Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-38-48
V. Poptsov, V. V. Slobodyanik, E. Spirina, N. V. Petukhov, A. K. Solodovnikova, V. Y. Voronkov, A. Dogonasheva, A. Skokova
Federation In certain categories of patients with end-stage heart failure (HF), short-term mechanical circulatory support (MSC) is successfully used as a mechanical «bridge» to heart transplantation (HTx). In predominantly left-ventricular (LV) dysfunction, the use of isolated coronary artery bypass, especially amidst high pulmonary hypertension (PH), seems to be a more physiological method of short-term MSC.Objective: to present the results of a series of clinical cases of the use of percutaneous left ventricular assist device (pLVAD) before HTx in potential recipients with predominantly LV dysfunction and concomitant high PH.Materials and methods. Three potential heart recipients with predominantly left-sided HF and high pre-transplant PH (pulmonary vascular resistance, PVR, 4.7–6.6 Wood units) who required MSC due to progression of hemodynamic disorders were included in the study. A standard venous extracorporeal membrane oxygenation (ECMO) cannula (26 F) was used for percutaneous left atrial-femoral artery (LA–FA) bypass. The cannula was passed from the transfemoral route through the interatrial septum into the left atrial cavity. A paracorporeal centrifugal pump provided blood injection through a standard arterial ECMO cannula (15 F).Results. pLVAD unloaded the left ventricle effectively (PCWP reduced from 27–32 to 15–20 mmHg), reduced pre-transplant PH (mean pulmonary artery pressure (mPAP) reduced from 45–53 to 28–33 mmHg) and improved systemic hemodynamics (cardiac index (CI) increased from 1.8–1.9 to 2.1–2.6 l/min/m2 and mean arterial pressure (mAP) from 56–59 to 70–75 mmHg). All these created the prerequisites for subsequent successful HTx. Against the background of pLVAD, transpulmonary pressure gradient (TPG) decreased from 15–25 to 13–15 mmHg, and PVR decreased from 4.7–6.6 to 2.7–3.4 Wood units. pLVAD flow rate was 2.9–3.8 L/min or 1.38–1.83 L/min/m2 at 4700–7100 rpm. pLVAD duration ranged from 4 (n = 1) to 7 (n = 2) days. All patients underwent successful HTx.Conclusion. pLVAD is a highly effective method of short-term MSC in potential recipients with predominantly LV dysfunction and concomitant high PH, leading to rapid regression of the dysfunction against the background of left ventricular unloading. This short-term MSC technique can be successfully realized using standard ECMO cannulas and centrifugal pumps of any modification, without requiring additional special equipment.
{"title":"Percutaneous left ventricular assist device as a short-term mechanical circulatory support before heart transplantation in patients with high pre-transplant pulmonary hypertension (series of clinical cases)","authors":"V. Poptsov, V. V. Slobodyanik, E. Spirina, N. V. Petukhov, A. K. Solodovnikova, V. Y. Voronkov, A. Dogonasheva, A. Skokova","doi":"10.15825/1995-1191-2023-2-38-48","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-38-48","url":null,"abstract":"Federation In certain categories of patients with end-stage heart failure (HF), short-term mechanical circulatory support (MSC) is successfully used as a mechanical «bridge» to heart transplantation (HTx). In predominantly left-ventricular (LV) dysfunction, the use of isolated coronary artery bypass, especially amidst high pulmonary hypertension (PH), seems to be a more physiological method of short-term MSC.Objective: to present the results of a series of clinical cases of the use of percutaneous left ventricular assist device (pLVAD) before HTx in potential recipients with predominantly LV dysfunction and concomitant high PH.Materials and methods. Three potential heart recipients with predominantly left-sided HF and high pre-transplant PH (pulmonary vascular resistance, PVR, 4.7–6.6 Wood units) who required MSC due to progression of hemodynamic disorders were included in the study. A standard venous extracorporeal membrane oxygenation (ECMO) cannula (26 F) was used for percutaneous left atrial-femoral artery (LA–FA) bypass. The cannula was passed from the transfemoral route through the interatrial septum into the left atrial cavity. A paracorporeal centrifugal pump provided blood injection through a standard arterial ECMO cannula (15 F).Results. pLVAD unloaded the left ventricle effectively (PCWP reduced from 27–32 to 15–20 mmHg), reduced pre-transplant PH (mean pulmonary artery pressure (mPAP) reduced from 45–53 to 28–33 mmHg) and improved systemic hemodynamics (cardiac index (CI) increased from 1.8–1.9 to 2.1–2.6 l/min/m2 and mean arterial pressure (mAP) from 56–59 to 70–75 mmHg). All these created