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

Tасrolimus (Tac) has been used for rescuing of renal allografts from refractory rejection that occurred during treatment with conventional cyclosporine A (CsA) mostly in the early posttransplant period. Less is known about effect of Tac in cases of late acute rejection. Aim of the study was to examine the long-term effects of switching from CyA-based therapy to Tac-based therapy versus continuation of CsA in renal transplant patients with acute rejection occurred 3 month after transplantation or later. In this comparative prospective clinical study 176 patients experiencing a late biopsy-proven acute or active chronic rejection were followed-up for up to 6 months. 61 pati- ents were converted from a CуA-based therapy to the Tac one; in 115 patients CsA-based therapy was continued. During the first month after the rejection episode the median serum creatinine concentration had decreased in both groups (from 0.27 (0.18; 0.4) to 0.25 (0.16; 0.41) mmol/l in the CsA group and from 0.25 (0.18; 0.3) to 0.18 (0.14; 0.25) mmol/l in the Tac group. During the follow-up graft function remained stable in the Tac group 0,17 (0,14; 0,3) mmol/l, while in the CsA group a trend to progression of graft failure was observed 0.33 (0.19; 0.8) mmol/l. The 3-year Kaplan-Meier estimates for graft loss were 57,1% (Tac) and 40,9% (CsA), respectively (р < 0.01). Conclusion: early switch from the CsA- to the Tac-based therapy after a late biopsy-confirmed rejection resulted in a significant improvement in the clinical output in renal graft recipients compared to patients for whom the CyA therapy was continued. 

To compare clinical and virologic course of de novo and recurrent HBV infection 104 liver graft recipients with 6 months and more follow-up after cadaveric transplantation have been analyzed. Recurred HBV infection occurred in 7 (30.4%) out of 23 HBsAg-positive and de novo HBV infection – in 11 out of 81 (13.6%) HBsAg- negative recipients. HBeAg and IgM anti-HBc appeared in 8 recipients with de novo and in one case – with recurrent infection. Two recipients with de novo HBV developed acute hepatitis with jaundice and one – chronic hepatitis with graft cirrhosis. Only one recipient with recurrent HBV developed severe acute hepatitis HBV/ HDV, with anti-HBs seroconversion after 12 weeks of peginterferon alfa treatment. Nucleoside analogs (NA) were started in all 11 de novo HBV cases and in 5 cases of recurrent HBV infection. Treatment with NA effec- tively suppressed HBV DNA replication in both recurrent and de novo infections; HBsAg clearance occurred in 64% of de novo HBV and in 20% – of recurrent HBV cases. No secondary drug resistance occurred. De novo HBV infection is a self-limited disease in most cases, and preemptive NA treatment is the best treatment choice. Recurrent HBV infection is usually chronic, and pegylated interferon may be under consideration as well as NA. 

Cardiac allograft vasculopathy (CAV) remains to be one of the most serious complications after heart trans- plantation (HTx) and a main cause of death in patients survived the first year after transplantation. Pregnancy- associated plasma protein A (PAPP-A), a potentially proatherosclerotic zinc binding metalloproteinase, has been shown to be elevated in ischemic heart disease patients and heart transplant recipient. The aim of the study was to evaluate the relationship between РАРР-A plasma levels and the extent of coronary lesions in heart transplant recipients. The study included 37 heart transplant recipients. CAV was diagnosed in 23 recipients. Our results showed that PAPP-A plasma levels were higher in recipients with CAV, did not correlate with the duration of time after HTx but were associated with the extent of coronary lesion. 

Being based on a private experience, authors considered necessary to study features of emotional disorders that will allow understanding the mechanism of mental adaptation to disease at patients before and after OLT. In comparative research of structure of emotional frustration at the patients making the most numerous groups of patients before transplantation of a liver (viral hepatitis and autoimmune liver diseases), 129 persons, from them 75 before OLT are included at entering into a waiting list and 54 to through 22 ± 9 days after OLT.

Distinctions in structure of emotional frustration are revealed: at patients with autoimmune liver diseases be- fore OLT and viral hepatitis after OLT the semiology combined with disturbing-depressive experiences and hypochondriac fixings is brightly expressed neurotic, them distinguishes high level of personal uneasiness. For patients with autoimmune liver diseases after OLT and viral hepatitis before OLT are characteristic moderately expressed neurotic frustration of an asthenia circle and low level of personal and situational anxiety. 

Neopterin (NP) is a marker of macrophages activation and is used for monitoring rejection in patients after heart, renal transplantation. The aim of the study was to evaluate plasma levels of NP in children before and after living-donor liver transplantation (LDLT) and its relationship with the postoperative course. The study included 72 children with end-stage liver disease (ESLD), aged 17 ± 11 (4–28) months before and after LDLT, 15 healthy children aged 9.9 ± 5.7 (3–21) months and 38 adult living-related liver donors, aged 37 ± 19 (18–56) years.

