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A. V. Shabunin, , D. A. Eremin, I. V. Nesterenko, D. A. Makeev, O. S. Zhuravel, S. A. Astapovich
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-278-285

Background. Urological complications are currently one of the main causes of the renal graft loss and the death of the recipient in the early and late periods after surgery. Objective. To reduce the risk of developing infectious complications after kidney transplantation by early removal of the internal ureteral stent. Material and methods. From June 2018 to March 2020, the Department of Organ and/or Tissue Transplantation of the City Clinical Hospital n.a. S.P. Botkin performed 89 deseased-donor kidney transplantations with the placement of an internal ureteral stent. Depending on the timing of stent removal, the patients were divided into 2 groups: the first group included 54 patients who had the stent removed on day 21, and the second group included 35 patients who had the stent removed on day 14. Results. No urological complications were recorded in both groups. Urinary tract infection was recorded in 8 patients (15%) in the first group, and in 1 patient (3%) in the second group (p = 0.01). Conclusion. Removal of the internal ureteral stent on the 14th day after kidney transplantation safely and reliably reduces the risk of a urinary tract infection development, improving the immediate results of the operation.
, B. M. Gorelik, A. Werner
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-332-352

Having studied the available printed, visual, and verbal sources from Russia, South Africa, the USA, and Germany, we have identified and reviewed in the article the facts of face-to-face and correspondence communication between V.P. Demikhov, the "father" of experimental heart transplantation (Moscow, USSR), and C.N. Barnard, a pioneer of clinical heart transplantation (Cape Town, South Africa). We have shown that C.N. Barnard mastered the heart surgery techniques, including those under conditions of artificial circulation, in the USA in 1956-1958, and later improved them in his homeland both in clinic (heart surgery for cardiac defects), and in the experiment (heart transplantation). The main events preceding the first world human heart transplant performed by C.N. Barnard on December 3, 1967, were his trip to the United States in August 1967 to study immunosuppression techniques, and the kidney transplantation he had performed in Cape Town in September, 1967. Prior to that time, C.N. Barnard had visited the USSR only once, in May 1960, as a delegate to the XXVII All-Union Congress of Surgeons. In the Soviet Union, he visited a number of clinics dealing with heart surgery and tissue and organ transplantation, including the N.V. Sklifosovsky Institute for Emergency Medicine, where he met V.P. Demikhov, but C.N. Barnard could neither talk to him personally, nor watch his operations. In December 1967, V.P. Demikhov spoke with C.N. Barnard on the phone, but the conversation was highly professional. This paper has shown different approaches of V.P. Demikhov and C.N. Barnard to the transplantation problem: the Soviet surgeon paid more attention to the transplantation technique, meanwhile, the South African surgeon considered the solution of immunological problems to be the basis of success. Nevertheless, C.N. Barnard knew about V.P. Demikhov's scientific achievements and used some of them in his surgical practice. The authors have substantiated the interaction between V.P. Demikhov and C.N. Barnard as between an ideological mentor and a student (in a broad sense) rather than as a teacher and a student (in a narrow sense). Therefore, in a broad, philosophical sense, the Soviet surgeon can be considered one of the inspirers of the world's first heart transplantation, which, in turn, proved that his ascetic work was not in vain.
S. A. Prozorov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-311-318

Introduction. Vascular complications after transplant nephrectomy are rather rare. The aim of this article is to analyze the effectiveness of the stent-graft implantation in the treatment of pseudoaneurysm after transplant nephrectomy. Clinical case. In the previous 23 years, a 50-year-old patient underwent 3 kidney transplantations from a cadaveric donor and 2 transplant nephrectomies. At 12 years after the left transplant nephrectomy he complained of abdominal pain and was admitted for a pulsating mass in his left pelvic region. Computed tomography angiography, ultrasonography, and arteriography were performed and showed a large pseudoaneurysm arising from the left external iliac artery. The stentgraft implantation solved the problem providing successful clinical and radiological results. Conclusion. Treatment options in this case were open or endovascular techniques. Surgical revision associated with high risk of complications. Endovascular treatment had the benefits of a minimally invasive approach with low blood loss.
I. V. Abdulyanov, I. M. Rakhimullin, M. R. Gaysin, R. R. Khamzin
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-301-310

Introduction. The number of surgically treated cases of heart failure by means of orthotopic heart transplantation is increasing every year. At the same time, there is a shortage of optimal donors for heart transplantation, being a factor that leads to a primary graft dysfunction in the intra- and immediate postoperative period. In order to reduce the risk of complications and increase patient survival rates in primary heart graft dysfunction, a number of transplant centers resort to the choice of the treatment by means of mechanical circulatory support, such as extracorporeal membrane oxygenation. Clinical case. In the early postoperative period after heart transplantation, the patient was diagnosed with developing primary graft dysfunction. The clinical response to medication support of hemodynamics was unsatisfactory. Venoarterial extracorporeal membrane oxygenation was performed. On the 4th day, the regional contractility of the left ventricle restored, the ejection fraction of both ventricles increased, their systolic function improved. The patient was discharged on the 21st day in a satisfactory condition. Conclusion. Mechanical circulatory support modalities, such as venoarterial extracorporeal membrane oxygenation, can compensate for the emerging primary myocardial dysfunction in recipients. The efficiency of the extracorporeal membrane oxygenation is achieved not only by knowledge of current clinical recommendations, but also depends on the implementation of other clinics' experience as well as technical readiness of the center and medical personnel' qualification.
M. V. Gurin, A. A. Venediktov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-286-294

Introduction. Ligaments play a critical role in the body, linking bones together. Ligament ruptures are the most common manifestations of serious musculoskeletal injuries. This is especially true for the anterior cruciate ligament of the knee joint. In trauma surgery, orthopedics, the ligament functional recovery can be achieved by using tissue autografting, synthetic and biological prostheses. Of great interest to surgeons is the use of prostheses made of biological tissues of animal origin, since they are easily available and, when high-quality processing is achieved, they are safe, retaining their natural structure and strength. Purpose of the study. To decellularize the bovine tendon according to our originally developed technique and to investigate its efficacy in terms of the presence of cellular elements and physical and mechanical parameters of the material. Material and methods. To manufacture the prototype of the ligament prosthesis product, we developed the technique for processing the bovine tendon, as the most similar material by structure, including its mechanical processing, chemical and physical processing methods and a special treatment with supercritical carbon dioxide fluid containing nonionic surfactant Tween-80 for decellularization and extraction of organic components in addition to collagen framework, while maintaining strength properties. Histological studies were performed to check for the residues of cellular elements, and the measurements of the physical and mechanical properties of the material were made. Results. Histological examination of the material showed that after processing, 0–2 cells in the field of view were found in the material. The strength properties of the material were 503 kgf/mm2 before processing and 605 kgf/mm2 after processing. Conclusion. The data obtained in the study confirmed that the processing performed qualitatively affected the elimination of cells, did not worsen but even increased the mechanical strength of the material. Further study of the biocompatible properties of the material is required.
V. L. Korobka, M. Yu. Kostrykin, O. V. Kotov, R. O. Dabliz, E. S. Pak
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-295-300

