Pub Date : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-319-331
S. Voskanyan, V. Syutkin, M. Shabalin, A. Artemyev, I. Kolyshev, A. Bashkov, A. Borbat, K. Gubarev, M. Popov, A. Maltseva
We present an uncommon case of liver graft dysfunction caused by seronegative hepatitis C-related fibrosing cholestatic hepatitis after cadaver liver transplantation for unresectable liver metastases of neuroendocrine small intestine cancer followed by living relation donor liver fragment retransplantation for primary graft nonfunction. Early postoperative period was complicated by hepatic artery thrombosis, cerebral hemorrhage, acute cellular rejection, bilateral polysegmental pneumonia, bleeding into neck soft tissues, severe surgical site infection, and sepsis. Anticoagulant therapy, as well as the absence of Hepatitis C Virus antibodies made difficult early diagnostics of fibrosing cholestatic hepatitis. A present-day antiviral therapy produced a complete clinical and virological response. At control examination performed at 240 days after surgery, there were neither signs of cancer progression no graft dysfunction. Liver transplantation in that case was an example of radical and effective treatment method for unresectable liver metastases of neuroendocrine small intestine cancer. Timely diagnosis and proper treatment of fibrosing cholestatic hepatitis made it possible to save the liver graft and patient's life.
{"title":"Seronegative fibrosing cholestatic hepatitis С after liver retransplantation for unresectable neuroendocrine tumor liver metastases","authors":"S. Voskanyan, V. Syutkin, M. Shabalin, A. Artemyev, I. Kolyshev, A. Bashkov, A. Borbat, K. Gubarev, M. Popov, A. Maltseva","doi":"10.23873/2074-0506-2020-12-4-319-331","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-319-331","url":null,"abstract":"We present an uncommon case of liver graft dysfunction caused by seronegative hepatitis C-related fibrosing cholestatic hepatitis after cadaver liver transplantation for unresectable liver metastases of neuroendocrine small intestine cancer followed by living relation donor liver fragment retransplantation for primary graft nonfunction. Early postoperative period was complicated by hepatic artery thrombosis, cerebral hemorrhage, acute cellular rejection, bilateral polysegmental pneumonia, bleeding into neck soft tissues, severe surgical site infection, and sepsis. Anticoagulant therapy, as well as the absence of Hepatitis C Virus antibodies made difficult early diagnostics of fibrosing cholestatic hepatitis. A present-day antiviral therapy produced a complete clinical and virological response. At control examination performed at 240 days after surgery, there were neither signs of cancer progression no graft dysfunction. Liver transplantation in that case was an example of radical and effective treatment method for unresectable liver metastases of neuroendocrine small intestine cancer. Timely diagnosis and proper treatment of fibrosing cholestatic hepatitis made it possible to save the liver graft and patient's life.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85631588","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 : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-301-310
I. V. Abdulyanov, I. M. Rakhimullin, M. R. Gaysin, R. R. Khamzin
Introduction. The number of surgically treated cases of heart failure by means of orthotopic heart transplantation is increasing every year. At the same time, there is a shortage of optimal donors for heart transplantation, being a factor that leads to a primary graft dysfunction in the intra- and immediate postoperative period. In order to reduce the risk of complications and increase patient survival rates in primary heart graft dysfunction, a number of transplant centers resort to the choice of the treatment by means of mechanical circulatory support, such as extracorporeal membrane oxygenation. Clinical case. In the early postoperative period after heart transplantation, the patient was diagnosed with developing primary graft dysfunction. The clinical response to medication support of hemodynamics was unsatisfactory. Venoarterial extracorporeal membrane oxygenation was performed. On the 4th day, the regional contractility of the left ventricle restored, the ejection fraction of both ventricles increased, their systolic function improved. The patient was discharged on the 21st day in a satisfactory condition. Conclusion. Mechanical circulatory support modalities, such as venoarterial extracorporeal membrane oxygenation, can compensate for the emerging primary myocardial dysfunction in recipients. The efficiency of the extracorporeal membrane oxygenation is achieved not only by knowledge of current clinical recommendations, but also depends on the implementation of other clinics' experience as well as technical readiness of the center and medical personnel' qualification.
