Pub Date : 2021-12-15DOI: 10.23873/2074-0506-2021-13-4-328-338
S. Zhuravel, N. K. Kuznetsova, V. E. Aleksandrova, I. I. Goncharova
Background. A pressing issue is the choice of an anesthetic agent for liver transplantation. The mechanism of the organprotective properties of desflurane and sevoflurane is not fully understood. It is important to understand the effects of desflurane and sevoflurane on the severity of ischemia-reperfusion injury of the liver graftAim. To study the effect of desflurane and sevoflurane on the intraoperative and early postoperative period in liver transplantation.Material and methods. The study included 47 patients with liver cirrhosis of various etiologies who underwent cadaveric liver transplantation between February and December 2020. The groups compared in the study included 24 patients who received desflurane and 23 patients who received sevoflurane.Results. There were no statistically significant differences in the effect of desflurane and sevoflurane on hemodynamic parameters, on the need for vasopressor drugs. Episodes of bradycardia and cardiac arrhythmias were significantly more frequent when using sevoflurane. Patients were extubated significantly faster after surgery in the desflurane group. In the early postoperative period, desflurane and sevoflurane did not adversely affect significantly the liver graft function and the degree of its ischemia-reperfusion injury. The groups appeared comparable in rates of using the renal replacement therapy, the incidence of the graft dysfunction development in the postoperative period, and the surgery outcomes.Conclusions. The use of modern inhalation anesthetics desflurane and sevoflurane to maintain anesthesia during liver transplantation does not adversely affect the course of the intraoperative and early postoperative period.
{"title":"The impact of desflurane and sevoflurane on the intraoperative and early postoperative period in liver transplantation","authors":"S. Zhuravel, N. K. Kuznetsova, V. E. Aleksandrova, I. I. Goncharova","doi":"10.23873/2074-0506-2021-13-4-328-338","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-4-328-338","url":null,"abstract":"Background. A pressing issue is the choice of an anesthetic agent for liver transplantation. The mechanism of the organprotective properties of desflurane and sevoflurane is not fully understood. It is important to understand the effects of desflurane and sevoflurane on the severity of ischemia-reperfusion injury of the liver graftAim. To study the effect of desflurane and sevoflurane on the intraoperative and early postoperative period in liver transplantation.Material and methods. The study included 47 patients with liver cirrhosis of various etiologies who underwent cadaveric liver transplantation between February and December 2020. The groups compared in the study included 24 patients who received desflurane and 23 patients who received sevoflurane.Results. There were no statistically significant differences in the effect of desflurane and sevoflurane on hemodynamic parameters, on the need for vasopressor drugs. Episodes of bradycardia and cardiac arrhythmias were significantly more frequent when using sevoflurane. Patients were extubated significantly faster after surgery in the desflurane group. In the early postoperative period, desflurane and sevoflurane did not adversely affect significantly the liver graft function and the degree of its ischemia-reperfusion injury. The groups appeared comparable in rates of using the renal replacement therapy, the incidence of the graft dysfunction development in the postoperative period, and the surgery outcomes.Conclusions. The use of modern inhalation anesthetics desflurane and sevoflurane to maintain anesthesia during liver transplantation does not adversely affect the course of the intraoperative and early postoperative period.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73296927","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 : 2021-12-15DOI: 10.23873/2074-0506-2021-13-4-339-355
R. O. Kantariya, Y. Moysyuk, E. Prokopenko, A. R. Karapityan, A. Ammosov, A. Makevnina, A. Gaydarova
Introduction. The pandemic caused by the SARS-CoV-2 coronavirus is characterized by significant morbidity and mortality. Kidney transplant recipients are at high risk of a more severe course of coronavirus infection due to ongoing immunosuppression, a high comorbidity index, and elder age.Aim. To investigate the features of the clinical course, the treatment applied and also the outcomes of the new coronavirus infection in patients after kidney transplantation.Material and methods. The retrospective study included 69 adult kidney transplant recipients continuously followed-up by our transplant nephrology service and who fell ill with COVID-19 from April 2020 till February 2021. The comparison study of the clinical pattern, laboratory and instrumental test results, treatment features and outcomes was made.Results. The most common clinical symptoms were hyperthermia (85.5%, n= 59), weakness (65.2%, n=45) and cough (52.2%, n=36), other symptoms were significantly less common. In 89.5% of cases (n=60), the virus ribonucleic acid was detected at least once by polymerase chain reaction; in 10.5% of