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, R. V. Storozhev, Yu. A. Anisimov, K. E. Lazareva, , O. Yu. Mikita, А. V. Pinchuk
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 236-241; https://doi.org/10.23873/2074-0506-2017-9-3-236-241

Abstract:
Введение: в нашей стране использование стандартизированных опросников у пациентов после трансплантации органов с целью оценки качества жизни не получило широкого распространения. Цель: оценка качества жизни пациентов после сочетанной трансплантации почки и поджелудочной железы с применением опросника SF-36. Материал  и  методы. Были обследованы 35 пациентов с сахарным диабетом 1-го типа, осложненным терминальной хронической почечной недостаточностью. Среди них было 16 женщин (45,7%) и 19 мужчин (54,3%). Медиана возраста составила 36 [33;45] лет. В зависимости от типа трансплантации пациенты были разделены на две группы: группа I была представлена пациентами, перенесшими изолированную трансплантацию почки, группа II – сочетанную трансплантацию почки и поджелудочной железы. Качество жизни больных оценивали с использованием опросника SF-36. Результаты: у пациентов группы II статистически значимо выше физическое функционирование, общее состояние здоровья и жизненная активность. Вывод: у больных, страдающих сахарным диабетом 1-го типа, сочетанная трансплантация почки и поджелудочной железы является операцией, значительно повышающей качество их жизни.
S. P. Glyantsev
Transplantologiya. The Russian Journal of Transplantation, Volume 9; https://doi.org/10.23873/2074-0506-2017-9-3-268-278

Abstract:
Статья (третья из пяти) посвящена анализу окончания 3-й главы монографии В.П. Демихова «Пересадка жизненно-важных органов в эксперименте» (Москва: Медгиз, 1960), посвященной гомопластическим пересадкам органов. В статье рассмотрены результаты создания В.П. Демиховым следующих моделей: изолированное сердце и легкое, почки, голова, половины туловища и целое туловище. Модели с изолированным сердцем, помещенным на место биологического, не были успешными. Наибольший срок жизни собаки-реципиента составил 15 часов. Собаки с пересаженной долей легкого (данных о пересадке целого легкого в книге нет) жили до 6 суток. С чужими почками – до 19 суток, причем причиной гибели трансплантатов В.П. Демихов называл биологическую несовместимость тканей донора и реципиента, указал на необходимость ее подавления и на значение совместимости групп крови двух организмов для успешной гомопластической пересадки. Пересадками головы щенят на сосуды шеи собак, которые он проводил с 1954 г., В.П. Демихов пытался доказать влияние центральной нервной системы на приживление органов, что было одной из целей этих экспериментов. Соединение двух организмов между собой с объединением их сосудистых систем и смешением крови преследовало две цели: создание условий для преодоления трансплантационного иммунитета и создание модели пересадки органов в комплексе с сохранением их нейрогуморальных связей. Модель перекрестного кровообращения позволила также сформулировать и реализовать концепцию банка органов в эксперименте.
M. Sh. Khubutiya, A. A. Ryk, E. A. Tarabrin, A. V. Grishin, T. E. Kallagov, A. V. Vodyasov, I. I. Utkina
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 259-263; https://doi.org/10.23873/2074-0506-2017-9-3-259-263

M. Sh. Khubutiya, V. A. Gulyaev, , Array Л. Леменёв, Array А. Кабанова, Array С. Новрузбеков, K. N. Lutsyk, , Array В. Журавель, Array В. Булава, et al.
Transplantologiya. The Russian Journal of Transplantation, Volume 9; https://doi.org/10.23873/2074-0506-2017-9-3-211-225

Abstract:
Моделирование иммунологической толерантности позволит отказаться от приема лекарственных средств для профилактики реакции отторжения донорского органа. В обзоре литературы освещаются иммунные механизмы отторжения аллотрансплантата и способы индукции толерантности. Обсуждаются роль мезенхимальных стволовых клеток и их применение для развития толерантности, авторы также обращают внимание на то, что переливание крови от донора органов приводит к снижению интенсивности иммунного ответа на донорские клетки при трансплантации.
N. S. Egorova, E. V. Chentsova, N. V. Borovkova, , M. V. Storozheva
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 226-235; https://doi.org/10.23873/2074-0506-2017-9-3-226-235

Abstract:
Цель  работы: исследовать влияние биоконструкции на основе коллагена I типа и клеток буккального эпителия на репаративные процессы в роговице кроликов после экспериментальной кератэктомии на разных этапах лечения (3-и, 7-е, 14-е и 30-е сутки). Материал  и  методы. Исследование проведено на 20 кроликах породы шиншилла, на 40 глазах которых выполнена дозированная кератэктомия с формированием эпителиально-стромального дефекта роговицы. На роговицы опытных глаз помещали биоконструкцию с клетками буккального эпителия на матриксе из коллагена I типа. Роговицы контрольных глаз укрывали мягкой контактной линзой. После завершения операции на всех глазах проводили временную блефарорафию на 3 суток. Оценивали скорость сокращения дефектов роговицы. Макрои микроскопическую оценку эффективности проводимой терапии осуществляли на 3-и, 7-е, 14-е и 30-е сутки эксперимента. Результаты. При использовании биоконструкции с клетками буккального эпителия длительность полной эпителизации дефекта роговицы сокращается в среднем на 7 суток относительно результатов в группе сравнения. Предложенная биоконструкция ускоряет миграцию и пролиферацию клеток на ранних стадиях репарации (3–7 суток после начала лечения), а также уменьшает выраженность воспалительной реакции. Заключение. Биоконструкция с клетками буккального эпителия на матриксе из коллагена I типа показала свою эффективность в лечении повреждений роговицы.
V. A. Sandrikov, M. M. Kaabak, E. N. Platova, V. I. Sadovnikov, N. N. Babenko, A. K. Zokoev
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 248-251; https://doi.org/10.23873/2074-0506-2017-9-3-248-251

Abstract:
Цель: оценить возможности мониторинга трансплантированной почки по данным ультразвуковой диагностики в развитии криза отторжения. Материал  и методы. В анализ результатов включены 154 пациента после трансплантации почки. Регистрировали размеры трансплантата, скорость кровотока в сосудах в интраоперационном и послеоперационном периодах. Результаты. Пациенты подразделены на две подгруппы: 1-я – с дисфункцией трансплантата, но без признаков криза отторжения; 2-я – с острой реакцией отторжения.
S. F. Bagnenko,
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 192-210; https://doi.org/10.23873/2074-0506-2017-9-3-192-210

Abstract:
В статье, выполненной в виде программной лекции ректора Первого Санкт-Петербургского медицинского университета им. И.П. Павлова, определяются главные проблемы современной трансплантологии и пути их разрешения в контексте сегодняшних реалий высшего профессионального медицинского образования.
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 153-163; https://doi.org/10.23873/2074-0506-2017-9-2-153-163

Abstract:
Статья (вторая из пяти) посвящена анализу начала 3-й главы монографии В.П. Демихова «Пересадка жизненно-важных органов в эксперименте» (М.: Медгиз, 1960), посвященной гомопластическим пересадкам органов. В статье рассмотрены результаты создания В.П. Демиховым следующих моделей: дополнительное изолированное сердце, дополнительное сердце с долей легкого и сердце в комплексе с двумя легкими. Ориентируясь на общепринятые «критические» сроки начала реакции отторжения пересаженных гомотканей (7-е, 14-е или 21-е сутки), свои наблюдения переживания пересаженными органами этих сроков В.П. Демихов рассматривал как факты их успешного приживления, а каждый новый отвоеванный им у природы срок жизни реципиента с донорским органом убеждал его в правильности выбранного пути. Пересадку комплекса «сердце-легкие» В.П. Демихов проводил с целью упрощения операции анатомической пересадки этих органов по отдельности и полагал, что совершенствование оперативной методики и техники позволит ему добиться их полного приживления для переноса в будущем результатов наиболее успешных экспериментов из лаборатории в клинику.
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 137-152; https://doi.org/10.23873/2074-0506-2017-9-2-137-152

