function were evaluated. Renal graft function was assessed using serial serum creatinine measurements during follow-up. Some recipients were lost to follow-up, which limited assessment of long-term graft function in these patients.
Results: In the available follow-up data, renal function was generally satisfactory and remained stable in most recipients with observations. Graft survival was 86.5%, with graft loss documented in five recipients: three surviving recipients experienced rejection-associated graft loss, and two patients died following rejection.
Among the five deaths, two were associated with confirmed COVID-19 infection, one was attributed to cerebral infarction caused by cerebral arterial thrombosis, and two were related to graft rejection. Among the three recipients with rejection-related complications, all experienced adverse effects associated with immunosuppressive therapy, including significant infectious complications.
Discussion: An important consideration is that the study period overlapped with the COVID-19 pandemic. Registry data showed substantially increased infection-related mortality among kidney transplant recipients receiving chronic immunosuppression during 2020, with infection and COVID-19 accounting for a major proportion of excess deaths. Therefore, mortality and survival outcomes should be interpreted in the context of the pandemic, limiting direct comparison with pre-COVID-19 cohorts.
Conclusion: Kidney transplantation at our center demonstrated favorable medium-term outcomes, with improvement in renal function and satisfactory outcomes in most recipients. Overall patient survival was 86.5%, and graft survival was also 86.5%. Continued monitoring of immunosuppression-therapy, complications, and long-term follow-up is important for improving patient and graft outcomes.

ABSTRACT: A 41-year old female patient who underwent kidney transplantation as an outcome of chronic glomerulonephritis came to the hospital with the signs of acute upper respiratory tract infection. As the patient further developed oliguria, peripheral edema, fever, and an increased BP, she was further relocated to the University Medical Center (UMC). Upon admission to UMC, signs of septic shock were detected, and acute transplant rejection was suspected, to exclude which kidney biopsy was performed and stage 3 chronic kidney disease (CKD) in allograft kidney was detected. Antibacterial treatment as well as pulse therapy were performed as patient had septic shock and tubulointerstitial nephritis (TIN).