the prerequisites for subsequent successful HTx. Against the background of pLVAD, transpulmonary pressure gradient (TPG) decreased from 15–25 to 13–15 mmHg, and PVR decreased from 4.7–6.6 to 2.7–3.4 Wood units. pLVAD flow rate was 2.9–3.8 L/min or 1.38–1.83 L/min/m2 at 4700–7100 rpm. pLVAD duration ranged from 4 (n = 1) to 7 (n = 2) days. All patients underwent successful HTx.Conclusion. pLVAD is a highly effective method of short-term MSC in potential recipients with predominantly LV dysfunction and concomitant high PH, leading to rapid regression of the dysfunction against the background of left ventricular unloading. This short-term MSC technique can be successfully realized using standard ECMO cannulas and centrifugal pumps of any modification, without requiring additional special equipment.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76930654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-63-81
D. V. Bulgin, A. L. Kovtun, I. Reshetov, E. Radomskaya
Three-dimensional (3D) printing is a method of creating a material object layer-by-layer in space from a virtual, mathematical model. 3D printing is based on additive technologies – a step-by-step formation of a structure by adding material to the base. 3D bioprinting is the fabrication of functional biological structures that mimic human organs and tissues. Analysis of scientific publications showed that in the near future, viable and fully functional artificial copies of individual human organs and tissues can be obtained.
{"title":"Prospects for fabrication of artificial human tissues and organs based on 3D bioprinting","authors":"D. V. Bulgin, A. L. Kovtun, I. Reshetov, E. Radomskaya","doi":"10.15825/1995-1191-2023-2-63-81","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-63-81","url":null,"abstract":"Three-dimensional (3D) printing is a method of creating a material object layer-by-layer in space from a virtual, mathematical model. 3D printing is based on additive technologies – a step-by-step formation of a structure by adding material to the base. 3D bioprinting is the fabrication of functional biological structures that mimic human organs and tissues. Analysis of scientific publications showed that in the near future, viable and fully functional artificial copies of individual human organs and tissues can be obtained.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85334961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-140-147
R. Kurabekova, O. Silina, O. Tsirulnikova, I. Pashkova, O. Gichkun, G. Olefirenko, S. Y. Oleshkevich, A. Monakhov, O. Shevchenko
Growth hormone (GH) plays a leading role in the regulation of cell and tissue metabolism and growth. Its effects are mediated through the so-called somatomedins, among which the most important is the liver-produced insulinlike growth factor 1 (IGF-1). It has been reported that serum GH levels in liver recipients is related to the clinical transplant outcomes.Objective: to evaluate the prognostic significance of GH in pediatric liver transplantation (LT).Materials and methods. The study enrolled 148 children (61 boys) aged 2 to 60 months (median, 8) with end-stage liver disease resulting from biliary atresia (n = 86), biliary hypoplasia (n = 14), Byler disease (n = 15), Alagille syndrome (n = 12), Caroli syndrome (n = 5), and other liver diseases (n = 16, cryptogenic cirrhosis, fulminant and autoimmune hepatitis, Crigler–Najjar and Budd–Chiari syndromes, alpha-1 antitrypsin deficiency, glycogenosis and hepatoblastoma). All the patients were transplanted with the left lateral segment of the liver from a living related donor. GH concentrations were measured by enzyme immunoassay before, at one month and at one year after transplantation.Results. Median plasma GH levels in children with liver disease were 4.3 [1.6–7.2] ng/mL, significantly higher than in healthy children of the same age at 1.2 [0.3–2.4] ng/mL, p = 0.001, while mean height and body weight were lower than in healthy controls. GH levels decreased significantly after transplantation. At one month and one year later, the levels did not differ from those of healthy children (p = 0.74, p = 0.67, respectively). One month after transplantation, GH concentrations were lower in 1-year survivors than in non-survivors (p = 0.02); the diagnostically significant threshold GH level was 1.8 ng/mL. Prior to LT, plasma GH levels did not differ between 1-year survivors and non-survivors. Children with GH levels below 1.8 ng/mL post-LT were 9 times more likely to survive one year post-transplant than patients with levels above the threshold.Conclusion. GH concentrations in pediatric liver recipients is a positive prognostic indicator of pediatric LT outcomes.