cases (n=7), the polymerase chain reaction results were negative. According to CT, the extent of lung tissue lesion was identified as CT1 stage in 28 patients (46.7%), CT2 stage in 24 (40%); and only in 8 (13%) patients the lesion was assessed as CT3. Later on the number of patients with more than 50% lung damage increased to 16 (26.7%) and in 1 case the severity of lung tissue damage was consistent with CT4. Typical features for all patients were anemia and lymphopenia of varying severity, hypoproteinemia, increased serum creatinine and urea, C-reactive protein, ferritin, procalcitonin and D-dimer in the laboratory test results. The treatment included antiviral, antibacterial, anticoagulant therapy, corticosteroids, biological anti-cytokine drugs. In 95% of cases (n=66), the maintenance immunosuppressive therapy was changed up to complete withdrawal of the certain components. The patient survival rate with a functioning graft was 76.8% (n=53), the graft loss was observed in 4.3% of cases (n=3), and the lethal outcome was reported in 18.8% (n=13). The cause of death was a severe respiratory distress syndrome with multiple organ dysfunction complicated by sepsis and septic shock in 8 patients (61.5%). Invasive ventilation and hemodialysis were associated with 17.2 (p<0.00001) and 21.5 (p<0.0006) times higher risk of death, respectively.Conclusions. Severe lymphopenia is associated with a clinical worsening of the COVID-19 course. Predictors of fatal outcome were identified as follows: bacterial sepsis, invasive ventilation, the need for renal replacement therapy (p<0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.><0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, po
{"title":"Clinical characteristics and outcomes of COVID-19 in kidney transplant recipients","authors":"R. O. Kantariya, Y. Moysyuk, E. Prokopenko, A. R. Karapityan, A. Ammosov, A. Makevnina, A. Gaydarova","doi":"10.23873/2074-0506-2021-13-4-339-355","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-4-339-355","url":null,"abstract":"Introduction. The pandemic caused by the SARS-CoV-2 coronavirus is characterized by significant morbidity and mortality. Kidney transplant recipients are at high risk of a more severe course of coronavirus infection due to ongoing immunosuppression, a high comorbidity index, and elder age.Aim. To investigate the features of the clinical course, the treatment applied and also the outcomes of the new coronavirus infection in patients after kidney transplantation.Material and methods. The retrospective study included 69 adult kidney transplant recipients continuously followed-up by our transplant nephrology service and who fell ill with COVID-19 from April 2020 till February 2021. The comparison study of the clinical pattern, laboratory and instrumental test results, treatment features and outcomes was made.Results. The most common clinical symptoms were hyperthermia (85.5%, n= 59), weakness (65.2%, n=45) and cough (52.2%, n=36), other symptoms were significantly less common. In 89.5% of cases (n=60), the virus ribonucleic acid was detected at least once by polymerase chain reaction; in 10.5% of cases (n=7), the polymerase chain reaction results were negative. According to CT, the extent of lung tissue lesion was identified as CT1 stage in 28 patients (46.7%), CT2 stage in 24 (40%); and only in 8 (13%) patients the lesion was assessed as CT3. Later on the number of patients with more than 50% lung damage increased to 16 (26.7%) and in 1 case the severity of lung tissue damage was consistent with CT4. Typical features for all patients were anemia and lymphopenia of varying severity, hypoproteinemia, increased serum creatinine and urea, C-reactive protein, ferritin, procalcitonin and D-dimer in the laboratory test results. The treatment included antiviral, antibacterial, anticoagulant therapy, corticosteroids, biological anti-cytokine drugs. In 95% of cases (n=66), the maintenance immunosuppressive therapy was changed up to complete withdrawal of the certain components. The patient survival rate with a functioning graft was 76.8% (n=53), the graft loss was observed in 4.3% of cases (n=3), and the lethal outcome was reported in 18.8% (n=13). The cause of death was a severe respiratory distress syndrome with multiple organ dysfunction complicated by sepsis and septic shock in 8 patients (61.5%). Invasive ventilation and hemodialysis were associated with 17.2 (p<0.00001) and 21.5 (p<0.0006) times higher risk of death, respectively.Conclusions. Severe lymphopenia is associated with a clinical worsening of the COVID-19 course. Predictors of fatal outcome were identified as follows: bacterial sepsis, invasive ventilation, the need for renal replacement therapy (p<0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.><0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, po","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78991462","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 : 2021-12-15DOI: 10.23873/2074-0506-2021-13-4-382-397
O. Rzhevskaya, A. Y. Moiseeva, A. N. Esaulenko, A. Pinchuk, K. Alidzhanova
