Transplantologiya. The Russian Journal of Transplantation

Journal Information
ISSN / EISSN : 2074-0506 / 2542-0909
Current Publisher: IPO Association of Transplantologists (10.23873)
Total articles ≅ 108
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Latest articles in this journal

, Yu. G. Shatunova, A. Werner
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-74-92

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

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

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

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

Introduction. One of the urgent tasks in modern transplantology is the search of biomarkers for predicting and early diagnosis of graft dysfunction. Objective. The study objective was to determine the biomarkers of liver graft dysfunction. Material and methods. We have examined 19 recipients who underwent liver transplantation and 36 healthy blood donors. Levels of 7 serum cytokines were measured by multiparametric fluorescence analysis with magnetic microspheres (xMAP technology, Luminex 200, USA). Statistical analysis was carried out by methods of nonparametric statistics. To determine the predictive value of the test, a ROC-analysis was performed. Results and discussion. We found that the interleukin-8 level was 3.6 times higher in recipients with liver graft dysfunction compared to those who had an uneventful postoperative course. The diagnostic sensitivity of the test was 75%, the specificity was 91%, and negative predictive value was 84.6. Conclusion. Serum interleukin-8 measurement provides a biomarker for early predicting a post-transplant liver graft dysfunction development
A. S. Mironov, N. V. Borovkova, M. S. Makarov, I. N. Ponomarev, Yu. V. Andreev
Transplantologiya. The Russian Journal of Transplantation, Volume 13; doi:10.23873/2074-0506-2021-13-1-49-62

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

Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task. The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes. Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed. Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance. Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.
I. V. Abdulyanov, I. M. Rakhimullin, M. R. Gaysin, R. R. Khamzin
Transplantologiya. The Russian Journal of Transplantation, Volume 12; doi:10.23873/2074-0506-2020-12-4-301-310

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

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

The clinical case of liver revascularization in a recipient using the technique of selective thrombolysis of the hepatic artery and its stenting at the arterial anastomosis site has been reported. The applied technique allowed a quick elimination of thrombosis and stenosis of the arterial anastomosis, providing a long-term effect, preventing more severe consequences for the recipient, and saving the liver graft. The presented case showed that the combined technique of endovascular intervention might be a good alternative to the reconstruction of arterial anastomosis by re-exploration and by liver retransplantation.
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