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Situs inversus is a rare congenital abnormality that affects approximately 0.005% of all live births. Traditionally, this condition is considered as a contraindication for liver donation, primarily due to the peculiarities of the vascular anatomy and the diffi culties in graft placement in the abdominal cavity. Review of the world literature testifi es to fi ve cases of use of the whole liver from deceased donor with situs inversus in adult recipients, and to just one case of inverted right lobe transplantation from living donor to 53-year-old man. Thus, transplantation of an inverted left liver lobe from a living related donor in pediatric patients was performed for the fi rst time. The article presents a successful experience of liver transplantation in child with tyrosinemia type 1 from AB0-incompatible living donor with situs inversus.

Background. Quality of life (QoL) is an important criterion for the treatment effi cacy that provides an important data regarding patient’s personal estimation of social adaptation and ability to perform daily duties.Methods. The study was aimed to evaluate QoL in cardiac transplant recipients. We have enrolled 42 stage D heart failure patients aged 29–61 (mean 39,23 ± 12,31 y/o), 38 males and 4 females, survived cardiac transplant surgery between Jan 2008 and Jan 2013. QoL was evaluated using the SF-36 survey prior to the heart surgery and during the follow-up period up to the 5 years.Results. Pre-operative assessment revealed low QoL indices of physical activity as well as general health status. Follow-up showed dramatic improvement in all QoL measures during 1 year after the surgery which was consistent through the whole observation period. There was an increase in physical functioning index by 2,8 times (p < 0,01), physical status dependent role functioning by 14 times (р

Transforming growth factor β1 (TGF-β1) plays a key role in the development of the immune response, as well as in the process of liver regeneration. Measuring the level of TGF-β1 may have important clinical implications in liver transplantation, because cytokine concentration in the tissue and in blood plasma varies with different liver diseases. Aim. To analyze the dynamics of TGF-β1 levels in children-recipients with liver transplant from related donors, including from incompatible blood groups.Materials and methods. The study involved 127 children aged 3 to 72 months (median – 8, average age – 12 ± 14 months), including 57 boys and 70 girls, with liver cirrhosis, developed as the result of congenital and hereditary diseases of the hepatobiliary system. All patients underwent transplantation of the left lateral liver sector from living related donors: 98 patients were transplantedfragment of a liver from identical or AB0-compatible donors and 29 – from incompatible donors. The concentration of TGF-β1 was determined by enzyme immunoassay method in blood plasma samples.Results. Average level of TGF-β1 in blood plasma of children with liver cirrhosis, developed as the result of congenital and hereditary diseases of the hepatobiliary system was 5,2 ± 5,5 ng/ml. A month after liver transplantation from a related donor level of TGF-β1 in blood plasma of recipients increased to 8,1 ± 9,6 ng/ml. One year after transplantation, the average level of TGF-β1 in the recipients of liver fragment was 7,7 ± 8,4 ng/ml, and signifi cantly (p = 0,00) differed from the level prior to transplantation. No association between TGF-β1 level in a month and a year after transplantation and the compatibility of the recipient with AB0 donor was found. A correlation (r = –0,23, p < 0,05) between level of TGF-β1 prior to transplantation and the development of graft dysfunction was observed: in recipients with graft dysfunction (16 cases) cytokine level prior to surgery was lower (p = 0,047) than in other recipients.Conclusion. Liver transplantation leads to a signifi cant increase in the level of TGF-β1 in the blood plasma of children and that level is not different in recipients after transplantation of a liver fragment from AB0-compatible and AB0-incompatible donors and in recipients with anti-group antibodies before and/or after transplantation, and without them.

It is shown that developed method of titrating AB0 antibodies allows defi ning the titer of the investigational antibodies more precisely on 1–3 dilution of serum compared to the prototype method (titration method of antibodiesin saline medium on the plane). It is more obvious as it excludes hardly interpretable results due to the possibility of conducting visual assessment of agglutination reaction in the gel card thick column and requires less time foranalysis. The results can be saved for comparison with the results of further research. That is not possible under prototype titration method. Aim: our aim is to create a laboratory technique that can accurately, reliably and clearly produce titration of AB0 system antibodies, including in patients with low initial concentration of agglutinins in the blood; a technique more economical in terms of spending serum and that takes less time.Materials and methods: those modes were empirically chosen which allow titration of AB0 system agglutinins using gel technology based micro typing; to titer group antibodies 1640 serum assays of recipients in AB0-incompatibletransplantation were analyzed.The result of the use of specially developed method in organ transplantation from incompatible blood donors consists in enhancing accuracy, sensitivity of natural, complete and incomplete AB0 system immune antibodies titration, in its clarity, using of blood micro-doses for earlier detection of sensitizing of the patient, which is especially important in Pediatrics. Conclusion: the developed procedure of AB0-antibodies’ titration using modern gel technology makes possible a more precise monitoring of the titer of antibodies that is necessary to predict the graft rejection risk, to select the Protocol of preoperative preparation and postoperative management of patients, to assess the effectiveness of therapy in patients for whom it is diffi cult to fi nd a compatible blood type donor, and for whom today AB0-incompatible transplantation is a life-saving.