Abstract:
Успешная трансплантация почки нивелирует эндокринно-метаболические нарушения, предрасполагающие к формированию закономерного для хронической болезни почек осложнения – гиперпаратиреоза, однако процесс восстановления минерально-костных нарушений замедлен. Наибольшая частота посттрансплантационного гиперпаратиреоза регистрируется в первый послеоперационный год. К факторам риска его развития или персистенции относят высокие уровни в крови паратиреоидного гормона, кальция, фосфора и (или) щелочной фосфатазы, длительную диализную терапию, тяжелый гиперпаратиреоз в предоперационном периоде, дефицит витамина D, субоптимальную функцию трансплантированной почки, а также ранее перенесенную реципиентом субтотальную или неполную паратиреоидэктомию. Характерными клиническими и лабораторными признаками посттрансплантационного гиперпаратиреоза являются поражения костей, почечного трансплантата, гиперкальциемия и гипофосфатемия. Диагностический алгоритм включает динамическое определение маркеров минерального и костного метаболизма, минеральной плотности кости и визуализацию околощитовидных желез. Коррекцию посттрансплантационного гиперпаратиреоза проводят хирургическим путем или медикаментозными средствами. Анализируют показания, объем и сроки выполнения паратиреоидэктомии. Обсуждается применение препаратов нативного витамина D, его аналогов и кальцимиметиков.
M. Sh. Khubutiya, M. E. Il'inskiy, A. A. Ryk, Yu. N. Lyashchenko
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 125-136; https://doi.org/10.23873/2074-0506-2017-9-2-125-136

Abstract:
В обзоре освещены ключевые особенности статуса питания больных муковисцидозом, современные подходы к мониторингу и коррекции нарушений алиментарного статуса пациентов до и после трансплантации легких (ТЛ).
, Z. A. Adyrkhaev, A. S. Ivandaev, A. V. Kozhanova, V. V. Kazennov, I. E. Timina, A. V. Sharshatkin, A. V. Pokrovskiy
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 108-112; https://doi.org/10.23873/2074-0506-2017-9-2-108-112

Abstract:
Ежегодно в мире отмечается рост числа пересадок почки у пациентов с терминальной стадией хронической почечной недостаточности. О частоте развития аневризмы брюшного отдела аорты у больных с пересаженной почкой можно судить лишь по отдельным публикациям. Так, по данным Cron, среди 2133 пациентов, которым была выполнена пересадка почки, аневризма аорты была выявлена в 29 случаях, что составило 1,35%. Операции по поводу аневризмы брюшного отдела аорты у данной группы больных попрежнему остаются редкостью в практике сосудистого хирурга и ставят перед нами ряд принципиальных вопросов, которые не имеют хрестоматийных ответов. При гетеротопической пересадке ишемия почки во время пережатия аорты является критически значимым аспектом лечения этой группы пациентов, недооценка которого может потенциально привести в потере трансплантата. Ряд авторов считают, что дополнительная защита почки во время пережатия аорты не обязательна, а операция может быть выполнена без вреда для трансплантата при быстрой технике протезирования. Ниже представляем наше клиническое наблюдение резекции аневризмы инфраренального отдела аорты у больного после гетеротопической пересадки почки без защиты трансплантата.
A. S. Kondrashkin, A. V. Pinchuk, P. A. Yartsev, , A. V. Oranskiy, M. Sh. Khubutiya
Transplantologiya. The Russian Journal of Transplantation, Volume 9; https://doi.org/10.23873/2074-0506-2017-9-2-101-107

Abstract:
Актуальность. У больных после трансплантации солидных органов развитие послеоперационных вентральных грыж наблюдается в 1,6–34,8%, что определяет актуальность данной проблемы. Цель: улучшение результатов лечения больных с послеоперационными вентральными грыжами после трансплантации солидных органов. Материал и методы. С 2006 по 2017 г. с использованием синтетических материалов были оперированы 36 больных с послеоперационными вентральными грыжами после трансплантации солидных органов. Среди них были 15 женщин (41,7%) и 21 мужчина (58,3%). Медиана возраста составила 55 лет [44,5;59], медиана индекса массы тела – 30 кг/м2 [27,1;33,2]. Результаты. Неосложненное течение послеоперационного периода наблюдалось у 13 пациентов (36,1%). У 23 больных (63,9%) имелись осложнения разной степени тяжести: у 13 пациентов (56,5%), однако, выявленные осложнения не были показанием к назначению таргетной терапии (категория I), у 3 больных (13,1%) они регрессировали после коррекции медикаментозной терапии (категория II), у 7 (30,4%) – после применения мини-инвазивных хирургических методов лечения (категория IIIа). Выводы. Протезирующая герниопластика показала высокую эффективность и безопасность в лечении послеоперационных вентральных грыж у пациентов после трансплантации солидных органов.
Array И. Расулов, Array А. Муратов, Array В. Дворниченко, Array Д. Мориков, Array К. Батороев, Array И. Сонголов
Transplantologiya. The Russian Journal of Transplantation, Volume 9; https://doi.org/10.23873/2074-0506-2017-9-2-118-124

Abstract:
Приведен анализ 5 клинических наблюдений, которые демонстрируют возможность использования органосохраняющих технологий в хирургии местно-распространенных ретроперитонеальных сарком. На клиническом примере поэтапно представлена методика органосохраняющего хирургического вмешательства: расширенная туморнефрэктомия с последующей экстракорпоральной прецизионной диссекцией почки из опухолевого массива с использованием обратимой фармакохолодовой ишемии и аутотрансплантацией выделенной почки в гетеротопическую позицию с учетом интраоперационного экспресс-цитологического контроля. Отображены особенности анестезиологического пособия, раннего послеоперационного периода и последующей реабилитации и диспансеризации данной группы пациентов.
, N. Yu. Bayramov
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 113-117; https://doi.org/10.23873/2074-0506-2017-9-2-113-117

Abstract:
Врожденный фиброз печени – редко встречающееся аутосомно-рецессивное заболевание. Описано всего несколько таких случаев во всем мире, но точная частота встречаемости неизвестна. Иногда бывает очень трудно поставить диагноз, и один из основных и окончательных методов диагностики – это гистологическое исследование. Прогноз заболевания и ведение больного зависят от алиментарного кровотечения, возникающего на фоне портальной гипертензии. В позднем детском возрасте абдоминальные боли, холангит и гиперспленизм усложняют эту проблему. В данной работе описан клинический случай пересадки печени от живого донора больному с врожденным фиброзом печени. Нашим выбором в лечении стала пересадка печени от живого донора. Несмотря на всю сложность указанной процедуры, это – единственный жизнесохраняющий метод для пациента с врожденным фиброзом печени.
V. A. Goryaynov, M. M. Kaabak, N. N. Babenko, M. M. Morozova, A. G. Aganesov, E. N. Platova, O. V. Dymova, V. V. Panin
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 7-11; https://doi.org/10.23873/2074-0506-2017-9-1-7-11

Abstract:
Цель: оценить влияние Экулизумаба на функцию пересаженной почки в непосредственном и раннем послеоперационном периодах. Материал и методы: 33 пациентам при пересадке почек вводили Экулизумаб в сочетании с Алемтузумабом (группа 1). Для сравнительного анализа были отобраны 38 больных (группа 2), которым индукционную иммунодепрессию осуществляли с помощью Алемтузумаба и плазмафереза. Для анализа были использованы следующие параметры: диурез в первые 24 часа после операции, срок снижения креатинина крови до 3 мг% (сут), суточная протеинурия через 30 дней после операции, скорость клубочковой фильтрации через 30 дней после операции, морфология биоптатов аллопочек через месяц после операции. Результаты. В группе 1 суточная протеинурия была значительно ниже, а скорость клубочковой фильтрации в 1,9 раза выше, чем в группе 2. Срок субнормализации креатинина крови в группе 1 был значительно ниже. Во всех случаях разница была статистически значимой (р = 0,002–0,003). Заключение. Функция пересаженной почки в группе 1 была значительно лучше, чем в группе 2. Следовательно, комбинация Экулизумаба и Алемтузумаба более благоприятно воздействует на функцию и морфологию трансплантированной почки в непосредственном и раннем послеоперационном периодах, чем сочетание Алемтузумаба и плазмафереза.
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 71-79; https://doi.org/10.23873/2074-0506-2017-9-1-71-79