{"title":"Prognostic significance of growth hormone in pediatric liver transplantation","authors":"R. Kurabekova, O. Silina, O. Tsirulnikova, I. Pashkova, O. Gichkun, G. Olefirenko, S. Y. Oleshkevich, A. Monakhov, O. Shevchenko","doi":"10.15825/1995-1191-2023-2-140-147","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-140-147","url":null,"abstract":"Growth hormone (GH) plays a leading role in the regulation of cell and tissue metabolism and growth. Its effects are mediated through the so-called somatomedins, among which the most important is the liver-produced insulinlike growth factor 1 (IGF-1). It has been reported that serum GH levels in liver recipients is related to the clinical transplant outcomes.Objective: to evaluate the prognostic significance of GH in pediatric liver transplantation (LT).Materials and methods. The study enrolled 148 children (61 boys) aged 2 to 60 months (median, 8) with end-stage liver disease resulting from biliary atresia (n = 86), biliary hypoplasia (n = 14), Byler disease (n = 15), Alagille syndrome (n = 12), Caroli syndrome (n = 5), and other liver diseases (n = 16, cryptogenic cirrhosis, fulminant and autoimmune hepatitis, Crigler–Najjar and Budd–Chiari syndromes, alpha-1 antitrypsin deficiency, glycogenosis and hepatoblastoma). All the patients were transplanted with the left lateral segment of the liver from a living related donor. GH concentrations were measured by enzyme immunoassay before, at one month and at one year after transplantation.Results. Median plasma GH levels in children with liver disease were 4.3 [1.6–7.2] ng/mL, significantly higher than in healthy children of the same age at 1.2 [0.3–2.4] ng/mL, p = 0.001, while mean height and body weight were lower than in healthy controls. GH levels decreased significantly after transplantation. At one month and one year later, the levels did not differ from those of healthy children (p = 0.74, p = 0.67, respectively). One month after transplantation, GH concentrations were lower in 1-year survivors than in non-survivors (p = 0.02); the diagnostically significant threshold GH level was 1.8 ng/mL. Prior to LT, plasma GH levels did not differ between 1-year survivors and non-survivors. Children with GH levels below 1.8 ng/mL post-LT were 9 times more likely to survive one year post-transplant than patients with levels above the threshold.Conclusion. GH concentrations in pediatric liver recipients is a positive prognostic indicator of pediatric LT outcomes.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73980164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-129-139
D. Velikiy, M. A. Osoblivaya, O. Shevchenko
Galectin-3 (Gal-3) is an important regulator of cell adhesion, migration, proliferation, differentiation and apoptosis under pathophysiological conditions. It plays a crucial role in diseases associated with chronic inflammation and fibrosis. In recent years, there have been reports indicating changes in serum Gal-3 levels in solid organ transplant recipients in the verification of kidney, liver, heart and lung transplant pathologies. Studies on Gal-3 levels and dynamics in solid organ recipients may serve to assess graft conditions using new minimally invasive methods and to identify therapeutic targets for personalized therapy. The first clinical trial data on Gal-3 pharmacological inhibition are emerging. This review summarizes the current understanding of the role of Gal-3 in transplant pathology and the prospects for its use as a diagnostic marker and therapeutic target in solid organ recipients.
