Aim of the study is to show the pathogenetic importance of myocardial revascularization and to estimate quantitatively effi ciency of the treatment of cardiac allograft vasculopathy after heart transplantation.

Materials and methods. 30 percutaneous coronary interventions (PCI) were performed to recipients of heart transplant (8 men and 7 women, aged from 18 to 56 years), who were diagnosed with cardiac allograft vasculopathy by coronary angiography within the time period from 1,5 to 12 years after heart transplantation. Before revascularization and one week after tolerances to physical activity, volume characteristics of the left ventricle were defi ned and diastolic function of heart was estimated. Average term of observation after stenting was 35,5 ± 5,5 months.

Results. Tolerance to physical activity (from 76,6 ± 8,5 to 116,9 ± 9,6 W), its duration (from 5,4 ± 2,2 to 8,5 ± 4,1 min) and rate pressure product – RPP (from 198 ± 15 to 247 ± 24 P < 0,05) increased. There was a restoration of diastolic function (Ve/Va from 0,57 ± 0,18 to 1,15 ± 0,2 P < 0,05). Signifi cant distinction in time frames of vasculopathy development, frequency and reasons of repeated interventions depending on age of patients is revealed. In the group of patients younger than 30 years of age (7 patients), the time interval between heart transplantation and vasculopathy development is twice shorter, than in more senior patient group, over 45 years old (8 patients). Young patients showed the expressed tendency to develop stent restenosis (20 coronary interventions).

Conclusion. Dynamics in functional condition of the left ventricle as a result of revascularization confi rms the leading role of miocardial ischemia in pathogenesis of transplant insuffi ciency due to vasculopathy. The signifi cant factor infl uencing upon long-term result of coronary intervention is the age of the patient.

Background. Quality of life (QoL) is an important criterion for the treatment effi cacy that provides an important data regarding patient’s personal estimation of social adaptation and ability to perform daily duties.

Methods. The study was aimed to evaluate QoL in cardiac transplant recipients. We have enrolled 42 stage D heart failure patients aged 29–61 (mean 39,23 ± 12,31 y/o), 38 males and 4 females, survived cardiac transplant surgery between Jan 2008 and Jan 2013. QoL was evaluated using the SF-36 survey prior to the heart surgery and during the follow-up period up to the 5 years.

Results. Pre-operative assessment revealed low QoL indices of physical activity as well as general health status. Follow-up showed dramatic improvement in all QoL measures during 1 year after the surgery which was consistent through the whole observation period. There was an increase in physical functioning index by 2,8 times (p < 0,01), physical status dependent role functioning by 14 times (р < 0,0001), emotional status dependent role functioning by 3 times (р = 0,02), social functioning by 4,8 times (p = 0,002), pain threshold by 3 times (p = 0,02), psychic health by 3,6 times (p = 0,001), life activity by 2,6 times
(p = 0,003), and total health by 1,6 times (p = 0,03). Physical activity was restored in 90% of patients during the fi rst year.

Conclusion. The study shows signifi cant improvement in all QoL variables after heart transplantation in stage D heart failure patients. Main indices of physical, psychical, and social activities rise at the fi rst year and remain high during the 5-year period. These data support heart transplantation as a radical and effective method of terminal heart failure treatment.

The article provides the overview of current international recommendations dedicated to selection of heart transplantation recipients based on urgency status. Authors found that cardiopulmonary bicycle stress test allowed to reveal additional criteria of high death risk within 1 year. These additional criteria were: the maximal oxygen consumption VO2max < 30% of the expected considering the age; VD/VT (ratio of physiologic dead space over tidal volume) increasing during the test; maximal tolerance to physical loading ≤50 Wt and/or < 20% of the expected considering the age. Authors created mathematical model for prediction of death within 1 year based on above mentioned data. Special software estimating the probability of death within 1 year was also created.

Transforming growth factor β1 (TGF-β1) plays a key role in the development of the immune response, as well as in the process of liver regeneration. Measuring the level of TGF-β1 may have important clinical implications in liver transplantation, because cytokine concentration in the tissue and in blood plasma varies with different liver diseases.

Aim. To analyze the dynamics of TGF-β1 levels in children-recipients with liver transplant from related donors, including from incompatible blood groups.

Materials and methods. The study involved 127 children aged 3 to 72 months (median – 8, average age – 12 ± 14 months), including 57 boys and 70 girls, with liver cirrhosis, developed as the result of congenital and hereditary diseases of the hepatobiliary system. All patients underwent transplantation of the left lateral liver sector from living related donors: 98 patients were transplanted
fragment of a liver from identical or AB0-compatible donors and 29 – from incompatible donors. The concentration of TGF-β1 was determined by enzyme immunoassay method in blood plasma samples.

Results. Average level of TGF-β1 in blood plasma of children with liver cirrhosis, developed as the result of congenital and hereditary diseases of the hepatobiliary system was 5,2 ± 5,5 ng/ml. A month after liver transplantation from a related donor level of TGF-β1 in blood plasma of recipients increased to 8,1 ± 9,6 ng/ml. One year after transplantation, the average level of TGF-β1 in the recipients of liver fragment was 7,7 ± 8,4 ng/ml, and signifi cantly (p = 0,00) differed from the level prior to transplantation. No association between TGF-β1 level in a month and a year after transplantation and the compatibility of the recipient with AB0 donor was found. A correlation (r = –0,23, p < 0,05) between level of TGF-β1 prior to transplantation and the development of graft dysfunction was observed: in recipients with graft dysfunction (16 cases) cytokine level prior to surgery was lower (p = 0,047) than in other recipients.

Conclusion. Liver transplantation leads to a signifi cant increase in the level of TGF-β1 in the blood plasma of children and that level is not different in recipients after transplantation of a liver fragment from AB0-compatible and AB0-incompatible donors and in recipients with anti-group antibodies before and/or after transplantation, and without them.

Aim: optimization of the surgical treatment policy with orthotopic liver transplantation (OLT) depending on the results of intraoperative fl owmetry and the state of intrahepatic microcirculatory bloodstream according to immunohistochemical (IHC) study of microspecimens of the donor’s liver.

Materials and methods. 60 patients are included in the study. Group I (n = 30) comprised of patients for whom it was not necessary to perform any additional interventions on the bloodstream in the hepatopancreatobiliary area during OLT. Group II (n = 30) had patients with insuffi cient arterial blood supply for the graft in the intraoperative stage where it was needed to perform additional and/or repeated interventions in the arteries of the hepatopancreatobilliary area. Intraoperative fl owmetry with assessment of the volume blood circulation (VBC) in the hepatic artery (HA) was carried out in the both studied groups. Reference value of VBC was 100 ml/min and higher. Before and after reperfusion in the liver biopsy material we performed immunohistochemical study with the use of endothelial marker CD 31 with subsequent morphometric estimation of the specifi c square of the microvascular bloodstream.

Results. In both groups there was no change in the specifi c square in the areas of portal tract and central vein before and after restoring blood fl ow. In the second group, an 8 times increase of the specifi c square of sinusoids was observed after restoring blood fl ow (р < 0,01).

Conclusion. Intraoperative fl owmetric control of the blood fl ow allows in due time to perform surgical correction of the graft arterial blood supply during OLT, and it reduces the risk of thrombosis up to 0%. The value of VBC in the hepatic artery (HA) has reliable dependence upon the state of microcirculatory bloodstream of cadaveric donor’s liver after reperfusion.

It is shown that developed method of titrating AB0 antibodies allows defi ning the titer of the investigational antibodies more precisely on 1–3 dilution of serum compared to the prototype method (titration method of antibodies
in saline medium on the plane). It is more obvious as it excludes hardly interpretable results due to the possibility of conducting visual assessment of agglutination reaction in the gel card thick column and requires less time for
analysis. The results can be saved for comparison with the results of further research. That is not possible under prototype titration method.

