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According to global health statistics, respiratory diseases, together with infectious complications and hereditary lung diseases, rank as the third leading cause of death. Today, lung transplantation (LTx) is a well-recognized modality of treatment for end-stage chronic lung disease. However, the number of LTx surgeries performed is much lower than other solid organs. This is due to the high requirements for the potential donor and characteristics of the lung graft, reflecting the efficiency of gas exchange function. Non-compliance with the selection criteria leads to deselection of donors, which, according to various estimates, occurs in 80–85% of cases. One of the ways to increase the number of lung transplant surgeries is to restore them to the level of optimal gas exchange parameters, which can be achieved and objectively assessed during normothermic ex vivo lung perfusion (EVLP). EVLP is becoming increasingly common at leading transplantation centers in Europe and North America. This has significantly increased the number of transplant surgeries as a result of using lungs procured from suboptimal donors and rehabilitated via EVLP. In our pilot study, the developed Russian-made mechanical circulatory support system showed that performing normothermic EVLP for isolated lungs under experimental conditions is feasible. Basic and optimized perfusion protocols have fully shown that they are reliable and efficient.

Over the past 10 years, significant breakthroughs have been achieved in Russian transplantology in the field of regulatory legal framework. During this period, the powers of government authorities in the field of healthcare on organization of transplant care and organ donation have been defined, and sources and mechanisms for target financing of medical activities related to organ donation for transplantation purposes have been identified. The procedure for providing medical care under surgery (human organ and/or tissue transplantation) has been adopted, and a state registry system for donor organs, donors and recipients has been created. Measures on organ donation and transplantation in the Russian Federation have been approved within the «Healthcare Development», a framework of the state program of the Russian Federation. The Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center) has also been identified as the core institution that coordinates the activities of the entire transplant industry in the Russian Federation. Transplant medical care is currently being provided by specialist physicians trained in human organ and tissue transplantation, in collaboration with other specialist physicians. The Nomenclature of Specialties of Specialists with Higher Medical and Pharmaceutical Education, approved by the Russian Ministry of Health via Order No. 700n of October 7, 2015, does not contain a separate specialty related to human organ and tissue transplantation activities, and this is quite justified. However, in order to improve the legal regulation of transplantation activities, it is necessary to unify the requirements for specialists providing medical care in human organ/tissue transplantation. This can be achieved by developing uniform approaches to the definition of labor functions in the professional standards of specialist doctors involved in transplantation.

Kidney injury in cardiac transplant recipients is one of the most severe complications affecting both short- and long-term transplant outcomes. The need for renal replacement therapy (RRT) is determined not only and not so much by the degree of renal dysfunction, as by the need for correction of fluid balance and metabolic disorders. These circumstances are associated with the specificity of extracorporeal renal replacement therapy in donor heart recipients. In this review, we discuss the problems of early versus delayed initiation of RRT, anticoagulation and vascular access, advantages and disadvantages of continuous and intermittent techniques. Special attention is paid to chronic kidney injury and peculiarities of kidney transplantation in heart recipients.

Respiratory diseases, together with infectious complications and hereditary lung diseases, rank third in international mortality statistics. Today, lung transplantation is a recognized method of treating end-stage lung diseases. However, the number of transplant surgeries performed is not much. This is down to the high requirements on the condition of a potential lung donor and directly on the quality of the donor lung. This has significantly limited the number of optimal donors. Rehabilitation of donor lungs to optimal gas exchange indicators can be achieved and objectively assessed in the course of ex vivo lung perfusion (EVLP). The EVLP procedure is widespread in leading transplantation centers in Europe and North America. It allows to significantly expand the pool of donor lungs, thereby serving a greater number of patients in need of lung transplantation. The possibility of EVLP procedure using publicly available perfusion equipment was demonstrated. The optimized protocol fully demonstrated its reliability and efficiency. The developed perfusion solution had no statistically significant differences in comparison with the Steen SolutionTM, which in the future will serve as an alternative for EVLP procedure.

Objective: to monitor the current trends and developments in organ donation and transplantation in the Russian Federation based on the 2020 data.Materials and methods. Heads of organ transplant centers were surveyed through questionnaires. Data control was done using the information accounting system of the Russian Ministry of Health. Between separate federal subjects of the Russian Federation and between transplantation centers, comparative analysis of data obtained over years was performed.Results. Based on data retrieved from the 2020 Registry, 44 kidney, 29 liver and 16 heart transplantation programs were functioning in the Russian Federation in 2020. The kidney transplant waitlist in 2020 included about 11.5% of the total 60,000 patients receiving dialysis. Organ donation activity in 2020 was 3.9 per million population, with a 74.6% multi-organ procurement rate and an average of 2.9 organs being procured from one effective donor. In 2020, there were 7.7 kidney transplants per million population, 3.8 liver transplants per million population and 1.7 heart transplants per million population. Same year, the number of transplant surgeries performed in the Russian Federation fell by 19.2% to 13.4 per million population against the background of the outbreak caused by the new coronavirus disease COVID-19. The city of Moscow and the Moscow region in 2020 accounted for 13 out of the 14 functioning organ transplantation centers, performing 66.3% of all kidney transplants and 72.4% of all extrarenal transplants in the country. The number of organ recipients in the Russian Federation have exceeded 130 per million population.Conclusion. In 2020, despite the new coronavirus disease COVID-19 pandemic and accompanying restrictive measures, transplant centers continued to perform organ transplants, run a waiting list and monitor organ recipients. However, the number of effective donors (–22.9%) and organ transplants (–19.2%) decreased, tentatively to the 2017 levels. In 2021, transplant centers with support from health authorities will have to restore the volume of transplant care with consideration to the real needs of the population and the donor resource. The COVID-19 factor, including vaccination of the population, as well as financial support to transplantation programs, will be decisive in shaping the trend of transplantation care and organ donation in the federal subjects of the Russian Federation in the coming 1–2 years.