Abstract:
Статья (первая из пяти) посвящена анализу 1-й и 2-й глав труда В.П. Демихова – монографии «Пересадка жизненно-важных органов в эксперименте» (М.: Медгиз, 1960), посвященных краткому литературному обзору и методическим предпосылкам проблемы. В обзоре автор привел сведения из доступной ему литературы по теме своего исследования, акцентировав внимание не столько на технике гомопластических пересадок тканей и органов, что было для него пройденным этапом, сколько на обосновании способов биологической регуляции трансплантационного иммунитета при пересадках внутри вида. Анализ использованных им методических подходов показал, что В.П. Демихов не только хорошо усвоил все разработанные до него способы пересадки органов с учетом современных ему иммунологических взглядов, но и предложил свои научно-практические решения целого ряда вопросов сосудистого шва, биологического преодоления несовместимости тканей, кардиоанестезиологии и кардиореаниматологии.
, D. Dzhiner, E. N. Ostroumov, Ya. G. Moysyuk
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 23-34; https://doi.org/10.23873/2074-0506-2017-9-1-23-34

Abstract:
Гепатопульмональный синдром – тяжелое осложнение заболевания печени, характеризующееся триадой симптомов: болезнь печени, легочная вазодилатация и артериальная гипоксемия (РаО2 менее 70 мм рт.ст. в покое). Прекапиллярная вазодилатация, ангиогенез в легких и гипердинамический тип кровообращения приводят к артериовенозному шунтированию в легких и ограничению диффузии газов. При выявлении макроскопических артериовенозных шунтов возможна эмболизация ветвей легочной артерии, однако единственным радикальным методом лечения гепатопульмонального синдрома на данный момент является трансплантация печени. Пятилетняя выживаемость пациентов, страдающих гепатопульмональным синдромом после трансплантации, составляет около 70%. Уровень периоперационной летальности сохраняется высоким (8,5–29%), особенно у пациентов с PaO2 менее 50 мм рт.ст. В послеоперационном периоде зачастую требуется пролонгирование искусственной вентиляции легких, возможно применение неинвазивной вентиляции, а в тяжелых случаях показана экстракорпоральная мембранная оксигенация. В данной статье приводятся обзор исследований, посвященных этой проблеме, и описание клинического случая успешной трансплантации печени пациенту, страдающему циррозом печени и гепатопульмональным синдромом с тяжелой гипоксемией (PaO2 менее 50 мм рт.ст.).
A. M. Dzyadz'ko, A. E. Shcherba, O. O. Rummo, M. L. Katin, A. F. Minov, S. V. Korotkov, O. A. Chugunova, E. O. Santotskiy, D. Yu. Efimov, M. Yu. Gurova
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 52-70; https://doi.org/10.23873/2074-0506-2017-9-1-52-70

Abstract:
Несмотря на то, что ключевая роль печени в формировании иммунных реакций организма на повреждение не вызывает сомнений, механизмы ослабления иммунного ответа на инфекционное и неинфекционное повреждения у пациентов с печеночной недостаточностью остаются неясными. Представлена оригинальная гипотеза формирования путей ограничения амплитуды реакций системного воспалительного ответа у пациентов с терминальными стадиями заболеваний печени. Основой гипотезы является представление о том, что вследствие снижения интенсивности естественной стимуляции мембранных рецепторов mСD14 лигандами инфекционной природы нарушается основной механизм индукции системных иммунных реакций печеночными макрофагами (клетками Купфера), что, по мнению авторов, приводит к ограничениям интенсивности и амплитуды защитных иммунных реакций. Таким образом, объясняется ряд клинических феноменов, наблюдающихся у пациентов с печеночной недостаточностью/дисфункцией, заключающихся в сниженной реактивности организма в целом к повреждению инфекционными и неинфекционными агентами. Авторы считают возможным использование данной гипотезы для поиска новых направлений по предупреждению гиперреактивности иммунной системы при сепсисе, а также для коррекции лечебных стратегий ведения пациентов с высоким риском инфекционных осложнений после операции по трансплантации печени.
M. Sh. Khubutiya, Vladimir Syutkin, S. V. Zhuravel', M. S. Novruzbekov, A. B. Fedin, A. A. Salienko
Transplantologiya. The Russian Journal of Transplantation, Volume 9; https://doi.org/10.23873/2074-0506-2017-9-1-13-22

Abstract:
В статье приведен опыт лечения гепатита С лекарственными средствами с прямым противовирусным действием у больных после трансплантации печени. Терминальная стадия заболевания печени вследствие хронического гепатита C является основным показанием для ортотопической трансплантации печени. В 2013 г. в клиническую практику внедрен первый в своем классе препарат с прямым противовирусным действием на HCV – ингибитор полимеразы HCV софосбувир, который возможно применять в безинтерфероновом режиме. Материал и методы. В исследование включены 33 реципиента печени с возвратным гепатитом С. Были проведены 35 курсов противовирусной терапии, одним из компонентов которой являлся софосбувир. Результаты. На момент проведения анализа 21 пациент завершил противовирусную терапию. У всех пациентов наблюдался первоначальный ответ на противовирусную терапию, была получена авиремия HCV. У 3 больных, у которых была возможна оценка стойкого вирусологического ответа, отмечено возобновление репликации HCV в первые недели после завершения противовирусной терапии. Заключение. Появление новых лекарственных препаратов прямого действия позволяет проводить эффективную противовирусную терапию всем реципиентам печени, инфицированным HCV.
M. S. Novruzbekov,
Transplantologiya. The Russian Journal of Transplantation, Volume 9, pp 35-50; https://doi.org/10.23873/2074-0506-2017-9-1-35-50

Abstract:
Сосудистые осложнения являются одной из наиболее актуальных проблем в трансплантации печени. Они также оказываются следующей по частоте причиной утраты органа после первично нефункционирующего трансплантата, при этом ведущая роль в структуре посттрансплантационных сосудистых проблем отводится нарушениям артериального кровотока. Сосудистые осложнения достоверно снижают выживаемость и трансплантата, и больных, увеличивают количество ретрансплантаций. В данной работе отражены вопросы эпидемиологии, этиологии, диагностики и лечения указанных осложнений после трансплантации печени.
A. A. Dmitrova, , , V. G. Savchenko
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-210-225

Abstract:
Cytomegalovirus infection is one of the critical and life-threatening infectious complications in patients after allogeneic hematopoietic stem cell transplantation. The most significant risk factors for the development of cytomegalovirus infection are cytomegalovirus serostatus of the donor and recipient and delayed reconstitution of cytomegalovirus-specific CD4+ and CD8+ T lymphocytes after allogeneic hematopoietic stem cells transplantation.The infection may be asymptomatic or may lead to serious complications such as cytomegalovirus disease, which happens in 10-40% of cases. Cytomegalovirus infection has different impact on patients after hematopoietic stem cell transplantation. For instance, acute and chronic graft versus host disease may also be the risk factors for the development of cytomegalovirus infection. There is also information about the influence of cytomegalovirus infection on a graft failure. We also know that cytomegalovirus replication is associated with lower relapse risk in patients with acute myeloid leukemia and chronic myeloid leukemia.Antiviral prophylaxis and preemptive therapy are good strategies to reduce the risk of the cytomegalovirus infection. Despite this, cytomegalovirus infection is still associated with decreased overall survival and increased non-relapse mortality in recipients of allogeneic stem cells.The aim of this review is to systematize modern concepts used in the management and treatment of cytomegalovirus infections in patients after hematopoietic stem cell transplantation.
A. M. Talyzin, S. V. Zhuravel, M. Sh. Khubutiya, E. A. Tarabrin, N. K. Kuznetsova
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-132-141

Abstract:
Background. One of the most frequent and severe complications in the early postoperative period in lung transplantation is primary graft dysfunction resulting from ischemia-reperfusion injury. There is evidence of the effectiveness of using inhaled nitric oxide in order to prevent such injury.Objective. To assess the effectiveness of nitric oxide in the intra- and early postoperative period in bilateral lung transplantation.Material and methods. We examined 43 patients who underwent bilateral lung transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2012-2021. The patients were divided into two groups. The study group consisted of 23 patients, whose complex of treatment included the use of inhaled nitric oxide. Patients in the comparison group (n=20) received a standard therapy. The end points of the study were: the mechanical ventilation duration, the frequency of using extracorporeal membrane oxygenation and its duration, mortality, dynamics of oxygenation index, blood lactate level, pH, base deficiency.Results. The use of inhaled nitric oxide therapy in patients in the intra- and early postoperative period during lung transplantation improved the ventilation-perfusion ratio, as evidenced by an increase in the oxygenation index by 1.1 times (p=0.128) and 1.3 times (p=0.026) at 48 and 72 hours after surgery, respectively. Meanwhile, the frequency of using extracorporeal membrane oxygenation during surgery was found to decrease by 1.2 times (p=0.033), and that after surgery decreased by 1.4 times (p=0.474); the mechanical ventilation duration decreased by 1.4 times (p=0.042); the duration of extracorporeal membrane oxygenation decreased by 1.6 times (p=0.028); mortality reduced by 8%.Conclusion. The use of inhaled nitric oxide therapy for lung transplantation had a positive effect on the intra- and early postoperative period, as indicated by an improvement in blood gas parameters, a reduction in the frequency and duration of veno-arterial extracorporeal membrane oxygenation, and the duration of mechanical ventilation.
A. V. Kildyushevsky, , T. A. Mitina, , Yu. Yu. Chuksina
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-195-209

