1.5. Surgical procedures in kidney transplantation

Transplantation of the kidneys is a surgical procedure where the donor's kidney is placed in the lower part of the abdominal cavity of the recipient. The renal artery and veins connect to the large pelvic artery and vein of the recipient. The urinary tract of the transplanted kidney is attached to the recipient's bladder.

#### 1.6. Immunosuppressive therapy

Renal transplantation is an important form of treatment for patients with terminal renal insufficiency. However, an obstacle to the success of the greatest number of transplants represents the immune response of a recipient directed against the transplanted kidney.

Due to the constant immunological response to renal allograft, permanent immunosuppressive therapy is carried out to prevent graft rejection. Theoretically, it should not be used only on identical twins. The basis of immunosuppression is a calcineurin inhibitor that is combined with corticosteroids and mycophenolate mofetil (Cellcept). Immunosuppressive drugs have enabled the success of organ transplantation, but they do not only act to prevent rejection of the transplanted organism but also they have numerous side effects on the body. Important side effects of immunosuppressants are the increased risk of infection and the atherogenic effect of immunosuppressive therapy.

around 25% of all deadly outcomes. The rate of cardiovascular mortality in patients undergoing chronic dialysis is nearly 9% per annum. In patients treated by chronic dialysis, the risk of development of CVD is 10–20 times higher than in general population. Uremic milieu contributes to occurrence of atherosclerosis and atherosclerotic cardiovascular complications and often the development of accelerated, galloping atherosclerosis is present. The patients undergoing chronic dialysis are exposed to traditional and nontraditional risk factors for the development of cardiovascular complications. Nontraditional risk factors are the consequences of the uremic milieu and are related with the dialysis technique itself, and they are divided into hemodynamic and metabolic risk factors. Hemodynamic risk factors are anemia, retention of sodium and water, arteriovenous (AV) fistula, while the metabolic risk factors are hyperhomocysteinemia, hypoalbuminemia, oxidative stress, microinflammation and secondary hyper-

Risk factors for cardiovascular diseases in patients with a transplanted kidney are divided into traditional and nontraditional [5]: traditional risk factors are: immutable (age, gender, and inheritance), variable (smoking, hyperlipidemia, hypertension, obesity, diabetes mellitus, physical activity, and stress); and nontraditional risk factors are: risk factors related to the status of transplantation and its treatment (immunosuppressive agents, graft rejection, and viral infection —cytomegalovirus) and risk factors associated with chronic regression in allograft function (anemia, volume load, hyperhomocysteinemia, oxidative stress, secondary hyperparathyroid-

Smoking is not only a risk factor for the development of cardiovascular diseases, but is also associated with the risk of developing chronic kidney disease defined as a reduction in glo-

day is associated with 1.52 times higher relative risk of chronic kidney disease [7]. For comparison, smoking and obesity are associated with a 1.77 times higher relative risk of chronic kidney disease. These risks are more conspicuous in men than in women. Smoking begins and improves the process of atherosclerosis in the blood vessels. In various studies, it has been shown that smoking leads to cardiovascular complications, reduces survival of the patient and graft, and its effect on patient survival is similar to the same one on patients with diabetes mellitus [8]. Smoking cigarette is an independent risk factor for the development of cardiovascular events in patients with a transplanted kidney. In the population of patients with transplanted kidney, the prevalence of smoking is 25%, and the smoking cessation includes

Risks of cardiovascular diseases increase with increasing body weight because it increases the blood pressure, serum lipids, and glucose intolerance. A particularly harmful factor is the central obesity characterized by an increase in intra-abdominal fat tissue. Central obesity (waistline >88 cm for women and >102 cm for men) is a risk factor for declining allograft function in patients with a transplanted kidney. Obesity fosters the development of the insulin resistance, diabetes mellitus, ischemic heart disease, and reduces survival of allograft [9].

. Long-term smoking of more than 20 cigarettes per

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parathyroidism.

ism, and microinflammation).

2.1. Traditional risk factors

merular filtration to <45 ml/min/1.73 m2

pharmacological therapy—NRT (nicotine replacement therapy).

#### 1.7. Transplantation complications

The early period after kidney transplantation relates to the first 2 months after the surgery [3]. Acute surgical complications (bleeding, thrombosis of the transplanted kidney) are common in first few days after surgery, other clinical and immunological complications occur later.

Reactions of graft rejections are classified into four types based on the clinical picture, but differ in pathogenesis, histomorphological picture, and reactions own flow [4]. Those are hyperactivity, acceleration, acute and chronic rejection. Hyperacute rejection occurs in the first minutes or hours after kidney transplantation. Accelerating rejection begins 5–7 days after kidney transplantation and is demonstrated by rapid deterioration of the graft function. Acute rejection usually occurs from the fifth day to the end of the third month after kidney transplantation, but it can occur later on. Chronic graft rejection signifies the process in which transplanted kidney progressively deteriorates for several months and years, although the transplantation was successful in the first place. Other complications after kidney transplant are: urological complications, cardiovascular diseases, infections, gastrointestinal tract and liver diseases, malignant tumors, skin, bone and muscle diseases [4].