One of the most relevant issues of nephrology, neurology, and cardiology is the management and treatment of patients with chronic kidney disease and stroke. Patients with chronic kidney disease have a risk of both thrombotic complications and bleeding, and they have a high risk of both ischemic and hemorrhagic stroke. Chronic kidney disease significantly worsens the outcome of stroke by limiting the treatment due to reduced drug clearance and side effects. Hemodialysis which causes drastic hemodynamic and biochemical changes leads to the "stress" of the cerebral vascular system, increasing the risk of stroke; kidney transplantation reduces the risk of stroke due to functional recovery. Chronic kidney disease and stroke have significant socio-economic consequences. Patients with end-stage chronic kidney disease, as a rule, are not included in clinical trials; and stroke treatment tactics have not been developed for them. This review examines the interaction between kidneys and brain, the pathophysiology and epidemiology of stroke in all stages of chronic kidney disease, after kidney transplantation and discusses the management and treatment of chronic kidney disease patients with stroke.The investigation of the factors responsible for the high prevalence of brain lesions in chronic kidney disease will allow developing new treatment methods.
{"title":"Chronic kidney disease as a risk factor for acute stroke","authors":"O. Rzhevskaya, A. Y. Moiseeva, A. N. Esaulenko, A. Pinchuk, K. Alidzhanova","doi":"10.23873/2074-0506-2021-13-4-382-397","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-4-382-397","url":null,"abstract":"One of the most relevant issues of nephrology, neurology, and cardiology is the management and treatment of patients with chronic kidney disease and stroke. Patients with chronic kidney disease have a risk of both thrombotic complications and bleeding, and they have a high risk of both ischemic and hemorrhagic stroke. Chronic kidney disease significantly worsens the outcome of stroke by limiting the treatment due to reduced drug clearance and side effects. Hemodialysis which causes drastic hemodynamic and biochemical changes leads to the \"stress\" of the cerebral vascular system, increasing the risk of stroke; kidney transplantation reduces the risk of stroke due to functional recovery. Chronic kidney disease and stroke have significant socio-economic consequences. Patients with end-stage chronic kidney disease, as a rule, are not included in clinical trials; and stroke treatment tactics have not been developed for them. This review examines the interaction between kidneys and brain, the pathophysiology and epidemiology of stroke in all stages of chronic kidney disease, after kidney transplantation and discusses the management and treatment of chronic kidney disease patients with stroke.The investigation of the factors responsible for the high prevalence of brain lesions in chronic kidney disease will allow developing new treatment methods.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90515027","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 : 2021-09-21DOI: 10.23873/2074-0506-2021-13-3-235-247
S. E. Voskanyan, E. Naydenov, A. I. Artemev, D. A. Zabezhinskiy, K. Gubarev, V. Rudakov, M. Shabalin, D. Svetlakova, A. Maltseva, Yu. V. Voskanyan, A. G. Naydenova, M. Muktarzhan, Z. Sadykhov
The aim was to study the results of using various treatment regimens for hepatic encephalopathy for patients with liver cirrhosis before and after liver transplantation and the effect on the incidence and severity of hepatic encephalopathy in the perioperative period, and on the posttransplantation course.Material and methods. Fifty four patients with cirrhosis of various etiologies and the presence of significant hepatic encephalopathy undergoing living donor liver transplantation were included in the study. In the comparison group, patients took lactulose and rifaximin. In the main group, patients took lactulose and rifaximin in combination with L-ornithine-L-aspartate in the preoperative period, and L-ornithine-L-aspartate after liver transplantation for 5 days.Results. The use of L-ornithine-L-aspartate in the complex therapy of hepatic encephalopathy led to significantly reduced time of performing the Number Connection Test, the improvement of cognitive functions in patients by the Montreal Cognitive Assessment, a decreased incidence of stage II–III hepatic encephalopathy and an increased incidence of stage 0-I hepatic encephalopathy in the preoperative period. In the postoperative period, patients of the main group showed a rapid decrease in the severe stages of hepatic encephalopathy (stage II–III) towards less severe forms (stage 0–I) on the 3rd, 5th and 7th days after liver transplantation, and also a faster recovery of cognitive functions, an earlier adequate recovery of consciousness, muscle tone, an earlier possibility of extubation, a shorter length of stay in the intensive care unit, and a decreased postoperative hospital length of stay relatively to the patients of the comparison group.Conclusion. The use of L-ornithine-L-aspartate in the combination therapy for hepatic encephalopathy in the peritransplantation period leads to a significant decrease of the incidence and severity of hepatic encephalopathy, accelerates rehabilitation of patients, reduces postoperative hospital length of stay.