Kidney injury in heart transplant recipients is of a complex nature and bears the features of all types of cardiorenal interaction impairment. Pre-transplant renal dysfunction, perioperative acute kidney injury, as well as factors associated with graft and immunosuppression, determine the prevalence and severity of kidney pathology in this group of patients. This review examines the pathophysiology of kidney dysfunction in heart failure, the epidemiology, and criteria for acute kidney injury.

Bronchial complications are among the main causes of impairing postoperative period and thansplant failure. Severe bronchial complications are very rare but have a high mortality rate. Light forms decrease transplant function and while progressing can leads to life-threatening conditions without required treatment. Nowadays there is a huge necessity in classification of diagnostic and bronchial complications treatment on different terms after lung transplantation. Methods of observation bronchoscopy and interventional bronchology are allowing us to realize prevention, diagnostic and treatment bronchial complications.

Living related liver transplantation has proved to be an effective, safe and radical method for treating end-stage liver diseases. In the last decade, a laparoscopic approach to donor hepatectomy has been gradually introduced into clinical practice. According to world literature, there are presently no uniform standards for performing laparoscopic liver resections in living donors. This literature review considers almost all methods for performing this surgery in living donors. These methods are described in transplant centers around the world.

The vanishing bronchus intermedius syndrome is a type of peripheral bronchial stenosis that develops in lung recipients within two to nine months after transplantation. Lack of timely diagnosis and effective treatment leads to increased mortality and poor quality of life. The clinical case presented demonstrates the successful long-term treatment of vanishing bronchus intermedius syndrome in a lung recipient using interventional bronchoscopy.

Liver transplantation is the treatment of choice for patients with end-stage liver disease or acute liver failure. However, vascular complications, such as hepatic artery stenosis and/or thrombosis, graft portal vein stenosis and biliodigestive strictures following liver transplantation are still common despite improvements and innovations in surgical techniques. These complications can lead to graft damage or even death, and they are caused by many factors. Although minimally invasive interventional radiology is an optional treatment for such post-liver transplant complications, there is little research on this method of treatment.

Objective: to investigate the functional efficiency of a cell-engineered construct (CEC) of the liver based on tissuespecific matrix consisting of decellularized rat liver fragments, allogeneic liver cells and multipotent mesenchymal stromal cells (MSCs) isolated from the bone marrow on an experimental model of chronic liver failure (CLF).Materials and methods. In creating liver CECs, the liver for decellularization and liver cells were obtained from male Wistar rats. MSCs were isolated from rat bone marrow. The functional efficacy of CEC was investigated on an experimental CLF model obtained by priming rats with CCl4 solution. At different periods after implantation, the outcomes were assessed based on the biochemical parameters of cytolysis. Morphological changes in the liver were analyzed by histochemical methods in the control (administration of saline solution into the liver parenchyma) and experimental (administration of liver CEC into the liver parenchyma) groups. Results. It was shown that implantation of the proposed CEC normalizes blood biochemical parameters and structural disorders of the damaged rat liver faster (by day 30 after introduction of CEC instead of day 180 in the control). The CEC was also shown to have reduced animal mortality from 50 to 0%, which is due to early activation of proliferation of viable liver cells and faster formation of new blood vessels. These effects are down to either stimulation of the internal regenerative potential of the damaged liver during CEC implantation or long-term functioning of the transplanted cells as part of the CEC based on the decellularized liver matrix. Conclusion. The liver CEC, implanted into the liver parenchyma in laboratory animals with a CLF model, has a functional activity.

We herein present our initial report from «ROKKOR-recipient», a national multicenter observational study. The prevalence, risk factors, clinical manifestations and outcomes of the novel coronavirus disease 2019 (COVID-19) in solid organ transplant recipients receiving immunosuppressive therapy were investigated. The study enrolled 251 COVID-19 patients (220 kidney recipients, 7 liver recipients, 1 liver-kidney recipient, and 23 heart recipients). The subjects came from 20 regions in Russia. The symptoms, clinical presentation, imaging and lab test results, therapy and outcomes of COVID-19 were described. It was established that solid organ transplant recipients with COVID-19 have a higher risk of developing adverse events. Predictors of adverse events include associated cardiovascular diseases, pulmonary diseases, diabetes, and kidney failure. Symptoms of the disease include dyspnea, rash and catarrhal signs, as well as initial low blood oxygen saturation (SpO2 10 × 109/L), elevated creatinine levels (>130 μmol/L) and a marked decrease in glomerular filtration rate, requiring hemodialysis. Performing organ transplant surgery in COVID-19 does not increase the risk of adverse events but could save the lives of waitlisted terminally ill patients.