{"title":"Galectin-3 in solid organ recipients: role in graft pathology and prospects for use","authors":"D. Velikiy, M. A. Osoblivaya, O. Shevchenko","doi":"10.15825/1995-1191-2023-2-129-139","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-129-139","url":null,"abstract":"Galectin-3 (Gal-3) is an important regulator of cell adhesion, migration, proliferation, differentiation and apoptosis under pathophysiological conditions. It plays a crucial role in diseases associated with chronic inflammation and fibrosis. In recent years, there have been reports indicating changes in serum Gal-3 levels in solid organ transplant recipients in the verification of kidney, liver, heart and lung transplant pathologies. Studies on Gal-3 levels and dynamics in solid organ recipients may serve to assess graft conditions using new minimally invasive methods and to identify therapeutic targets for personalized therapy. The first clinical trial data on Gal-3 pharmacological inhibition are emerging. This review summarizes the current understanding of the role of Gal-3 in transplant pathology and the prospects for its use as a diagnostic marker and therapeutic target in solid organ recipients.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82461655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-49-56
M. Zhulkov, D. Sirota, D. Khvan, A. G. Makaev, H. Agaeva, I. Zykov, A. Fomichev, O. Poveschenko, M. Surovtseva, A. Chernyavsky
Medical management of end-stage chronic heart failure (HF) has evolved significantly over the past few decades. With a better understanding of the pathophysiology of HF, new pharmacological agents have been synthesized. However, survival in this cohort of patients with medical treatment remains extremely low. This has stimulated the development of surgical methods of treatment. Recent technological advances in the development of mechanical circulatory assist devices have made possible a single-stage implantation of two centrifugal pumps as an alternative to a total artificial heart. Today ventricular assist devices can be implanted to provide both univentricular and biventricular support depending on the severity of hemodynamic disorders, target organ damage, likelihood of recovery and heart transplantation.
{"title":"Biventricular mechanical circulatory support. History and current state of the problem","authors":"M. Zhulkov, D. Sirota, D. Khvan, A. G. Makaev, H. Agaeva, I. Zykov, A. Fomichev, O. Poveschenko, M. Surovtseva, A. Chernyavsky","doi":"10.15825/1995-1191-2023-2-49-56","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-49-56","url":null,"abstract":"Medical management of end-stage chronic heart failure (HF) has evolved significantly over the past few decades. With a better understanding of the pathophysiology of HF, new pharmacological agents have been synthesized. However, survival in this cohort of patients with medical treatment remains extremely low. This has stimulated the development of surgical methods of treatment. Recent technological advances in the development of mechanical circulatory assist devices have made possible a single-stage implantation of two centrifugal pumps as an alternative to a total artificial heart. Today ventricular assist devices can be implanted to provide both univentricular and biventricular support depending on the severity of hemodynamic disorders, target organ damage, likelihood of recovery and heart transplantation.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72608168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-118-128
O. Yamskova, M. S. Krasnov, E. V. Sidorsky, V. Lozinsky