目的是研究肝移植前后肝硬化患者肝性脑病的不同治疗方案对围手术期肝性脑病发病率、严重程度及移植后病程的影响。材料和方法。54例不同病因的肝硬化和存在显著肝性脑病的患者接受活体供肝移植。对照组患者同时服用乳果糖和利福昔明。主组患者术前服用乳果糖、利福昔明联合l -鸟氨酸- l -天冬氨酸，肝移植后服用l -鸟氨酸- l -天冬氨酸5 d。在肝性脑病综合治疗中使用l -鸟氨酸- l -天冬氨酸可显著缩短执行数字连接测试的时间，改善蒙特利尔认知评估患者的认知功能，降低术前II-III期肝性脑病的发病率，增加0-I期肝性脑病的发病率。术后，主组患者肝移植后第3、5、7天重型肝性脑病(II-III期)向轻重型肝性脑病(0-I期)迅速减少，认知功能恢复较快，意识、肌张力恢复较早，拔管可能性较早，重症监护室住院时间较短;与对照组相比，术后住院时间明显缩短。移植围期应用l -鸟氨酸- l -天冬氨酸联合治疗肝性脑病，可显著降低肝性脑病的发生率和严重程度，加快患者康复，缩短术后住院时间。
{"title":"Results of using L-ornitin-L-aspartate in the treatment of hepatic encephalopathy in liver transplantation","authors":"S. E. Voskanyan, E. Naydenov, A. I. Artemev, D. A. Zabezhinskiy, K. Gubarev, V. Rudakov, M. Shabalin, D. Svetlakova, A. Maltseva, Yu. V. Voskanyan, A. G. Naydenova, M. Muktarzhan, Z. Sadykhov","doi":"10.23873/2074-0506-2021-13-3-235-247","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-3-235-247","url":null,"abstract":"The aim was to study the results of using various treatment regimens for hepatic encephalopathy for patients with liver cirrhosis before and after liver transplantation and the effect on the incidence and severity of hepatic encephalopathy in the perioperative period, and on the posttransplantation course.Material and methods. Fifty four patients with cirrhosis of various etiologies and the presence of significant hepatic encephalopathy undergoing living donor liver transplantation were included in the study. In the comparison group, patients took lactulose and rifaximin. In the main group, patients took lactulose and rifaximin in combination with L-ornithine-L-aspartate in the preoperative period, and L-ornithine-L-aspartate after liver transplantation for 5 days.Results. The use of L-ornithine-L-aspartate in the complex therapy of hepatic encephalopathy led to significantly reduced time of performing the Number Connection Test, the improvement of cognitive functions in patients by the Montreal Cognitive Assessment, a decreased incidence of stage II–III hepatic encephalopathy and an increased incidence of stage 0-I hepatic encephalopathy in the preoperative period. In the postoperative period, patients of the main group showed a rapid decrease in the severe stages of hepatic encephalopathy (stage II–III) towards less severe forms (stage 0–I) on the 3rd, 5th and 7th days after liver transplantation, and also a faster recovery of cognitive functions, an earlier adequate recovery of consciousness, muscle tone, an earlier possibility of extubation, a shorter length of stay in the intensive care unit, and a decreased postoperative hospital length of stay relatively to the patients of the comparison group.Conclusion. The use of L-ornithine-L-aspartate in the combination therapy for hepatic encephalopathy in the peritransplantation period leads to a significant decrease of the incidence and severity of hepatic encephalopathy, accelerates rehabilitation of patients, reduces postoperative hospital length of stay.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86761557","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 : 2021-09-21DOI: 10.23873/2074-0506-2021-13-3-260-271
A. Pinchuk, N. Shmarina, I. Dmitriev, E. Stolyarevich, N. V. Natalya V. Zagorodnikova, K. Lazareva
Introduction. Despite the improvements in immunosuppressive therapy, the growing number of repeat kidney transplantations and associated risks of acute rejection make it relevant to assess the impact of early acute rejection on a long-term kidney graft survival.Objective. The aim of the study was to evaluate the rate, the clinical aspects of early acute rejection after repeat kidney transplantation and the outcomes of its treatment, to perform the assessment of the impact of rejection episodes on a long-term kidney graft survival.Material and methods. We carried out the retrospective analysis of kidney graft survival after 121 repeat kidney transplantations performed in N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2007 to 2018. Group I included 96 recipients after kidney transplantation without acute rejection in postoperative period. Group II consisted of 25 patients with early acute rejection after kidney transplantation. We performed the assessment of the impact of early acute rejection on the kidney graft survival in comparison with recipients with uncomplicated postoperative period. Statistical processing was carried out by nonparametric methods. Survival was assessed using the Kaplan–Meier curves.Results. 1-year and 3-year kidney graft survival rates amounted to 90.3% (95%, confidence interval 85–95) and 85.4% (95%, CI 79–91), respectively, in recipients of Group I; and 72% (95%, CI 58–86) and 60% (95%, CI 46–76) in patients of Group II. Significant differences in 1-year and 3-year kidney graft survival between patients of Group I and II have been noticed (P=0.0022 and P=0.0065, respectively).Conclusions. Patients with early acute rejection after kidney transplantation had poorer kidney graft survival in comparison with patients without rejection episodes in postoperative period.