The clinical case of liver revascularization in a recipient using the technique of selective thrombolysis of the hepatic artery and its stenting at the arterial anastomosis site has been reported. The applied technique allowed a quick elimination of thrombosis and stenosis of the arterial anastomosis, providing a long-term effect, preventing more severe consequences for the recipient, and saving the liver graft. The presented case showed that the combined technique of endovascular intervention might be a good alternative to the reconstruction of arterial anastomosis by re-exploration and by liver retransplantation.
S. E. Voskanyan, V. E. Syutkin, M. V. Shabalin, A. I. Artemyev, I. Yu. Kolyshev, A. N. Bashkov, A. M. Borbat, K. K. Gubarev, M. V. Popov, A. P. Maltseva
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-319-331

We present an uncommon case of liver graft dysfunction caused by seronegative hepatitis C-related fibrosing cholestatic hepatitis after cadaver liver transplantation for unresectable liver metastases of neuroendocrine small intestine cancer followed by living relation donor liver fragment retransplantation for primary graft nonfunction. Early postoperative period was complicated by hepatic artery thrombosis, cerebral hemorrhage, acute cellular rejection, bilateral polysegmental pneumonia, bleeding into neck soft tissues, severe surgical site infection, and sepsis. Anticoagulant therapy, as well as the absence of Hepatitis C Virus antibodies made difficult early diagnostics of fibrosing cholestatic hepatitis. A present-day antiviral therapy produced a complete clinical and virological response. At control examination performed at 240 days after surgery, there were neither signs of cancer progression no graft dysfunction. Liver transplantation in that case was an example of radical and effective treatment method for unresectable liver metastases of neuroendocrine small intestine cancer. Timely diagnosis and proper treatment of fibrosing cholestatic hepatitis made it possible to save the liver graft and patient's life.
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-245-258

The article has described, analyzed, and introduced into scientific circulation some previously unknown facts from V.P. Demikhov's life, namely, his nomination as a Corresponding Member to the USSR Academy of Sciences in the specialty "physiology" in May, 1966, and his experimental and research work in 1966. The inspection of his scientific activities undertaken on behalf of the Academic Council of N.V. Sklifosovsky Institute for Emergency Medicine, showed that the discoveries and achievements V.P. Demikhov had made in the field of physiology were significant, and he was worthy of being nominated for the rank of a Corresponding Member to the USSR Academy of Sciences. However, he lacked several votes for being elected to the Academy. Meanwhile, in 1966 V.P. Demikhov continued his unique research, having initiated studying the coronary blood flow of the transplanted heart, implementing immunosuppression in kidney transplantation, and starting the experiments on creating a bank of organs to preserve their functions before transplantation.
E. V. Parabina, B. I. Yaremin,
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-213-219

A case of a long-term management of a patient with Kaposi’s sarcoma developed as presumably related to a “standard” immunosuppressive therapy after kidney transplantation has been described. Immunosuppressive therapy conversion to mTOR receptor inhibitors and administering chemotherapy with prospidium chloride allowed for a long-term remission of the disease and a satisfactory clinical outcome.
, , V. N. Martinkov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-189-198

Introduction. One of the main problems in transplantology is the detection of simple, reliable and non-invasive markers that could predict adverse immune reactions and adjust immune suppressive therapy in allograft recipients in a timely manner. Objective. To determine the immunological criteria for the prediction of a graft dysfunction. Material and methods. We have examined 197 recipients who underwent kidney transplantation. All of them were immunologically examined with the identification of more than 40 subpopulations of leukocytes. Allograft function was assessed on day 7 with the division of patients into two groups: with either primary or graft dysfunction. Simple and multiple logistic regressions were used to predict a graft dysfunction. Preliminary statistical analysis was performed using nonparametric statistics. Results and discussion. A scoring system to predict the graft function has been worked out. At CD19+IgD+CD27- 72.7%. At CD3+CD8+CD69+>9.7% score 1 is assigned, and 0 score is given at CD3+CD8+CD69+1 predicts a graft dysfunction. This scoring system has the sensitivity of 91.9%, еру specificity of 100%, еру accuracy of 94.9%, positive predictive value of 1 and negative predictive value of 0.877. Conclusions. 1. Percentage of CD19+IgD+CD27- and CD3+CD8+CD69+ subpopulations can be used to predict a graft dysfunction. 2. At values of CD19+IgD+CD27- not exceeding 72.7% and CD3+CD8+CD69+ more than 9.7%, the development of a graft dysfunction can be anticipated.
M. Sh. Khubutiya, S. E. Voskanyan, V. E. Syutkin, V. P. Chulanov, M. S. Novruzbekov, V. D. Pasechnikov, V. L. Korobka, O. O. Rummo, E. N. Bessonova, S. F. Bagnenko, et al.
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-231-244

Рекомендации по профилактике и лечению инфекций вирусами гепатита В и С у больных, находящихся в Листе ожидания трансплантации печени, и реципиентов печени
E. V. Migunova, Е. А. Tarabrin, N. E. Kudryashova, O. G. Sinyakova, N. A. Karchevskaya, A. G. Petukhova, A. A. Saprin, T. E. Kallagov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-174-188

Study objective. Evaluation of the possibilities of ventilation and perfusion scintigraphy in detecting functional disorders and determining the severity of lung damage that may occur after organ transplantation. Material and methods. The study included 27 patients after bilateral lung transplantation; mucoviscidosis was the main cause of terminal respiratory failure in most cases (19 patients; 77.8%). The ventilation scintigraphy was performed with 99mTc-pentatech using a nebulizer, and the perfusion scintigraphy was performed with 99mТс-albumin macroaggregate. The investigations were performed on Infinia II and Discovery 670 NM/CT single-photon emission tomographs (GE, USA). Results. Changes in the quantitative parameters of ventilation and perfusion scintigraphy in patients after lung transplantation were studied. When analyzing the results of radionuclide studies, we identified a restoration of function after lung transplantation, and the appearance of disorders with the development of complications in the early (up to 4 months) and later (more than one year) periods after bilateral lung transplantation. Conclusion. The study has shown that the radionuclide method has wide possibilities for assessing the ventilation and perfusion functions in patients after lung transplantation, helping in the differential diagnosis of obliterating bronchiolitis and graft vascular sclerosis, in assessing the nature of alveolar-capillary diffusion disorders, and determining the extent of functional abnormalities in every individual patient. Monitoring the function of transplanted lungs using scintigraphy allows separate monitoring of ventilation and perfusion changes, which is important for the choice of treatment tactics.
P. A. Brygin, S. V. Zhuravel, D. A. Troitskiy,
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-220-230

The purpose of this article is to describe the problem of predicting the lung function recovery in patients with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Data from CESAR and EOLIA clinical trials on the efficacy of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome have been reviewed and some controversial results discussed. The prognostic PRESERVE and RESP scores developed as prognostic tools on the basis of the results of these studies, are presented, the limitations of their applicability in various forms of acute respiratory distress syndrome are discussed. We propose to subdivide the predictors of the extracorporeal membrane oxygenation outcome in patients with acute respiratory distress syndrome into 4 following groups: 1. Lung injury severity criteria, including parameters of their lung mechanical and functional properties. 2. Time from acute respiratory failure onset to extracorporeal membrane oxygenation initiation, which reflects the rate of pathological processes in lungs and timing of decision to initiate extracorporeal membrane oxygenation. 3. The etiology of pulmonary disorders, directly affecting the reversibility of pathological processes in the lungs. 4. The severity of the patient's general condition, including the severity of manifestations of multiple organ failure, the degree of decompensation of concomitant chronic diseases, including oncological and associated with immunosuppression. Several diseases are associated with a higher risk of specific complications, particularly hemorrhagic, during extracorporeal membrane oxygenation.
I. Yu. Kolyshev, S. E. Voskanyan, M. V. Shabalin, A. I. Artemyev, V. S. Rudakov, A. P. Maltseva, A. N. Bashkov, V. E. Syutkin, K. K. Gubarev, D. S. Svetlakova, et al.
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-3-199-212

Background. Cancer occurring in recipients of living donor liver transplantation may be characterized by a progressive course requiring an immediate specialized treatment initiation and adjustment of immunosuppression regimen. Aim. To specify the malignancy development mechanisms and risk factors in the recipients of living donor liver transplantation. Material and methods: 275 living donor liver transplantations were made in Burnasyan Federal Medical Biophysical Center of FMBA from 2010 to 2020. Forty two (15.27 %) patients underwent surgery for hepatocellular carcinoma. The median time to the onset of malignancy development was estimated. The incidence of malignancy in general population and in recipients of living donor liver transplantation was compared. Results. The development of neoplastic lesion was registered in 9 cases (3.27%). Malignances were detected in 8 cases (2.90%). Median time to the onset of malignancy development was 48 months. 1, 3, and 5 year overall survival rates were 97%, 96%, 94%;respectively; 1, 3, and 5 year survival rates after transplantation for hepatocellular cancer were 97%, 91%, 91% respectively. Survival rate of patients with De-novo malignancy was 90%. Conclusion. Recipients of living donor liver transplantation have an increased risk of malignancy development that requires a close long-term follow-up.
B. I. Yaremin, P. Kh. Nazarov, K. F.O. Alekberov, D. Yu. Konstantinov, E. V. Kudinova, U. V. Maslikova, M. S. Novruzbekov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-2-135-142

Changes in current scientific literature and regulatory documents related to the issues of infectious safety in organ and tissue donation have been analyzed. The suggestions have been given for changing the existing practices to meet new challenges. Data on threats to the safety of organ and tissue donation associated with the COVID-19 pandemic have been presented.
V. E. Syutkin, , M. S. Novruzbekov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-2-126-134

The publisher has not yet granted permission to display this abstract.
S. V. Zhuravel, N. K. Kuznetsova, , M. S. Novruzbekov, P. V. Gavrilov, T. V. Chernenkaya, G. K. Ospanova
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-2-104-111

The publisher has not yet granted permission to display this abstract.
N. K. Kuznetsova, V. E. Aleksandrova, , A. M. Talyzin, S. V. Zhuravel
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-2-94-103

The publisher has not yet granted permission to display this abstract.
, , N. A. Gavrilova, Yu. Yu. Kalinnikov, M. Kh. Khubetsova, A. A. Zheltonozhko
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-2-112-125

The publisher has not yet granted permission to display this abstract.
O. A. Levina, , M. Sh. Khubutiya, , A. K. Shabanov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-1-28-41

The ability to eliminate any form of oxygen debt by transporting oxygen to organs and tissues, by dissolving it in body fluids, brings hyperbaric oxygenation to a new level of application in transplantology. The review discusses the pathophysiological aspects of hyperbaric oxygenation during ischemia and reinfusion, especially when used in transplantology, and also investigations on the use of hyperbaric oxygenation in model experiments and in clinical practice. Analysis of the efficacy of hyperbaric oxygenation therapy at various stages of the transplantation process (preconditioning, donation, organ storage, in the early and late post-transplant periods) allows us to conclude that this method should be more widely involved in transplantation practice.Authors declare no conflict of interest.
F. Hackl, A. V. Kopylov, M. D. Kaufman
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-1-49-60

Cardiac complications are currently the leading cause of early mortality following liver transplantation. Guidelines for the cardiac workup prior liver transplantation are limited. In this review we are discussing commonly modalities used for cardiovascular evaluation of liver transplant candidates.Authors declare no conflict of interest.
R. N. Akalaev, G. Z. Aripkhodzhaeva, S. A. Rashidova, A. N. Abdullaev, K. A. Khashimov
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-4-282-289

Background. Today, the programmed hemodialysis belongs to the clinical medicine area where patients are at a constant risk of viral hepatitis infection. This is associated with surgical interventions on the vessels, fairly frequent transfusions of blood components, and regular hemodialysis procedures. But in recent years, the ratio of reported cases of viral hepatitis B and C in patients on programmed hemodialysis has changed significantly. With an abrupt increase in the incidence of viral hepatitis C, there is a decrease in the number of registered viral hepatitis B cases.The aim. To study the clinical, epidemiological and pathogenetic features of viral hepatitis C in hemodialysis units.Material and methods. A multicenter study was conducted that enrolled the patients from the Programmed Hemodialysis Units in Tashkent and the regional departments of the Republic of Uzbekistan. The study involved 395 patients on programmed hemodialysis for 7.5 ± 0.7 years. The age of patients was 43.5 ± 0.91 years. The diagnosis of chronic viral hepatitis C was made on the basis of medical history, clinical and laboratory data, and detection of anti-HCV IgG and RNA-HCV in blood.Results. When analyzing the clinical examination and laboratory test results of 395 patients, the parenteral viral infection markers were detected in 181 patients (45.8%). The analysis of the overall incidence of viral hepatitis showed that chronic viral hepatitis C had the highest rates and was found in 125 patients (31.6%). The analysis of the chronic viral hepatitis C course in the presence of the end-stage chronic renal disease showed that in 11 (34%) of 32 patients of the Main group the disease proceeded as a fulminant form of chronic renal-hepatic failure with the development of adverse outcomes. Twenty seven patients (84%) in this group developed progressive anemia. In 16 patients (50%), persistent polyserositis developed in the form of hydrothorax, ascites, and pericarditis, which reflected the aggravating effect of chronic viral hepatitis C on the course of chronic renal disease.Conclusions. In Hemodialysis Units, both in the city of Tashkent, and in the regional departments of the Republic of Uzbekistan, the incidence of chronic viral hepatitis C prevails, having the form of a pathological process with a minimally low activity. Chronic viral hepatitis C has an aggravating effect on the course of the underlying disease with the development of adverse outcomes.
, M. Sh. Khubutiya, O. A. Levina, , A. K. Shabanov, I. V. Goroncharovskaya, A. A. Medvedev
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-4-290-300

Introduction. Studies on the effects of hyperbaric oxygenation have often been represented as animal model experiments. Currently, the number of studies on the use of hyperbaric oxygen therapy in the post-transplant period in humans is growing. The need in investigating the efficacy of hyperbaric oxygen therapy in the postoperative period in female transplant patient with tumors of the reproductive system is dictated by time.The aim of the study was to evaluate the efficacy of hyperbaric oxygen therapy in the complex treatment of transplant patients at an early stage of the postoperative period.Material and methods. We have studied the course of an early postoperative period in 8 female transplant patients with reproductive system tumors treated in N.V. Sklifosovsky Research Institute for Emergency Medicine, using hyperbaric oxygenation. The hyperbaric oxygen therapy sessions were provided in a single-patient hyperbaric chamber at 1.2–1.6 ATA for 40 minutes. The status of the redox homeostasis system was assessed based on the data of the platinum electrode open circuit potential measured in blood plasma by using the potentiometric method; and the blood plasma antioxidant activity was assessed by cyclic voltammetry.Results. The analysis of the results showed that there was a direct relationship indicating the positive effect of hyperbaric oxygen therapy on the balance status of the pro- and antioxidant systems of the body, and on the improvement of blood counts.Conclusion. The early inclusion of hyperbaric oxygen therapy in the complex treatment of transplant patients with tumors of the reproductive system contributes to a more rapid recovery of pro- and antioxidant systems of the body, blood counts.
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-4-330-348

This paper has first put into scientific circulation the transcript of the Meeting of the Presidium of the USSR Healthcare Ministry Council for the Coordination of Scientific Research and Implementation of the Scientific Achievements that was held on October 8, 1963, and discussed the current state and development of scientific research in organ transplantation in the USSR. The presentations of the meeting participants who discussed the reports of V.P. Demikhova and V.I. Burakovsky have been described and analyzed. The concept of organ homotransplantation put forward by V.P.Demikhov who did not take into account (in some speakers's opinion) the latest achievements in immunobiology was reasonably criticized. V.I.Burakovsky's proposals on establihing a Research Institute of Organ and Tissue Transplantation and the Problem Commission for Transplantology were considered rational, supported, and included in the Presidium Resolution.
D. V. Shumakov, D. I. Zybin,
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-4-311-319

In recent years, the mechanical support of blood circulation has proved to be a vital therapy for a terminal heart failure, and is considered as a "bridge" to transplantation or is used on a permanent basis in a patient who can not be included in the waiting list for a donor organ. Recent studies of the critical heart failure treatment during an assist device in situ have shown the myocardial recovery at the molecular and cellular levels. However, the transition of these changes to a functionally stable recovery of the heart function, which would allow the long-term results to be achieved without a heart transplant or switching off the mechanical support, is now rather an exception to the rule. At this time, the cause of the discrepancy between the high rate of recovery at the cellular and molecular levels and the low rate of cardiac function recovery remains poorly understood. Patients with chronic progressive heart failure can demonstrate the normalization of many structural myocardial abnormalities after a mechanical support that is actually a reverse remodeling. However, the reverse remodeling is not always considered equivalent to clinical recovery. The aim of this research is to study a significant improvement in the structure and function of the myocardium during the mechanical support of blood circulation.
V. V. Sokolov, A. V. Redkoborodyy, N. V. Rubtsov, L. G. Khutsishvili, E. N. Ostroumov, E. V. Migunova, N. M. Bikbova
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-4-301-310

Introduction. Cardiovascular diseases rank leading in the world. The decompensation of chronic heart failure is the direct cause of death in most patients. The choice of a definitive treatment tactics is the key factor in these patients.Clinical case. A patient who had experienced myocardial Q-infarction with an ST segment elevation of anterior septal location complicated by the left ventricle anterior wall aneurysm and a decreased myocardial contractility was hospitalized with subcompensated chronic heart failure. Previously, and initially with that hospitalization, the patient was considered a candidate for heart transplantation. After the examination, a decision was made on the possibility of a multi-component reconstructive heart surgery, which was performed with a good clinical effect.Conclusion. The presented clinical case has confirmed the possibility of correcting the combined pathology in a patient with low myocardial contractility obtaining good immediate and long-term (1.5 years after surgery) results.
K. Yu. Kokina, Yu. O. Malinovskaya, A. B. Sidorenko,
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-4-320-329

Recent statistics have shown increased rates of morbidity and mortality from Clostridium difficile infection worldwide. This problem is mainly typical for surgical patients and is associated with an antibiotic therapy and a prolonged hospital stay. Recipients of solid organs are at a high risk of developing severe forms of C. difficile infection due to immunosupression. Existing recommendations for the treatment of C. difficile infection are based on the severity of the disease and do not consider patients after liver transplantation. The aim of this work is to determine an actual tactics for the diagnosis and treatment of C. difficile in organ recipients in clinical practice.
A. P. Maltseva, V. E. Syutkin, I. Yu. Kolyshev, V. S. Rudakov, D. S. Svetlakova, Z. A. Sadykhov, Yu. D. Udalov, S. E. Voskanyan
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-3-218-233

The publisher has not yet granted permission to display this abstract.
A. A. Ofitserov, , A. E. Talypov, I. N. Ponomarev
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-3-234-243

The publisher has not yet granted permission to display this abstract.
E. V. Migunova, M. Sh. Khubutiya, N. E. Kudryashova, O. G. Sinyakova, G. A. Berdnikov, S. I. Rey, M. S. Novruzbekov, O. D. Olisov
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-3-188-200

Objective. The study objective was to assess the scintigraphy potential in the evaluation of portal hypertension and the severity of liver damage in diffuse diseases and after liver transplantation.Material and methods. The study enrolled 325 patients suffering from hepatitis and liver cirrhosis of various etiology and severity, including those after liver transplantation, namely, the patients with hepatitis (n=96), patients with liver cirrhosis of Child–Pugh class A (n=24), class B (n=87), and class C (n=118); 11 more healthy volunteers without clinical and laboratory signs of diffuse liver disease were enrolled as controls. The assessment of liver reticuloendothelial system was performed by scintigraphy with (99m)Tc-phytate colloid in a static planar mode and "whole body" mode by SPECT (Infinia II, GE).Results. In contrast to the control group, significant radionuclide signs of hepatosplenomegaly were revealed with the predominant functional activity of the left lobe; the liver function was found impaired that correlated with the cirrhosis severity evaluated according to the Child–Pugh Сlassification. The analysis of scintigraphy quantitative parameters showed that the most informative of them were the intensity of radiopharmaceutical accumulation in the spleen (S%) and in bone marrow (Вm%), and the radiopharmaceutical uptake by the reticuloendothelial cells of the liver and spleen in percentage from the administered activity (Lwb%, Swb%). Depending on the cirrhosis severity assessed by the Child–Pugh Score, the changes in quantitative parameters were accompanied by a progressive enlargement of the spleen, liver left lobe, the increase of (99m)Tc-phytate uptake by the bone marrow with a decreased radiopharmaceutical uptake by the liver. The study results showed that among the Child–Pugh class C patients, the impairment of liver reticuloendothelial function was more pronounced in the patients with cirrhosis of viral and mixed etiology, when compared to those with alcoholic cirrhosis.Conclusion. The paper has identified the most informative parameters characterizing portal hypertension and the reticuloendothelial function for all Child–Pugh defined classes of cirrhosis. These parameters include the increase of (99m) Tc-phytate accumulation in the spleen (S%) and bone marrow (Bm%); the liver and spleen uptake of the radiopharmaceutical in percentage from the administered activity (Lwb%, Swb%). The calculation of the remaining parameters is necessary for a detailed description of the organ function and for the assessment of the portal hypertension severity in repeated studies.Summary. Criteria for the objective assessment of reticuloendothelial function and portal hypertension in diffuse liver diseases, including after liver transplantation, have been developed. Contrary to the control group, in patients with diffuse liver diseases, the radionuclide signs of hepatosplenomegaly (or a decreased liver size) with a predominant functional activity of the left lobe were identified, as were the changes in the quantitative parameters of the radiopharmaceutical uptake by the liver (Lwb%), including the radiopharmaceutical accumulation in the liver left lobe (Ll%), spleen (Swb%), bone marrow (Bm%), and the liver-to-spleen area ratio (Lar/Sar). The informative and reliable (p
N. K. Kuznetsova, E. V. Klychnikova, S. V. Zhuravel, O. D. Olisov, , M. S. Novruzbekov, V. I. Reshetnyak
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-3-209-217

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E. I. Pervakova, V. V. Vasilets, O. N. Rzhevskaya, ,
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-3-201-208

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Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-2-158-168

The article describes and analyzes the circumstances related to the translation of V.P. Demikhov's book Experimental Transplantation of Vital Organs into English by Basil Haigh in 1962, its publication in the USA and an ambiguous response of foreign readers and surgeons to it. At that time, V.P. Demikhov continued actively preparing for human heart transplantation and declared that in the foreign press. He was granted a gratitude and a cash prize for completed research for the year of 1962 in the Sklifosovsky Research Institute for Emergency Medicine. The results of the preparatory work were summarized. The fact of V.P. Demikhov's readiness to perform heart transplantation on clinic was stated, including that one to harvesting and revitalizing a cadaveric organ, but there were no permission to transplant it to a human.
, E. I. Pervakova, I. V. Goroncharovskaya, E. A. Tarabrin, M. Sh. Khubutiya, М. М. Гольдин
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-2-128-140

Introduction. Monitoring of redox potential (platinum electrode open circuit potential) in biological media (serum, blood plasma) is one of the promising methods for diagnosing and predicting the development of complications in patients in the early post-transplantation period. The study of the diagnostic capabilities of this technique in patients after lung transplantation is highly relevant.The objective was to assess the diagnostic and prognostic capabilities of monitoring platinum electrode open circuit potential in blood plasma of lung transplant patients.Material and methods. The data obtained at monitoring of platinum electrode open circuit potential in blood plasma and clinical laboratory test results of 14 patients after double lung transplantation surgery were analyzed. The platinum electrode open circuit potential value in the blood plasma was measured by the potentiometric method.Results. The study demonstrated the differences in the dynamics and values of platinum electrode open circuit potential in the blood plasma between the lung transplant patients with a favorable outcome and those with a fatal outcome. Wave-like segments on the relationship curves of the platinum electrode open circuit potential in blood plasma to time coincided with inflammatory markers (C-reactive protein, stab neutrophils, erythrocyte sedimentation rate) activation. Statistically significant correlations between platinum electrode open circuit potential values in blood plasma and clinical laboratory test results were revealed.Conclusion. The informative value and diagnostic capabilities of the technique of the platinum electrode open circuit potential measurement in blood plasma of lung transplant patients have prospects of using its results as a criterion for assessing the patient’s condition and improving the quality of therapy.
E. V. Fedoseeva, E. V. Chentsova, , I. N. Ponomarev, A. O. Petrova, Yu. A. Pavlenko
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-2-150-157

The purpose. Using clinical observation, to study the feasibility of applying a coagulant and to assess its efficacy in the treatment of patients with post-burn erosion of the cornea.Material and methods. The treatment was carried out in the Department of Trauma and Reconstructive Surgery, the Helmholtz Moscow Research Institute of Eye Diseases, Russia. Based on clinical test results, the patient, was diagnosed with post-burn persistent erosion of the cornea with sub-total cornea conjunctivization and: limbal stem cell deficiency (LSCD) in the right eye. The keratoprotective therapy conducted for several months turned ineffective. In order to activate the cornea regeneration process, the erosion site was covered with autologous thrombofibrin clot that had been obtained from the stabilized blood. Following a two-stage centrifugation of patient's stabilized blood, the plasma with the platelets were collected into a round-bottomed test-tube; and the chloride calcium activator was added. The clot was formed in the thermostat at a temperature of 37 С. The patient was given a local anesthesia, and the thrombofibrin clot was placed on the cornea surface and covered with an amniotic membrane. The membrane was fixed with a circular stitch along the limbus of the cornea.Result. The patient was followed-up and showed positive changes over time in the form of a diminished erosion area at day 5 and a complete corneal epithelialization at day 14.Summary. Our methodaimed at enhancing the reparative and regenerative processes in the cornea, reducing swelling, accelerating epithelialization, expanding transparency, and improving the optic characteristics thanks to less intensive opacity formation showed a high efficacy.
R. O. Kantariya, A. V. Vatazin, A. B. Zul’Karnayev, V. A. Stepanov
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-2-141-149

Introduction. Tuberculosis is one of the most common infections in the general population, as well as among the recipients of solid organs. In kidney transplant recipients, the diagnosis of tuberculosis is often extremely difficult to make because of unclear clinical and radiological symptoms, and a highly frequent atypical (extrapulmonary) localization. The tuberculosis treatment in patients on drug immunosuppression is a significant problem.Clinical case. At five years after renal transplantation, the patient noted the onset of fever up to 38 degrees C. It was suspicious of respiratory infection. Chest X-ray, computed tomography, and ultrasound examination of the graft revealed no pathology. Antibacterial and antiviral therapy brought stable improvement. A repeated computer tomography demonstrated an enhanced pulmonary pattern in S6 of the left lung with visualization of small grouped lesions located peribronchially, the terminal ileitis in the abdominal cavity: (an intensive contrast accumulation in the mucosa of the affected part of the small intestine, the mesentery hypervascularity at this level). A colonoenteroscopy with a ileum intestine biopsy was performed; the findings were highly consistent with a tuberculous process. A targeted treatment of tuberculosis was carried out, which had a marked positive trend.Conclusion. Thus, the diagnosis of tuberculosis in kidney transplant recipients is complex; the clinical signs and instrumental test results are often ambiguous, which greatly complicates the timely diagnosis. An integrated approach with the use of modern diagnostic methods is required.
M. L. Katin, A. M. Dzyadz`ko, M. Yu. Gurova, O. O. Rummo
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-2-116-127

Introduction. Accurate blood pressure (BP) measurements are the mainstay for the efficient management of abrupt changes of hemodynamics and perfusion during orthotopic liver transplantation (OLT).Material and methods. The prospective study included 39 patients. We compared the BP values measured in the femoral and radial arteries during the different phases of the OLT.Results. The central systolic arterial pressure (SAP) and mean arterial pressure (MAP) measured invasive in the femoral artery were significantly higher than those measured in the peripheral artery during the anhepatic phase (95.1±10.6 vs. 84.5±9.9 mm Hg, and 66±8.8 vs. 59.7±7.1 mm Hg, respectively), after 5 minutes of reperfusion (91.1±17.3 vs. 78.5±18.4 mm Hg, and 63.9±13.1 vs. 57.7±13.6 mm Hg, respectively), and after 15 minutes of reperfusion (102.2±16.8 vs. 88.1±14.4 mm Hg, and 67.7±10.7 vs. 62.5±10.4 mm Hg, respectively). We found a strong correlation between the differences of SAP and MAP and the dose of norepinephrine administered during the anhepatic phase (r=0.76 and r=0.77 for SAP and MAP, respectively), and after 5 minutes of reperfusion (r=0.71 and r=0.52 for SAP and MAP, respectively). The difference between central and peripheral BPs after 15 minutes of reperfusion mainly depended on the changes in the potassium concentration (r=0.55 for SAP and MAP) and base deficiency (r=0.73 and r=0.82 for SAP and MAP, respectively).Conclusion. Thus, it was proved that the invasive measurement of BP in the femoral artery is a more accurate method compared with that in the radial artery as it is less exposed to high doses of vasopressors and variations in the acid-base state during OLT.
M. Sh. Khubutiya, E. A. Tarabrin, S. V. Zhuravel, V. G. Kotandzhyan, N. A. Karchevskaya, E. I. Pervakova, Sh. N. Danielyan, T. E. Kallagov, A. A. Saprin, I. U. Ibavov, et al.
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-2-107-115

Rationale. Lung transplantation is the only definitive treatment in end-stage pulmonary disease. Extracorporeal membrane oxygenation (ECMO) has been used during surgery in recent years as a replacement for respiratory function; ECMO, however, has some drawbacks: the presence of an extracorporeal circuit, the need for heparinization, potential thrombogenicity that underlies the risks of developing specific complications that worsen the transplantation prognosis. In this regard, it is relevant to study the factors that make it possible to predict the need in intraoperative ECMO in order to avoid its unjustified use.Purpose. To identify predictors for intraoperative use of ECMO in lung transplantation.Material and methods. The medical records of patients who underwent lung transplantation in the Sklifosovsky Research Institute for Emergency Medicine from May 2011 to July 2017 were retrospectively reviewed. Forty nine bilateral lung transplantations were made where 15 patients (30.6%) had lung transplantation performed without ECMO, and 34 (69.4%) underwent lung transplantation and ECMO. A central veno-arterial connection was used in all patients. The study analyzed various factors of patient condition at baseline and identified the most significant of them that enabled to predict the need of ECMO use at surgery with a high degree of probability, avoiding episodes of gas exchange and hemodynamic impairments, the prolongation of surgery, and, therefore, the graft ischemia time.Results. As assessed in this study, pulmonary hypertension was the only predictor of an increased likelihood of using ECMO. The probability of connection to ECMO statistically significantly increased in the patients with systolic pulmonary artery pressure higher 50 mm Hg (pConclusion. The presence of pulmonary hypertension > 50 mm Hg determines the preventive use of ECMO during lung transplantation, which should reduce the number of uncontrolled emergencies during the main stages of surgical intervention; in all other cases, ECMO should be connected basing either on the pulmonary artery compression test results or when indicated.
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-1-71-87

Correspondence to: Sergey P. Glyantsev, Prof., Dr. Med. Sci., Head of the Department of the History of Cardiovascular Surgery at A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery, Head of the Medical History Unit within the Medical History Department at N.A. Semashko National Research Institute of Public Health, e-mail: [email protected] Received: August 08, 2018 Accepted for publication: September 12, 2018 The article presents the evidence of a scientific revolution in transplantology that occurred in the world in 1960-1964 with the shift of the paradigm from the impossibility of homoplastic organ transplants to the hope on their feasibility. It began in 1960 with awarding the Nobel Prize to P. Medawar and F. Burnet for the discovery of artificial immunological tolerance, it had its continuation in 1961–1962 with the advances in experimental transplantation of vital organs undertaken in conditions of mechanical circulation (R. Lower, N. Shumway) and immunosuppression (K. Reemstma), and completed with human transplantations of lung in 1963 and of heart in 1964 (J. Hardy). In those years, the concept of mechanical support for an ill heart by using an implanted mechanical assist device was developed and introduced (1963). But even against that background, V.P. Demikhov's achievements in homologous organ transplantation and the development of biological techniques to overcome tissue incompatibility looked impressive. His highest achievement was the transplantation of a supplemental heart to the dog Grishka in June 1962, and the dog survived with it for 141 days. However, after the discoveries in the field of transplantation immunity, the train of experimental transplantation where V.P. Demikhov was riding, began picking up speed very quickly, and the Soviet surgeons were to jump on its footboard.
V. A. Gulyaev, M. Sh. Khubutiya, M. S. Novruzbekov, A. S. Mironov, O. D. Olisov, K. N. Lutsyk, S. V. Zhuravel, K. M. Magomedov, R. B. Akhmetshin, B. I. Yaremin
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-1-37-54

The paper reviews the milestones and prerequisites in the history of the emergence and development of xenotransplantation. The currently existing barriers (immunological, infectious, genetic, ethical, and regulatory) to the development of this organ and tissue transplantation type have been studied. Available data on theoretical research and experimental studies have been reviewed. The prospects for performing xenotransplantation in various combination of species have been assessed. The forms and variants of the xenograft rejection reaction have been described. Genetic engineering approaches to overcoming xenoimmunological incompatibility are described. An assessment is made of ways to overcome existing barriers and prospects for the further development of xenotransplantation as a scientific section of transplantology.
A. V. Nevedrov, E. Yu. Shibayev, V. O. Kalenskiy, N. N. Zadneprovskiy, V. B. Shishkin, F. A. Sharifullin, O. A. Tsoy, M. P. Lazarev, P. A. Ivanov, A. L. Rybinskaya
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-1-9-20

Background.Vascular bone graft transposition is the one of most effective method of nonunion fracture and bone defect treatment. However, the use of this technique is associated with some difficulties. One is the adjustment of recipient bed size and the graft. The other is the difficulty to reconstruct the alignment and length of bone. A promising method of preparing for the vascular bone graft transposition is virtual three-dimensional planning based on computed tomography data and three-dimensional printing templates.The aimwas to summarize our experience in the treatment of bone nonunion and defects with vascular bone autografts using tree-dimensional virtual planning and printing.Material and methods.We analyzed the treatment process and outcomes of 4 patients with limb bone nonunion and 6 patients with bone defects. In all cases, we used vascular bone grafts. Internal fixation of grafts was used in 7 cases, external fixation was used in 3 cases. At preparation stage in 4 cases, we used tree-dimensional virtual surgery planning and printing templates.Results.One case was diagnosed with bone graft necrosis caused by venous thrombosis. Consolidation was achieved in all patients; a late consolidation was observed in 2 cases. Hematoma in donor area was seen in 2 patients. When using three-dimensional virtual planning and tree-dimensional printing templates, the operation time was decreased by 1 hour 5 minutes. We identified two cases of poor reposition in the group without virtual planning. No poor reposition was observed in the cases where tree-dimensional planning was used.Conclusion.Vascularized bone grafts provide an effective method to treat bone defects and nonunion. But the planning of graft and recipient site sizes is associated with certain difficulties. Our preliminary results have shown that virtual three-dimensional planning and printing allow improving the precision of the surgical procedure and decreasing operative time.
M. Sh. Khubutiya, A. M. Gasanov, E. A. Tarabrin, T. E. Kallagov, E. I. Pervakova, S. A. Krasovskiy
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-1-55-60

Introduction. Currently, lung transplantation is an approved method for treating a wide range of end-stage lung diseases refractory to medical or surgical treatments when patient's life expectancy without transplantation makes no more than two years.The aim was to evaluate the efficacy of continuous nutritional support via percutaneous endoscopic gastrostomy in potential recipients of lung transplantation with a Body Mass Index under 16 kg/m2.Material and methods. The study was based on the analysis of 93 potential recipients with various lung diseases; 27 of them with diagnosed cystic fibrosis. The enteral nutrition results of the patients with cystic fibrosis whose Body Mass Index (BMI) was under 16 kg/m2 were assessed by the increment in BMI and compared between those (15) fed via gastrosomy and those (22) fed per os.Results. As a result of enteral nutrition via the gastrostomy in the daytime and at night, the majority of recipients (73.3% of cases) had the Body Mass Index (BMI) corrected from 0.1 to 4.91 kg/m2 during the first year, the mean BMI increment made 1.87 ± 0.4 kg/m2. After the BMI correction, 11 of the 15 potential recipients were included in the waiting list, and 6 of them (40%) underwent lung transplantation. In the comparison group, the BMI increment was 0.9 ± 0.3 kg/m2, also having reached a significant difference compared to the baseline (p = 0.04). However, the BMI increment in the main group was significantly higher than in the comparison group (p = 0.02).Conclusion. A statistically significant increase in BMI in a group of patients with cystic fibrosis and BMI under 16 kg/m2, has been demonstrated after percutaneous endoscopic gastrostomy, which allows extending the criteria for the inclusion in the waiting list for lung transplantation.
, M. Sh. Khubutiya, O. N. Rzhevskaya, , D. A. Vasil’Chenkov
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-1-21-36

Kidney transplantation is the most effective treatment for the end-stage chronic renal disease that has been observed to increase in the incidence consistently in recent years. Despite the achievements in immunosuppressive therapy in patients after renal transplantation, the graft survival length has remained unchangeable during the recent few decades. Bone marrow multipotent mesenchymal (stromal) stem cells (BM MMSCs) are known as a potential tool to influence this situation. Since their discovery in the middle of the XX century, their wide therapeutic potential in the transplantation of solid organs was demonstrated both in experimental and clinical trials. They have the ability to modify recipient’s immune response and improve postoperative course, however, having a low level of their own immunogenicity. MMSCs realize their properties through interactions both with the innate and adoptive immune system. Meanwhile, actual questions such as an optimal dosage and injection timing are still need answers. Actual experience of both experimental and clinical use of MMSCs in kidney transplantation has been analyzed in the present publication.
, E. V. Mogilevets, Yu. I. Povolanskiy, A. K. Sonchik, A. Y. Pyshko, A. N. Barkova, I. A. Logosh, Yu. N. Brukhanskaya, E. V. Kolontay, S. V. Kondel’
Transplantologiya. The Russian Journal of Transplantation, Volume 11; doi:10.23873/2074-0506-2019-11-1-61-70

