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A. S. Mironov, N. V. Borovkova, M. S. Makarov, I. N. Ponomarev, Yu. V. Andreev
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-49-62

The article outlines the main stages of the formation, development and specialization of medical institutions associated with the harvesting and procurement of allogeneic tissues, considers the global practice in the field of tissue institutions, taking into account medical and legal aspects. In the second half of the XX century, the tendency has developed towards the consolidation of tissue banks and the expansion of their functional capabilities within individual states. The development of this trend in the late XX - early XXI centuries led to the establishment of international tissue banking associations. The goal of international associations of tissue banks has been to develop cooperation, standardize procedures at all stages of tissue harvesting and procurement, and form an effective legislative framework. In the Soviet Union, the procurement of donor tissues was widely developing, but in the 90s, in our country there was an abrupt decline in this field. To date, in Russia, the harvesting and procurement of allogeneic tissues is carried out in only a few institutions; the development of tissue institutions is difficult due to the lack of an adequate legal framework. The article proposes to legally differentiate the concepts of "organ transplantation" and "tissue transplantation"; as an example, the US experience in this area is discussed.
, K. K. Gubarev, V. L. Vinogradov, V. S. Rudakov, D. S. Svetlakova, A. A. Fedyunin, M. Krstich, A. I. Zakhlevnyy, A. I. Artemiev, S. E. Voskanyan
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-10-24

Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task. The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes. Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed. Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance. Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.
, Yu. G. Shatunova, A. Werner
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-74-92

For the first time, the article introduces into scientific circulation and analyzes the Preface by V.P. Demikhov to his book "Transplantation of vital organs in experiment", published in 1967 in Spanish under the title "Transplante experimental de órganos vitales". Judging by the facts mentioned in the text, V.P. Demikhov wrote it in 1966, reflecting his views on the current state and prospects of homoplastic tissue and organ transplantation. As in previous publications, in particular, in the Preface to the German edition of the book published in Berlin in 1963, V.P. Demikhov substantiated the concept that the main condition for a successful transplantation of homoplastic organs was to restore the blood circulation in them. In his opinion, the success of engraftment depends, first of all, on the ideally performed vascular suture and the immediate inclusion of the transplanted donor organ into the blood circulation of the host body, as well as on the sterility of the undertaken intervention. Having discussed the use of pharmacological immunosuppression as a method of overcoming the biological incompatibility of homologous organs during their transplantation, V.P. Demikhov pointed out the toxicity of the drugs used for this purpose he tested experimentally, as well as his experiments, indicating the possibility of overcoming incompatibility by means of other methods (the selection of the donor and recipient with regard to the blood group, mixing the blood of the donor and recipient by parabiosis, etc.). In this text V.P. Demikhov again mentioned the scheme he had developed for two-stage transplantation of an additional heart as a reserve organ to maintain the function of the patient's decompensated heart and named the main stages of the operation: implantation on the femoral vessels (stage 1) and transplantation into the chest (stage 2). As in the Preface to the German edition of the book, V.P. Demikhov spoke in detail about the model of a “living physiological system” he had developed in 1963 aimed at creating a bank of reanimated organs that would retain their viability until transplanted into another body. Projects for growing the organs in anencephalic newborns for the rejuvenation of the elderly were also outlined.
L. V. Donova, M. S. Novruzbekov, V. E. Syutkin
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-25-32

Rationale. Hepatorenal syndrome is a threatening complication in patients with liver cirrhosis and portal hypertension. The occurrence of renal dysfunction associated with hepatorenal syndrome manifestations significantly affects the condition severity, the disease duration, and the survival time during the waiting period for liver transplantation. The study purpose was to investigate the potential of a complex ultrasonography examination in the assessment of intrarenal hemodynamic impairments in patients with various diffuse liver diseases. Material and methods. The ultrasound examination results of 167 patients were analyzed. The 1st group included 28 patients with confirmed diffuse liver diseases of viral etiology who did not have signs of cirrhosis formation, the 2nd group included 139 patients with liver cirrhosis due to diffuse liver diseases of various etiologies, and the 3-rd group included 137 patients who had previously been in the 2nd group in whom orthotopic liver transplantation was performed. Results. The study revealed a statistically significant increase in the incidence of secondary hemodynamic impairments in kidney function in patients with liver cirrhosis and no relationship of their severity and incidence to the disease etiology, and also to such markers of the portal hypertension severity as splenomegaly, ascites, and portal vein thrombosis. Conclusions. The resistive index measured on the renal arterial branches by Doppler ultrasound, has a certain predictive value in relation to hepatorenal syndrome in patients with liver cirrhosis of various origins. This also makes it possible to timely identify a group of patients at a high risk of developing severe renal dysfunction and to assess the efficacy of the treatment that has been given.
E. G. Agafonov, , D. I. Zybin, D. V. Shumakov
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-40-48

Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on the waiting list for heart transplantation. Purpose. The purpose of this article is to review the role of surgical management in patients with heart failure complicated by mitral regurgitation. Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.
F. A. Khadjibaev, V. Kh. Sharipova, P. K. Sultanov
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-63-73

Background. The one-year renal graft survival rates have grown to 93.4% for transplantation from cadaveric and 97.2% from living donors. Early detection and elimination of complications after kidney transplantation improve these figures. The study purpose was to develop an algorithm for the diagnosis and treatment tactics of postoperative complications after kidney transplantation by reviewing literature data and analyzing the results of our own experience. Material and methods. The study included 75 patients who underwent kidney transplantation from a living donor at the Republican Research Centre of Emergency Medicine from March 2018 to December 2019. Results. The original authors' algorithm developed for the diagnosis and treatment of complications after kidney transplantation covers all postoperative complications that lead to renal transplant dysfunction. It is based on assessing the symptoms that typically occur in a specific complication. The main instrumental methods in the diagnosis of postoperative complications are ultrasound and radiological investigational techniques. The biopsy has the main role in diagnosing a graft rejection. Among 75 patients after kidney transplantation, 23 (30.6%) developed various early postoperative complications, including both surgical and immunological ones. Renal graft dysfunction was eliminated in 17 (73.9%) of 23 patients. The loss of a transplanted kidney was associated with the death of 7 recipients (9.3%). The causes of death were pulmonary embolism in 2 (2.7%) cases, infection and sepsis as a result of immunosuppression in 2 (2.7%) cases, hypovolemic shock in 2 (2.7%) cases, and acute ischemic stroke in 1 (1.3%) case. Two recipients underwent renal transplant nephrectomy. The cause of nephrectomy was graft rejection and bleeding from the renal artery. A oneyear survival rate was 90.7%. The proposed treatment and diagnostic algorithm showed a 95.7% diagnostic value in identifying the complications, and 91.3% of the therapeutic effect in coping with a renal transplant dysfunction. Conclusions. Early treatment of revealed complications allows saving the transplanted kidney function. Step-bystep differential diagnosis of complications after kidney transplantation, according to the proposed algorithm, allows choosing the treatment tactics based on complication pathogenesis.
A. Yu. Maksimova, E. N. Bessonova, V. V. Bazarnyy
Transplantologiya. The Russian Journal of Transplantation, Volume 13, pp 33-39; doi:10.23873/2074-0506-2021-13-1-33-40

Introduction. One of the urgent tasks in modern transplantology is the search of biomarkers for predicting and early diagnosis of graft dysfunction. Objective. The study objective was to determine the biomarkers of liver graft dysfunction. Material and methods. We have examined 19 recipients who underwent liver transplantation and 36 healthy blood donors. Levels of 7 serum cytokines were measured by multiparametric fluorescence analysis with magnetic microspheres (xMAP technology, Luminex 200, USA). Statistical analysis was carried out by methods of nonparametric statistics. To determine the predictive value of the test, a ROC-analysis was performed. Results and discussion. We found that the interleukin-8 level was 3.6 times higher in recipients with liver graft dysfunction compared to those who had an uneventful postoperative course. The diagnostic sensitivity of the test was 75%, the specificity was 91%, and negative predictive value was 84.6. Conclusion. Serum interleukin-8 measurement provides a biomarker for early predicting a post-transplant liver graft dysfunction development
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

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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

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, , 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

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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.
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.
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.
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

The publisher has not yet granted permission to display this abstract.
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

The publisher has not yet granted permission to display this abstract.
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.
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. 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.
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