{"title":"The first experience of extracorporal membrane oxygenation application in severe primary graft failure following heart transplantation","authors":"I. V. Abdulyanov, I. M. Rakhimullin, M. R. Gaysin, R. R. Khamzin","doi":"10.23873/2074-0506-2020-12-4-301-310","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-301-310","url":null,"abstract":"Introduction. The number of surgically treated cases of heart failure by means of orthotopic heart transplantation is increasing every year. At the same time, there is a shortage of optimal donors for heart transplantation, being a factor that leads to a primary graft dysfunction in the intra- and immediate postoperative period. In order to reduce the risk of complications and increase patient survival rates in primary heart graft dysfunction, a number of transplant centers resort to the choice of the treatment by means of mechanical circulatory support, such as extracorporeal membrane oxygenation. Clinical case. In the early postoperative period after heart transplantation, the patient was diagnosed with developing primary graft dysfunction. The clinical response to medication support of hemodynamics was unsatisfactory. Venoarterial extracorporeal membrane oxygenation was performed. On the 4th day, the regional contractility of the left ventricle restored, the ejection fraction of both ventricles increased, their systolic function improved. The patient was discharged on the 21st day in a satisfactory condition. Conclusion. Mechanical circulatory support modalities, such as venoarterial extracorporeal membrane oxygenation, can compensate for the emerging primary myocardial dysfunction in recipients. The efficiency of the extracorporeal membrane oxygenation is achieved not only by knowledge of current clinical recommendations, but also depends on the implementation of other clinics' experience as well as technical readiness of the center and medical personnel' qualification.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81006075","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 : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-332-352
S. Glyantsev, B. M. Gorelik, A. Werner
Having studied the available printed, visual, and verbal sources from Russia, South Africa, the USA, and Germany, we have identified and reviewed in the article the facts of face-to-face and correspondence communication between V.P. Demikhov, the "father" of experimental heart transplantation (Moscow, USSR), and C.N. Barnard, a pioneer of clinical heart transplantation (Cape Town, South Africa). We have shown that C.N. Barnard mastered the heart surgery techniques, including those under conditions of artificial circulation, in the USA in 1956-1958, and later improved them in his homeland both in clinic (heart surgery for cardiac defects), and in the experiment (heart transplantation). The main events preceding the first world human heart transplant performed by C.N. Barnard on December 3, 1967, were his trip to the United States in August 1967 to study immunosuppression techniques, and the kidney transplantation he had performed in Cape Town in September, 1967. Prior to that time, C.N. Barnard had visited the USSR only once, in May 1960, as a delegate to the XXVII All-Union Congress of Surgeons. In the Soviet Union, he visited a number of clinics dealing with heart surgery and tissue and organ transplantation, including the N.V. Sklifosovsky Institute for Emergency Medicine, where he met V.P. Demikhov, but C.N. Barnard could neither talk to him personally, nor watch his operations. In December 1967, V.P. Demikhov spoke with C.N. Barnard on the phone, but the conversation was highly professional. This paper has shown different approaches of V.P. Demikhov and C.N. Barnard to the transplantation problem: the Soviet surgeon paid more attention to the transplantation technique, meanwhile, the South African surgeon considered the solution of immunological problems to be the basis of success. Nevertheless, C.N. Barnard knew about V.P. Demikhov's scientific achievements and used some of them in his surgical practice. The authors have substantiated the interaction between V.P. Demikhov and C.N. Barnard as between an ideological mentor and a student (in a broad sense) rather than as a teacher and a student (in a narrow sense). Therefore, in a broad, philosophical sense, the Soviet surgeon can be considered one of the inspirers of the world's first heart transplantation, which, in turn, proved that his ascetic work was not in vain.
