IMMUNOLOGICAL FOUNDATIONS AND CHALLENGES IN ORGAN TRANSPLANTATION

ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ

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IMMUNOLOGICAL FOUNDATIONS AND CHALLENGES IN ORGAN

TRANSPLANTATION

Ismoilov Ibodjon Imomjonovich

Bukhara State Medical Institute named after Abu Ali Ibn Sino

ismoilov.ibodjon@bsmi.uz

Abstract.

Compared to transplantation of other organs, such a direction as kidney

transplantation has more than half a century of history. During this period, tremendous

experience has been accumulated regarding the modernization of surgical techniques,

organ preservation, improvement and optimization of immunosuppression protocols,

as well as postoperative management of patients. By the end of the 90s, modern

survival rates for renal transplants and recipients had been achieved. The success of

kidney transplantation, however, has led to the fact that "waiting lists" for the operation

are growing steadily every year around the world.

Keywords.

Immunosuppression, hemodialysis, allogeneic transplant, immune

response.

One of the essential factors determining the success of organ transplantation is the

immunological compatibility of donor and recipient tissues. Achievements of the last

decade of the last century in the field of fundamental immunogenistics, which made it

possible to concretize the mechanisms of the implementation of the main functions of

proteins. The gene-encoded immune response, as well as the transition from the study

of genes of the human immune response from serological to molecular-genetic, have

not only opened up fundamentally new possibilities for introducing these advances into

medicine, but have made it possible to put them into practice with unprecedented speed

[4].

Thanks to these advances, the effectiveness of kidney transplants (based on the

results of the annual survival rate in the centers that switched to donor selection based

on molecular genetic typing) increased by

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twenty%. At the same time, the remaining indicators of the functional graft

significantly improved.

Treatment of end-stage chronic renal failure is one of the most pressing modern

medical and social problems. Existing methods of renal replacement therapy for end-

stage chronic renal failure: hemodialysis. Perntoneal dialysis and allotransplants of the

kidneys are constantly being improved, which leads to an increase in the life

expectancy of patients, but not always - in quality. At the same time, the number of

patients requiring renal replacement therapy is constantly increasing, which

complicates the availability of J10. Today, kidney transplantation is considered as the

optimal method of renal replacement therapy, since it increases the duration and quality

of life of patients to a greater extent than perntoneal and hemodialysis. In addition, it

is known that kidney transplantation provides a higher quality of life for patients, and

is also the most preferred by the method of renal replacement therapy from an

economic point of view [5],

The discovery and use of modern methods of immunosuppressin made it possible

to reduce the likelihood of developing an acute rejection reaction and to increase the

graft survival rate during the first year after the operation, leaving the long-term

survival rates of the rsial allatran graft unsatisfactory. In connection with this, methods

of predicting the conflict "donor bale-recipient" are being actively developed.

The interest of researchers in the study of immunological parameters in organ

transplantation and kidney transplantation in particular has always remained at a high

level, but the opportunity to study the delicate relationship between the recipient's

organism and the donor organ has appeared in the last twenty years. This is associated

with a number of important discoveries in the field of fundamental immunology. This

entailed the introduction into wide practice of new reliable and highly sensitive

research methods, modern instruments and diagnostic systems [2]. The use of new

complex methods requires clinical understanding.

So, in particular, after the introduction into practice of the molecular genetic

approach to typing HLA genes, it became necessary to conduct a comparative analysis

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of the results obtained by both methods. Such studies were carried out by many

laboratories around the world that are engaged in histotyping [1]. The data obtained

revealed serious discrepancies in the typing results. Therefore, similar works aimed,

ultimately, at the optimization of imunophenotinning continue and remain relevant.

Treatment of chronic renal failure is one of the medical and social problems for

modern modern medicine. There are now a growing number of methods for the kidney

and its maintenance, for example: Temporary renal hemodialysis, in addition to kidney

transplantation, which increases the life expectancy of patients. But not always.

Currently, the number of patients in need of kidney transplantation and the number of

transplant options is increasing.

Renal transplantation, renal complications, impaired adaptation of the donor

organism to the transplanted kidney are associated with the immunogenesis of the

individual organism. Changes in the physiological activity of class T lymphocytes in

the div after kidney transplantation are accompanied by changes in all

immunogenetic conditions in the div, which leads to a decrease in renal vital signs,

resulting in renal complications, decreased vital signs of renal transplantation within

three years and changes in physiological functions. . In this regard, we organize

research, observational work on the preservation of vital signs of the kidney, placed in

the state of studying its immunogenesis after kidney transplantation.

It is known that a graft transplanted to a recipient from a genetically foreign donor

does not take root and is inevitably rejected. At the same time, genetic differences

between donor and recipient tissues play a key role in the development of allogeneic

transplant rejection.

Antigens providing intraspecific differences are designated as tissue compatibility

(histocompatibility) antigens and belong to the major histocompatibility gene complex

(MHC) [6]. In humans, the MHC is called HLA (human leukocyte antigen). The

biological significance of MHC lies in ensuring the interaction of div cells,

recognizing its own, foreign and altered own cells, triggering and implementing an

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immune response against carriers of foreign information, positive and negative

selection of T-cell clones, presentation of the targets of the immune response.

The immunological nature of graft rejection was demonstrated by Peter Medawar

in an experiment on the transplantation of a genetically alien skin graft in rabbits [7].

Both humoral and cellular mechanisms play a role in transplant rejection. Cellular

rejection mechanisms cause T-lymphocytes to become sensitized to the transplanted

antigens. These lymphocytes cause damage to cells of foreign tissue by either direct

cytotoxicity or secretion of lymphokines. T cell damage is characterized by

parenchymal cell necrosis, lymphocytic infiltration, and fibrosis. Humoral mechanisms

are mediated by antibodies that may be present in the serum of the recipient before

transplantation or develop after transplantation of foreign tissue. Humoral factors

damage the transplanted tissue through reactions that are equivalent to type II and III

hypersensitivity reactions. The interaction of antibodies with the antigen on the surface

of the transplanted cells leads to cell necrosis, and the accumulation of immune

complexes in the blood vessels activates complement, which leads to the development

of acute necrotizing vasculitis or chronic fibrosis of the intima with vasoconstriction.

The tolerance of the immune system is understood as a specific immunological

nonresponsiveness to antigens. In this case, the absence of a response to this antigen is

characteristic, but the response to any other is preserved. According to the figurative

expression of R.V. Petrova, tolerance is immunity with a minus sign. The lack of

response of the immune system to its own antigens protects the div from

autoaggression [8]. When tolerance to alloantigens is established, the transplanted

tissue may take root. Tolerance to antigens exogenously entering the div can be

induced both during the neonatal period and at puberty. The mechanisms of the

immune system that allow blocking aggression against one's own or donor cells and

tissues are conditionally divided into central and peripheral. Central tolerance is

induced in the central organs of immunogenesis - in the thymus gland and bone marrow

- and limits the autoreactivity of T and B lymphocytes.

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