Liver transplantation is the only effective treatment modality for end-stage liver disease. However, donor organs are not always available. In some cases, the gravity of the patient’s condition makes transplantation impossible. In this regard, the use of artificial liver support systems helps in preparing a patient for transplant surgery. Objective: to conduct a retrospective study aimed at evaluating the efficiency of fractionated plasma separation and adsorption system. Materials and methods. From January 2019 to May 2020, 139 pediatric liver transplants were. We analyzed the data of 5 pediatric patients (2 girls and 3 boys, aged 12 to 17 years) who received fractionated plasma separation and adsorption (FPSA) sessions as a bridge to transplantation. The main clinical indication for FPSA was severe hepatic encephalopathy (grade 3 according to the West Haven Criteria), which was observed at 350–872 μmol/L (average 597 ± 98 μmol/L) serum bilirubin level. The FPSA sessions were conducted on a Prometheus device using AV-600 hemofilters as dialyzers (Fresenius Medical Care, Germany). Results. Depending on the extent of bilirubinemia in patients, it took from one (in one case) to three (in one case) daily FPSA sessions to restore clear consciousness, appetite and physical activity. Average bilirubin levels after treatment cycles decreased from 597 ± 98 to 236 ± 73 μmol/L. All patients successfully underwent liver transplant surgery within two to five days, two patients received a liver fragment from a living related donor. Conclusion. The FPSA system stabilizes the condition of potential recipients with acute liver failure. Further research is required to develop optimal regimens for albumin dialysis.

Many studies have shown that biliary complications after transplantation of the left lateral segment (LLS) of the liver reduce graft and recipient survival. Thus, timely correction of biliary complications, and strictures in particular, improves long-term outcomes in transplantation. Objective: to analyze our own experience in correcting biliary strictures in LLS graft transplantation. Materials and methods. From February 2014 to April 2020, 425 LLS grafts were transplanted in children. 19 (4.5%) patients were diagnosed with biliary strictures at different times after transplantation (from 0.2 to 97 months). Results. Biliary strictures were more often formed a year after transplantation (17.8 ± 23.9 months). In 14 out of the 19 patients, internal-external biliary drainage was successfully performed with phased replacement of the catheter with one that was larger in diameter (from 8.5 Fr to 14 Fr). The catheters were removed in 8 patients after completion of the treatment cycle. Restenosis was not observed during follow-up (13 ± 8.7 months) after the internal-external biliary drainage catheter had been removed. In 5 cases, antegrade passage of a guide wire through the stricture was unsuccessful. As a result, biliary reconstruction was performed in 4 (21.1%) patients and retransplantation was required in 1 (5.3%) patient. Conclusion. An antegrade minimally invasive approach can successfully eliminate biliary strictures in most children after liver LLS graft transplantation. The proposed technique is effective and safe.

Objective: to provide guidelines on how to improve the quality of health care in transplantation services for Russian regions; the recommendations were prepared by the Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center) based on field trips made by Shumakov Center from 2018 to 2019 in order to assess the status and development prospects of organ donation and organ transplantation in various regions of the Russian Federation. Materials and methods. Based on the over 40 field trips made by the Center, analytical reports, as well as recommendations were prepared by the Ministry of Health of Russia for regional health authorities and transplant centers. Guidelines were selected from these recommendations to address the most significant and common gaps and errors inherent in organ donation and organ transplantation in the regions. On the basis of the analytical reports, guidelines for the roadmap (plan) for organ donation and transplantation in the region were prepared. Results. A methodological framework for solving a wide range of managerial challenges on organ donation and organ transplantation is proposed for heads and experts at healthcare institutions and medical organizations. Conclusion. Organ donation and organ transplantation should be developed for the regions using the roadmap (plan) prepared and approved by the regional health authority. This approach brings stability and consistency to the development process, creates a resource base for development, and provides coordination and oversight.

Objective: to monitor current trends and developments in organ donation and transplantation in the Russian Federation based on the 2019 data. Materials and methods. Heads of organ transplant centers were surveyed. Data obtained over years from federal subjects of the Russian Federation and from organ transplant centers in the country were analyzed and compared. Results. Based on data retrieved from the 2019 Registry, only 46 kidney, 31 liver and 17 heart transplant centers were functioning in Russia. In 2019, there were 6,878 potential recipients in the kidney transplant waitlist. This represents 13.7% of the 50,000 dialysis patients in the country. Donation activity in 2019 reached 5.0 per million population; multi-organ procurement rate was 71.6%; 2.9 organs on average were procured from one effective donor. In 2019, there were 10.0 kidney transplants per million population, 4.0 liver transplants per million population and 2.3 heart transplants per million people. Same year, the number of transplant surgeries performed in Russia rose 10.7% from the previous year. Moscow and Moscow Oblast alone have 13 functioning organ transplantation centers. They account for half of all kidney transplant surgeries and 70% of all liver and heart transplants performed in the country. Organ recipients in the Russian Federation have exceeded 16,000 in number. Conclusion. Organ transplantations in Russia keep on increasing – 10–15% per year. Donor and transplant programs are also becoming more effective and efficient. However, the demand for organ transplants far exceeds the current supply of available organs in the Russian Federation. Peculiarities of the development of organ donation and organ transplantation in Russia in 2019 were associated with some factors, such as structure and geographical location of transplant centers, waitlisting of patients, funding sources and amount, and management of donor and transplant programs. The national transplantation registry will be developed taking into account new monitoring and analysis challenges.