Abstract:
One of the greatest medical advances of the last century has been the introduction of organ transplantation. However, despite the considerable potential of transplantation as often the only therapy for severe diseases, the toxicity of immunosuppressive drugs supporting the transplant remains a serious problem for its further development. Modification of immune response in order to form tolerance to the transplanted organ can play an important role on the way to minimize immunosuppression. Successful cases of withdrawal of immunosuppressive drugs for medical reasons in kidney and liver transplantation recorded in the literature, as well as the results obtained in the process of modeling such a situation in the experiment, prove that achieving tolerance in organ transplantation is fundamentally possible.The aim of this review is to investigate the ways of immunologic suppression and fundamental mechanisms of immunologic tolerance in the field of transplantation and to review the latest clinical achievements in this respect.The review describes various approaches to the induction of central tolerance in solid organ transplantation implemented in the framework of the original clinical protocols. Special attention is given to a new direction in transplantation medicine – cell technologies providing tolerogenic effect by means of peripheral mechanisms activation, in particular due to activation of suppressor function of regulatory T cells.We draw the attention to the advantages and disadvantages of these two trends. Which of them is preferable? In which direction will scientific thought be developed for realization of the long-term goal of transplantologists: to avoid allograft rejection without affecting the physiological homeostasis of the body? Possible answers to these questions are discussed in this review.
D. L. Tsoy, , O. G. Orlov, E. N. Bessonova, I. G. Leshchenko, L. V. Kardopoltsev, A. N. Ageev, S. I. Solodushkin
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-159-173

Abstract:
Rationale. Portal blood flow is a key component in the viability of the liver transplant.Portocaval shunts formed on the background of the liver cirrhosis before transplantation can cause portal vein steal syndrome, with subsequent development of ischemic necrosis of the graft.To date, the tactics of treating patients with portal vein steal syndrome during liver transplantation has not been sufficiently developed.This paper presents a literature review and our own experience on this important, but little-studied issue.Purpose. The purpose of this research is to study the role of portocaval shunts in the development of complications after liver transplantation, based on a retrospective analysis of clinical cases.Conclusions. In liver transplantation, portocaval shunts can cause the development of portal vein steal syndrome with subsequent development of liver failure. For the diagnosis of portal vein steal syndrome, it is important to use the data obtained at all stages of liver transplantation. Surgical correction of portal vein steal syndrome can be performed during liver transplantation and in the early postoperative period.
S. E. Voskanyan, A. I. Artemyev, , K. K. Gubarev, D. S. Svetlakova, M. V. Popov, V. S. Rudakov, A. N. Bashkov, E. V. Naydenov, M. Muktarzhan
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-142-158

Abstract:
Rationale. The refinement of liver transplantation technique, the development and implementation of new surgical technologies into clinical practice, including those for inferior vena cava reconstruction, are important for the improvement of surgery outcomes.The study purposes were to present our own modification of cavocavostomy and options for its technical implementation in deceased donor liver transplantation, as well as to study the clinical effects and the impact of new surgical technique on the outcomes.Material and methods. A retrospective, single-centre study included the data from 109 consecutive deceased donor liver transplantations performed between 2012 and 2021. In 106 procedures, inferior vena cava reconstruction was performed either according to the classic technique (group 1, n=23, 22%), or using our own modification of cavocavostomy (group 2, n=83, 78%). To assess the clinical efficacy and safety of the new surgical technique, we compared the characteristics of donors and recipients, intraoperative parameters, features of early postoperative course, incidence of surgical complications, initial function, immediate and long-term graft survival. Three piggyback procedures were not included in the comparative analysis.Results. Two groups were generally comparable in terms of the characteristics of donors and recipients, however, the classic inferior vena cava was significantly more often used during transplants for unresectable parasitic liver lesions (17% vs. 1%, p=0.008) and retransplantations (30% vs. 5%, p=0.002). There were no statistically significant differences in the main intraoperative parameters between groups 1 and 2. The duration of transplantations was 8.0 h (interquartile range: 6.5–8.5 h) and 7.0 h (interquartile range: 6.0–8.0 h), p=0.112; anhepatic phase lasted 70 min (interquartile range: 60–75 min) and 70 min (interquartile range: 59–90 min), p=0.386; warm ischemia time was 45 min (interquartile range: 38–52 min) and 45 min (interquartile range: 38–50 min), p=0.690; inferior vena cava was clamped for 47 min (interquartile range: 40–55 min) and 50 min (interquartile range: 40–55 min), p=0.532. The volumes of intraoperatively transfused blood components were, respectively: packed red cells 630 ml (interquartile range: 0–1280 ml) and 600 ml (interquartile range: 0–910 ml), p=0.262; blood reinfusion 770 ml (interquartile range: 360–1200 ml) and 700 ml (interquartile range: 0–1200 ml), p=0.370; fresh frozen plasma 2670 ml (interquartile range: 2200 and 3200 ml) and 2240 ml (interquartile range: 1880–2900 ml), p=0.087.When using classic caval reconstruction technique, the proportion of grafts with early dysfunction was higher: 44% vs. 17% (p=0.011), due to the higher rate of retransplantations in this group. The incidence of acute kidney injury (by RIFLE > I) was 35% and 19% (p=0.158), the need for renal replacement therapy was 22% and 15% (p=0.520) in group 1 and group 2, respectively. The total incidence of surgical complications in the early postoperative period was 30% and 16%, p=0.110.Conclusions. The proposed technique of cavocavostomy can be considered as a priority method for caval reconstruction during deceased donor liver transplantation, with the exception of specific indications for the use of the classic technique (retransplantation, involvement of the inferior vena cava wall in a parasitic process or presentation of a tumor node to it, as well as in cases of widespread adhesive process in the abdominal cavity, hypertrophy of the 1 segment of the native liver, the presence and location of TIPS, thinning of the wall of the retrohepatic inferior vena cava, the risk of graft compression with its large size).The choice of the cavocavostomy variant should be carried out taking into account the size ratio of the graft to the recipient's right subdiaphragmatic space, and the topography features of the recipient's hepatic veins.
B. Z. Khubutiya, M. Sh. Khubutiya, ,
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-174-183

Abstract:
Introduction. Among the growing number of patients with chronic renal failure who need dialysis therapy or kidney transplantation, a significant proportion are people over 60 years old, making from 30 to 45% of all patients who need dialysis, according to various sources. The elderly age of the recipient contributes to the risk of developing graft dysfunction due to the presence of concomitant diseases that worsen the immediate and long-term results of transplantation. And the probability of receiving a kidney graft in elderly patients is significantly lower than in young recipients. One of the ways to solve this problem is to use kidneys from suboptimal donors.Material and methods. The analysis of clinical examinations, laboratory and instrumental test results obtained in 124 patients who underwent cadaveric kidney allotransplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine, including that from suboptimal donors, was carried out. Of these, 69 (55.6%) recipients aged 60 years and older were included in the main group (group 1), and 55 recipients younger than 60 years (44.4%) in the comparison group (group 2).Results. Kidney transplantation to elderly patients (aged 60 years and older), including from a suboptimal donor, provides a sufficiently high efficiency with a 1-year recipient survival rate of 98.6% and a functioning graft for 1 year in 75.4% of cases, which does not differ from the survival rate of younger recipients (98.2%), but is inferior by the case rate of keeping the graft functioning (91.9%). Meanwhile, the parameters characterizing the functional state of the transplanted organs that maintained their function for 1 year did not differ statistically significantly between elderly and younger recipients.Conclusions. The results of the study showed that kidney transplantation from suboptimal donors to patients of the older age group provides acceptable results with low mortality of recipients and a 1-year functioning of the graft in 75% of cases. This makes it possible to increase the availability of kidney transplantation for patients of the older age group and achieve better survival results, provided adequate selection of recipients and an objective assessment of the quality of transplanted organs.
, A. Werner
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-226-236