In children with ESLD pre-transplant plasma levels of NP (25.2 ± 19.9 nmol/l) was significantly higher than in healthy donors or healthy children (5.5 ± 3.4 and 6.3 ± 2.7 nmol/l, resp., p < 0.01). After LDLT plasma level of NP was higher in children, who had graft dysfunction at days 28–32 (61.9 ± 30.9 nmol/l) after LDLT than in children who had no graft dysfunction (24.0 ± 5.6 nmol/l). The measurement of NP concentrations may be useful for monitoring of the postoperative course. 

The analysis of results of hybrid treatment of complex combined coronary and valve disease at patients with high level of operational risk between January 2005 and December 2010. The hybrid treatment of complex combined coronary and valve disease, provides performance of percutaneous coronary interventions (PCI) in a combinati- on valve surgery. 118 patients, with a median age 64.4 ± 8.9 years, are included in research. 2 approaches of a hy- brid method of treatment – 2-Staged (n = 86) and a method «1-stop» (n = 32) are applied. The оperative mortality has made 4.2%. On the basis of the received results were the conclusion is drawn that at high-risk patients with complex combined coronary and valve disease the hybrid method of treatment allows to lower risk of operation. 

EDITORIAL 

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

In the article there is described the case of the accelerated humoral (antibody-mediated) rejection of the cardiac allograft with morphologic and immunohistochemical details revealed at the investigation of the endomyocardial biopsy and myocardial autopsy. 

Complications of the biliary tract like bile leaks, strictures are an important cause of morbidity and mortality after liver transplantation. The frequency of such complications ranges from 5 to 25%. In most cases, biliary complications can be treated by endoscopy and/or methods of interventional radiology. This article is about the clinical case of liver transplantation with duct-to-duct biliary reconstruction, complicated by bile leaks, biliary tract stricture. Surgical correction of complications was ineffective. We used miniinvasive methods and got po- sitive clinical outcome after radiology intervention for prosthetics of the common bile duct. 

The pure red blood cell aplasia of renal transplant recipients caused by parvovirus B19 (PB19) is characterized by persistent anemia which resistant to erythropoietin therapy, lack of reticulocytes, bone marrow hypoplasia, and clinically accompanied by severe recurrent bacterial, fungal and viral infection. In case of reactivation PB19 it is necessarv, first of all, eliminate the causes activation of this virus and to cancel or reduce the dose of drugs which depressed the normal hematopoiesis germs, thus to reduce the pancytopenia associating complications in this population. 

Splenic artery steal syndrome is one of possible arterial complications after orthotopic liver transplantation. Material includes personal experience in diagnostics and treatment of this syndrome. In each case complication was opportunely suspected basing on laboratory and ultrasound data and proved by angiography. Successful treatment was performed using different variants of splenic artery embolization. 

Activation of destructive adaptive and inherited immunity is the main reason of graft opacification by high-risk keratoplasty. Approximately 46% of recipients from this group are absolute resistant to immunosuppressive therapy with glucocorticoids and cyclosporine A and need tolerization. Discovery of limbal mesenchymal stem cells that resemble phenotype of mesenchymal stem cells of bone marrow reveal the prospects of their use like inductors of local immune tolerance in high-risk keratoplasty. It will help to increase percentage of successful engraftment and shorten the period of medical immunosuppression. 

In the following paper we present the literature review concerning the correlation between the ischemic injury of kidney allografts and matrix metalloproteinases activity. 

Much attention has been placed recently in transplantation in highly HLA-sensitized patients. In attempts to remove these antibodies and enable successful renal transplantation, several approaches have been developed. Intravenous immunoglobulin (IVIG) was found to be effective in the treatment of autoimmune and inflammatory disorders (e. g. Kawasaki disease, Guillain-Barre syndrome). Recently, a beneficial effect of IVIG on the reduc- tion of anti-HLA antibodies was described. The anti-inflammatory effect of IVIG provides hopeful opportunities in antibody-mediated rejection (AMR) management. There are several protocols of IVIG administration for pre-transplant desensitization and AMR treatment: high-dose IVIG, low-dose IVIG + plasmapheresis, IVIG + plasmapheresis + rituximab. These advancements have enabled transplantation in patients previously considered untransplantable and in concert with new diagnostic techniques has resulted in new approaches to management of AMR. 

From from February 7th to 9th 2011, the World Health Organization (WHO), the Italian National Transplant Cen- tre and the EU-funded Project «Vigilance and Surveillance of Substances of Human Origin» joined forces to organise a major global consultation that took place in Bologna, Italy. The scope of the project included organs, tissues and cells for transplantation and for assisted reproduction. The participants represented regulatory and non-regulatory government agencies, professional societies and scientific and clinical specialities from all WHO regions. The meeting explored the work already carried out on-line and agreed on priorities for the future deve- lopment of the Project «Vigilance and Surveillance of Substances of Human Origin». 

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