Objective: to evaluate the clinical efficacy and outcomes of kidney transplants performed using an alternative immunosuppressive therapy protocol that is based on double induction. Materials and methods. We examined 296 cases of kidney transplants performed in 295 patients between January 1, 2004 and December 31, 2018. Based on induction immunosuppressive therapy regimen, the patients were divided into two groups. Group 1 included patients who underwent transplantation from January 1, 2004 to June 30, 2013 and who used the standard induction immunosuppression protocol. Group 2 included patients who did transplant surgeries between the period January 7, 2013 and December 31, 2018 and who received the “double” induction protocol being analyzed. The method of dividing patients into these groups is associated with routine implementation of the analyzed protocol at the transplantation center since July 1, 2013. Results. Graft and recipient survival rates at all follow-up periods were higher in the group of patients who received the “double” induction immunosuppressive protocol than in the standard group. The studied protocol provides initially better and more stable graft function than in standard therapy. This is especially valuable in centers experiencing difficulties in assessing pre-transplant immunological risk. The graft and recipient survival rates achieved by the analyzed protocol are more pronounced in deceaseddonor kidney transplantation. Conclusion. Positive results obtained from retrospective analysis of the protocol under study justify a prospective randomized study.

Aim: to monitor current trends and developments in organ donation and transplantation in the Russian Federation based on the 2018 data.Materials and methods. Heads of organ transplant centers were surveyed. Data obtained over years from constituent entities of the Russian Federation (also called regions) and from organ transplant centers located in these regions was analyzed and compared.Results. According to data retrieved from the 2018 National Registry, only 49 kidney, 28 liver and 18 heart transplant centers were functional in Russia. As of the end of 2018, there were about 6,219 people on the kidney transplant waiting list. This is about 13.8% of the total number of the 45,000 patients receiving dialysis. Donation rate in 2018 was 4.3 donors per million population, while multi-organ procurement level stood at 67.3%. An average of 2.9 organs were procured from one effective donor. In 2018, there were 9.3 kidney transplants, 3.4 liver transplants and 1.9 heart transplants per million population. In the same year, the number of transplants performed in Russia in creased by 12.3% from the year 2017. In Moscow and Moscow Oblast alone, there are 15 functioning organ transplantation centers. These centers perform half of all kidney transplants and 70% of all liver and heart transplants in the country. The number of organ transplant recipients in Russia is approaching 16,000.Conclusion. Russia continues to witness a long-term trend of growing number of organ transplants – 10–15% per year. The geographical presence or organ transplant centers continues to expand. The number of transplant centers and their activity is increasing. Donor programs are becoming more effective and efficient. Extrarenal transplantation technologies are being deployed in Russian regions. The number of patients on the national waiting list for organ transplantation is increasing, while their mortality is decreasing. The number of patients with transplanted organs is increasing. Shortages in donor organs in Russia is still down to human causes – poor organization. The number of organ transplants in Russian regions depends on government funding. The quality and safety of transplant programs rely on the transplant activity of centers. In order to achieve the clinical and economic benefits of organ transplantation as a treatment method, monitoring and follow-up after transplant will be required.

Post-kidney transplant urological complications (failure of a newly formed anastomosis, obstructive uropathy, necrosis of graft ureter, graft ureteral stricture, development of vesicoureteral reflux in the renal graft, recurrent urinary infection) are one of the main causes of graft loss and various deaths. This literature review aims at analyzing world studies on prevention methods (routine graft ureteric stenting) and surgical techniques for treating urological complications (laparoscopic correction of supravesical urinary tract obstruction in a graft kidney) in kidney recipients.

Aim: the aim of the study was a comparative assessment of the quality of life of recipients with donor heart at the stages before and after heart transplantation.Materials and methods: the study included 150 patients who underwent orthotopic heart transplantation at the «Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs», Ministry of Health of the Russian Federation from January 2009 to March 2018.Results. Analysis of the research results indicates extremely low rates of both physical activity and overall health assessment at the pre-transplantation stage. During the first month after heart transplantation, the role of functioning due to physical condition (p = 0.02), general health (p = 0.001), mental health (p = 0.01) and vital activity (p = 0.01) significantly increase. Tolerance to physical activity increases by 201.26% during the first month after the heart transplantation (p = 0.02). The most complete indicators of quality of life are restored after one year of operation: physical functioning (p = 0.00007), role-based functioning due to physical condition (p = 0.00006), pain threshold (p = 0.04), general health (p = 0.00007), mental health (p = 0.0001), role functioning due to the emotional state (p = 0.01), social functioning (p = 0.0001), vital activity (p = 0.000032). High rates of quality of life are maintained for periods longer than 5 years after transplantation. The best indicators of quality of life in recipients of transplanted heart are observed a year after surgery and manifest a significant increase in all indicators. A comparative analysis of the results obtained in the preoperative period and a year after the operation of orthotopic heart transplantation indicates a significant improvement in the quality of life of patients.Conclusion. The results of the study showed that during the year after heart transplantation in patients with terminal heart failure, there was a significant improvement in all indicators characterizing the quality of life. High levels of physical, mental and social activity achieved by the first year are maintained for at least 5 years, which indicates the high efficiency of orthotopic heart transplantation as a radical method of treating severe heart failure.

Lung transplantation is the final treatment option for end-stage lung disease when all possible conservative treatment is exhausted. According to the International Society for Heart and Lung transplantation Registry, more than 60000 lung transplantations have been performed worldwide. The early post-transplant period following lung transplantation remains critical because of numerous complications. These complications can be divided into several groups. These are surgical complications, primary graft dysfunction and acute rejection, infection, cardiovascular, abdominal and renal disorder. This complications may result in significant morbidity, mortality and limit short and long-term survival. The aim of this review is to describe the main postoperative complications in first month after lung transplantation in the world practice.

Aim: to determinate the most effective liver cells and multipotent mesenchymal stromal cells of bone marrow (MMSC BM) ratio into implantable cell engineering constructions (CECs) used for chronic liver failure (CLF) correcting.Materials and methods. For creating liver CECs it was used a biopolymer implant – a composition of a heterogeneous collagen-containing gel (BMCG) (Sphero®GEL trademark) containing viable liver cells and MMSC BM in the following ratios – 1 : 1; 5 : 1 and 10 : 1 respectively. CECs with different ratios of liver cells and MMSC BM were implanted into liver of rats in which chronic liver failure (CLF), was modeled by using CCl4. The effectiveness of the regulatory effects of CECs (with different cell ratios) on regenerative processes in livers were assessed by using biochemical, morphological and morphometric methods at different periods after their implantation.Results. Corrective effect of CECs with different cell composition on biochemical and morphological parameters of livers at chronic liver failure was established. During studying the liver CECs with various cell ratios of liver cells and MMSC BM (1 : 1; 5 : 1 and 10 : 1 respectively), it was found that the most optimal ratio of cells into the CECs is 5 : 1, because at this ratio of cells, there were a more distinct normalization of the morphological and functional liver parameters within 365 days after modeling CLF and maintenance of the structural homeostasis into the CECs. Themselves, which allows predicting their long-term regulatory effect on the liver tissue in CLF and maintaining its normal structural and functional state.Conclusion. The effective correction of chronic liver failure can be carried out by using the implanted liver CECs, in which donor liver cells and MMSC BM where presented in ratios – 1 : 1; 5 : 1 and 10 : 1. But analysis of prolonged correction of liver morphological and functional parameters at CECs using it was allow to recommend the preferences using of CECs with ratio 5 : 1, because prolonged preservation of structural homeostasis into these CECs makes possible to prognosticate their prolonged regulatory action on the liver tissue at CLF, especially for recipients on a waiting list for liver transplantation.

The aim: to analyze the waiting list for heart transplantation from 2010 to 2017 and to characterize recipients with chronic heart failure III–IV NYHA Class.Methods. The study comprised 997 patients (139 [14%] females and 858 [86%] males) included in the waiting list for heart transplantation the period from January 2010 to December 2017. The average age of patients on the waiting list was 49.0 ± 12.0 (from 10 to 78 years). Before making a decision on inclusion in the waiting list, all patients underwent clinical and instrumental examination, including general clinical studies, echocardiography, measurement of central hemodynamic parameters using a Swan–Gans catheter, computer and/or magnetic resonance imaging of the chest, abdominal and brain.Results. Heart transplantation was performed on 728 patients (99 females – 13.6% and 629 males – 86.4%) including 18 children aged 12 to 17 years (14.18 ± 2.07 years). Mortality in the waiting list in 2010 was 16.1%, compared with 3.2% in 2017.

Lung transplantation (LT) for idiopathic pulmonary arterial hypertension (IPAH) now is the only radical treatment of this disease.Aim: to analyze own experience of performing LT in patients with IPAH.Materials and methods. 8 adult IPAH patients, who underwent LT between 2014 and october 2018, were included. In 7 of 8 patients undergoing bilateral lung transplantation on intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) with prolongation into the postoperative period.Results. VA ECMO support was prolonged into postoperative period 6 and 7 days respectively in 2 (25,0%) patients and 3 days in 6 (75,0%) patients. Hospital mortality in IPAH patients was 1.Conclusions. Own experience demonstrates that LT is an effective method of treatment in patients with IPAH. Hospital, 1- and 3-year survival rates for the patient collective were 87.5, 75.0 and 75.0% respectively.

Aim. To analyse the status and trends in the development of organ donation and organ transplantation in the Russian Federation according to 2017 data.Materials and methods. The survey of heads of transplantation centers was conducted. A comparative analysis of the data obtained in the dynamics of years, between individual subjects of the Russian Federation, the centers of transplantation is performed.Results. According to the register in 2017 in Russia there were only 41 centers for kidney transplantation, 24 liver and 16 hearts. The waiting list for kidney transplantation in 2017 included 5,531 potential recipients, which is approximately 13.8% of the total number of 40,000 patients receiving dialysis. The level of donor activity in 2017 was 3.8 per million of the population, while the share of multiorgan seizures was 66.5%, the average number of organs received from one effective donor was 2.8. In 2017, the level of kidney transplantation was 8.0 per million of the population, the liver transplantation index was 3.0 per million of the population; the rate of heart transplantation is 1.7 per million of the population. In 2017 the number of transplants in Russia increased by 11.3% compared to 2016. There are 11 transplantation centers on the territory of Moscow and the Moscow Region, and half of all kidney transplants and 70% of all liver and heart transplantations are performed. The number of patients with transplanted organs in the Russian Federation is approaching 13,000.Conclusion. In the Russian Federation there is a strong tendency to increase the number of effective donors and to increase the number of organ transplants, and the number of transplant centers is also increasing. In recent years, the country has created prerequisites for the development of organ donation and transplantation: the regulatory and legal framework, public donation funding, material and technical base, etc. In the coming years, positive experience and organizational patterns of organ donation and transplantation from successful regions in Other subjects of the Russian Federation for building effective programs. The leading role in this process should be played by the Academician V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs.