{"title":"The impact of early acute rejection on kidney graft survival after repeat kidney transplantation","authors":"A. Pinchuk, N. Shmarina, I. Dmitriev, E. Stolyarevich, N. V. Natalya V. Zagorodnikova, K. Lazareva","doi":"10.23873/2074-0506-2021-13-3-260-271","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-3-260-271","url":null,"abstract":"Introduction. Despite the improvements in immunosuppressive therapy, the growing number of repeat kidney transplantations and associated risks of acute rejection make it relevant to assess the impact of early acute rejection on a long-term kidney graft survival.Objective. The aim of the study was to evaluate the rate, the clinical aspects of early acute rejection after repeat kidney transplantation and the outcomes of its treatment, to perform the assessment of the impact of rejection episodes on a long-term kidney graft survival.Material and methods. We carried out the retrospective analysis of kidney graft survival after 121 repeat kidney transplantations performed in N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2007 to 2018. Group I included 96 recipients after kidney transplantation without acute rejection in postoperative period. Group II consisted of 25 patients with early acute rejection after kidney transplantation. We performed the assessment of the impact of early acute rejection on the kidney graft survival in comparison with recipients with uncomplicated postoperative period. Statistical processing was carried out by nonparametric methods. Survival was assessed using the Kaplan–Meier curves.Results. 1-year and 3-year kidney graft survival rates amounted to 90.3% (95%, confidence interval 85–95) and 85.4% (95%, CI 79–91), respectively, in recipients of Group I; and 72% (95%, CI 58–86) and 60% (95%, CI 46–76) in patients of Group II. Significant differences in 1-year and 3-year kidney graft survival between patients of Group I and II have been noticed (P=0.0022 and P=0.0065, respectively).Conclusions. Patients with early acute rejection after kidney transplantation had poorer kidney graft survival in comparison with patients without rejection episodes in postoperative period.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81857278","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 : 2021-09-21DOI: 10.23873/2074-0506-2021-13-3-280-292
A. A. Budaev, M. Makarov, V. V. Slastinin, N. Borovkova
The authors have presented the review of scientific literature on producing grafts intended for surgical reconstruction of ligament ruptures. The treatment of ligament ruptures in reconstructive plastic surgery could be performed by using synthetic grafts, autologous and allogenic grafts from tissue donors. Advantages of synthetic grafts include the possibility of their regular manufacturing under sterile conditions, and providing mechanical properties, high biocompatibility. However, synthetic implants significantly increase the risk of synovitis and other complications, they can not be replaced by the native tissue, and have no ability to regeneration. Autologous grafts have ideal tissue compatibility and quick biointegration, could be harvested from different anatomical sites, but commonly the graft harvesting is followed by donor site morbidity and potential risk of injury nerves, elongates operation time, bad cosmetic results. The use of autografts may be also limited by anatomical features of the patient. Allogenic ligament biomaterial could provide wide range of grafts, but in our days there is no standardized methods for ligament graft sterilization and long storage. Wellknown sterilization methods, such as ionized radiation and chemical treatment, gave controversial results. One could conclude that estimation of ligament graft viability must include a complex study of biomechanical properties, cell and fibers integrity.
