The article raises a question about the possible and effective kidney transplantation in elderly patients with various severe comorbidities. The analysis is based on an example of successful kidney transplantation from a deceased donor when a 67-year-old patient had severe concomitant background: obesity, diabetes mellitus, and cardiovascular disturbances. Despite unfavorable prognosis and further unpredictable illnesses such as COVID-19, candidal esophagitis, coronary attack, and pneumonia, the patient has not develop graft injury or rejection and kept sufficient kidney function. The research was mainly focused on coexisting illnesses and their influence on kidney transplantation consequences. Following disease groups were discussed regarding their impact on transplantation outcomes and prognosis: arterial hypertension, cardiac disorders, diabetes mellitus, and obesity. Patient’s age, previous interventions, and  comorbidities were observed for association with outcomes and risk of graft rejection. A review of available publications compared approaches for recipient selection in different clinical centers as well.

UDC  616.12.331.1+616.379-008.65):616-008.9:616.36-003.826]-006-002.64-092.19

Abstract. Background. Lack of information about proinflammatory interleukins (IL) and tumor necrosis factor alpha (TNFα) levels in case of metabolic-associated liver steatosis (MALS) and their roles in its progression to steatohepatitis are key reasons for the relevance and actuality of our study. The purpose: to evaluate proinflammatory interleukins 2, 6, and TNFα levels in concomitant liver steatosis. Materials and methods. Thirty- five patients with hypertension stage II–III, type 2 diabetes mellitus were examined. All of them were treated on an outpatient basis according to the guidelines of the Ministry of Health of Ukraine and the Declaration of Helsinki. Participants were divided into the main group with MALS (n = 24, males 45.8 %, females 54.2 %; average age 55.83 ± 0.89 years) and the control group without steatosis (n = 11, males 54.5 %, females 45.5 %; average age 53.00 ± 1.55 years). In addition to standard parameters, levels of IL6, IL2, TNFα, selectin, resistin, insulin, C-peptide, glycated hemoglobin, non-esterified fatty acids were evaluated, and some indexes were calculated, including triglyceride-glucose index and Castelli indexes I and II. Results were processed statistically, with significance level of р < 0.05. Results. Although MALS is not followed by qualitative differences in proinflammatory IL2, IL6 and TNFα compared to no steatosis, the risk of TNFα elevation was 5 times higher in patients with MALS (odds ratio 5.08; 95% confidence interval 1.02–25.17). An increase in IL2 and TNFα is unfavorable for patients with MALS, it can be considered as a marker of steatosis progression to steatohepatitis, as it is associated with transaminase activation, endogenous intoxication, lipid distress and glucose intolerance. IL6 was rather lower in patients with MALS compared to those without steatosis, but its growth was exponential and proceeded simultaneously to IL2 and TNFα. Conclusions. MALS was not associated with significant changes in IL2, IL6 and TNFα compared to no steatosis, but their elevation can be criteria for transformation into steatohepatitis due to the activation of transaminases, inflammation, endogenous intoxication, lipid distress, glucose intolerance.

Keywords: diabetes mellitus; interleukin-2; interleukin-6; tumor necrosis factor alpha; metabolic-associated liver steatosis

Obesity can cause respiratory disorders inflicted by adipose tissue accumulation and the numerous cytokines adipocytes produce. Smoking is, first of all, associated with a wide range of lung diseases characterized by diffuse changes in the lung tissue and a decrease in the respiratory volume of the lungs. The study aimed to investigate the ultrastructural changes in the lungs of sexually mature male rats under conditions of experimental obesity and smoking. The total sample of experimental animals consisted of 120 rats, divided into four groups: the control group (n=30) – conditionally healthy rats fed on a standard diet; a group of rats subjected to isolated exposure to tobacco smoke (n=30); a group of experimentally obese rats (n=30) and a group of experimentally obese rats simultaneously exposed to tobacco smoke (n=30) – feeding using a high-fat diet with exposure to a chamber with tobacco smoke. The revealed ultrastructural features of the lungs in the group of rats with experimental obesity and the group of rats with experimental obesity that were simultaneously exposed to tobacco smoke did not differ qualitatively, which indicates that pathological changes in the ultrastructure of the lung tissue developed regardless of the presence or absence of a direct damaging effect on the lung tissue of passive smoking.

The spleen has several important functions in the human body, the leading of which is protective Therefore, its removal is often not safe, but is accompanied by various complications, primarily infectious and vascular, which can occur even 20 years after surgery. The most serious consequence of asplenia is the development of instant sepsis, which is accompanied by mortality of up to 70%. Therefore, it is important, first of all, to prevent infection in these patients. Using the literature from the MedLine database, modern ideas about the immunological function of the spleen, the pathogenesis of complications and the main ways of prevention, including the use of vaccines, antibiotics, are described. Particular attention is paid to the awareness of people with asplenia or hyposplenism.

In recent decades, the role of hydrogen sulfide (H2S), a gas mediator and signaling agent, has been studied in the regulation of intercellular signaling and intracellular signal transduction pathways with various physiological and pathophysiological effects in cells and tissues. These cellular pathways are responsible for changes in metabolism, epigenetic, and cellular behavior. There are enzymatic and non-enzymatic pathways of endogenous hydrogen sulfide biosynthesis. Numerous studies have shown the diverse effects of H2S on the physiological processes of neurotransmission in the brain, vascular smooth muscle relaxation in synergy with nitric oxide (NO), apoptosis, autophagy, angiogenesis, aging, inflammation, redox system, manifestations of oxidative stress, protein, as well as bioenergetic effects and systemic bioregulatory effects, including ANS. Recently, it was shown that H2S signaling is often dysregulated in different dysfunctions. The effect of H2S on insulin secretion and protection of the heart, kidneys, and brain from ischemic damage, and hypoxia is known. The availability of H2S as a bioregulator has led to changes in cytoprotection, scavenger’s function, and antiinflammatory activities in the digestive system, as well as it could be a molecular target for the creating new safe hybrid compounds, esp., H2S-realized nonsteroidal anti-inflammatory drugs. Our recent research has shown a cytoprotective effect on the mucous membrane of the esophagus and stomach. Thiosulfate sulfurtransferase (TST, EC 2.8.1.1)-derived H2S plays an important role in maintaining redox balance but its effects on mesenteric integrity in aspects of age-related changes and during stress response or high-carbohydrate diet are still limited.