在研究了来自俄罗斯、南非、美国和德国的可用的印刷、视觉和口头资料后，我们在文章中确定并回顾了实验心脏移植之父V.P.德米霍夫(苏联莫斯科)和临床心脏移植先驱C.N.巴纳德(南非开普敦)之间面对面和通信的事实。我们已经证明，C.N. Barnard于1956-1958年在美国掌握了心脏手术技术，包括人工循环条件下的心脏手术技术，后来在他的祖国在临床(心脏缺陷的心脏手术)和实验(心脏移植)中改进了这些技术。1967年12月3日，C.N. Barnard进行了第一次世界人类心脏移植手术，在此之前的主要事件是他于1967年8月前往美国研究免疫抑制技术，以及他于1967年9月在开普敦进行的肾脏移植手术。在此之前，C.N. Barnard只在1960年5月作为第27届全苏外科医生大会的代表访问过苏联一次。在苏联，他参观了许多从事心脏手术和组织器官移植的诊所，包括N.V.斯克利福索夫斯基急诊医学研究所(N.V. Sklifosovsky Institute for Emergency Medicine)，在那里他见到了副总统德米霍夫(Demikhov)，但C.N.巴纳德既不能亲自与他交谈，也不能观看他的手术。1967年12月，副总统德米霍夫与C.N.巴纳德通了电话，但谈话内容非常专业。本文展示了V.P. Demikhov和C.N. Barnard对移植问题的不同看法:苏联外科医生更注重移植技术，而南非外科医生则认为免疫问题的解决是成功的基础。然而，C.N.巴纳德知道德米霍夫副总统的科学成就，并在他的外科手术中使用了其中的一些。作者证实了V.P.德米霍夫和C.N.巴纳德之间的互动是一种思想导师和学生之间的互动(广义上)，而不是老师和学生之间的互动(狭义上)。因此，从广泛的哲学意义上讲，这位苏联外科医生可以被认为是世界上第一例心脏移植手术的灵感来源之一，这反过来又证明了他的苦行僧般的工作没有白费。
{"title":"PHENOMENON OF DEMIKHOV. In the Sklifosovsky Institute (1960–1986). C.N. Barnard and the first clinical heart transplantation (December 3, 1967). V.P. Demikhov and C.N. Barnard: touchpoints","authors":"S. Glyantsev, B. M. Gorelik, A. Werner","doi":"10.23873/2074-0506-2020-12-4-332-352","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-332-352","url":null,"abstract":"Having studied the available printed, visual, and verbal sources from Russia, South Africa, the USA, and Germany, we have identified and reviewed in the article the facts of face-to-face and correspondence communication between V.P. Demikhov, the \"father\" of experimental heart transplantation (Moscow, USSR), and C.N. Barnard, a pioneer of clinical heart transplantation (Cape Town, South Africa). We have shown that C.N. Barnard mastered the heart surgery techniques, including those under conditions of artificial circulation, in the USA in 1956-1958, and later improved them in his homeland both in clinic (heart surgery for cardiac defects), and in the experiment (heart transplantation). The main events preceding the first world human heart transplant performed by C.N. Barnard on December 3, 1967, were his trip to the United States in August 1967 to study immunosuppression techniques, and the kidney transplantation he had performed in Cape Town in September, 1967. Prior to that time, C.N. Barnard had visited the USSR only once, in May 1960, as a delegate to the XXVII All-Union Congress of Surgeons. In the Soviet Union, he visited a number of clinics dealing with heart surgery and tissue and organ transplantation, including the N.V. Sklifosovsky Institute for Emergency Medicine, where he met V.P. Demikhov, but C.N. Barnard could neither talk to him personally, nor watch his operations. In December 1967, V.P. Demikhov spoke with C.N. Barnard on the phone, but the conversation was highly professional. This paper has shown different approaches of V.P. Demikhov and C.N. Barnard to the transplantation problem: the Soviet surgeon paid more attention to the transplantation technique, meanwhile, the South African surgeon considered the solution of immunological problems to be the basis of success. Nevertheless, C.N. Barnard knew about V.P. Demikhov's scientific achievements and used some of them in his surgical practice. The authors have substantiated the interaction between V.P. Demikhov and C.N. Barnard as between an ideological mentor and a student (in a broad sense) rather than as a teacher and a student (in a narrow sense). Therefore, in a broad, philosophical sense, the Soviet surgeon can be considered one of the inspirers of the world's first heart transplantation, which, in turn, proved that his ascetic work was not in vain.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82043938","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 : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-295-300
Вячеслав Леонидович Коробка, М. Ю. Кострыкин, О. В. Котов, Р. О. Даблиз, Е. С. Пак
The clinical case of liver revascularization in a recipient using the technique of selective thrombolysis of the hepatic artery and its stenting at the arterial anastomosis site has been reported. The applied technique allowed a quick elimination of thrombosis and stenosis of the arterial anastomosis, providing a long-term effect, preventing more severe consequences for the recipient, and saving the liver graft. The presented case showed that the combined technique of endovascular intervention might be a good alternative to the reconstruction of arterial anastomosis by re-exploration and by liver retransplantation.