Aim: our aim is to create a laboratory technique that can accurately, reliably and clearly produce titration of AB0 system antibodies, including in patients with low initial concentration of agglutinins in the blood; a technique more economical in terms of spending serum and that takes less time.

Materials and methods: those modes were empirically chosen which allow titration of AB0 system agglutinins using gel technology based micro typing; to titer group antibodies 1640 serum assays of recipients in AB0-incompatible
transplantation were analyzed.

The result of the use of specially developed method in organ transplantation from incompatible blood donors consists in enhancing accuracy, sensitivity of natural, complete and incomplete AB0 system immune antibodies titration, in its clarity, using of blood micro-doses for earlier detection of sensitizing of the patient, which is especially important in Pediatrics. Conclusion: the developed procedure of AB0-antibodies’ titration using modern gel technology makes possible a more precise monitoring of the titer of antibodies that is necessary to predict the graft rejection risk, to select the Protocol of preoperative preparation and postoperative management of patients, to assess the effectiveness of therapy in patients for whom it is diffi cult to fi nd a compatible blood type donor, and for whom today AB0-incompatible transplantation is a life-saving.

Aim. To study microbiota of the intestinal tract of recipients with cirrhosis of the liver lobes before transplantation and its association with postoperative bacteremia pathogens.

Materials and methods. Microbiota of the intestinal tract was studied in 235 recipients (1–17 years) prior to transplantation of the liver fragment from a related donor (2005–2014). Microbiological study of intestinal contents, trachea, blood, vascular catheters was performed by plating a material on the standard culture medium. Identifi cation was carried out using microbial BD Crystal panels and BBL Crystal MIND databases. Susceptibility of isolated opportunistic bacteria to antibiotics was investigated by disk diffusion method.

Results. Deep microecological disturbances in the intestinal tract in children
were revealed. All recipients showed the reduction of resident microbiota with reduced content of bifi dobacteria, lactobacilli and coliform bacteria. The growth rate of isolating opportunistic Gram-negative bacteria, especially Klebsiella and enterobacteria (up 100%) was detected. Non-fermenting Gram-negative bacteria, in particularly, Pseudomonas aeruginosa were isolated rarely. Among Gram-positive bacteria dominated coagulase-negative staphylococci (CoNS). In patients with unremarkable post-transplant period (Group 1) CoNS and enterococci were often isolated. In the blood of patients with complicated postoperative period (Group 2) Pseudomonas aeruginosa (44%) and Klebsiella pneumoniae (36%) were isolated. Similar microorganisms were seeded from vascular catheters of the same patients. It is worth noting that no essential differences in the content of Klebsiella and non-fermenting microorganisms in microbiota of the intestinal tract of the recipients of both groups were not determined.

Conclusion. Studies showed deep microecological disorders of the intestinal microbiota. Klebsiella pneumonia was the main pathogen, whose high content was detected in all liver lobe recipients studied. Isolation of Klebsiella pneumonia in the blood was 23,7% in patients with complicated postoperative period, and 12,9% in those with unremarkable post-transplant period. No such dependence was revealed in relation to Pseudomonas aeroginosa.

Aim. Analysis of the results of kidney allotransplantations over 20 years (1990–2010), made by the research group from the Regional Hospital № 1 (Ekaterinburg, Russia).

Materials and methods. We analyzed the outcomes of kidney transplantations in 340 patients: men – 218 (64%), women – 122 (36%), average age: 12 to 61
(37,57 ± 0,64). We focused on the patient and transplant survival rates, structure of mortality and transplant loss. For the statistical analysis we used SPSS.

Results. Patient survival rate during 10-year period was 64%; transplant
survival rate during 10-year period was 48%. Patient survival rate during 20-year period was 43%; transplant survival rate during 20-year period was 41%. The main causes of patients’ death were infections; the dominant causes of transplant losses were deaths of patients with functioning transplants and chronic allograft nephropathy. We defi ned statistically reliable improvement of transplant results over last 10 years. We showed the advantages of molecular genetic method of immunological selection of donor-recipient pair for improvement of transplant outcomes.

