In the article first experience with the usage of coupled plasmafiltration and adsorption in the treatment of sepsis in patients after kidney transplantation has been presented. Aim: to make a comparative assessment of the impact of hemofiltration and coupled plasmafiltration and adsorption (CPFA) on systemic hemodynamics and alveolar-capillary diffusion, as well as the dynamics of the pro- and antiinflammatory cytokines in patients with sepsis after renal transplantation.

Methods and results. The study included 24 recipients. In the main group (n = 14), we used a combination of CPFA and hemofiltration. The patients of the comparison group (n = 10) we used an isolated hemofiltration. In patients of both groups we observed improvement of hemodynamics and lung function. In doing so by the fifth day after the second procedure in patients of the main group the results were significantly better. This effect we mainly associate with a reduction in the activity of the systemic inflammatory response and the rate of progression of sepsis. This is confirmed by the fact that circulating pro- and anti-inflammatory cytokines were expressly removed during the CPFA.

Conclusion. As a result of the CPFA and the hemofiltration we observed an increase in mean arterial blood pres- sure, improving gas exchange in the lungs, as well as reducing the need for vasopressor support. In this case, the additional sorption removal of circulating inflammatory mediators reduces the activity of the systemic inflam- matory response, which can significantly increase the effectiveness of the therapy. 

Aim was to evaluate clinical results of donor corneal graft survival in high-risk recipients in co-transplantation of preserved allogenic limbal grafts.

Materials and methods. Two types of penetrative keratoplasties were carried out in patients with corneal graft opacities and high risk of rejection (n = 69). Co-transplantation of donor cornea and allogenic MMSC-like limbal cells in the form of limbal transplants was carried out in the 1st group (n = 36); in the 2nd group (n = 33) only the cornea was transplanted.

Results. Observation of the patients during one year after surgery showed that the rate of transparent cornea engraftment increased in the 1st group (86,1 against 69,7% in the 2nd group). The density of endothelial cells was also higher in the 1st group (85,9 against 76,2% in the 2nd group). At the same time, progressive decreasing of pro-inflammatory cytokines (IL-6, IFNγ, TNFα) and increasing of anti-inflammatory cytokines (IL-10, IL-1RA, TGFβ) along with higher level of HLA-G5 were revealed in the recipients’ tear fluid in the 1st group in comparison to the 2nd group.

Conclusion. Simultaneous transplantation of preserved limbal grafts with corneal graft in high-risk keratoplasty favors the transparent cornea engraftment, obviously, this is due to immunoregulatory activity of the MMSC-like limbal cells. 

Aim. Treatment of urosepsis in patients after renal transplantation is very difficult. Currently selective endotoxin adsorption is a perspective method of treatment. Works devoted to the study of the effectiveness of this method in patients with renal transplant are extremely rare.

Materials and methods. 94 recipients were included in study: 54 in prospective main group and 40 – in retrospective comparison group. For each patient of the main group we performed 2 sessions of selective endotoxin adsorption. Patients of comparison group were not trea- ted with sorption of endotoxin. We investigated the dynamics of APACHE II score, the concentration of IL-6, IL-8, TNF-alpha, procalcitonin and endotoxin.

Results. As a result of endotoxin adsorption there was noted more pronounced decrease in the APACHE II score in patients of the main group, than in the comparison group. There was a decrease in activity of the systemic inflammatory response, and that was reflected in the decrease in the concentration of proinflammatory cytokines and procalcitonin in patients of the main group. Application of endotoxin adsorption resulted in a significant increase in survival in patients of the main group.

Conclusion. Sorption of endotoxin is very effective and safe procedure that affects the pathogenesis of sepsis. Application of this procedure can significantly improve the condition of patients and survival. 

Aim. A study of the influence of microstructured collagen hydrogel (biomatrix) on survival and growth charac- teristics of islet cell cultures at their co-incubation.

Materials and methods. As a biomatrix, the microstructured collagen hydrogel of linear series Sphero® GEL was used. Islet cell cultures obtained from newborn rabbit pan- creas were inoculated onto the biomatrix surface, covered with growth medium, and placed in a CO2 incubator. Changes occurring with biomatrix and cultures were observed by means of an inverted microscope and histolo- gical studies, including immunohistochemical analysis.