{"title":"The management of the hepatic artery thrombosis after liver transplantation","authors":"Вячеслав Леонидович Коробка, М. Ю. Кострыкин, О. В. Котов, Р. О. Даблиз, Е. С. Пак","doi":"10.23873/2074-0506-2020-12-4-295-300","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-295-300","url":null,"abstract":"The clinical case of liver revascularization in a recipient using the technique of selective thrombolysis of the hepatic artery and its stenting at the arterial anastomosis site has been reported. The applied technique allowed a quick elimination of thrombosis and stenosis of the arterial anastomosis, providing a long-term effect, preventing more severe consequences for the recipient, and saving the liver graft. The presented case showed that the combined technique of endovascular intervention might be a good alternative to the reconstruction of arterial anastomosis by re-exploration and by liver retransplantation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85201342","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 : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-311-318
S. Prozorov
Introduction. Vascular complications after transplant nephrectomy are rather rare. The aim of this article is to analyze the effectiveness of the stent-graft implantation in the treatment of pseudoaneurysm after transplant nephrectomy. Clinical case. In the previous 23 years, a 50-year-old patient underwent 3 kidney transplantations from a cadaveric donor and 2 transplant nephrectomies. At 12 years after the left transplant nephrectomy he complained of abdominal pain and was admitted for a pulsating mass in his left pelvic region. Computed tomography angiography, ultrasonography, and arteriography were performed and showed a large pseudoaneurysm arising from the left external iliac artery. The stentgraft implantation solved the problem providing successful clinical and radiological results. Conclusion. Treatment options in this case were open or endovascular techniques. Surgical revision associated with high risk of complications. Endovascular treatment had the benefits of a minimally invasive approach with low blood loss.
{"title":"Endovascular treatment of the pseudoaneurysm using stent-graft after transplant nephrectomy","authors":"S. Prozorov","doi":"10.23873/2074-0506-2020-12-4-311-318","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-311-318","url":null,"abstract":"Introduction. Vascular complications after transplant nephrectomy are rather rare. The aim of this article is to analyze the effectiveness of the stent-graft implantation in the treatment of pseudoaneurysm after transplant nephrectomy. Clinical case. In the previous 23 years, a 50-year-old patient underwent 3 kidney transplantations from a cadaveric donor and 2 transplant nephrectomies. At 12 years after the left transplant nephrectomy he complained of abdominal pain and was admitted for a pulsating mass in his left pelvic region. Computed tomography angiography, ultrasonography, and arteriography were performed and showed a large pseudoaneurysm arising from the left external iliac artery. The stentgraft implantation solved the problem providing successful clinical and radiological results. Conclusion. Treatment options in this case were open or endovascular techniques. Surgical revision associated with high risk of complications. Endovascular treatment had the benefits of a minimally invasive approach with low blood loss.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89772537","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 : 2020-12-11DOI: 10.23873/2074-0506-2020-12-4-278-285
A. Shabunin, P. Drozdov, D. Eremin, I. Nesterenko, D. A. Makeev, O. S. Zhuravel, S. А. Astapovich
Background. Urological complications are currently one of the main causes of the renal graft loss and the death of the recipient in the early and late periods after surgery. Objective. To reduce the risk of developing infectious complications after kidney transplantation by early removal of the internal ureteral stent. Material and methods. From June 2018 to March 2020, the Department of Organ and/or Tissue Transplantation of the City Clinical Hospital n.a. S.P. Botkin performed 89 deseased-donor kidney transplantations with the placement of an internal ureteral stent. Depending on the timing of stent removal, the patients were divided into 2 groups: the first group included 54 patients who had the stent removed on day 21, and the second group included 35 patients who had the stent removed on day 14. Results. No urological complications were recorded in both groups. Urinary tract infection was recorded in 8 patients (15%) in the first group, and in 1 patient (3%) in the second group (p = 0.01). Conclusion. Removal of the internal ureteral stent on the 14th day after kidney transplantation safely and reliably reduces the risk of a urinary tract infection development, improving the immediate results of the operation.
