Transplantologiya. The Russian Journal of Transplantation

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ISSN / EISSN : 2074-0506 / 2542-0909
Published by: IPO Association of Transplantologists (10.23873)
Total articles ≅ 117
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S. V. Zhuravel, V. E. Aleksandrova, N. K. Kuznetsova, M. S. Novruzbekov, L. V. Donova
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-151-157

Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.
V. E. Syutkin, A. A. Salienko, O. D. Olisov, S. V. Zhuravel, M. S. Novruzbekov
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-121-129

Introduction. The lifelong use of calcineurin inhibitors in liver transplant recipients leads to an increased incidence of chronic kidney disease.Objective. To compare the changes in glomerular filtration rate over five years in liver transplant recipients between those on everolimus with a reduced exposure to calcineurin inhibitors and those on standard doses of calcineurin inhibitors.Material and methods. Fourteen liver transplant recipient switched to everolimus with a minimization of calcineurin inhibitors exposure in the first months after liver transplantation from February 2009 to February 2015 who had received that therapy continuously for at least 60 months were included in the case-control study. Twenty eight liver transplant recipients (matched by sex, etiology of the underlying disease, calcineurin inhibitors) who were followed-up for at least 60 months after liver transplantation, who had received no dose of everolimus, in whom the glomerular filtration rate could be calculated at all points of analysis were selected as a comparison group (1:2). Glomerular filtration rate was calculated immediately before liver transplantation; 12, 24, 36, 48, and 60 months after liver transplantation. The glomerular filtration rate after liver transplantation was also calculated for liver transplant recipients from the main group immediately before the conversion to everolimus.Results. Before liver transplantation, the median of glomerular filtration rate in the main group of liver transplant recipients was lower (81.2 ml/min) than in the comparison group (97.5 ml/min, p=0.01). After liver transplantation, the renal function worsened in both groups of patients. In a pairwise comparison, the medians of glomerular filtration rate were statistically significantly lower after 12 months, 24 months, 36 months, 48 months after liver transplantation, than before liver transplantation. The median of glomerular filtration rate at the time of immunosuppression conversion was 44.3 ml/min. After the conversion of immunosuppression, the median of glomerular filtration rate gradually increased, and after 36 months the differences in glomerular filtration rate reached statistical significance compared with the level before conversion (69.4 ml/min;p=0.048). These differences still increased after 60 months after conversion (72.3 ml/min; p=0.041).Conclusion. Long-term administration of everolimus with minimization of calcineurin inhibitors exposure with the early conversion to this immunosuppression regime provides a steady improvement in renal function in liver transplant recipients with a low glomerular filtration rate in the preoperative and early post-transplant period.
, N. V. Shmarina, E. V. Migunova, A. Rustambek Uulu, N. E. Kudryashova, , D. V. Lonshakov, A. G. Balkarov
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-112-120

Introduction. The urinary tract incompetence ("extravasation of urine") of the renal allograft is the most common urological complication in the early postoperative period.The purpose was to evaluate the efficacy of the dynamic angionephroscintigraphy technique in diagnosing the extravasation of urine after kidney transplantation.Material and methods. The results of dynamic angionephroscintigraphy were analyzed for the purpose of verifying/ diagnosing the extravasation of urine in 63 patients who underwent kidney transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019. Dynamic angionephroscintigraphy of the renal allograft was performed with the glomerulotropic 99mTc-pentatech radiopharmaceutical on a two-detector single-photon emission tomography "Infinia II" and a combined CT SPECT / CT system "Discovery NM/CT670".Results. The sensitivity of dynamic angionephroscintigraphy in detecting the extravasation of urine was 100%, the specificity was 88%, and the accuracy of the method was 89%.Conclusion. Dynamic angionephroscintigraphy is a highly sensitive and specific method for diagnosing the extravasation of urine after kidney transplantation.
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-141-150

Introduction. The presence of multiple subsets of B-cells with specific regulatory functions capable of modulating inflammatory responses havebeen detected. Most of the studies of Bregs function were carried out in the context of autoimmune and infectious diseases, whereas the objective of this research was to study the characteristics of the main, activated and tolerogenic subpopulations of B lymphocytes in patients who underwent kidney transplantation. Objective. To study the indices of B-lymphocyte subpopulations and determine their role in the development of immunological tolerance after kidney transplantation.Material and methods. We have examined 197 recipients who underwent kidney transplantation. We determined B lymphocyte subpopulation levels (CD19+IgD+CD27+ and CD19+IgD-CD27+) before transplantation, on the 1st, 3rd, 7th and 30th days after the transplantation. Allograft function was assessed on day 7 with the division of patients into two groups: with primary graft function and graft dysfunction.Results and discussion. Significant differences were revealed between the groups of recipients over three months in the following cell subpopulation levels CD19+IgD+CD27+ and CD19+IgD-CD27+. During the first 7 days, lower levels of these subpopulations were associated with satisfactory allograft function. However, by the 90th day after surgery, an increase in CD19+IgD+CD27+ B lymphocytes was noted in the group of patients with graft dysfunction.Conclusions. Low levels of not-switched (CD19+IgD+CD27+) and switched (CD19+IgD-CD27+) memory В lymphocytes in the peripheral blood of kidney transplant recipients are associated with a favorable postoperative course. We have found that on the 3rd post-transplant day, the relative level of non-switched memory B lymphocytes (CD19+IgD+CD27+) exceeding or equal to 11.47%, and the level of switched memory B lymphocytes (CD19+IgD-CD27+) exceeding or equal to 20.74% might predict the development of early renal graft dysfunction with a sensitivity and specificity of 88.40% and 84.30% for the former parameter and of 88.70% and 82.40% for the latter one, respectively.
M. Sh. Khubutiya, , N. V. Shmarina, , V. E. Vinogradov, A. I. Kazantsev, A. G. Balkarov
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-130-140