Aim of the study was to evaluate patient and graft survival after liver transplantation (LT) and to determine if primary disease diagnosis, early graft dysfunction or other factors affect it. Furthermore, we analyzed the reasonsof short-term and long-term deaths or retransplantations.Materials and methods. 192 LTs from donors with brain death were performed from December 2004 until June 2014. Recipient age varied from 5 to 71 years. Most frequent diagnosis was liver cirrhosis (mainly due to hepatitis C), then hepatocellular carcinoma (HCC), liver graft dysfunction, etc.Results and discussion. 1-year patient survival is 89.5%, graft survival is 87.7%, 3-year –87% and 84.6%, respectively, and 5-year – 83.5% and 83.0%, respectively. Early mortality (in fi rst 30 days after transplantation) was 8%, long-term mortality – 5.9%. Primary non-function graft (PNF) was the reason of 66.7% early deaths. In the long term, infections and oncology were the reasons of death with the same frequency – 36.4%. Early graft dysfunction including primary non-function signifi cantly decreases short term survival (p = 0.0002). Nevertheless, in the majority of cases graft function improves and doesn’t affect survival. Donor factors play role in outcomes: early dysfunction is higher (40.6%) in extended criteria donor group than in standard donor group (р = 0.0431). PNF has the same trend – 8.5% and 0.0%, respectively, but without signifi cance (р =0.0835). 5-year survival is remarkably lower in HCC group 40.8% (p = 0.003) than in other groups.Conclusion: survival after liver transplantation in our Center is comparable with the results of the world’s centers.

Aim. To estimate opportunities, prospects and safety of using heart transplants from aged donors who are at high risk of coronary atherosclerosis.Materials and methods. Over the period from March 1987 to May 2014450 heart transplantations (HTx) were performed in V.I.Shumakov Federal Research Center of Transplantology and Artifi cial Organs. During the fi rst month after HTx coronarography was made to 152 (37,8%) recipients inorder to exclude/confi rm donor-transmitted coronary atherosclerosis (DTCA) and to identify tactics of treatment. Coronary atherosclerosis was detected among 16 patients (3,6% of total number of HTx), 15 (93,8%) men and 1 (6,2%) women. Mean age of recipients with DTCA at the moment of HTx was 48,3 ± 13,1 years.Results. Hemodynamically relevant coronary atherosclerosis was not detected and percutaneous coronary intervention (PCI) was not made in the group of patients with the mean age of 42,24 ± 8,91 years. Using heart transplants from aged donors is connected with increasing risk of DTCA among the recipients. DTCA-dependent PCI is not connected with coronary mortality. Actuarial survival rate of patients who underwent PCI is comparable with the same one in the total population of HTx recipients and is equal to 87,5% at 5 years and less.Conclusion. Hearts from aged donors (older than 50 years) may be used for HTx with suffi cient level of safety. Due to high level of DTCA using of hearts from such donors is preferable for completing urgent HTx to recipients 1А–В UNOS.

The analysis of clinical outcomes of cardiac transplantation is presented. The main directions of research on the development and implementation of methods for early diagnosis of adverse events and treatment of patients with heart transplant in V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation are given. Among the non-invasive methods of forecasting, assessment of the risk of cardiovascular complications in heart recipients being developed are: analysis of laboratory biomarkers involved in the formation of relationship of the graft and the recipient; ultrasound diagnosis of functional and structural remodeling of peripheral arteries. The issues of improving drug therapy are discussed. The importance of multidisciplinary approach, continuity in management of the patients with heart transplant is emphasized.

