Clinical Transplantology
We report the first Russian experience of successful ABO-incompatible kidney transplantation using anti-CD20 + IA + IvIg pretransplant conditioning protocol and tacrolimus + MMF + steroids as maintenance immunosuppression. IA procedures were performed on reusable columns ABO-Adsopak® (POCARD Ltd. Moscow, Russia). IA treatments following the administration of rituximab efficiently lowered the immunoglobulin M (IgM) and G (IgG) anti-A/B antibodies titers in all patients. The transplantation could be performed in all cases and the kidneys showed primary function. Unfortunately, the biopsy-proven clinical antibody-mediated rejection (AMR) occurred in one case. Episo- de of AMR was successfully reversed. On 6, 4 and 2 months follow-up, serum creatinine levels were 117, 127 and 87 μmol/l, respectively. We consider ABO-incompatible transplantation as a safe and promising procedure in particu- lar cases for those patients having related but ABO-incompatible donors. Given the shortage of donor organs ABO- incompatible living donor kidney transplantation may become a treatment of choice for many patients.
In this review we describe our own experience of anesthetic management and early intensive care of two patients after heart retransplantation. As shown in this article, preretransplant clinical condition (severity of organs dys- function) influences on character of intra- and postoperative periods including duration of anesthesia, surgery, postoperative ventilation and ICU stay, intra- and postoperative bleeding, volume of blood product transfusion, infection complications, need in renal replacement therapy, selective LPS-adsorption and other therapeutic op- tions.
This article presents a retrospective analysis of infectious complications in the structure of morbidity and mortality of the patients underwent orthotopic heart transplantation. A significant role was assigned to the predisposing to in- fection factors. This study was based on the two years heart transplantation experience in the Republic of Belarus.
The purpose of this study was to investigate the occurrence of HLA and MICA antibodies in patients from the waiting list for kidney transplantation and their influence on the course of post-transplant period. Determination of HLA antibodies class I and II, and MICA antibodies was performed on a platform of Luminex (xMAP-tech- nology) using sets LABScreen ONE LAMBDA (U.S.). A total of 156 patients from the waiting list for kidney transplantation. Revealed the presence of HLA and MICA antibodies in the serum of 31.4% of patients. Regraf- ted patients increased the content of antibodies to the antigens of HLA system was noted in 88.2% of cases, 47% met the combination of antibodies to the I, II classes and MICA. In patients awaiting first kidney transplantation, HLA and MICA antibodies were determined in 23.7% of cases. The presence of pretransplant HLA and MICA antibodies had a significant influence on the course of post-transplant period. Patients with the presence of HLA and MICA in 50% of cases delayed graft function. Sessions of plasmapheresis can reduce the concentration of HLA and MICA antibodies on average by 61.1%.
Soluble CD30 (sCD30) is a marker of T-lymphocytes activation and is used for monitoring rejection in patients after heart, lung and renal transplantation. The aim of the study was to evaluate plasma levels of sCD30 in child- ren 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 level of sCD30 (84,9 ± 43,8 ng/ml) was significantly higher than in healthy donors and healthy children (26.4 ± 12.0 and 32.6 ± 6.9 ng/ml, resp., p < 0.01). After LDLT plasma level of sCD30 was higher in children, who had graft dysfunction at days 28–32 (108.9 ± 17.7 ng/ml) after LDLT than in children who had no graft dysfunction (40.2 ± 5.3 ng/ml, р < 0.01). In patients with graft dysfunction elevation of sCD30 concentration was observed before 2–5 days increasing of liver enzyme activity. The measurement of sCD30 concentration may be useful for monitoring of the postoperative course.
The article gives the report about the experience in repeated liver transplantation (LT). Totally 99 LT including 6 repeated operation at five patients performed between june 1999 and june 2011. In 3 of 6 cases bile ducts necroses was the indication to repeated LT. Retransplantations were connected with difficulties, enlargement of duration and replacement therapy volume, also explained high number of complication after operation. It is demonstrated that chronic biliary infection and bad condition of patients are the main reasons of complication and poor prognosis after repeated liver transplantation.
Gaining the experience of liver transplantation waiting list formation is the important condition of transplant cen- ter successful work. In the era of transplant organ shortage careful medical examination of the patient before the operation and detection of unfavorable facts and transplantation contraindications are of paramount importance. At the same time evaluation of the structure of potential liver transplant recipients category allows to develop maximal effective management of waiting list patients and prevention of fatal complications before operation.