Abstract:
It is generally accepted that the concept of mechanical circulatory support originates from the USA in the 1960s and was implemented in the clinic by American surgeons S. Crawford, M. DeBakey, D. Cooley, D. Liotta and others by creating portable implantable pneumatic devices included in the cardiovascular system parallel to the biological heart to maintain its activity in heart failure. However, we found that twenty years earlier, in 1947, a similar concept was first put forward by the Soviet biologist and physiologist V.P. Demikhov, who had implemented it in an experiment by creating implantable electromechanical devices and transplanting a second, additional heart into the animal chest. At the same time, V.P. Demikhov suggested using his models both for maintaining the function of a weakened biological heart and for its recovery. Since an idea similar to that published in an English-language edition had never been formulated by anyone before V.P. Demikhov, his priority is global.
A. M. Fayn, A. Yu. Vaza, S. F. Gnetetskiy, K. I. Skuratovskaya, V. B. Bondarev, Yu. A. Bogolyubskiy, R. S. Titov, A. Yu. Sergeev
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-2-184-194

Abstract:
In the previous article, we talked about the use of platelet-rich plasma. One of the promising ways to stimulate the processes of repair and regeneration in the tissues of the damaged organ in different types of pathology is the use of platelet-rich plasma lysate. This part of the literature review covers the mechanism of action of platelet-rich plasma lysate, indications and contraindications for its use, describes the results of treatment when platelet-rich plasma lysate is used to stimulate osteogenesis. The preparation technology provides for the removal of all cellular components from the plasma, so it becomes possible to store the obtained graft for a long time. The procedure for the preparation of platelet lysate allows the simultaneous isolation of all growth factors from the cells, since the platelet lysis occurs. Lysate of platelet concentrates can be considered as a preparation that contains a complete set of stimulating growth factors. Under the influence of the lysate, the proliferation of latent osteoblasts is resumed, the signaling pathways of angiogenesis are activated, the secretion of the factors accelerating angiogenesis is stimulated, the differentiation of osteoblasts and the formation of bone tissue are triggered. The aim of this article is to summarize the results of treatment using autologous platelet lysate to improve bone regenerative potential in orthopaedics. In a final article, we shall look at the ways to use autologous red bone marrow.
A. V. Shabunin, , O. N. Levina, D. A. Makeev, O. S. Zhuravel, E. Yu. Astapovich
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-10-19

Abstract:
Aim. The study aim was to assess the negative dynamics of the hepatic artery resistive index as a reliable predictor of early thrombosis in liver transplant recipients from a postmortem donor, to determine risk factors and to identify a group of patients with an increased risk of this complication.Material and methods. From July 2018 to August 2021, 92 orthotopic liver transplants from a deceased donor were performed at the Surgical Clinic of the City Clinical Hospital n.a. S.P. Botkin. All liver grafts were taken from donors with brain death. Control Doppler ultrasound examination of hepatic blood flow in all patients was performed on days 1, 3, 5, 7, if necessary, daily. The hepatic arteries resistive index was considered normal at values from 0.55-0.79, high at 0.8-0.89, extremely high above 0.9. Depending on the resistive index value on the 1st postoperative day and its further dynamics, we divided the patients into 3 groups. In each group, we analyzed the incidence of hepatic artery thrombosis and assessed the impact of various risk factors on the resistive index elevation on the 1st day after surgery and on its growth during dynamic observation in the early postoperative period.Results. Of 92 liver transplants, in three cases, we recorded hepatic artery thrombosis (3.2%), which was not associated with technical difficulties of arterial reconstruction. No mortality was recorded in all three cases. In patients with a normal or high resistive index on the 1st day, without its increase during dynamic observation, the incidence of arterial thrombosis was 0%. In patients with a normal or high resistive index on the 1st day, and its increase during dynamic observation, as well as in patients with an extremely high resistive index on the 1st day, the incidence of arterial thrombosis was 18.1% and 11.1%, respectively. The risk factors of thrombosis were the age of the recipient over 50 years old in an extremely high resistive index on the 1st postoperative day (p=0.024), and the age of the donor over 50 years old in the growth of the resistive index during follow-up (p=0.04).Conclusion. The lack of positive dynamics in the hepatic artery resistive index reduction may be an additional predictor of arterial thrombosis after liver transplantation. This fact makes it possible to identify a high-risk group of arterial thrombosis, to take additional preventive measures in these patients and to improve the immediate results of treatment in this group of patients.
S. E. Voskanyan, , V. S. Rudakov, D. S. Svetlakova, M. V. Popov, A. N. Pashkov, M. Muktarzhan, A. S. Lukianchikova
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-20-33

Abstract:
Background. The novel coronavirus infection (COVID-19) pandemic has had a significant impact on all areas of health care system, including organ donation and transplantation. Despite this, there were no large Russian studies of COVID-19 course and outcomes in liver transplant recipients.The study purpose was to determine prevalence, clinical course, severity, outcomes of COVID-19, as well as to assess the safety and efficiency of vaccination for disease prevention in liver transplant recipients.Material and methods. 260 recipients (71% of all patients at risk of COVID-19 disease) who underwent liver transplantation at State Research Center – Burnasyan Federal Medical Biophysical Center from May 2010 to September 2021 were included in a single-center cross-sectional study. Data collection was performed during a telephone or face-to-face interview from September 6, 2021 to September 20, 2021. If patients were hospitalized with COVID-19, we also analyzed the results of laboratory and instrumental tests, other medical documentation.Results. By mid-September 2021, the incidence of COVID-19 after liver transplantation was 31% (75 cases in 260 recipients). Asymptomatic course was observed in 11 (15%) patients. Hospitalization was required in 18 (28%) cases. In one case, COVID-19 infection was the cause of death. Mortality and death rate in the study cohort were 1% (1/75) and 0.4% (1/260), respectively. Risk factors that statistically significantly increased the likelihood of infection with SARS-CoV-2 were contact with the patient (OR: 12.9; 95% CI: 6.6 - 25.0) and non-compliance with non-specific prophylaxis measures (OR: 2.0; 95 % CI: 1.1 - 3.7). The recipient's age of 60 years or more significantly increased the risk of severe infection (OR 5.0; 95% CI: 1.3 - 18.7). None of the immunosuppressive therapy regimens significantly increased the risk of severe disease. Tacrolimus monotherapy or in combination with other drugs reduced the risk of severe COVID-19 (OR: 0.2; 95% CI: 0.1 - 0.95). Vaccination against SARS-CoV-2, which was performed in 42 (17%) recipients, did not cause serious adverse events and significantly reduced the risk of COVID-19 disease (OR: 7.2; 95% CI: 1.7 - 31.3). The detection rate of specific IgG antibodies to SARS-CoV-2 was 94% in recipients who had undergone the disease and 45% among those vaccinated (p<0.001). The achieved level of herd immunity against COVID-19 in the analyzed cohort was 48%. Conclusion. Adult liver transplant recipients are not at an excessive risk of COVID-19 disease. Compliance with preventive measures and vaccination can significantly reduce the risks of infection and severe infection. There is no objective evidence that immunosuppressive therapy increases the risk of severe COVID-19 in liver transplant recipients. In the context of the ongoing COVID-19 pandemic, tacrolimus monotherapy may be considered as a safe regimen of maintenance immunosuppression.
, Э. С. Гильметдинова, M. A. Mulendeeva
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-58-67

Abstract:
Relevance. The United States of America is currently one of the world leaders in organ donation and transplantation. In 2020, donor activity in the United States amounted to 38.0 per 1 million of the population, even exceeding the number in Spain 37.9 per 1 million of the population. In this context, the study of the American system of organ donation and transplantation in order to develop an accessible format for interaction with the population to strategically stimulate the potential of organ donation is of particular interest.Aim. To study the organ donation and transplantation system in Nebraska, United States of America, to develop an accessible format for interaction with the population to strategically stimulate the potential of organ donation in the Republic of Tatarstan.Material and methods. We presented the experience of the international internship «Organ donation and transplant management » at the University of Nebraska Medical Center (USA). We described the peculiarities of the functioning of the American transplant programs, the advantages in the matter of organizing organ and tissue donation.Results. In the USA, with a population of 327 million people, today more than 165 million (51%) people are registered as potential donors. At the end of 2018, in the United States 36,428 transplants of various organs and tissues, or 111.4 per 1 million population, were performed. At the same time, the number of deceased donors was 10,700, the number of living donors – 6,800. At the University of Nebraska Medical Center during the same period, 301 transplants (158.4 per million population) were performed from 68 deceased and 40 living donors. The analysis of the American system of organ donation and transplantation with effective interaction of the state, commercial and non-profit sectors, independent of the National Health System, made it possible to organize in 2020 the first social project in the Republic of Tatarstan on organ donation – "Donate Life Russia".Conclusion. The experience of the Republic of Tatarstan in attracting the non-profit sector to solving problems in the development of the transplant programs, following the example of the United States of America, has high potential in the Russian Federation.
T. V. Tselaya, E. V. Chentsova, N. V. Borovkova
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-68-78