Introduction. Over the past few decades in Russia and other countries there has been signifi cant progress in the development of liver transplantation in children. It became possible to operate recipients with very low body mass, to perform transplant from cadaveric and living donors with incompatible blood type, as well as to perform single-step transplantation of liver with kidney or pancreas in patients with combined diseases.Aim: to investigate the 6-year experience of liver transplantation in children in V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs.Materials and methods. From May 2008 to June 2014 304 liver transplantswere performed in 297 children aged from 3 months to 17 years with body mass 4 to 32 kg. 241 living donor liver left lateral section transplants (including 2 in conjunction with kidney), 8 left lobe (including 1 in conjunction with kidney), 40 right lobe liver transplants (including 1 in conjunction with kidney), and 9 cadaveric whole liver transplants (including 1 case of simultaneous liver and pancreas transplantation) and 6 split liver transplants (4 – split left lateral section transplantations and 2 extended right lobe liver grafts) were achieved.41 of these patients received a graft from AB0 – incompatible donors.Results. A retrospective evaluation of surgical technique and analysis of results were carried out. Early mortality was 8.1%, 1-year survival rate – 86.4%, 5-year survival rate – 78.8%.Conclusion. These results suggest the prospects of this procedure for pediatrictransplantation and require further investigation and promotion approaches in medical and social public.

Aim. To analyze approaches to pretransplant treatment of potential heart recipients and heart donation criteria, directed to reduction of mortality on a waiting list and to increase of volume and effi ciency of heart transplantations.Methods and results. Data on 285 HT recipients (performed in 2008–2013) were analyzed. The analysis and comparison of patients with circulatory support before heart transplantation, using «high-risk» donors (aged over 40 years, with left ventricular hypertrophy ≥ 1.5 cm, after cardiopulmonary resuscitation, with the reduced systolic function of the left ventricle (< 40%), with potentially repair pathology of the heart valve and coronary arteries); to high risk recipients (over 60 years, with high pulmonary hypertension and earlier operated) were made.Conclusion. The proposed scientifi c, technological and organizational solutions made possible the timely performance of heart transplantation to patients with an inevitable lethal outcome as a result of heart failure.

Aim: Clinical case of successful two-stage surgical treatment of a 1-year-old child with congenital heart disease and biliary cirrhosis is represented in this article. At the first day of life laparotomy was performed because of high intestinal obstruction. Kasai procedure and Roux-en-Y choledochojejunostomy were per- formed on 12th day and at the end of second month of life, respectively. Liver biopsy showed the signs of biliary cirrhosis. At the same time ventricular septal defect and atrial septal defect with pulmonary hyper- tension were diagnosed. The first step of treatment was the surgical septal defects closure. No complications during procedure, cardiopulmonary bypass and post-operative period were registered. There were no nega- tive effects on liver function after cardiac surgery. 11 months later living-donor liver transplantation was performed without any complications. Patient was discharged at 35th post-transplant day with stable graft function.

Aim of the work. Сlinical and morphological research of the features of biliary atresia at children-recipients of liver, to whom a portoenterostomy was made in comparison with patients to whom such surgery wasn't carried out. Materials and methods. Clinical records and histological research of liver of 49 children suffering a bili- ary atresia are analyzed. Two groups were created: the 1st group – 21 children without portoenterostomy before liver transplantation and 2nd group – 28 children with portoenterostomy before liver transplantation. Results. Pathomorphology of liver the characteristics in structure of proliferation bile ducts are established: hypostasis and dystrophic changes of cholangiocytes at patients of the first group (p = 0,035) and sclerosis of bile ducts with disappearance of an epithelium at patients of the second group (p = 0,01). In first group of children activity of inflammatory process in liver were significantly higher than in second group (p = 0,02). Conclusion. Our experi- ence has demonstrated that portoenterostomy doesn’t prevent fibrosis of intrahepatic bile ducts and development of fibrosis, and then a development of cirrhosis.

Aim: to calculate number of the centers of transplantation according to real requirement of the population and a donor resource, to prove their geography and the nomenclature, providing with donor organs. Methods and results. The analysis and comparison of statistical data on population, number of the centers of transplantation, their transplant activity in Russia and abroad are made. Calculation of number of the centers of transplantation is carried out and justification of their geography is offered. The analysis of statistical data on hospitals in the Russia is made, calculation of a rational number of donor hospitals according to need for a donor resource is carried out. Justification of transplant coordination in territorial subjects of the Russia, in federal districts is offered. Justification of the nomenclature of the centers of transplantation and donor hospitals is offered.Conclusion. Settlement data on a rational number of the centers of transplantation, their geography and the nomenclature, providing with the donor organs, suitable developments for planning of the hi-tech medical care in territorial subjects of the Russia are obtained.