{"title":"Materials used for knee ligament grafting","authors":"A. A. Budaev, M. Makarov, V. V. Slastinin, N. Borovkova","doi":"10.23873/2074-0506-2021-13-3-280-292","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-3-280-292","url":null,"abstract":"The authors have presented the review of scientific literature on producing grafts intended for surgical reconstruction of ligament ruptures. The treatment of ligament ruptures in reconstructive plastic surgery could be performed by using synthetic grafts, autologous and allogenic grafts from tissue donors. Advantages of synthetic grafts include the possibility of their regular manufacturing under sterile conditions, and providing mechanical properties, high biocompatibility. However, synthetic implants significantly increase the risk of synovitis and other complications, they can not be replaced by the native tissue, and have no ability to regeneration. Autologous grafts have ideal tissue compatibility and quick biointegration, could be harvested from different anatomical sites, but commonly the graft harvesting is followed by donor site morbidity and potential risk of injury nerves, elongates operation time, bad cosmetic results. The use of autografts may be also limited by anatomical features of the patient. Allogenic ligament biomaterial could provide wide range of grafts, but in our days there is no standardized methods for ligament graft sterilization and long storage. Wellknown sterilization methods, such as ionized radiation and chemical treatment, gave controversial results. One could conclude that estimation of ligament graft viability must include a complex study of biomechanical properties, cell and fibers integrity.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79681334","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 : 2021-09-21DOI: 10.23873/2074-0506-2021-13-3-293-308
S. Glyantsev
The analysis of literature on experimental and clinical transplantation for the period of the 1968–1969 demonstrated that in the period from 1960 to 1970 the world transplantation saw a paradigm change in the field of homoorgan transplant: instead of overcoming the incompatibility between the donor organ and the recipient's body by using biological and physiological methods to influence the organ, which V.P. Demikhov had been dealing with for many years; surgeons and scientists, first abroad, and then in the USSR started developing and applying the creation of artificial immunological tolerance by using various physical, chemical and biological methods to impact recipient's body. The change of paradigms significantly influenced the implementation of organ transplantation techniques in clinic, including those of vital organs, and the further development of clinical transplantology. The data on the first heart transplants in 1968 and lung transplants in 1963–1970 have been presented.