Delivering bioactive substances to certain spots in the human and animal body is a crucial task. To address this problem, we have developed a delayed-release bioactive substance carrier – an albumin-based cryogel obtained by cryostructuring. It was tested on an organotypic culture model of the posterior eye segment of a newt.Objective: to study the effectiveness of porous albumin-based cryogel obtained by cryostructuring and loaded with a bioregulator isolated from bovine sclera in different quantities in maintaining eye tissue integrity and preserving Iberian ribbed newt fibroblasts on an organotypic culture model.Materials and methods. Albumin sponges were obtained after being denatured at temperatures –15 °C, –17.5 °C, and –20 °C, with albumin levels 40 mg/mL, 50 mg/mL, and 60 mg/mL in a thermostatic cooler. Their modulus of elasticity was measured. Eye tissues were isolated from adult sexually mature Iberian ribbed newts of both sexes. The posterior segment of each eye was placed on a sponge sample of albumin cryogel in penicillin vials, sealed and placed in a thermostat. At the end of cultivation, the samples were fixed, washed, dehydrated, and embedded in paraffin. Paraffin sections were made, followed by staining. A Leica microscope (Germany) with an Olympus DP70 camera (Japan) was used to view histological sections. Fibroblast count in the histological sections was estimated using the ImageJ program.Results. Cryogel with initial albumin solution levels of 50 mg/mL obtained at –20 °C with 4.50 kPa elastic modulus, was chosen for the organ culture experiment. Histological studies showed that eye tissue integrity was maintained in the experiment when albumin-based scaffold was loaded with the bioregulator at doses of 2.46 × 10–5, 2.46 × 10–7, 2.46 × 10–9, 2.46 × 10–13, 2.46 × 10–15 μg. Moreover, the statistically significant difference for fibroblast count per unit area in the sclera partially correlates with the qualitative state of the posterior eye tissue itself. Groups where bioregulator isolated from the sclera had a dose of 2.46 × 10–7, 2.46 × 10–9 and 2.46 × 10–15 μg, showed the best result as compared with the control group.Conclusion. Albumin-based scaffold as a carrier with a bioregulator adsorbed on it (doses of 2.46 × 10–5, 2.46 × 10–7, 2.46 × 10–9, 2.46 × 10–13, 2.46 × 10–15 μg) is effective in maintaining eye tissue integrity and preserving Iberian ribbed newt fibroblasts. Albumin cryogen is an effective carrier for delayed release of bioactive substances.
{"title":"Influence of protein-peptide bioregulator isolated from bovine sclera and incorporated into an albumin-based cryogel on the sclera in a model cultivation of a posterior eye segment","authors":"O. Yamskova, M. S. Krasnov, E. V. Sidorsky, V. Lozinsky","doi":"10.15825/1995-1191-2023-2-118-128","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-118-128","url":null,"abstract":"Delivering bioactive substances to certain spots in the human and animal body is a crucial task. To address this problem, we have developed a delayed-release bioactive substance carrier – an albumin-based cryogel obtained by cryostructuring. It was tested on an organotypic culture model of the posterior eye segment of a newt.Objective: to study the effectiveness of porous albumin-based cryogel obtained by cryostructuring and loaded with a bioregulator isolated from bovine sclera in different quantities in maintaining eye tissue integrity and preserving Iberian ribbed newt fibroblasts on an organotypic culture model.Materials and methods. Albumin sponges were obtained after being denatured at temperatures –15 °C, –17.5 °C, and –20 °C, with albumin levels 40 mg/mL, 50 mg/mL, and 60 mg/mL in a thermostatic cooler. Their modulus of elasticity was measured. Eye tissues were isolated from adult sexually mature Iberian ribbed newts of both sexes. The posterior segment of each eye was placed on a sponge sample of albumin cryogel in penicillin vials, sealed and placed in a thermostat. At the end of cultivation, the samples were fixed, washed, dehydrated, and embedded in paraffin. Paraffin sections were made, followed by staining. A Leica microscope (Germany) with an Olympus DP70 camera (Japan) was used to view histological sections. Fibroblast count in the histological sections was estimated using the ImageJ program.Results. Cryogel with initial albumin solution levels of 50 mg/mL obtained at –20 °C with 4.50 kPa elastic modulus, was chosen for the organ culture experiment. Histological studies showed that eye tissue integrity was maintained in the experiment when albumin-based scaffold was loaded with the bioregulator at doses of 2.46 × 10–5, 2.46 × 10–7, 2.46 × 10–9, 2.46 × 10–13, 2.46 × 10–15 μg. Moreover, the statistically significant difference for fibroblast count per unit area in the sclera partially correlates with the qualitative state of the posterior eye tissue itself. Groups where bioregulator isolated from the sclera had a dose of 2.46 × 10–7, 2.46 × 10–9 and 2.46 × 10–15 μg, showed the best result as compared with the control group.Conclusion. Albumin-based scaffold as a carrier with a bioregulator adsorbed on it (doses of 2.46 × 10–5, 2.46 × 10–7, 2.46 × 10–9, 2.46 × 10–13, 2.46 × 10–15 μg) is effective in maintaining eye tissue integrity and preserving Iberian ribbed newt fibroblasts. Albumin cryogen is an effective carrier for delayed release of bioactive substances.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82660651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-8-14
A. Shabunin, O. Loran, D. Pushkar, E. Veliev, M. Minina, P. Drozdov, I. Nesterenko, D. A. Makeev, V. M. Sevostiyanov, O. S. Zhuravel, S. А. Astapovich, L. R. Karapetyan
Objective: to determine the efficacy and safety of an integrated strategy aimed at preventing delayed renal graft function (DGF).Materials and methods. From June 2018 to December 2022, 478 deceased-donor kidney transplants were performed at Botkin Hospital, Moscow. The patients were divided into two groups: Group I consisted of 128 patients who did not use the integrated strategy; Group II included 67 patients in whom the DGF prevention strategy was used at the perioperative stage. The integrated strategy involved the use of hypothermic oxygenated machine perfusion (HOPE) using expanded criteria donors, the use of a second warm ischemia (SWI) elimination device, personalized initial calcineurin inhibitor (CI) dosing, and use of alprostadil for high vascular resistance in renal graft arteries.Results. DGF occurred in 5 of 44 patients (11.4%) that used the integrated strategy, and in 13 of 44 patients (29.5%) in the control group. The differences were statistically significant (p = 0.034), there was a medium strength relationship between the traits (V = 0.225). The use of the integrated DGF prevention approach reduced the chances of developing DGF by a factor of 0.3 (95% CI: 0.1–0.95). The risk of DGF in the integrated strategy group was 61.3% of the risk of DGF in the non-strategy group, thus the relative risk (RR) is 1.63 (95% CI: 1.1–2.4). Median duration of graft function normalization was statistically significantly lower in group II: 5 (IQR: 3–9) versus 15 (IQR: 7–19) days (p = 0.012). Mean length of hospital stay was 19.1 ± 4.2 (95% CI: 14.5–26.1) bed-days in group I and 13.9 ± 3.4 (95% CI: 9.3–17.2) bed-days in group II. Differences in this indicator were also statistically significant (p = 0.043).Conclusion. The set of DGF prevention measures, developed at Botkin Hospital, evidence-based and implemented in clinical practice, can reduce the burden of modifiable risk factors of this complication significantly, thereby improving treatment outcomes for kidney transplant recipients considerably.
{"title":"Integrated strategy for preventing delayed renal graft function","authors":"A. Shabunin, O. Loran, D. Pushkar, E. Veliev, M. Minina, P. Drozdov, I. Nesterenko, D. A. Makeev, V. M. Sevostiyanov, O. S. Zhuravel, S. А. Astapovich, L. R. Karapetyan","doi":"10.15825/1995-1191-2023-2-8-14","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-8-14","url":null,"abstract":"Objective: to determine the efficacy and safety of an integrated strategy aimed at preventing delayed renal graft function (DGF).Materials and methods. From June 2018 to December 2022, 478 deceased-donor kidney transplants were performed at Botkin Hospital, Moscow. The patients were divided into two groups: Group I consisted of 128 patients who did not use the integrated strategy; Group II included 67 patients in whom the DGF prevention strategy was used at the perioperative stage. The integrated strategy involved the use of hypothermic oxygenated machine perfusion (HOPE) using expanded criteria donors, the use of a second warm ischemia (SWI) elimination device, personalized initial calcineurin inhibitor (CI) dosing, and use of alprostadil for high vascular resistance in renal graft arteries.Results. DGF occurred in 5 of 44 patients (11.4%) that used the integrated strategy, and in 13 of 44 patients (29.5%) in the control group. The differences were statistically significant (p = 0.034), there was a medium strength relationship between the traits (V = 0.225). The use of the integrated DGF prevention approach reduced the chances of developing DGF by a factor of 0.3 (95% CI: 0.1–0.95). The risk of DGF in the integrated strategy group was 61.3% of the risk of DGF in the non-strategy group, thus the relative risk (RR) is 1.63 (95% CI: 1.1–2.4). Median duration of graft function normalization was statistically significantly lower in group II: 5 (IQR: 3–9) versus 15 (IQR: 7–19) days (p = 0.012). Mean length of hospital stay was 19.1 ± 4.2 (95% CI: 14.5–26.1) bed-days in group I and 13.9 ± 3.4 (95% CI: 9.3–17.2) bed-days in group II. Differences in this indicator were also statistically significant (p = 0.043).Conclusion. The set of DGF prevention measures, developed at Botkin Hospital, evidence-based and implemented in clinical practice, can reduce the burden of modifiable risk factors of this complication significantly, thereby improving treatment outcomes for kidney transplant recipients considerably.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84911245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-57-62
K. S. Kiryakov, A. R. Zakiryanov, T. A. Khalilulin, N. Y. Zakharevich, O. A. Pozdnyakov, А. M. Goltz, D. S. Ivanov, A. A. Sukhachev, V. M. Zakharevich
Postoperative pericardial effusion (PPE) represents a very common complication in cardiac surgery. Accumulation of a significant amount of free fluid in the pericardial cavity is a multifactorial process. Identifying the cause is not always possible. This complication occurs more frequently in patients after heart transplantation than in patients who underwent reconstructive cardiac surgery. Having hemodynamically significant effusion requires surgical evacuation of fluid from the pericardial cavity. This can affect the postoperative period and increase the length of stay at the hospital. For this reason, developing and ensuring widespread use of methods for prevention of this complication are urgent and relevant tasks.
{"title":"Pericardial window as a surgical method for preventing significant postoperative pericardial effusion","authors":"K. S. Kiryakov, A. R. Zakiryanov, T. A. Khalilulin, N. Y. Zakharevich, O. A. Pozdnyakov, А. M. Goltz, D. S. Ivanov, A. A. Sukhachev, V. M. Zakharevich","doi":"10.15825/1995-1191-2023-2-57-62","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-57-62","url":null,"abstract":"Postoperative pericardial effusion (PPE) represents a very common complication in cardiac surgery. Accumulation of a significant amount of free fluid in the pericardial cavity is a multifactorial process. Identifying the cause is not always possible. This complication occurs more frequently in patients after heart transplantation than in patients who underwent reconstructive cardiac surgery. Having hemodynamically significant effusion requires surgical evacuation of fluid from the pericardial cavity. This can affect the postoperative period and increase the length of stay at the hospital. For this reason, developing and ensuring widespread use of methods for prevention of this complication are urgent and relevant tasks.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90237158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-15-25
S. Popov, R. Huseynov, D. A. Saydulaev, S. V. Sadovnikov, Yu. V. Kisil, K. V. Sivak, N. S. Bunenkov, V. V. Perepelitsa, A. S. Ulitina, T. Lelyavina
St. Petersburg, Russian Federation The paper presents a comparative assessment of different methods of treating symptomatic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) who underwent kidney transplantation (KT).