Abstract:
The actual problem of treatment of patients with limbal cell stem deficiency is reviewed. We summarized practical experience in various fields of medicine, aimed at tissue reconstruction using cells of the buccal mucosa. In ophthalmology, an effective method has long been searched to treat patients with the limbal stem cell deficiency causing an intense opacification and vascularization of the cornea and followed by a significant decrease in visual acuity. Recent studies have shown that the transplantation of epithelial cells of oral mucosa can significantly improve the treatment of patients with this disease. Although the mechanisms of oral mucosa epithelial cells' action are still insufficiently studied, the existing positive experience of oral mucosa using for tissue repair has great interest to practitioners, giving potential possibilities of its use, therapeutic effectiveness and ease of obtaining. A brief review of the literature presents the description of the morphological features of the. buccal mucosa and the analysis of published data about the use of buccal epithelium in various branches of medicine and in ophthalmology, in particular.
, E. S. Maksimov, M. V. Gordeeva
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-98-114

Abstract:
On June 20, 1962, at the N.V. Sklifosovsky Research Institute for Emergency Medicine in Moscow, V.P. Demikhov, a biologist, physiologist, and experimental surgeon transplanted a second, additional heart together with the lung through the left thoracotomy access in the fourth intercostal space into the place of the removed two upper lobes of the left lung into the chest to the dog named Grishka. The second heart was implanted in such a way that arterial blood circulated in it and in the transplanted lung. The donor and recipient were selected according to the blood group match. The immediate postoperative period was uneventful. On day 4, the dog became active. On day 12, the sutures were removed from the skin wound. On day 15, antibiotics (penicillin and streptomycin) were discontinued. During the daily examination, general condition and physical activity were noted, rectal temperature, respiratory rate and contractions of one's own and transplanted heart were measured; electrocardiograms were taken from both hearts. On day 13, Grishka gnawed through the electrode, which helped taking the electrocardiograms from the transplanted heart during the first 2 weeks. As a result, in place of the electrode remaining in the chest, the animal developed a fistula with purulent discharge. For this reason, as well as for coughing and wheezing in the lungs on the left, Grishka was periodically administered antibiotics. After the operation and before the withdrawal from the experiment, the dog was injected with heparin. No other pharmaceuticals were given. The dog led an active lifestyle, ate well, and displayed interest in female dogs. The second heart ceased beating 142 days after the operation, on November 8, 1962. Resuscitation measures were unsuccessful. At autopsy, in the right atrial auricle of the transplanted heart, diffuse transmural hemorrhage and a thrombus from the endocardium were revealed, which blocked the blood flow to the heart. The lower lobe of Grishka's lung was in a state of hepatization. Signs of edema and inflammation were observed in the transplanted lung. There were no blood clots at the sites of vascular anastomoses. There were no visual signs of rejection. The results of histological studies are not known. This article for the first time introduced into scientific circulation an operation protocol, a diary of postoperative management and an autopsy protocol for an animal that had lived with a second, additional heart and a transplanted lung without immunosuppression for 142 days, which has been a unique observation in world transplantology. Despite the long-term survival of the animal, nursing the recipient dog in the postoperative period did not meet the complexity of the operation performed, which allows us to conclude that it was impossible at that time to implement the results obtained in the experiment into clinical heart transplantation in humans.
A. B. Sidorenko, Y. I. Zakharov,
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-34-44

Abstract:
Background. Reconstructive surgery for iatrogenic injuries of the bile ducts involves the formation of a biliodigestive anastomosis. The development of anastomotic stricture is the most severe complication of this operation.Aim of the study. To evaluate the immediate and long-term results of treatment and follow-up of patients with iatrogenic injuries of the bile ducts who underwent reconstructive surgery on the bile ducts with additional creation of gastroenteroanastomosis.Material and methods. The study included 26 patients operated on according to the original method in the period 2010-2018.Results. In the study group, complications in the early postoperative period developed in 3 (11.5%) patients. Endoscopic interventions using the formed gastroenteroanastomosis in the long-term period were performed in 7 patients. The results of treatment were followed in 25 (96%) patients. The median follow-up period was 90 months [81.5;110] (42-129). Conclusion. The use of the proposed original technique of reconstructive surgery has demonstrated its effectiveness and safety, with the possibility of dynamic endoscopic control and, if necessary, the treatment of postoperative complications such as cholelithiasis and biliodigestive anastomosis strictures.
, V. A. Matkevich, , , N. E. Stolbova, I. A. Tyurin, S. S. Petrikov
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-45-57

Abstract:
Background. The problem of pathologically increased permeability of the intestinal wall is actualized with the accumulation of information about the correlation of this phenomenon with complications of an inflammatory nature and multiple organ failure in critical conditions, including acute poisoning.Aim of study. To assess the effect of the program of enteral correction of homeostasis disorders on intestinal permeability in acute poisoning.Material and methods. 40 patients (67.5% of women and 32.5% of men) admitted at the Intensive Care Unit as part of the Scientific Department of Acute Poisonings and Somatopsychiatric Disorders of the N.V. Sklifosovsky Research Institute for Emergency Medicine were examined, 20 of them (group I) with severe acute oral poisoning with corrosive substances: acetic acid 35.6% and alkali (sodium hydroxide) 64.4 %, as well as 20 patients (group II) with severe acute oral poisoning with psychopharmacological agents. Both groups were divided into two subgroups: I-a and II-a – (10 patients in each), in whom an enteral correction program was used in addition to the standard treatment, and I-b and II-b comparison groups (10 patients in each each) who received only standard therapy.Results. It was found that in all observed patients with severe acute oral poisoning with corrosive substances, as well as psychopharmacological agents, the ratio of lactulose / mannitol concentration in urine as an indicator of intestinal permeability was increased before the start of treatment in relation to its reference value of 3.8-4.9 times.After 5 days, in patients who received the enteral correction program, the lactulose/mannitol ratio decreased by 15.4% in cases of poisoning with corrosive substances, and by 19.8% in cases of poisoning with psychopharmacological agents. At the same time, in patients with poisoning with corrosive substances, who received standard treatment, this parameter decreased by only 1%. Attention was drawn to the fact that in patients with psychopharmacological agents poisoning who received standard therapy, the intestinal permeability index after 5 days did not decrease, but continued to increase and exceeded the initial value by 11.4%.Conclusion. With the help of the enteral correction program, it is possible to reduce the permeability of the intestinal wall in acute poisoning with corrosive substances and psychopharmacological agents.
A. M. Fayn, A. Yu. Vaza, S. F. Gnetetskiy, K. I. Skuratovskaya, V. B. Bondarev, Yu. A. Bogolyubskiy, R. S. Titov, A. Yu. Sergeev
Transplantologiya. The Russian Journal of Transplantation, Volume 14; https://doi.org/10.23873/2074-0506-2022-14-1-79-97

Abstract:
The main method of surgical treatment of patients with post-traumatic disorders of bone regeneration is the use of bone grafting. Until now, the optimal plastic material has been a bone autograft, which use involves additional trauma to the patient. Alternative materials that are used for grafting have only an osteoconductive effect, of varying effectiveness. To optimize the properties of plastic materials, giving them an osteostimulating effect, they can be used in combination with biologically active substances. A source of biologically active substances can be platelet-rich plasma, platelet lysate and red bone marrow. This literature review includes a description of three main methods to stimulate osteogenesis. The first part examines the mechanism of action of platelet-rich plasma, indications and contraindications for its use, describes the results of treatment when platelet-rich plasma is used to stimulate osteogenesis. Platelet-rich plasma is a product of a human native blood obtained by centrifugation. The output is a high concentration of platelets in a small volume of plasma, which contain growth factors and cytokines that have a direct effect on the regeneration process. Local platelet-rich plasma therapy is performed to stimulate osteogenesis. Autologous platelet-rich plasma with growth factors contained in α-granules of platelets is injected into an allogeneic graft or into a fracture zone. The aim of this article is to summarize the results of treatment using platelet-rich plasma to improve bone regenerative potential in orthopaedics.
, A. Werner
Transplantologiya. The Russian Journal of Transplantation, Volume 12; https://doi.org/10.23873/2074-0506-2020-12-1-61-75