{"title":"PHENOMENON OF DEMIKHOV. At N.V. Sklifosovsky Institute (1960–1986). Paradigm shift in homologous organ transplantation: from overcoming biological incompatibility to artificial immunological tolerance (1960–1970)","authors":"S. Glyantsev","doi":"10.23873/2074-0506-2021-13-3-293-308","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-3-293-308","url":null,"abstract":"The analysis of literature on experimental and clinical transplantation for the period of the 1968–1969 demonstrated that in the period from 1960 to 1970 the world transplantation saw a paradigm change in the field of homoorgan transplant: instead of overcoming the incompatibility between the donor organ and the recipient's body by using biological and physiological methods to influence the organ, which V.P. Demikhov had been dealing with for many years; surgeons and scientists, first abroad, and then in the USSR started developing and applying the creation of artificial immunological tolerance by using various physical, chemical and biological methods to impact recipient's body. The change of paradigms significantly influenced the implementation of organ transplantation techniques in clinic, including those of vital organs, and the further development of clinical transplantology. The data on the first heart transplants in 1968 and lung transplants in 1963–1970 have been presented.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89205369","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 : 2021-09-20DOI: 10.23873/2074-0506-2021-13-3-220-234
I. Dmitriev, S. Shchelykalina, D. Lonshakov, Y. Anisimov, A. Kazantsev, A. Pinchuk
Introduction. The total number of pancreas transplantations performed in Russia by the end of 2019 had been 176. There are no detailed reports on the number and results of pancreas transplantation in Russia with analysis of factors that significantly affect outcomes.Material and methods. This article presents a retrospective analysis of 60 pancreas transplantation results, which had been performed from January 2008 to July 2019 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. In addition, the assessment of factors that significantly affect the outcomes of pancreas transplantations was performed.Results. 17 intra-abdominal pancreas transplantations with duodenoejunoanastomosis and 43 retroperitoneal pancreas transplantations with interduodenal anastomosis were performed. In 52 patients, the pancreas graft after vascular reconstruction with a Y-shaped vascular prosthesis was used; in other 8 patients, the pancreas graft with isolated blood flow through the splenic artery was used. The rates of immunological and surgical complications were 23.3% and 56.7%, respectively. In-hospital and 1-year recipient, kidney and pancreas graft survival rates were 88.3%, 86.4%, 83.3% and 86.6%, 84.8%, and 81.7%, respectively. The factors that significantly affected the outcomes of pancreas transplantation were the conversion of the dialysis therapy modality, the development of parapancreatic infection, repeated open surgical interventions, surgical complications of IIIb-IVa severity grades by Clavien-Dindo Classification, some features of basic and induction immunosuppressive therapy.Conclusion. The results of pancreas transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine are comparable to the outcomes of pancreas transplantation in most world transplant centers.
{"title":"Analysis of the results of pancreas transplantation in one transplant center in Russia","authors":"I. Dmitriev, S. Shchelykalina, D. Lonshakov, Y. Anisimov, A. Kazantsev, A. Pinchuk","doi":"10.23873/2074-0506-2021-13-3-220-234","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-3-220-234","url":null,"abstract":"Introduction. The total number of pancreas transplantations performed in Russia by the end of 2019 had been 176. There are no detailed reports on the number and results of pancreas transplantation in Russia with analysis of factors that significantly affect outcomes.Material and methods. This article presents a retrospective analysis of 60 pancreas transplantation results, which had been performed from January 2008 to July 2019 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. In addition, the assessment of factors that significantly affect the outcomes of pancreas transplantations was performed.Results. 17 intra-abdominal pancreas transplantations with duodenoejunoanastomosis and 43 retroperitoneal pancreas transplantations with interduodenal anastomosis were performed. In 52 patients, the pancreas graft after vascular reconstruction with a Y-shaped vascular prosthesis was used; in other 8 patients, the pancreas graft with isolated blood flow through the splenic artery was used. The rates of immunological and surgical complications were 23.3% and 56.7%, respectively. In-hospital and 1-year recipient, kidney and pancreas graft survival rates were 88.3%, 86.4%, 83.3% and 86.6%, 84.8%, and 81.7%, respectively. The factors that significantly affected the outcomes of pancreas transplantation were the conversion of the dialysis therapy modality, the development of parapancreatic infection, repeated open surgical interventions, surgical complications of IIIb-IVa severity grades by Clavien-Dindo Classification, some features of basic and induction immunosuppressive therapy.Conclusion. The results of pancreas transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine are comparable to the outcomes of pancreas transplantation in most world transplant centers.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80255032","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 : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-151-157
S. Zhuravel, V. E. Aleksandrova, N. K. Kuznetsova, M. Novruzbekov, L. V. Donova
Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.