Results. The presence of the microstructured collagen hydrogel matrix during the incubation of floating islet cell cultures promoted long-term preservation of the structural integrity and hormonal activity. Simultaneously the formation of cultures of pancreatic progenitor cells (islet cells precursors) was observed.

Conclusion. Collagen hydrogel has a favorable effect on the formation and survival of islet cell cultures and can be used as a matrix of a tissue-engineered pancreas construct. 

Aim: of our clinical study was to present own experience of veno-venous extracorporeal membrane oxygenation (VV ECMO) for the treatment of an adult patient (female, 28 yrs, 150 cm, 35 kg) with acute respiratory distress syndrome (ARDS) in the early period after liver transplantation against satisfactory liver graft function.

Materials and methods. Double-lumen cannula 22 F was placed percutaneously in the right internal jugular vein. The ext- racorporeal contour reduced in length and the polymethylpeptene oxygenator (priming volume 175 ml) were also. 

Results. In 1 hour after the beginning of VV ECMO, we registered the noted improvement of arterial blood gas and acid-base balance (regress of respiratory acidosis, improvement of arterial oxygenation) which allowed us to use the «protective» mode of mechanical ventilation. Improvement of gas exchange and regress of clinical and radiological manifestations of ARDS allowed for VV ECMO weaning and decannulation on day 7. The patient was discharged from ICU and then from our Centre to a homestay respectively on the 9th and 16th day after VV ECMO weaning with the satisfactory liver graft and lungs function.

Conclusion. VV ECMO can be successfully applied to correct the life-threatening acute respiratory failure in the early period after liver transplantation. 

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

Aim. Evaluate the efficacy and safety of cinacalcet in the treatment of hyperparathyroidism (HPT) in renal transplant recipients.

Materials and methods. During the year, three patients with satisfactory functioning kid- ney transplant (glomerular filtration rate − GFR 44–80 ml/min) and HPT (parathyroid hormone − PTH 320– 348 pg/ml), resistant to treatment with active forms of vitamin D and hypercalcemia (2,6–3,1 mmol/l) were treated with cinacalcet (initial dose of 30 mg/day, supporting − 60–15 mg/day) with the added in 2–3 months alfacalcidol (0,25–0,75 μg/day). Investigated the serum concentrations and renal excretion of calcium and phos- phorus, PTH, renal transplant function (blood creatinine, GFR, plasma concentrations of tacrolimus), bone mine- ral density (BMD) in different parts of the skeleton (dual energy X-ray absorptiometry).

Results. A month later, the level of calcium in the blood to normal, PTH levels decreased by 1,2–3,2 times. A year later, in two patients, blood levels of PTH was back to normal, one − up − 142 pg/ml. Renal excretion of calcium varied differently − in two patients increased gradually, without exceeding the physiological norm, and in one − remained stable. Gene- ral pattern in the dynamics of serum concentration and urinary excretion of phosphorus was not observed. Renal graft function remained stable − GFR 46–76 ml/min. BMD of the distal forearm, femoral neck and lumbar spine in two patients remained the same, in one − increased by 14, 6 and 7%. Adverse events were absent.

Conclusion. Application of cinacalcet is promising for the correction of HPT in renal transplant recipients. 

At present, online hemodiafiltration is the most effective dialysis modality as it uses a combination of diffusive and convective transmembrane solute transport. First part of this review summarizes historical, technical aspects and international standards for online hemodiafiltration. 

Second part of review summarizes legal and financial aspects of online hemodiafiltration and its influence on short-term and long-term treatment results. According to recently completed randomized clinical trials, high vo- lume online hemodiafiltration is able to improve patients' survival rate. The results mentioned in the review must overpower the inertia which obstructs a wide implementation of online hemodiafiltration into routine clinical practice. 

Reducing the risk of kidney transplant rejection is a perspective trend in modern medical science. One of the promising methods for reducing the activity of immune conflict between the recipient and the donor organ and the achievement of partial immunological tolerance is photochemotherapy. This method is widely used in over- seas heart and lung Transplantation. Domestic experience of applying this method in renal transplant recipients is extremely small. In this review of literature a modern representation of the scientists on the mechanism of action of this method is presented. 

By analyzing data from the literature and the results of own clinical the authors suggest the presence of its own physiological rhythmogenesis motility of the urinary system to ensure its functional viability after denervation in the process of donor kidney recоvery and its transplantation to the recipient.