The method of mechanical circulation support using non-pulsating fl ow pumps, built on the principle of rotary (centrifugal and axial) pumps, took the leading direction (94%) in the world clinical practice for the treatment of the patients with terminal heart failure. Despite this, the clinic application of these pumps in a number of cases faced with the numbers of negative problems associated with this technology. This is stimulated of a new direction of principles for a control of the rotary pumps, based on the modulation of the speed pumps. The article analyzes the negative factors of the clinical application of non-pulsating fl ow pumps and gives an overview of the methods the optimization of the control pump based on the modulation of the output fl ow.

Aim: to develop an optimal surgical tactic for implantation of “AVK-N” system as a “bridge” to heart transplantation.Materials and methods. 17 patients were included. They were operated in the period from 2012 to October 2017 in Federal State Budgetary Institution «V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs». A tiny implantable system «Portable device for assisting cardiac circulation» (AVK-N; Russia) was used for replacing the pumping function of the left ventricle. All patients were examined according to the program of potential recipients for heart transplantation, before the applying of prolonged mechanical circulatory support. Among the operated patients there were 16 (94.1%) men and 1 (5.9%) woman, the average age was 52.64 ± 10.56 (from 33 to 67 years). All patients had congestive heart failure III–IV functional class according to NYHA, refractory to optimal drug therapy. Heart failure was triggered by dilated cardiomyopathy in 12 (70,58%) cases, and by postinfarction systolic dysfunction of the left ventricle in 5 (29,42%). Implantation of «AVK-N» system was performed to potential recipients of the donor heart with terminal stage of CHF with a decrease in LV ejection fraction up to 10%.Results. As a result of this study there were developed several technological aspects facilitating the subsequent heart transplantation.Conclusion. Our experience in optimizing the surgical tactics of the “AVK-N” system implantation as a bridge to heart transplantation, demonstrated the possibility and safety of its active use in both patients with terminal heart failure on the waiting list of heart transplantation and patients having temporary contraindications to HTX.

Donor organs shortage leads to extending criteria for deceased liver donation in the whole world.Aim: to compare results of deceased donor liver transplantation (DDLT) depending of donor age over 60 years old.Materials and methods: the study includes 390 DDLT from January 2010 to November 2017. All liver donors separated by age for two groups: I – 60 years and older (n = 26); II – younger than 60 years (n = 364). All donors were standardized by demographic, laboratory fi ndings and inotropic drug requirement. Results: no difference between both groups in severity of ischemia-reperfusion injury, ICU or in-hospital staying (median 2 and 7,5 days respectively) was found. There is also no difference between biliary or vascular complication rate. 5-year actuarial survival rate found no difference between both groups (I: 70%: II: 76%, p = 0,54).Conclusion. Using grafts from donors older than 60 years don’t worsen early and late results of DDLT. Care should be taken to avoid other risk factors (cold ischemia time, warm ischemia time).

Aim: to evaluate clinical effi ciency of percutaneous coronary interventions (PCI) at potential recipients of heart with the chronic ischemic heart failure (CHF).Materials and methods. In this retrospective study results of treatment at 76 patients with CHF NYHA III and 36 patients with CHF NYHA IV by scheduled PCI are presented. Duration of observation was from 6 to 160 months. The age of patients at the time of intervention was 61,7 ± 0,62 years (from 33 to 76). 108 male and 4 female. Defi ned life expectancy and echocardiography parameters of the left ventricle (LV) of heart. Results. 20 patients were died, 16 of them from cardiovascular events. 18 patients during this period undergo orthotopic heart transplantation (HT). The endovascular revascularization leads to LV volumes reduction, increase of ejection fraction and decrease of pulmonary artery pressure. Progress CHF is followed by negative dynamics of these characteristics and need of HT performance. In 74% of cases the effect of myocardial revascularization allows to provide increase in life expectancy of potential recipients of heart with the chronic ischemic heart failure. Conclusion. Performance of PCI at patients with the chronic ischemic heart failure can delay heart transplantation or become its alternative.

Biliary atresia is a congenital disease characterized by a progressive course with the lesion of primarily extrahepatic bile ducts leading to the development of cholestasis. Treatment consists in performing an operative intervention such as, Kasai portoenterostomy, or liver transplantation. This clinical case shows the experience of left lobe living donor liver transplantation in child, who underwent complicated portoenterstomy in young years. In case of AB0-compatible donors is absence, the AB0-incompatible living donor can become useful opportunity for urgent recipient. Endovascular embolization of the branches of the splenic artery can become a «bridge» to AB0-incompatible liver transplantation.

Lung transplantation is not a routine treatment option of the pediatric lung diseases. Nowadays, there are performed not more than 100 of these operations per year worldwide due to the obvious diffi culty of obtaining the pediatric donor organs. One of the ways to solve this problem is using the adult donor lungs which have been previously reduced or anatomically partitioned. This is not a standard method of pediatric lung transplantation, but in case of the donor organs defi ciency it takes its place in the world medical practice. In this case we report the fi rst successful pediatric lung transplantation from adult donor in Russian Federation.

As we present the first issue of the Journal in 2021, we would like, as always, to outline our plans and perspectives for the coming year.

Review of the main research areas and the most significant results obtained in recent years in the Federal Research Center of Transplantology and Artificial Organs including heart transplantation, lung transplantation, the evolution of liver transplantation and kidney transplantation is presented. The article also describes advanced developments in the field of creating artificial organs – artificial circulatory support systems – and regenerative medicine, nano- and cellular technologies, the creation of bioartificial organs.