{"title":"Choice Of treatment method for symptomatic Bladder outlet obstruction in patients with benign prostatic hyperplasia after kidney transplantation","authors":"S. Popov, R. Huseynov, D. A. Saydulaev, S. V. Sadovnikov, Yu. V. Kisil, K. V. Sivak, N. S. Bunenkov, V. V. Perepelitsa, A. S. Ulitina, T. Lelyavina","doi":"10.15825/1995-1191-2023-2-15-25","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-15-25","url":null,"abstract":"St. Petersburg, Russian Federation The paper presents a comparative assessment of different methods of treating symptomatic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) who underwent kidney transplantation (KT).","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74917419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.15825/1995-1191-2023-2-99-106
A. Fedyakov, E. A. Nemets, O. Dreval, A. V. Gorozhanin, L. A. Sidneva, Z. H. Plieva, M. A. Razin, N. V. Perova, V. Sevastianov
At present, the search for effective ways of restoring peripheral nerves with anatomical damage continues. Autoplasty still remains the gold standard, which, however, is not without its drawbacks. The use of nerve implants for promoting directional axon growth is essential and promising.Objective: to study the biomechanical properties of laboratory samples of an artificial nerve conduit (NGC) made of hybrid biomaterials and to, on cadaveric material, assess the technical feasibility of using them in surgical practice to repair extended peripheral nerve defects.Material and methods. The objects of the study were three electrospun NGC samples: from synthetic material (polycaprolactone, PCL) and hybrid biomaterials (PCL + gelatin or PCL + collagen). The work compared the physical and mechanical properties of NGC: stiffness, plasticity, elasticity, brittleness, resistance to chemical attack, their ability to be impregnated with liquid media, permeability, possibility of making an anastomosis between the implant and the nerve during surgical procedure. Cadaveric material was the object of the study: we used a dissected superficial sensory branch of the human right radial nerve, 2 mm in diameter, isolated on the forearm, about 12 cm in length, because it most corresponded to the diameter of the NGC samples tested. After surgery, the echogenic features of the implants and their anastomoses with the nerve were assessed by ultrasound imaging.Results. It was found that hybrid NGC samples, based on their biomechanical properties, are fundamentally suitable for use in surgical practice, to ensure growth and replacement of a peripheral nerve defect. However, the best composition of a nerve guide can be established after comparative preclinical study of the biocompatible and functional properties of hybrid material samples.Conclusion. The physical and mechanical properties of the investigated NGC samples made of hybrid biomaterials meet the technical requirements for implantable nerve conduits for surgical application.
{"title":"Artificial nerve conduit for guiding peripheral nerve growth (cadaveric study)","authors":"A. Fedyakov, E. A. Nemets, O. Dreval, A. V. Gorozhanin, L. A. Sidneva, Z. H. Plieva, M. A. Razin, N. V. Perova, V. Sevastianov","doi":"10.15825/1995-1191-2023-2-99-106","DOIUrl":"https://doi.org/10.15825/1995-1191-2023-2-99-106","url":null,"abstract":"At present, the search for effective ways of restoring peripheral nerves with anatomical damage continues. Autoplasty still remains the gold standard, which, however, is not without its drawbacks. The use of nerve implants for promoting directional axon growth is essential and promising.Objective: to study the biomechanical properties of laboratory samples of an artificial nerve conduit (NGC) made of hybrid biomaterials and to, on cadaveric material, assess the technical feasibility of using them in surgical practice to repair extended peripheral nerve defects.Material and methods. The objects of the study were three electrospun NGC samples: from synthetic material (polycaprolactone, PCL) and hybrid biomaterials (PCL + gelatin or PCL + collagen). The work compared the physical and mechanical properties of NGC: stiffness, plasticity, elasticity, brittleness, resistance to chemical attack, their ability to be impregnated with liquid media, permeability, possibility of making an anastomosis between the implant and the nerve during surgical procedure. Cadaveric material was the object of the study: we used a dissected superficial sensory branch of the human right radial nerve, 2 mm in diameter, isolated on the forearm, about 12 cm in length, because it most corresponded to the diameter of the NGC samples tested. After surgery, the echogenic features of the implants and their anastomoses with the nerve were assessed by ultrasound imaging.Results. It was found that hybrid NGC samples, based on their biomechanical properties, are fundamentally suitable for use in surgical practice, to ensure growth and replacement of a peripheral nerve defect. However, the best composition of a nerve guide can be established after comparative preclinical study of the biocompatible and functional properties of hybrid material samples.Conclusion. The physical and mechanical properties of the investigated NGC samples made of hybrid biomaterials meet the technical requirements for implantable nerve conduits for surgical application.","PeriodicalId":21400,"journal":{"name":"Russian Journal of Transplantology and Artificial Organs","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77906452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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