Introduction. Expanding donation criteria is one way of solving the problem of the increasing need of transplantation. The article is dedicated to comparison of the outcomes of first and second repeated kidney transplantation using grafts from standard criteria and expanded criteria donors.Aim. To evaluate 1-year and 5-year recipient and kidney graft survival rates after first and second kidney transplantation according to the donor type – standard criteria or expanded criteria donors.Material and methods. From 2007 till 2019 we performed 1459 kidney transplantations. The comparison study of outcomes of first (n=196) and second (n=143) kidney transplantations from standard criteria (n=245) and expanded criteria (n=94) donors was made.Results. There were no significant differences in a 1-year patient survival according to the donor type (98% and 95%, p=0.13). A 5-year recipient survival was significantly poorer after kidney transplantation from expanded criteria donors (97.6% and 88%, p=0.01). There were no significant differences in 1-year and 5-year graft survival rates according to the order of transplantation (p=0.21 and p=0.36). We found no significant difference in 1-year recipient survival after kidney transplantation from expanded criteria donors according to the order of transplantation (p=0.50). A 5-year recipient survival was significantly difference poorer after second kidney transplantation from expanded criteria donors (p=0.04). One-year and 5-year graft survival rates were significantly lower after kidney transplantation from expanded criteria donors (94%, 88% vs 86%, 65%, p=0.0025 and p=0.0011, respectively). One-year and 5-year survival rates were higher after first kidney transplantation from standard criteria donors in comparison with second kidney transplantation (p=0.052 and p=0.02, statistically significant in both cases). Analyzing outcomes of kidney transplantation from expanded criteria donors we found 1-year and 5-year graft survivals to be higher after first kidney transplantation comparing with second kidney transplantation (p=0.030 and p=0.018, statistically significant in both cases).Conclusion. In case of second organ transplantation, it is reasonable to use organs from standard criteria donors.
B. Z. Khubutiya, O. N. Rzhevskaya, A. A. Lisenok
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-165-178

Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-179-197

Analysis of the materials of the 2nd All-Union conference on the problem of tissue incompatibility, conservation and transplantation of tissues and organs (Odessa, 1967) showed that Soviet and foreign scientists had similar approaches to solving the problem of organ and tissue transplantation. Soviet scientists spoke about overcoming tissue incompatibility by hybridization of plants and chimerization of animals, about the effect of drug sleep on transplant immunity, about neurohumoral immunological shifts and the role of the central and peripheral nervous systems in the engraftment of grafts, about the influence of external factors on immunity. They also discussed the characterization of the antigenic structure of grafts, the role of DNA in immunity, the genetic transformation of homomaterial, the use of pharmacological agents to suppress immunogenesis, the cryopreservation of auto- and homo-organs and tissues with perfusion of their vascular bed, and the study of immunogenesis at the molecular level. A year earlier, the Americans discussed immunological paralysis, the effect on the recipient's immunity of the donor's blood transfused to him and its components, and biochemical studies of immunity. At the same time, without any ethical doubts, American scientists conducted experiments, including clinical ones, with multiple passages of homosexual skin, with exchange transfusion of blood to newborns and subsequent transplantation of homosexual donors to them, with irradiation of recipients with powerful doses of X-rays. It is shown that most of the trends that had been developed by V.P. Demikhov, were approved by the 2nd All-Union Conference. But what he lacked was close and comprehensive integration with morphologists, physiologists, immunologists, biochemists, pharmacologists and, sadly, with clinical surgeons. Based on the research conducted, an unambiguous conclusion can be drawn: Soviet scientists should not have criticized V.P. Demikhov for his "misunderstanding" of immunology, and to help him in every possible way, directing his energy in the right direction.
A. V. Shabunin, S. P. Loginov, , I. V. Nesterenko, D. A. Makeev, O. S. Zhuravel, L. R. Karapetyan
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-2-158-164

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.
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
, 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.
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