{"title":"\"Early\" removal of the internal ureteral stent after kidney transplantation","authors":"A. Shabunin, P. Drozdov, D. Eremin, I. Nesterenko, D. A. Makeev, O. S. Zhuravel, S. А. Astapovich","doi":"10.23873/2074-0506-2020-12-4-278-285","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-4-278-285","url":null,"abstract":"Background. Urological complications are currently one of the main causes of the renal graft loss and the death of the recipient in the early and late periods after surgery. Objective. To reduce the risk of developing infectious complications after kidney transplantation by early removal of the internal ureteral stent. Material and methods. From June 2018 to March 2020, the Department of Organ and/or Tissue Transplantation of the City Clinical Hospital n.a. S.P. Botkin performed 89 deseased-donor kidney transplantations with the placement of an internal ureteral stent. Depending on the timing of stent removal, the patients were divided into 2 groups: the first group included 54 patients who had the stent removed on day 21, and the second group included 35 patients who had the stent removed on day 14. Results. No urological complications were recorded in both groups. Urinary tract infection was recorded in 8 patients (15%) in the first group, and in 1 patient (3%) in the second group (p = 0.01). Conclusion. Removal of the internal ureteral stent on the 14th day after kidney transplantation safely and reliably reduces the risk of a urinary tract infection development, improving the immediate results of the operation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73885193","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 : 2020-09-10DOI: 10.23873/2074-0506-2020-12-3-245-258
S. Glyantsev
The article has described, analyzed, and introduced into scientific circulation some previously unknown facts from V.P. Demikhov's life, namely, his nomination as a Corresponding Member to the USSR Academy of Sciences in the specialty "physiology" in May, 1966, and his experimental and research work in 1966. The inspection of his scientific activities undertaken on behalf of the Academic Council of N.V. Sklifosovsky Institute for Emergency Medicine, showed that the discoveries and achievements V.P. Demikhov had made in the field of physiology were significant, and he was worthy of being nominated for the rank of a Corresponding Member to the USSR Academy of Sciences. However, he lacked several votes for being elected to the Academy. Meanwhile, in 1966 V.P. Demikhov continued his unique research, having initiated studying the coronary blood flow of the transplanted heart, implementing immunosuppression in kidney transplantation, and starting the experiments on creating a bank of organs to preserve their functions before transplantation.
{"title":"PHENOMENON OF DEMIKHOV. In the Sklifosovsky Institute (1960–1986). Nomination as a Corresponding Member to the USSR Academy of Sciences (1966)","authors":"S. Glyantsev","doi":"10.23873/2074-0506-2020-12-3-245-258","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-3-245-258","url":null,"abstract":"The article has described, analyzed, and introduced into scientific circulation some previously unknown facts from V.P. Demikhov's life, namely, his nomination as a Corresponding Member to the USSR Academy of Sciences in the specialty \"physiology\" in May, 1966, and his experimental and research work in 1966. The inspection of his scientific activities undertaken on behalf of the Academic Council of N.V. Sklifosovsky Institute for Emergency Medicine, showed that the discoveries and achievements V.P. Demikhov had made in the field of physiology were significant, and he was worthy of being nominated for the rank of a Corresponding Member to the USSR Academy of Sciences. However, he lacked several votes for being elected to the Academy. Meanwhile, in 1966 V.P. Demikhov continued his unique research, having initiated studying the coronary blood flow of the transplanted heart, implementing immunosuppression in kidney transplantation, and starting the experiments on creating a bank of organs to preserve their functions before transplantation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78078852","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 : 2020-09-10DOI: 10.23873/2074-0506-2020-12-3-189-198
S. Zybleva, S. Zyblev, V. Martinkov
Introduction. One of the main problems in transplantology is the detection of simple, reliable and non-invasive markers that could predict adverse immune reactions and adjust immune suppressive therapy in allograft recipients in a timely manner. Objective. To determine the immunological criteria for the prediction of a graft dysfunction. Material and methods. We have examined 197 recipients who underwent kidney transplantation. All of them were immunologically examined with the identification of more than 40 subpopulations of leukocytes. Allograft function was assessed on day 7 with the division of patients into two groups: with either primary or graft dysfunction. Simple and multiple logistic regressions were used to predict a graft dysfunction. Preliminary statistical analysis was performed using nonparametric statistics. Results and discussion. A scoring system to predict the graft function has been worked out. At CD19+IgD+CD27-<72.7%, score 1 is assigned, and 0 score is given at > 72.7%. At CD3+CD8+CD69+>9.7% score 1 is assigned, and 0 score is given at CD3+CD8+CD69+<9.7%. Total score is calculated by summing up the scores. The total score = 0 predicts a primary graft function; total score >1 predicts a graft dysfunction. This scoring system has the sensitivity of 91.9%, еру specificity of 100%, еру accuracy of 94.9%, positive predictive value of 1 and negative predictive value of 0.877. Conclusions. 1. Percentage of CD19+IgD+CD27- and CD3+CD8+CD69+ subpopulations can be used to predict a graft dysfunction. 2. At values of CD19+IgD+CD27- not exceeding 72.7% and CD3+CD8+CD69+ more than 9.7%, the development of a graft dysfunction can be anticipated.