Diabetes mellitus is a significant social problem. In the Russian Federation, the prevalence of diabetes type 1 is 340.000 people, 21% of them having diabetic nephropathy, as well as other secondary complications leading to disability and high mortality. There are several options for diabetic patients with chronic kidney disease dialysis: kidney transplantation with insulin therapy, simultaneous kidney-pancreas transplant or islet transplant. Good long-term results could be obtained by the whole pancreas and kidney combined transplantation through maximum metabolism recovery comparing to other replacement therapy options. The recipientselection with special attention to the cardiovascular system evaluation is essential to successful transplantation. The proper pancreatic graft assessment needs a wide range of criteria to be analyzed. Integral scores can simplify and systematize the assessment. The choice of preservation technique is important to pancreatic graft ischemia-reperfusion injury minimization. Despite the progress in graft preservation methods, cold storage using University of Wisconsin (UW) solution remains to be the gold standard. The evolution of surgical technique has resulted in utilizing the most physiologic variations of exocrine drainage and venous outflow of the pancreas, so-called portoenteric drainages, which were designed to improve remote metabolic effects and to reduce complications probability.

Over the last decades mechanical circulation support has become one of the most effective treatment methods for patients with terminal heart failure. Unfortunately, in pediatrics this method is generally used on a short-term basis and includes, first of all, extracorporeal membranous oxygenation and left ventricular bypass by means of the extracorporeal centrifugal pumps. Nevertheless, using of these methods in children allowed considerably reducing mortality on the waiting list for heart transplant. Today, practically the only method of long term mechanical circulatory support in newborns and children at an early age being used is the system of paracorporeal artificial ventricles EXCOR, the usage of which results in larger problems of thrombosis. There is little clinical experience in using of the fully implanted systems developed for adults in older children. Therefore, as shown in the present review, the problem of creating long term circulatory support systems for newborns and younger children on the basis of the implanted pumps continues to be relevant.

Aim. A comparative analysis of the functional efficacy of biomedical cell products (BMCP) for the regeneration of damaged liver based on biopolymer scaffolded porous and hydrogel matrices was performed on the experimental model of acute liver failure. Materials and methods. Matrices allowed for clinical use were employed for BMCP in the form of a sponge made from biopolymer nanostructured composite material (BNCM) based on a highly purified bacterial copolymers of poly (β-hydroxybutyrate-co-β-oxyvalerate) and polyethylene glycol and a hydrogel matrix from biopolymer microheterogeneous collagen-containing hydrogel (BMCH). Cellular component of BMCP was represented by liver cells and multipotent mesenchymal bone marrow stem cells. The functional efficacy of BMCP for the regeneration of damaged liver was evaluated on the experimental model of acute liver failure in Wistar rats (n = 40) via biochemical, morphological, and immunohistochemical methods. Results. When BMCP was implanted to regenerate the damaged liver on the basis of the scaffolded BNCM or hydrogel BMCH matrices, the lethality in rats with acute liver failure was absent; while in control it was 66.6%. Restoration of the activity of cytolytic enzyme levels and protein-synthetic liver function began on day 9 after modeling acute liver failure, in contrast to the control group, where recovery occurred only by days 18–21. Both matrices maintained the viability and functional activity of liver cells up to 90 days with the formation of blood vessels in BMCP. The obtained data confirm that scaffolded BNCM matrix and hydrogel BMCH matrix retain for a long time (up to 90 days) the vital activity of the adherent cells in the BMCP composition, which allows using them to correct acute liver failure. At the same time, hydrogel matrix due to the presence of bioactive components contributes to the creation of the best conditions for adhesion and cell activity which accelerate the regeneration processes in the damaged liver compared to BMCP on scaffolded matrix. Conclusion. A statistically significant difference was found between the functional efficacy of the BMCP studied based on BNCM and BMCH matrices. BMCP based on hydrogel BMCH matrix was more effective for the regeneration of damaged liver.

Aim. To optimize implantable axial pump to increase hydraulic efficiency and reduce blood hemolysis. Materials and methods. In this article the basic geometric parameters of impeller’s geometry (the blade’s angle, the blade’s length and the twist angle’s ratio) were investigated and optimized using methods of computer hydrodynamics. The calculations were carried out for the optimum operation of the pump at the speed of 8000 rpm. Results. The main parameters of impeller’s geometric were determined which made it possible to increase efficiency of the pump by an average of 7.5% (depending on the pump operation mode) and pressure drop of 8% on average. The value of shear stress in the flow region obtained as a result of the calculations did not exceed 147 Pa admissible from the point of view of blood hemolysis.

Wilson’s disease is a rare congenital disease caused by deficiency of the copper-transporting P-type ATPase-B enzyme. The course of disease varies widely from the latent form to the acute liver failure which is observed in 5% of Wilson’s disease cases. This clinical case represents experience of liver transplantation as the only curative treatment for patients with fulminant form of Wilson’s disease demonstrating excellent postoperative results. Living donor liver transplantation allows performing the operation in the shortest possible time which is necessary in acute liver failure. The plasmapheresis with plasma exchange AB (IV) allows preparing the patient for transplantation with incompatible blood group.