Abstract:
The article has discussed V.P. Demikhov's views on a homoplastic transplantation of tissues and organs in 1963 and his achievements in experimental transplantation by that time. The authors first translated the monograph Die experimentelle Transplantation lebenswichtiger Organe (1963) from German into Russian and presented V.P. Demikhov's Preface to it. In this text, having critically analyzed the current provisions in the field of immunobiology, V.P. Demikhov came to the conclusion that a number of his achievements contradicted those provisions and did not fit into the framework of existing immunobiological laws. In 1963, confessing the primacy of function over structure, V.P. Demikhov believed that the restoration of blood circulation in transplanted organs played the main role in their survival, and the subsequent functioning of the transplanted organ for a long time meant its engraftment. In this text V.P. Demikhov for the first time substantiated the model of a “physiological organism” he had invented for reviving a human in a state of agony, for creating a bank of organs, growing it in infants and rejuvenating the elderly.Authors declare no conflict of interest.
M. Sh. Khubutiya, N. V. Shmarina, K. E. Lazareva, E. V. Migunova, A. I. Kazantsev,
Transplantologiya. The Russian Journal of Transplantation, Volume 12; https://doi.org/10.23873/2074-0506-2020-12-1-10-19

Abstract:
Introduction. Currently, the type 2 diabetes mellitus is in the nature of an epidemic of non-infectious etiology. In this regard, the incidence of diabetes mellitus complications, including diabetic nephropathy, which lead to end-stage chronic renal disease, is also increasing. The treatment of type 2 diabetic patients with end-stage chronic renal disease presents significant difficulties, which is associated with an additional risk of developing infectious complications and, as a rule, the presence of concomitant pathology of the cardiovascular system.Objective. To analyze the results of kidney transplantation in elderly patients with diabetes mellitus in the early postoperative period.Material and methods. The study is based on a retrospective analysis of the results of 77 kidney transplants ations performed to elderly recipients at N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2015 to 2019. The study group included 22 recipients over 60 years old with type 2 diabetes mellitus, as main or concomitant disease. The comparison group consisted of 55 recipients over 60 years without diabetes.Results. Survival of recipients with type 2 diabetes mellitus was significantly lower (p = 0.026). So, there were 20 surviving recipients (90.9%) in the group of patients with type 2 diabetes mellitus, and 55 (100%) surviving recipients in the group without diabetes. When comparing the kidney graft survival rates in the recipients between the two groups, no statistically significant difference (p = 0.29) was found. The overall graft survival was 77.3% (n = 17) in the group of recipients with type 2 diabetes mellitus, and 89.1% (n = 49) in the comparison group.Conclusions. It has been proven that kidney transplant recipients with type 2 diabetes mellitus have a significantly lower survival rate after transplantation than recipients without diabetes; and the kidney graft survivals were not significantly different early after transplantation. The recipients did not show differences in the recovery of the transplanted kidney function depending on the presence of type 2 diabetes mellitus.Authors declare no conflict of interest.
Transplantologiya. The Russian Journal of Transplantation, Volume 12; https://doi.org/10.23873/2074-0506-2020-12-1-20-27

Abstract:
Introduction. CD3+CD4- CD8- cells represent one of the subpopulations of T-regulatory lymphocytes. According to literature reports, an increase in the content of graft-infiltrating CD3+CD4- CD8- T cells was detected in the heart xenograft tissues of an experimental model with a long-term graft survival. The efficacy of CD3+CD4- CD8- infusion to induce skin graft tolerance was described. Some studies have shown that a decrease in CD3+CD4- CD8- content in peripheral blood of patients undergoing to hematopoietic stem cell transplantation was associated with the development of a graft-versus-host reaction.Objectives. To study changes in the values of CD3+CD4- CD8- double-negative T lymphocytes in peripheral blood in kidney transplant recipients.Material and methods. The study included 165 recipients who underwent kidney transplantation. The creatinine and urea concentrations in blood were determined before surgery, on day 7, and day 360 after transplantation. The content of CD3+CD4- CD8- lymphocytes was studied before surgery, on the 3rd, 7th, 30th, 90th, 180th and 360th days after surgery. Early graft function was assessed on day 7 after transplantation. The function was defined as a primary one at creatinine levels below 300 μmol/L. The graft dysfunction was defined as creatinine values equal to or greater than 300 μmol/L and the need for dialysis in the first week after surgery. The satisfactory graft function after a year was characterized by the blood creatinine level below 150 μmol/L, absent episodes of graft rejection, and no need for dialysis in the first year of follow-up. There were 4 groups of recipients formed. The first group included patients with the primary graft function and satisfactory late graft function. The second group included patients with the primary function and late graft dysfunction. The third group included patients with the primary dysfunction and late satisfactory function. The fourth group included patients with the primary and late graft dysfunction.Results. In the first and second groups, there were no significant differences in the blood level of CD3+CD4- CD8- during the year. After a year, a significant CD3+CD4- CD8- decrease was noted in the group with late graft dysfunction. A similar tendency was revealed in the third and fourth groups. In the fourth group (with late graft dysfunction), the level of CD3+CD4- CD8- was significantly lower only after a year of observation compared with the levels in the third group. A negative correlation was noted between the CD3+CD4- CD8- values and the creatinine and urea levels. Thus, high CD3+CD4- CD8- values in kidney transplant recipients after a year were associated with a satisfactory graft function.Conclusions. 1. A stable 1-year satisfactory kidney graft function is characterized by an increase in the blood level of CD3+CD4- CD8- T lymphocytes. 2. A kidney graft dysfunction in the late post-transplant period is characterized by a decrease in the blood level of CD3+CD4- CD8- T lymphocytes.Authors declare no conflict of interest.
, , D. I. Zybin, E. G. Agafonov
Transplantologiya. The Russian Journal of Transplantation, Volume 12; https://doi.org/10.23873/2074-0506-2020-12-1-42-48

Abstract:
Despite the widespread use of mechanical circulatory support systems, modern optimal drug therapy and various interventional methods of heart transplantation remain the "gold standard" for the treatment of end-stage heart failure patients.At the same time the required number of heart transplants is significantly increasing due to the progressively increasing number of patients needing transplants and the actual donor pool. In recent years there has been a trend towards the increase in the number of recipients and the decrease in the number of donor organs. However, the use of donor hearts with pathological changes, including left ventricular myocardial hypertrophy, remains a controversial topic. It is believed that the use of expanded criteria significantly increases the risk of graft failure in the post-transplant period and leads to deterioration of immediate and long-term results. This work aimed to analyze the data on using donor hearts with left ventricular myocardial hypertrophy for allotransplantation.Authors declare no conflict of interest.
Yu. O. Malinovskaya, K. Yu. Kokina, , O. V. Sumtsova
Transplantologiya. The Russian Journal of Transplantation, Volume 13; https://doi.org/10.23873/2074-0506-2021-13-4-356-366

Abstract:
Introduction. Liver transplantation restores patients' physical and social life, and its quality. The prevalence of low physical activity in liver recipients is unknown as well as the impact of late liver allograft dysfunction on it. Liver transplantation enhances patient's return to the usual physical and social activity and improves the quality of life. However, the prevalence of low physical activity among liver recipients and the impact of the late allograft dysfunction on it, which is a risk factor for obesity and cardiovascular diseases, require studying.The aim of the study was to identify whether the late liver allograft dysfunction influences the physical activity of recipients.Material and methods. The study included 87 liver recipients. We measured anthropometric parameters, physical performance (SPPB, LFI, 6-min walk test), mean step count per day. Late liver allograft dysfunction was determined if elevated transaminases and/or cholestatic enzymes or hepatic failure have been diagnosed later than 3 months posttransplant. Activity trackers were provided to assess physical activity.Results. Median age was 54 years [45;61], 33% were men. The median follow-up period was 36 months [16;64]. The median of the average steps count was 5.9 [4.1;8.7] thousand per day. 60.5% of recipients were sedentary and low active, 24.4% were somewhat active, 15.1% were active. In cases of liver allograft dysfunction, the mean step count was significantly lower than in patients with normal liver function: 4.1 thousand [2.6;5.3] versus 6.8 thousand [4.2;9.4], p=0.003, despite no differences in the physical activity test results.Conclusion. In case of a late liver allograft dysfunction, the physical activity can decrease; 60.5% of liver recipients, in the absence of pathological restriction of movement, have a sedentary and low active lifestyle. Activity trackers may allow identifying patients who need additional check-up or physical training.
S. V. Zhuravel, N. K. Kuznetsova, V. E. Aleksandrova,
Transplantologiya. The Russian Journal of Transplantation, Volume 13; https://doi.org/10.23873/2074-0506-2021-13-4-328-338