Introduction. The number of patients with chronic kidney disease has been steadily increasing throughout the world, which makes this pathology a pressing problem. The purpose. The analysis of heterotopic kidney transplantation results. Material and methods. The authors analyzed the experience of the clinical work arrangement, the results of operations, assessed the complication rate and the quality of life in 133 patients after heterotopic cadaveric kidney transplantation performed in the Grodno regional clinical hospital in the period from 2013 to mid August of 2018. Results. In the early postoperative period, complications occurred in 22 (13.5 %) patients, the postoperative mortality was 1.8% (3 patients). In the late postoperative period, the kidney explantation was performed in 4 (2.45%) patients, 6 patients died (3.7%) as a result of progressing comorbidities and complications (average at 15.6±9.8 months after transplantation). A 5-year predicted patient survival after heterotopic kidney transplantation calculated by using the Kaplan-Meier' method was 94.5%. Conclusions. Kidney transplantation in the Grodno Region, the results of operations, graft survival, quality of life and patient survival are comparable to international standards. A careful selection, examination, and preparation of patients for transplantation have a great effect on treatment outcomes.
Transplantologiya. The Russian Journal of Transplantation, Volume 10; doi:10.23873/2074-0506-2018-10-4-336-346

The article describes the results of V.P. Demikhov's working at N.V. Sklifosovsky Institute for Emergency Medicine in 1961. We have presented a brief report of his laboratory activities and a prospective working plan that included preparing for vital organ transplantations in clinic, conducting immunological and morphological studies, resolving resuscitation issues, all aimed at: 1) revitalizing dead people and their organs for transplantatio, and 2) preserving the vitality of the isolated organs before transplantation. For the first time in the history of national surgery, the question of "brain death" was raised as a criterion for the possibility of organ harvesting. However, the documents we have reviewed demonstrated that such a plan was impossible to be realized with the efforts of a single institution. V.P. Demikhov was advised to revise the plan, abridge it, and bring it into line with the modest potential of the Institute to organ transplantations.
A. V. Sachkov, , , A. S. Mironov, V. S. Borisov, , I. N. Ponomarev, A. V. Svishchev
Transplantologiya. The Russian Journal of Transplantation, Volume 10; doi:10.23873/2074-0506-2018-10-4-327-335

The article has analyzed the world experience and main trends in the preparation of cadaveric skin for use in the treatment of patients with wounds of various etiologies. The history of the question is described from the first attempts of transplantation of the native skin to the creation of specialized banks of allogenic decellularized tissue grafts. Presented are the modern approaches of donor material conservation, specifically, to the principle and topical question: whether the viability of the cells should be preserved in the graft, or it is more efficient to transplant the skin devoid of cellular elements. The advantages and disadvantages of lyophilized grafts have been described, namely the possibility of longterm storage, but loss of elasticity, after rehydration. The methods of cryoconservation of cutaneous allografts, their properties, and acceptable methods of sterilization have been discussed. A perspective technology of graft decellularization has been assessed and the methodologies of their manufacturing have briefly been presented.
I. Yu. Drachev, V. Yu. Shilo, G. S. Dzhulay
Transplantologiya. The Russian Journal of Transplantation, Volume 10; doi:10.23873/2074-0506-2018-10-4-298-307

The aim of the study was to evaluate the efficacy of various approaches to correcting and preventing hypotension episodes in patients on maintenance hemodialysis (HD).Material and methods. The study included 35 patients on maintenance hemodialysis in the Dialysis Center "MCHTP No. 1", which is a part of "B. Braun Avitum" network centers in the Russian Federation. All patients underwent an automatic blood pressure (BP) measurement using a machine-inbuilt option device for noninvasive blood pressure measurement. Prior to the study, all patients underwent a clinical test with a "dry weight" assessment and a bio-impedance analysis. The study had a cross-over design: first, all patients were treated using the standard methods for correcting hypotension episodes (at 4 initial procedures). Then, in the following 4 procedures, in addition to standard methods, a computer algorithm was used to automatically regulate the ultrafiltration (UF) rate: the automatic pressure monitoring system (biologic rr comfort) with continuous monitoring of blood pressure throughout the procedure; BP was recorded before and after the HD procedure, as well as at least once every 5 minutes during 3 initial procedures; and starting from the 4th procedure, the intervals were determined by the algorithm automatically. The average blood pressure values were analyzed during the dialysis procedures for the entire observation period. The duration of the study was 3 weeks for each patient.Results. The average predialysis blood pressures in the group with the standard approach to hemodynamic correction were 124.6 ± 27.7 and 74.5 ± 21.1 mm Hg, the postdialysis blood pressures were 114.4 ± 24.4 and 71.3 ± 16.3 mm Hg. With the use of automatic pressure monitoring system, the predialysis and postdialysis blood pressures were significantly higher than those with the standard approach: 133.2 ± 21.3 and 79.3 ± 15.8 mm Hg (p < 0.001 and p = 0.009), vs. 125.7 ± 23.9 and 75.9 ± 18.3 mm Hg (p < 0.001 and p < 0.001), respectively. Upon closer examination of the intradialysis pressure variations, the intradialysis blood pressures were 110.2 ± 17.3 and 68.3 ± 13.9 mm Hg when measured by using the standard approach, and significantly higher: 124 ± 20.5 and 75.9 ± 14.2 mm Hg when the automatic pressure monitoring system was used (p = 0.03; p = 0.02). Also, higher mean arterial pressures were noted: 82.5 ± 13.9 with the standard approach vs.91.5 ± 15.6 mm Hg (p = 0.01) with the automatic pressure monitoring system. Studying UF rates, we found that the UF rate was slightly higher without using the automatic pressure monitoring system (8.0 ml/kg/h vs. 7.9 ml/kg/h). Thus, the new approach used in addition to the standard methods of correcting hypotension was effective and safe. No significant differences were seen in Kt/V values. However, when automatic pressure monitoring system was used in patients, the target phosphate levels were achieved: the inorganic phosphorus value was 1.5...
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