Aim. To carry out monitoring of the organization and tendencies in the development of organ donation and transplantation in the Russian Federation in 2016. Materials and methods. Questioning of the heads of all the centers of transplantation is carried out. The comparative analysis of the obtained data in dynamics of the years, between certain regions of the Russian Federation and transplantation centers is done. Results. According to the register 35 centers of kidney transplantation, 22 centers of liver transplantation and 11 centers of heart transplantation were functioning in the Russian Federation in 2016. The waiting list of kidney transplantation in 2016 included 4818 potential recipients that make 14% of total number of the patients (35 000) receiving dialysis. The rate of donor activity in 2016 made 3.3 p. m. p. Efficiency of donor programs in 2016 continued to increase: the share of multiorgan retrieval made 64.1%, average number of organs received from one effective donor made 2.7. In 2016 the rate of kidney transplantation made 7.4 p. m. p., the rate of liver transplantation made 2.6 p. m. p.; the rate of heart transplantation made 1.5 p. m. p. In 2016 the number of transplantations in the Russian Federation increased by 14.8% in comparison with 2015 having overcome the level of 1700 organs transplantation. The Moscow region still remains to be the core of stability and development of the organ donation and transplantation in the country where 10 centers of transplantation function and half of all kidney transplantations and more than 70% of all liver and heart transplantations are carried out. Conclusion. The results of 2016 were positively affected by the introduction of targeted financial support of medical activity, related to organ donation, from federal budget resources. Among unresolved problems which constrain the development there are collision of legal regulation of licensing of medical activities for organ donation and transplantation, lack of the state order for the organization of transplantological medical care in each region, lack of responsibility of the heads of the regions and medical organizations for the organization of organ donation. Positive tendencies of the development of organ donation and transplantation in Russia call for further monitoring, strengthening and building.

Orthotopic liver transplantation is the only way to cure chronic liver failure and certain liver tumors. Deceased donor organs are the prevailing source in most transplantation centers. However, there is an organ shortage because of the increasing number of patients in need of transplantation. Using expanded criteria deceased donors is a routine way to overcome organ shortage. The majority of transplantation centers take older donors depending on the local rules. Successful liver transplantation from 73-year-old deceased donor. Recipient suffered from liver neuroendocrine tumor without signs of extrahepatic spread. Liver function is adequate during 90-day follow-up. Liver transplantation from older deceased donors has good outcome according to world experience. Careful donor-recipient selection is the key to success. The first positive trial in our center enlightens the way for further practice.

Introduction. Quality of life (QoL) is a new promising area of clinical medicine that provides the opportunity to assess the state of health of the patient and to have a notion of the surgery effects based on the parameters which are lying at the intersection of scientific approach of the surgeons and subjective point of view of the patient.Materials and methods. The study included 52 living-related liver fragment donors operated between 2009 and 2014. Donors were surveyed after 2–5 years from the surgery. Comparison group was formed by healthy volunteers, students of the Medical University. The Russian version of the non-specific SF-36 questionnaire was used to assess QoL.Results. Donors in the postoperative period have demonstrated a high level of physical parameter (57.65 ± 3.8). Parameter of psychological health in the postoperative period was (52.01 ± 5.2). These figures are comparable with the results in the comparison group (p > 0.05). All donors have returned to normal life.Conclusions. Overall results of this study were similar to those of the foreign colleagues which confirm the high safety of liver resection surgery and the efficacy of SF-36 questionnaire in the assessment of quality of life of the living-related liver fragment donors.

Introduction. Liver transplantation is a multi-component and complex type of operative treatment. Patients undergoing such a treatment sometimes are getting various complications. One of these complications is a portal hypertension associated with portal vein stenosis.Materials and methods. In 6 years after the left lateral section transplantation from living donor in a pediatric patient the signs of portal hypertension were observed. Stenosis of the portal vein was revealed. Due to this fact percutaneous transhepatic correction of portal vein stenosis was performed.Results. As a result of the correction of portal blood flow in the patient a positive trend was noted. According to the laboratory and instrumental methods of examination the graft had a normal function, portal blood flow was adequate. In order to control the stent patency Doppler ultrasound and MSCT of the abdominal cavity with intravenous bolus contrasting were performed. Due to these examinations the stent function was good, the rate of blood flow in the portal vein due to Doppler data has reached 80 cm/sec, and a decrease of the spleen size was noted.Conclusion. Diagnosis and timely detection of portal vein stenosis in patients after liver transplantation are very important for the preservation of graft function and for the prevention of portal hypertension. In order to do that, ultrasound Doppler fluorimetry examination needs to be performed to each patient after liver transplantation. In cases of violation of the blood flow in the portal vein CT angiography performance is needed. Percutaneous transhepatic stenting of portal vein is a minimally invasive and highly effective method of correction of portal hypertension. Antiplatelet therapy and platelet aggregation control are the prerequisites for successful stent function.

The study of quality of life of living organ donors in transplantation by questionnaires has increasingly become the subject of clinical studies. However, there are no unified criteria and standard norms of quality of life. Each questionnaire has its own criteria and evaluation scale. This review presents the main general questionnaires that have been applied worldwide for the quality of life assessment of living kidney and liver donors. Special questionnaires used to refine the parameters of quality of life and their coordination with common questionnaires are considered. Optimal questionnaire to detect quality of life in modern research for living organ donors is identified.

In most cases, severe left ventricular systolic dysfunction is a consequence of ischemic heart disease. In clinical condition, current recommendations support myocardial revascularization in patients with ischemic cardiomyopathy by performing coronary artery bypass grafting. Information on safety and effectiveness of percutaneous coronary intervention in patients with ischemic heart failure is limited. The aim of this review is to study the current state of this problem.