{"title":"Protein C in a patient with portal vein thrombosis in liver transplantation","authors":"S. Zhuravel, V. E. Aleksandrova, N. K. Kuznetsova, M. Novruzbekov, L. V. Donova","doi":"10.23873/2074-0506-2021-13-2-151-157","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-151-157","url":null,"abstract":"Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86435925","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 : 2021-06-21DOI: 10.23873/2074-0506-2021-13-2-130-140
M. Khubutiya, A. Pinchuk, N. Shmarina, I. Dmitriev, V. Vinogradov, A. Kazantsev, A. Balkarov
Introduction. Expanding donation criteria is one way of solving the problem of the increasing need of transplantation. The article is dedicated to comparison of the outcomes of first and second repeated kidney transplantation using grafts from standard criteria and expanded criteria donors.Aim. To evaluate 1-year and 5-year recipient and kidney graft survival rates after first and second kidney transplantation according to the donor type – standard criteria or expanded criteria donors.Material and methods. From 2007 till 2019 we performed 1459 kidney transplantations. The comparison study of outcomes of first (n=196) and second (n=143) kidney transplantations from standard criteria (n=245) and expanded criteria (n=94) donors was made.Results. There were no significant differences in a 1-year patient survival according to the donor type (98% and 95%, p=0.13). A 5-year recipient survival was significantly poorer after kidney transplantation from expanded criteria donors (97.6% and 88%, p=0.01). There were no significant differences in 1-year and 5-year graft survival rates according to the order of transplantation (p=0.21 and p=0.36). We found no significant difference in 1-year recipient survival after kidney transplantation from expanded criteria donors according to the order of transplantation (p=0.50). A 5-year recipient survival was significantly difference poorer after second kidney transplantation from expanded criteria donors (p=0.04). One-year and 5-year graft survival rates were significantly lower after kidney transplantation from expanded criteria donors (94%, 88% vs 86%, 65%, p=0.0025 and p=0.0011, respectively). One-year and 5-year survival rates were higher after first kidney transplantation from standard criteria donors in comparison with second kidney transplantation (p=0.052 and p=0.02, statistically significant in both cases). Analyzing outcomes of kidney transplantation from expanded criteria donors we found 1-year and 5-year graft survivals to be higher after first kidney transplantation comparing with second kidney transplantation (p=0.030 and p=0.018, statistically significant in both cases).Conclusion. In case of second organ transplantation, it is reasonable to use organs from standard criteria donors.
{"title":"Patient and kidney graft survival rates after first and second kidney transplantation","authors":"M. Khubutiya, A. Pinchuk, N. Shmarina, I. Dmitriev, V. Vinogradov, A. Kazantsev, A. Balkarov","doi":"10.23873/2074-0506-2021-13-2-130-140","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-2-130-140","url":null,"abstract":"Introduction. Expanding donation criteria is one way of solving the problem of the increasing need of transplantation. The article is dedicated to comparison of the outcomes of first and second repeated kidney transplantation using grafts from standard criteria and expanded criteria donors.Aim. To evaluate 1-year and 5-year recipient and kidney graft survival rates after first and second kidney transplantation according to the donor type – standard criteria or expanded criteria donors.Material and methods. From 2007 till 2019 we performed 1459 kidney transplantations. The comparison study of outcomes of first (n=196) and second (n=143) kidney transplantations from standard criteria (n=245) and expanded criteria (n=94) donors was made.Results. There were no significant differences in a 1-year patient survival according to the donor type (98% and 95%, p=0.13). A 5-year recipient survival was significantly poorer after kidney transplantation from expanded criteria donors (97.6% and 88%, p=0.01). There were no significant differences in 1-year and 5-year graft survival rates according to the order of transplantation (p=0.21 and p=0.36). We found no significant difference in 1-year recipient survival after kidney transplantation from expanded criteria donors according to the order of transplantation (p=0.50). A 5-year recipient survival was significantly difference poorer after second kidney transplantation from expanded criteria donors (p=0.04). One-year and 5-year graft survival rates were significantly lower after kidney transplantation from expanded criteria donors (94%, 88% vs 86%, 65%, p=0.0025 and p=0.0011, respectively). One-year and 5-year survival rates were higher after first kidney transplantation from standard criteria donors in comparison with second kidney transplantation (p=0.052 and p=0.02, statistically significant in both cases). Analyzing outcomes of kidney transplantation from expanded criteria donors we found 1-year and 5-year graft survivals to be higher after first kidney transplantation comparing with second kidney transplantation (p=0.030 and p=0.018, statistically significant in both cases).Conclusion. In case of second organ transplantation, it is reasonable to use organs from standard criteria donors.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90232534","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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