{"title":"Studying some lymphocyte subpopulations in search for predictors of renal graft dysfunction","authors":"S. Zybleva, S. Zyblev, V. Martinkov","doi":"10.23873/2074-0506-2020-12-3-189-198","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-3-189-198","url":null,"abstract":"Introduction. One of the main problems in transplantology is the detection of simple, reliable and non-invasive markers that could predict adverse immune reactions and adjust immune suppressive therapy in allograft recipients in a timely manner. Objective. To determine the immunological criteria for the prediction of a graft dysfunction. Material and methods. We have examined 197 recipients who underwent kidney transplantation. All of them were immunologically examined with the identification of more than 40 subpopulations of leukocytes. Allograft function was assessed on day 7 with the division of patients into two groups: with either primary or graft dysfunction. Simple and multiple logistic regressions were used to predict a graft dysfunction. Preliminary statistical analysis was performed using nonparametric statistics. Results and discussion. A scoring system to predict the graft function has been worked out. At CD19+IgD+CD27-<72.7%, score 1 is assigned, and 0 score is given at > 72.7%. At CD3+CD8+CD69+>9.7% score 1 is assigned, and 0 score is given at CD3+CD8+CD69+<9.7%. Total score is calculated by summing up the scores. The total score = 0 predicts a primary graft function; total score >1 predicts a graft dysfunction. This scoring system has the sensitivity of 91.9%, еру specificity of 100%, еру accuracy of 94.9%, positive predictive value of 1 and negative predictive value of 0.877. Conclusions. 1. Percentage of CD19+IgD+CD27- and CD3+CD8+CD69+ subpopulations can be used to predict a graft dysfunction. 2. At values of CD19+IgD+CD27- not exceeding 72.7% and CD3+CD8+CD69+ more than 9.7%, the development of a graft dysfunction can be anticipated.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90851914","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 : 2020-09-10DOI: 10.23873/2074-0506-2020-12-3-220-230
P. A. Brygin, S. Zhuravel, D. A. Troitskiy, I. I. Utkina
The purpose of this article is to describe the problem of predicting the lung function recovery in patients with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Data from CESAR and EOLIA clinical trials on the efficacy of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome have been reviewed and some controversial results discussed. The prognostic PRESERVE and RESP scores developed as prognostic tools on the basis of the results of these studies, are presented, the limitations of their applicability in various forms of acute respiratory distress syndrome are discussed. We propose to subdivide the predictors of the extracorporeal membrane oxygenation outcome in patients with acute respiratory distress syndrome into 4 following groups: 1. Lung injury severity criteria, including parameters of their lung mechanical and functional properties. 2. Time from acute respiratory failure onset to extracorporeal membrane oxygenation initiation, which reflects the rate of pathological processes in lungs and timing of decision to initiate extracorporeal membrane oxygenation. 3. The etiology of pulmonary disorders, directly affecting the reversibility of pathological processes in the lungs. 4. The severity of the patient's general condition, including the severity of manifestations of multiple organ failure, the degree of decompensation of concomitant chronic diseases, including oncological and associated with immunosuppression. Several diseases are associated with a higher risk of specific complications, particularly hemorrhagic, during extracorporeal membrane oxygenation.