Transplantomics
Structural changes in eyes are present in all patients with chronic kidney disease. A study to detect ocular patho- logy in patients with end-stage chronic renal failure after kidney transplantation in the early and late postopera- tive period compared with patients receiving replacement therapy with hemodialysis. Revealed that in the early post-transplant period in recipients of kidneyas in patients on hemodialysis, continued angioretinopatiya, 40% of patients had «dry eye syndrome». In the delayed post-transplant period, patients showed significant impro- vement in the retina and retinal vessels, the improvement of spatial-temporal parameters of visual perception. However, a decrease of visual acuity on the background of the development of posterior subcapsular cataract caused by prolonged corticosteroid, and an increased incidence of viral and bacterial conjunctivitis.
The last therapeutic alternative in severe postsurgical hypoparathyroidism is allotransplantation of macroen- capsulated parathyroid cells. With this technique, it is possible to implant cells or tissue of parathyroid origin to replace them in such patients, without immusupression. We report an allotransplant of parathyroid cells in a patient with continous endovenous requirement of calcium to survive. The macroencapsulation was carried out with a polyvinylidine difluoride (PVDF). We implant ~100 000 parathyroid cells in the deep femoral artery. In this article, we show functionality of the graft for at least 3 months without requirement of endovenous calcium. We report this procedure as a therapeutical alternative in severe hypoparathyroidism.
The article presents the results of a 24-month study of various schemes of immunosuppressive therapy aimed at minimizing the nephrotoxic effects of calcineurin inhibitors. There are set the indications to the early postope- rative conversion to an inhibitor of the proliferative signal (Everolimus) for the prevention of chronic transplant nephropathy in recipients kidney obtained from expanded criteria donors. We compare the results of two-year kidney transplants using standard immunosupression and conversion to Everolimus.
It is established that increased parameters of oxidative stress result from an imbalance between reactive oxygen molecules and endogenous antioxidants. Oxidative stress parameters may be considered to be biomarkers of heart failure. The aim of our study was to asses oxidative stress and antioxidant system parameters in experi- mental model with the axial pump. Our study included 7 calves (the mean age 120.33 days, the mean weight 99.17 kg). We used «FORM Plus CR3000» analyzer (Callegary, Italy) and heparinized venous blood samples for the evaluation of the oxidative status (FORT test) and the total antioxidant capacity (FORD test). In healthy animals oxidative system parameters differ from those in humans (FORT – 0.42 ± 0.11 versus 1.74 ± 0.32 mmol/l H2O2; FORD/FORT – 3.92 ± 1.30 versus 1.33 ± 0.27, p < 0.05) what should be taken into consideration when interpreting the results of clinical and experimental studies. In three calves with experimental assisted circulation maximal oxidative stress values were observed on 1–3 days after the axial pump connection with the subsequent normalization of these parameters. Direct evaluation of oxidative stress parameters may be used as monitoring tool for estimation of assisted circulation adequacy in experiment (animal model).
Porcine intrathoracic arteries were devitalized by application of low temperatures and electron beam irradiati- on. The resulted connective tissues vascular scaffolds could be used as the prosthesis of small diameter arteries (≤6 mm). Biocompatibility, immunogenicity degree and thrombogenicity were estimated in the study. Results of electron microscopy are presented. Described treatment reduces an immunogenicity of xenoarteries, their ade- quate functioning during 6 months was shown by means of experimental surgeries.
Editorial
Implants and Artificial Organs
The article presents a theoretical analysis of the dynamic interaction of the left ventricle assist axial pump and the cardiovascular system. It is shown the axial pumps are working in conditions «left ventricle- aorta» generates a pulsed flow. The slope of the flow-pressure characteristics determine the amplitude of the pulsation. Data are confirmed in the chronic experiments on the biological models with the extracorporeal connection of the pump. The possibility of using this characteristic for the develope of the automatic control systems to ensure adequate operation of the pump in range of the physical activity of a patient ‘s physical activity.
In article modern researches of processes of development of artificial ventricles of heart are described. Advanta- ges of application computer (CAD/CAE) technologies are shown by development of artificial ventricles of heart. The systems developed with application of the given technologies are submitted.
Literature Reviews
It was analyzed traditional and modern types of cadaveric donor corneas preservation for penetrating kerato- plasty, descemet stripping endothelial keratoplasty and descemet membrane endothelial keratoplasty. It was described the possibility of corneal damage decreasing and increasing of efficient corneal endothelia cells pre- serving by using regulatory peptides into preserving medium. It was emphasized the main role of peptide drugs as new generation revitalizers for preserving viability of endothelial cells.
Anniversary
Information
Information of scientific and training facility at Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs