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Aim. To compare the effectiveness of MSC with different degree of ontogenetic maturity (MSC bone marrow – MSC BM and MSC umbilical cord – MSC UC) on regenerative processes in injured liver. Methods. In 4 groups of experiments on Wistar rats (n = 80) with a model of fibrotic toxic liver damage (FLD) it was studied the effect of MSCs with different degree of ontogenetic maturity on recovery processes at the regeneration of damaged liver: 1 gr. – Control, 2 gr. and 3 gr. introduction of MSC BM, included in Sphero®GEL-long in doses of 2.5 ×106 and 5.0 x 106 cells, respectively, and 4 gr. – introduction of MSC UC in the form of cell-spheroids (8–10 × 105 cells). The cells were injected into the damaged liver in 7 days after the end of FDL-modeling. The effect of cell therapy was studied during 180 days. The effectiveness of corrective therapy was evaluated by the results of functional and morphological investigations of livers (histological control of parenchymal and nonparenchy- mal liver tissue). Results. MSC BM in both doses and MSC UC contributed to a more rapid normalization of liver enzyme indices compared with the control (1 gr.), but the differences in the rate of recovery of disturbed enzymatic liver functions between groups 2, 3 and 4 – were absent. In 90 days after the cell application it was determined a more pronounced recovery activity of cells in groups 3 and 4; in 180 days the more pronounced activation of recovery processes was observed in group 3; but in group 4 the sclerotic processes were more pro- nounced in this period. Conclusion. For the induction of recovery processes in damage liver it is advisable not to use the MSC UC, but to use MSC BM in the Sphero®GEL, because MSC BM exert not only local but also systemic immune-regulatory effect, increasing the pool of T-reg. cells, which are additional carriers of regenera- tion information in organism.

The paper describes the first clinical experience in RF of successful application of domestic circulatory support device based on implantable axial pump for two stage heart transplantation. This case demonstrate the effec- tiveness and safety of our device (АВК-Н) for a longtime (270 days) left ventricular bypass and the ability to perform a successful transplantation of donor,s heart after application of this system.

Aim. To estimate the requirement of the population of the Russian Federation for an organ transplantation and donor resource, to offer approach to planning of an effective network of the medical organizations (the centers of transplantation). Materials and methods. The analysis and comparison of statistical data on population, number of the patients receiving a dialysis, data about medical care on an organ transplantation in Russia and foreign countries is made. Results. On the basis of what the assessment of requirement of the population of the Russian Federation in an organ transplantation and donor resource is carried out, approach to planning of an effective network of the medical organizations (the centers of transplantation) and scenarios of development of organ do- nation and transplantation in Russia is offered. Conclusion. To provide the population of the Russian Federation with medical care on an organ transplantation according to real requirement and donor resource, in each region of the Russian Federation have to be organized deceased organ donation and transplantation of a cadaveric kidney. But the transplantation of extrarenal organs is better to develop in the federal centers of hi-tech medical care with donor providing from territories of adjacent regions.

Monitoring of a condition and prospects of organ donation and transplantation development in Russia in the form of the National Registry is carried out under the auspices of the Profile commission on transplantology of Minis- try of Health of Russia and the Russian Transplant Society. According to the registry in 2012 the indicator of do- nor activity decreased, but the indicator of transplant activity remained at the level of the last years. Decrease the number of deceased donors managed to be compensated by means of increase of efficiency of donor programs: by increase of the number of donors after brain death and multi-organ explantation, by increase in average of the organs received from one deceased donor. In 2012 the number of transplantations of heart and liver increased. The main funding mechanism for organs transplantation in Russia is the state task to the transplant centers (fede- ral financing), its role increases. For increase of stability of donor providing it is necessary to continue to develop legal base in the organ donation and transplantation sphere.

Aim is to develop a method for a prolonged support of recovery processes in damaged liver. Materials and me- thods. It was carried out 3 groups of experiments on Wistar rats with the modeling of chronic fibrotic liver injury (n = 70): I group control (n = 20); in the II group (n = 20) a suspension of liver cells was transplanted into liver; in the III group (n = 30) cell-engineering designs (CED), which contained liver cells and BM MMSC, enclosed in a heterogeneous biodegradable gel “Sphero®GEL-long” were transplanted into damaged liver. The activity of recovery processes was evaluated by using biochemical and morphological methods in dynamics on 30, 60, 90 and 180 days. Results. It was shown that in the II and III gr. significantly accelerated the recovery processes in damaged livers compared with the I gr. The normalization of biochemical parameters took place in II and III du- ring 30 days instead of 90 days in the I group. However, the normalization of morphological signs of hepatocytes theirs viability and a degree of defibrotic changes in liver were more pronounced and prolonged in the III group. A study showed integration of CED by liver structures with formation of new bile ducts after 90 and 180 days. Conclusion. Higher levels and prolonged periods of recovery processes in damaged liver after CED transplanta- tion were due to the creation of biologically appropriate conditions for prolonged cell activity, included in their structure (donor liver cells and BM MMSC).

Aim. To study the clinica-morphological features of syndromatic and nonsyndromatic paucity of intrahepatic bile ducts in pediatric liver transplant recipients. Methods and results. The clinical records were analyzed and histological studies of native livers of 20 children, who had suffered from paucity of intrahepatic bile ducts and to whom liver transplantation were made, were completed. The obtained data indicate higher levels of AST in patients with nonsyndromatic paucity of intrahepaticbile ducts (p = 0,023). Ductopenia was the more frequent indication of syndromatic form of paucity of intrahepatic bile ducts (p = 0,01), while ductular proliferations, which form «ductular structure», were discovered more often in nonsyndromatic paucity of intrahepaticbile ducts (p = 0,03). The extent of inflammatory-destructive changes was more expressed in nonsyndromatic pauci- ty of intrahepatic bile ducts (p = 0,01). Fibrosis or cirrhosis was formed more often in nonsyndromatic paucity of intrahepatic bile ducts (p = 0,008). Conclusion. Our results indicate more severe clinical and morphological manifestations in nonsyndromatic paucity of intrahepatic bile ducts. These findings may suggest about heavier liver condition in patient with nonsyndromatic form of paucity of intrahepatic bile ducts.

Aim of study. The demonstration of our own experience in heart transplantation after valve reconstruction. Methods and results. From May 2012 to March 2013 3 mitral valve annuloplasties were performed to recipi- ents, requiring urgent HT and having extremely unfavorable prognosis of survival without HT. The recipients were classified as United Network for Organ Sharing (UNOS) IB, and all of them were on inotropic support. In one case, HT was performed after reconstruction of rheumatic mitral stenosis, in two other cases – after dege- nerative mitral regurgitation. The technical aspects are reviewed of ex-vivo mitral and tricuspid valves repair with concomitant heart transplantation. All patients were discharged from the hospital having excellent postope- rative recovery. Conclusion. Taking into consideration the demonstrated satisfactory result of surveillance and presence of significant experience in performing of reconstructive valve surgery among no-HT cardiosurgical patients, an increase in the pool of suitable donor organs is expected due to the liberalization of the selection criteria and the possibility of the innovative valve reconstruction procedures ex vivo.

Glycogen storage diseases I, III and IV types are congenital disorders, which are commonly associated with severe liver diseases. Liver transplantation has been proposed as a treatment of choise for these disorders. While liver transplantation corrects the primary hepatic enzyme defect, the extrahepatic manifestations of glycogenoses often complicate the posttransplant management. Upon review of the English-language literature, 42 children under 18 years old were discovered to have undergone liver transplantation for complications associated with glycogenoses (18 patients with Ia type, 6 – with Ib type, one patient – with III type, 17 – with IV type). This artic- le represents the pediatric liver transplantation for complications associated with glycogenosis Ia type, analyzed posttransplant period in this recipient.

Chronic rejection, especially cardiac allograft vasculopathy, is a major limiting factor for long-term transplant survival. This process affects not only the blood vessels, but also cardiomyocytes. However, there are extremely few reports on the evaluation of their macromolecular structure state. The aim of the study was to evaluate the structural proteins of cardiomyocytes (actin, myosin, troponin I, titin, desmin, vinculin) of heart allografts in different periods after the operation (from 6 days to 15 years). Major changes of macromolecular structure were revealed in late period after transplantation (6 months – 15 years). The contribution of humoral immune response in the process of chronic cardiac allograft rejection was observed: in eight of twelve recipients episodes of acute humoral rejection had been repeatedly registered; disorders of the expression of 5 proteins out of 6 characterized were found in recipients with recurrent and persistent antibody-mediated rejection.

The research plasma levels of homocysteine (Hcy) in 99 children with congenital and hereditary diseases of hepatobiliary system was performed before liver transplantation. 27% of patients had hyperhomocysteinemia. There was correlation between Hcy levels and sCD40L. High (≥5.1 μmol/L) pretransplant concentration of Hcy is one of the negative factors that affect function of the liver graft in the early post-transplant period.

Registry data analysis shows stabilization of indicators of donor and transplant activity in 2011 after continuous growth within five years, increase in a share of effective donors after brain death and multi-organ explantation, development of thoracic organs transplantation and living related donor kidney transplantation. In the conditions of decentralization of organ donation and transplant programs it is necessary to develop coope- ration between transplant centers and to expand the practice of an interregional exchange of donor organs. The federal law «About bases of health protection of citizens in the Russian Federation», accepted in 2011, creates a legal basis for development and acceptance of the new legislation in the sphere of organ donation and transplantation.

End stage liver disease is often associated with growth retardation in children with congenital and hereditary diseases of hepatobiliary system. The aim was to investigate the serum growth hormone level before and after liver transplantation in 52 children with congenital and hereditary diseases of hepatobiliary system. Data of our research work revealed increased serum level of growth hormone in children with liver cirrhosis (3,32 ± 7,7 ng/ml vs. 1,16 ± 1,46 ng/ml in healthy children, p = 0,01), which correlates with PELD score (r = 0,62, p < 0,001). In a month after liver transplantation growth hormone concentration decreases (p < 0,001) and in a year after transplantation it doesn’t differ from healthy children. There wasn’t revealed any interaction between serum growth hormone level and anthropometric parameters before liver transplantation, but in a year after there was significant correlation between growth hormone concentration and height (r = 0,79, p = 0,01). Investigation of growth hormone level in children with liver cirrhosis and its evolution after liver transplantation is of interest as objective criterion of recovery of physical development regulation and as an additional parameter, which cor- relates with severity of end-stage liver disease.

Biliary atresia is an inflammatory fibrosing process, which invades both extrahepatic and intrahepatic bile ducts. There are two forms of biliary atresia: embryonic form, associated with another visceral malformations, and perinatal form, which is an isolated disease. Biliary atresia is a heterogeinc disease which may appear as a result of different etiological factors, the most important of them are genetics, viral infection, vascular factors, toxins and disregulation of immune system. The characteristic morphological features of biliaryatresia are: intracellular and ductular cholestasis, ductular proliferation, giant cell transformation, portal and perilobular oedema and/or fibrosis. As the patalogical process progresses, ductopenia appears, and fibrosis turns to cirrhosis. Embryonic form mophologically manifests with ductal plate malformation is, what is an important diagnostic criterion. Pro- gnosis of biliary atresia depends on form of disease, age of patient and type of surgical operation. Today surgical treatment includes two steps: palliative portoenterostomia, performed in neonatal period and further liver trans- plantation. However liver transplantation is more preferable as first and single-step treatment.

The article presents analysis of scientific literature of the last 20 years about medicamental immunosupression in early age pediatric liver recipients in view of immune response characteristics and immunosuppressive drugs pharmacokinetics in such patients. The modern concept of immunosuppressive therapy protocol choice in pedia- tric liver recipients depending on complications development (nephrotoxicity, arterial hypertension and neuroto- xicity, the high risk of infectious complications, post-transplant proliferative disorders, metabolic and cosmetic side effects) is presented. Different opportunities of early steroid withdrawal, calcineurin inhibitor minimization in pediatric liver allograft recipients are covered.

We studied 11 cases of HBV-infection de novo in patients after orthotopic liver transplantation performed because of non-viral cirrhosis. Serum НBeAg, was revedled in all patients. In most cases clinical course of HBV-infection was benign. Treatment with entecavir was more effective than lamivudin, and brought to НBsAg elimination in 4 patients. Treatment with lamivudin led to descrease viral load in all patients and HBsAg elimination in one case.

In a review of the comparative analysis of methods and tools for long-term mechanical circulatory support with continuous flow and pulsatile flow implantable pumps. Particular attention is paid to the choice of the optimal modes of the operation of pumps based on the physical principles of the interaction between a the steady flow of blood to the pulsatile mechanics of the heart chambers.

The aim of the study was to evaluate plasma levels of sCD40L in children before and after living donor liver transplantation (LDLT) and its prognostic value with postoperative course. The study included 67 children with end-stage liver disease (ESLD), aged from 4 to 36 months before and after LDLT, 25 healthy children aged from 7 to 24 months and 38 adult living-related liver donors, aged from 18 to 56 years. In children with ESLD pre-transplant plasma level of sCD40L (3.3 ± 2.2 ng/ml) did not differ in children with and without liver disease but were significantly higher in patients with end-stage liver disease than in donors (4.1 ± 2.3 ng/ml and 1.07 ± 1.1 ng/ml, resp., p < 0.01). Graft dysfunction frequency was significantly higher in recipients with high sCD40L level (≥3.3 ng/ml). A mea- surement of pre-transplant sCD40L concentrations might be useful to identify patients with ESLD at high risk for graft dysfunction development.

Assessing the condition of the structural proteins of cardiomyocytes in patients with various forms of cardiomyo- pathy (49 samples) revealed changes characteristic for dilated cardiomyopathy, as well as common disorders of the molecular structure, developing, regardless of the etiology of the disease.

We report the first Russian experience of successful ABO-incompatible kidney transplantation using anti-CD20 + IA + IvIg pretransplant conditioning protocol and tacrolimus + MMF + steroids as maintenance immunosuppression. IA procedures were performed on reusable columns ABO-Adsopak® (POCARD Ltd. Moscow, Russia). IA treatments following the administration of rituximab efficiently lowered the immunoglobulin M (IgM) and G (IgG) anti-A/B antibodies titers in all patients. The transplantation could be performed in all cases and the kidneys showed primary function. Unfortunately, the biopsy-proven clinical antibody-mediated rejection (AMR) occurred in one case. Episo- de of AMR was successfully reversed. On 6, 4 and 2 months follow-up, serum creatinine levels were 117, 127 and 87 μmol/l, respectively. We consider ABO-incompatible transplantation as a safe and promising procedure in particu- lar cases for those patients having related but ABO-incompatible donors. Given the shortage of donor organs ABO- incompatible living donor kidney transplantation may become a treatment of choice for many patients.

Soluble CD30 (sCD30) is a marker of T-lymphocytes activation and is used for monitoring rejection in patients after heart, lung and renal transplantation. The aim of the study was to evaluate plasma levels of sCD30 in child- ren before and after living-donor liver transplantation (LDLT) and its relationship with the postoperative course. The study included 72 children with end-stage liver disease (ESLD), aged 17 ± 11 (4–28) months before and after LDLT, 15 healthy children aged 9.9 ± 5.7 (3–21) months and 38 adult living-related liver donors, aged 37 ± 19 (18–56) years. In children with ESLD pre-transplant plasma level of sCD30 (84,9 ± 43,8 ng/ml) was significantly higher than in healthy donors and healthy children (26.4 ± 12.0 and 32.6 ± 6.9 ng/ml, resp., p < 0.01). After LDLT plasma level of sCD30 was higher in children, who had graft dysfunction at days 28–32 (108.9 ± 17.7 ng/ml) after LDLT than in children who had no graft dysfunction (40.2 ± 5.3 ng/ml, р < 0.01). In patients with graft dysfunction elevation of sCD30 concentration was observed before 2–5 days increasing of liver enzyme activity. The measurement of sCD30 concentration may be useful for monitoring of the postoperative course.

Number of CD34/CD45+ cells were determined in blood of pediatric recipients and adult living-related liver do- nors. It has been investigated 15 pairs of recipients (aged from 4 to 60 months) and donors (29 ± 5 years). All the children had liver cirrhosis caused by congenital and inherited diseases of hepatobiliary system. Concentration of CD34/CD45+ cells in venous blood of recipients was higher than in donors. In recipients level of CD34/CD45+ cells did not correlate with sex, age, weight and height but did correlate with some biochemical parameters related to liver function. After liver transplantation number of CD34/CD45+ cells did not change in peripheral blood of recipients. In donors partial liver resection did not cause statistically significant changes in number or concentration of CD34/CD45+ cells in blood. Presented data suggests that neither liver transplantation nor liver resection has remarkable influence on number of CD34/CD45 + cells in peripheral blood.

The aim of this study was to evaluate our experience on laparoscopic living donor nephrectomy (LDN). During the last 1,5 years we have gradually expanded the use of minimally invasive LDN with various techniques: strictly laparoscopic and hand-assisted laparoscopic. This comparative study is based on 250 conventional open LDN and 61 laparoscopic LDN. Minimally invasive hand-assisted technique was shown to be associated with a significantly lower risk of major complications and intraoperative incidents, as well as reduced warm ische- mia and operative time. There was no negative impact on recipient’s results. In our opinion, the introduction of hand-assisted technique is probably the most significant single factor for improved results, although accumulated experience and developments in equipment will contribute. Improvements in surgical outcomes following donor nephrectomy may enhance living donor programmes.

It was examined a new method for correction of hepatic failure by transplantation of liver support biounit (liver cells, immobilized on biocompatible and biodegradable 3D-matrixes ElastoPOB®) into small intestine mesentery. It was determined that after modeling of acute hepatic failure on dogs by 65–70% liver resection) and transplantation liver support biounit the restoration of disturbed biochemical indecies (such as total protein, lactate, cytolytic ensymes-ALT, AST, ALP, LDH, fibrinogen, protrombine index and others) took place more rapidly on 9–14th day instead of 18th day in control. It was made a preposition about efficiency of the suggested method for correction both acute hepatic failure because even 90 days after transplantation of liver support biounit alive hepatocytes and neogenic plethoric vessels, growing through matrix were revealed.

The review presents the data on the results of recovery the myocardial function in patients with end-stage chro- nic heart failure and prolonged using of the systems assist device. The most effective treatment of the chronic heart failure was received by the combination of the left ventricular bypass and the medical therapy aimed at normalizing the cellular, structural and functional characteristics of the myocardium («reverse remodeling»). An important step in restoring the myocardium to explantation pump is to create the conditions for the «physiologic hypertrophy» of the heart. The application of this technology will open the way for the treatment of patients with dilated cardiomyopathy, alternative heart transplantation.

The article presents the third report of the Registry of Russian transplant society, taking into account donor and transplant activity in the Russian Federation in 2006–2010. Data analysis proves clear positive trends during the last 5 years. The further progress is possible through the creation and modernization of regional donor infra- structures whose activities should be aimed at increasing of the number of donor hospitals and its rational use by expansion of brain death verification and performance of multiorgan procurement.

Since 2008 up to 2010 eight ABO-incompatible liver transplantations have been performed in our center: one of them was urgent liver transplantation to adult patient from deceased donor, other seven were transplantations of left lateral segment to children from living relative donors. Own experience, as well as world one, proves, that barrier of ABO-incompatibility can be overcome more successfully in liver transplantation, particularly in pediatric population, that in other solid organs transplantation. Good results can be achieved even with less ag- gressive immunosuppressive therapy. Recipient conditioning before operation can significantly improve results of ABO-incompatible liver transplantation, but as own experience has shown, often there’s no need to hold some special preparation of children, because their anti-ABO antibodies are very low or absent before transplantation and do not increase after it. Thereby ABO-incompatible liver transplantation is reasonable in urgent cases and in pediatric population because of the limited pull of living relative donors for children.

We performed histological examination of 80 liver allograft biopsies, the diagnosis of acute rejection was proved in 34 cases. Histological changes in liver biopsies in different grades of acute rejection were estimated according to Banff classification 1995, 1997 and were compared with current literature data. The article deals with the question of morphological value of grading acute rejection on early and late, also we analyze changes in treat- ment tactics after morphological verification of liver allograft acute rejection.

Neopterin (NP) is a marker of macrophages activation and is used for monitoring rejection in patients after heart, renal transplantation. The aim of the study was to evaluate plasma levels of NP in children before and after living-donor liver transplantation (LDLT) and its relationship with the postoperative course. The study included 72 children with end-stage liver disease (ESLD), aged 17 ± 11 (4–28) months before and after LDLT, 15 healthy children aged 9.9 ± 5.7 (3–21) months and 38 adult living-related liver donors, aged 37 ± 19 (18–56) years. In children with ESLD pre-transplant plasma levels of NP (25.2 ± 19.9 nmol/l) was significantly higher than in healthy donors or healthy children (5.5 ± 3.4 and 6.3 ± 2.7 nmol/l, resp., p < 0.01). After LDLT plasma level of NP was higher in children, who had graft dysfunction at days 28–32 (61.9 ± 30.9 nmol/l) after LDLT than in children who had no graft dysfunction (24.0 ± 5.6 nmol/l). The measurement of NP concentrations may be useful for monitoring of the postoperative course.

The aim of our work is to develop diagnostic criteria of liver ischemic injury according to needle biopsies of liver allograft using light microscopy. We studied 45 zero liver biopsies from cadaver donors with diagnosed brain death and 16 needle biopsies of liver allograft from 12 recipients 1 hour up to 1 month after operation. Grading to three stages of ischemic injury in liver allograft is based on clinical and morphological criteria. Ischemic injury of liver allograft is an acute alterative-inflammatory process i.e. there are hepatocyte degeneration and necrosis with following inflammation (exudation with edema, hemorrhage, neutrophil infiltration). In case of favorable outcome ischemic injury of liver allograft is a reversible process.