Abstract:
Background. A pressing issue is the choice of an anesthetic agent for liver transplantation. The mechanism of the organprotective properties of desflurane and sevoflurane is not fully understood. It is important to understand the effects of desflurane and sevoflurane on the severity of ischemia-reperfusion injury of the liver graftAim. To study the effect of desflurane and sevoflurane on the intraoperative and early postoperative period in liver transplantation.Material and methods. The study included 47 patients with liver cirrhosis of various etiologies who underwent cadaveric liver transplantation between February and December 2020. The groups compared in the study included 24 patients who received desflurane and 23 patients who received sevoflurane.Results. There were no statistically significant differences in the effect of desflurane and sevoflurane on hemodynamic parameters, on the need for vasopressor drugs. Episodes of bradycardia and cardiac arrhythmias were significantly more frequent when using sevoflurane. Patients were extubated significantly faster after surgery in the desflurane group. In the early postoperative period, desflurane and sevoflurane did not adversely affect significantly the liver graft function and the degree of its ischemia-reperfusion injury. The groups appeared comparable in rates of using the renal replacement therapy, the incidence of the graft dysfunction development in the postoperative period, and the surgery outcomes.Conclusions. The use of modern inhalation anesthetics desflurane and sevoflurane to maintain anesthesia during liver transplantation does not adversely affect the course of the intraoperative and early postoperative period.
O. N. Rzhevskaya, A. Y. Moiseeva, A. N. Esaulenko, , Kh. G. Alidzhanova
Transplantologiya. The Russian Journal of Transplantation, Volume 13; https://doi.org/10.23873/2074-0506-2021-13-4-382-397

Abstract:
One of the most relevant issues of nephrology, neurology, and cardiology is the management and treatment of patients with chronic kidney disease and stroke. Patients with chronic kidney disease have a risk of both thrombotic complications and bleeding, and they have a high risk of both ischemic and hemorrhagic stroke. Chronic kidney disease significantly worsens the outcome of stroke by limiting the treatment due to reduced drug clearance and side effects. Hemodialysis which causes drastic hemodynamic and biochemical changes leads to the "stress" of the cerebral vascular system, increasing the risk of stroke; kidney transplantation reduces the risk of stroke due to functional recovery. Chronic kidney disease and stroke have significant socio-economic consequences. Patients with end-stage chronic kidney disease, as a rule, are not included in clinical trials; and stroke treatment tactics have not been developed for them. This review examines the interaction between kidneys and brain, the pathophysiology and epidemiology of stroke in all stages of chronic kidney disease, after kidney transplantation and discusses the management and treatment of chronic kidney disease patients with stroke.The investigation of the factors responsible for the high prevalence of brain lesions in chronic kidney disease will allow developing new treatment methods.
R. O. Kantariya, , E. I. Prokopenko, A. R. Karapityan, A. A. Ammosov, A. V. Makevnina, A. A. Gaydarova
Transplantologiya. The Russian Journal of Transplantation, Volume 13; https://doi.org/10.23873/2074-0506-2021-13-4-339-355

Abstract:
Introduction. The pandemic caused by the SARS-CoV-2 coronavirus is characterized by significant morbidity and mortality. Kidney transplant recipients are at high risk of a more severe course of coronavirus infection due to ongoing immunosuppression, a high comorbidity index, and elder age.Aim. To investigate the features of the clinical course, the treatment applied and also the outcomes of the new coronavirus infection in patients after kidney transplantation.Material and methods. The retrospective study included 69 adult kidney transplant recipients continuously followed-up by our transplant nephrology service and who fell ill with COVID-19 from April 2020 till February 2021. The comparison study of the clinical pattern, laboratory and instrumental test results, treatment features and outcomes was made.Results. The most common clinical symptoms were hyperthermia (85.5%, n= 59), weakness (65.2%, n=45) and cough (52.2%, n=36), other symptoms were significantly less common. In 89.5% of cases (n=60), the virus ribonucleic acid was detected at least once by polymerase chain reaction; in 10.5% of cases (n=7), the polymerase chain reaction results were negative. According to CT, the extent of lung tissue lesion was identified as CT1 stage in 28 patients (46.7%), CT2 stage in 24 (40%); and only in 8 (13%) patients the lesion was assessed as CT3. Later on the number of patients with more than 50% lung damage increased to 16 (26.7%) and in 1 case the severity of lung tissue damage was consistent with CT4. Typical features for all patients were anemia and lymphopenia of varying severity, hypoproteinemia, increased serum creatinine and urea, C-reactive protein, ferritin, procalcitonin and D-dimer in the laboratory test results. The treatment included antiviral, antibacterial, anticoagulant therapy, corticosteroids, biological anti-cytokine drugs. In 95% of cases (n=66), the maintenance immunosuppressive therapy was changed up to complete withdrawal of the certain components. The patient survival rate with a functioning graft was 76.8% (n=53), the graft loss was observed in 4.3% of cases (n=3), and the lethal outcome was reported in 18.8% (n=13). The cause of death was a severe respiratory distress syndrome with multiple organ dysfunction complicated by sepsis and septic shock in 8 patients (61.5%). Invasive ventilation and hemodialysis were associated with 17.2 (p<0.00001) and 21.5 (p<0.0006) times higher risk of death, respectively.Conclusions. Severe lymphopenia is associated with a clinical worsening of the COVID-19 course. Predictors of fatal outcome were identified as follows: bacterial sepsis, invasive ventilation, the need for renal replacement therapy (p<0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.
B. B. Gegenava, S. A. Kurnosov, , , A. A. Ammosov
Transplantologiya. The Russian Journal of Transplantation, Volume 13; https://doi.org/10.23873/2074-0506-2021-13-4-367-381

Abstract:
Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.
Transplantologiya. The Russian Journal of Transplantation, Volume 13; https://doi.org/10.23873/2074-0506-2021-13-4-398-416

Abstract:
The article has reviewed the advances of Soviet and world Transplantology in the field of heart and other organ transplantation achieved by the end of the 1960s. It is shown that there were several groups of doctors and scientists who worked in the USSR dealing with the problem of experimental organ transplantation and trying to bring this experience into clinic. The group of surgeons and urologists (B.V. Petrovsky, Y.M. Lopukhin, etc.) from the Research Institute of Clinical and Experimental Surgery and the 2nd MOLGMI named after N.I. Pirogov, which had the greatest administrative resources and technical capabilities, was successfully implementing kidney transplantation into clinic. The staff of the Faculty Surgery Department (V.S. Savelyev and others) of the 2nd MOLGMI named after N.I. Pirogov developed experimental approaches to heart and liver transplantation. Surgeons from the Tuberculosis Research Institute (N.I. Gerasimenko and others) were dealing with in lung auto- and homotransplats in experiment. All those studies were conducted in close contact with the Department of Operative Surgery and Topographic Anatomy of the 2nd MOLGMI named after N.I. Pirogov (G.E. Ostroverkhov) and the Research Laboratory for Organ Transplantation established at that Department (Y.M. Lopukhin). The leading position in heart transplantation in the country belonged to the Vishnevsky Institute of Surgery (A.A. Vishnevsky, etc.). Surgeons of the MMA named after S.M. Kirov (I.S. Kolesnikov, etc.) rendered a great assistance to the Institute. Apart from these institutions, the Organ Transplantation Laboratory (headed by V.P. Demikhov) worked at N.V. Sklifosovsky Research Institute for Emergency Medicine; it had gained a huge experimental experience, but had very modest opportunities to purchase equipment and pharmaceuticals, to conduct laboratory and morphological studies, having practically no prospects for introducing the results of its research into clinic. Meanwhile, the world clinical Transplantation continued to develop successfully, which was reflected in the materials of the 2nd International Symposium on Heart Transplantation held in 1969 in Montreal (Canada).
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