{"title":"Predictors of extracorporeal membrane oxygenation efficacy in patients with acute respiratory failure","authors":"P. A. Brygin, S. Zhuravel, D. A. Troitskiy, I. I. Utkina","doi":"10.23873/2074-0506-2020-12-3-220-230","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-3-220-230","url":null,"abstract":"The purpose of this article is to describe the problem of predicting the lung function recovery in patients with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Data from CESAR and EOLIA clinical trials on the efficacy of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome have been reviewed and some controversial results discussed. The prognostic PRESERVE and RESP scores developed as prognostic tools on the basis of the results of these studies, are presented, the limitations of their applicability in various forms of acute respiratory distress syndrome are discussed. We propose to subdivide the predictors of the extracorporeal membrane oxygenation outcome in patients with acute respiratory distress syndrome into 4 following groups: 1. Lung injury severity criteria, including parameters of their lung mechanical and functional properties. 2. Time from acute respiratory failure onset to extracorporeal membrane oxygenation initiation, which reflects the rate of pathological processes in lungs and timing of decision to initiate extracorporeal membrane oxygenation. 3. The etiology of pulmonary disorders, directly affecting the reversibility of pathological processes in the lungs. 4. The severity of the patient's general condition, including the severity of manifestations of multiple organ failure, the degree of decompensation of concomitant chronic diseases, including oncological and associated with immunosuppression. Several diseases are associated with a higher risk of specific complications, particularly hemorrhagic, during extracorporeal membrane oxygenation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73833375","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 : 2020-09-10DOI: 10.23873/2074-0506-2020-12-3-199-212
I. Kolyshev, S. Voskanyan, M. Shabalin, A. Artemyev, V. Rudakov, A. Maltseva, A. Bashkov, V. Syutkin, K. Gubarev, D. Svetlakova, M. Popov, A. Sushkov, Z. Sadykhov
Background. Cancer occurring in recipients of living donor liver transplantation may be characterized by a progressive course requiring an immediate specialized treatment initiation and adjustment of immunosuppression regimen. Aim. To specify the malignancy development mechanisms and risk factors in the recipients of living donor liver transplantation. Material and methods: 275 living donor liver transplantations were made in Burnasyan Federal Medical Biophysical Center of FMBA from 2010 to 2020. Forty two (15.27 %) patients underwent surgery for hepatocellular carcinoma. The median time to the onset of malignancy development was estimated. The incidence of malignancy in general population and in recipients of living donor liver transplantation was compared. Results. The development of neoplastic lesion was registered in 9 cases (3.27%). Malignances were detected in 8 cases (2.90%). Median time to the onset of malignancy development was 48 months. 1, 3, and 5 year overall survival rates were 97%, 96%, 94%;respectively; 1, 3, and 5 year survival rates after transplantation for hepatocellular cancer were 97%, 91%, 91% respectively. Survival rate of patients with De-novo malignancy was 90%. Conclusion. Recipients of living donor liver transplantation have an increased risk of malignancy development that requires a close long-term follow-up.
{"title":"Extrahepatic malignancies in a liver transplant recipient from a living related donor","authors":"I. Kolyshev, S. Voskanyan, M. Shabalin, A. Artemyev, V. Rudakov, A. Maltseva, A. Bashkov, V. Syutkin, K. Gubarev, D. Svetlakova, M. Popov, A. Sushkov, Z. Sadykhov","doi":"10.23873/2074-0506-2020-12-3-199-212","DOIUrl":"https://doi.org/10.23873/2074-0506-2020-12-3-199-212","url":null,"abstract":"Background. Cancer occurring in recipients of living donor liver transplantation may be characterized by a progressive course requiring an immediate specialized treatment initiation and adjustment of immunosuppression regimen. Aim. To specify the malignancy development mechanisms and risk factors in the recipients of living donor liver transplantation. Material and methods: 275 living donor liver transplantations were made in Burnasyan Federal Medical Biophysical Center of FMBA from 2010 to 2020. Forty two (15.27 %) patients underwent surgery for hepatocellular carcinoma. The median time to the onset of malignancy development was estimated. The incidence of malignancy in general population and in recipients of living donor liver transplantation was compared. Results. The development of neoplastic lesion was registered in 9 cases (3.27%). Malignances were detected in 8 cases (2.90%). Median time to the onset of malignancy development was 48 months. 1, 3, and 5 year overall survival rates were 97%, 96%, 94%;respectively; 1, 3, and 5 year survival rates after transplantation for hepatocellular cancer were 97%, 91%, 91% respectively. Survival rate of patients with De-novo malignancy was 90%. Conclusion. Recipients of living donor liver transplantation have an increased risk of malignancy development that requires a close long-term follow-up.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76197506","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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