Conclusion. Over last 10 years we observed an improvement of kidney allograft results by means of contemporary methods of immunosuppressive therapy, immunological selection of transplants and other factors.

Aim. This work is to research the aortic valve functioning during left ventricle bypass with non-pulsatile pump.

Materials and methods. The main part of the research is author’s algorithm to estimate aortic valve state (open/closed). The research includes mathematical modeling, mock loop experiments and animal experiments.

Results. The author develops the algorithm of rotary blood pump fl owrate processing to estimate (with reliability of more than 90%) the state of aortic valve during heart mechanical support.

Conclusion. The proposed algorithm of estimating the aortic valve state allows identifying abnormal mode of cardiac support that can cause thrombosis and aortic valve commissural fusion. This algorithm can be incorporated into nonpulsatile LVAD.

Multiple sclerosis (MS) is a major infl ammatory and demyelinating disease of the central nervous system (CNS), associated with a broad spectrum of physical, psychological, and social impairments. High-dose immunosuppressive therapy (HDIT) with autologous hematopoietic stem cell transplantation (AHSCT) is a new and promising approach to MS treatment. In this paper we present the clinical monitoring results of 93 patients with different MS types after AHSCT. The mobilization and transplantation procedures were well tolerated. At long-term
follow-up (mean 47,2 months), the overall clinical response in terms of disease improvement or stabilization was 95% in patients with relapsing-remitting MS and 77,5% in patients with progressive MS. The results of our study support the feasibility of AHSCT in MS patients.

Aim. To study the effects of nitroglycerin on proliferative and migratory activity of mononuclear cells and endothelial progenitor cells in patients with chronic heart failure.

Materials and methods. Proliferative potential of peripheral blood mononuclear cells in donors and patients were studied in MTT-test in the presence of 50 and 100 mg/ml nitroglycerin. Proliferation and migration of endothelial progenitor cells in patients were evaluated by changes in the cell impedance in real-time in the presence of various doses of nitroglycerin.

Results. It is shown that nitroglycerin reduces in vitro both spontaneous and Concanavalin A stimulated proliferative activity of mononuclear cells in patients with chronic heart failure. Peripheral blood mononuclear cells in patients with chronic heart failure, obtained after procedure of mobilization by granulocyte colony-stimulating factor respond to nitroglycerin dose of 50 mg/ml with the increased proliferative activity, and with the suppressed proliferative activity to nitroglycerin dose of 100 mg/ml. Mononuclear cells of healthy donors respond to 50 mg/ml of nitroglycerin with the activation of proliferative capacity, but at a dose of 100 mg/ml spontaneous proliferative activity of mononuclear cells inhibit. It is also shown that the presence of nitroglycerin in medium dose in stimulating test leads to the inhibition of mononuclear cells proliferation from healthy donors. It is shown the stimulating effect of nitroglycerin on proliferative and migration potential of endothelial progenitor cells.

Conclusion. Multidirectional and dose-dependent effects of nitroglycerin to the various types of human cells in vitro were observed.

Aim. Through the experiments on animals, mandibular fragments reparative regeneration and osteohistogenesis in the post-resection period using different ways of their optimization by artifi cial nitinol matrices were investigated.

Materials and methods. Rabbits (two groups) were subjected to similar resections of mandibular right branch fragments with articular head exarticulation. In the fi rst group (n = 10) extrafocal matrix structures placement option towards regeneration foci (sagittal dislocation) was used, in the second one (n = 10) intrafocal matrix bone and periosteum nitinol constructions placement option was used.

Results. In the fi rst group, the following reconstructive results were received: organ-like osteogenic regenerates fully displaced mandibular defects in 12 months. In the second group reconstructive results were the following: tissue-engineered composites fully displaced mandibular defects in 3 months. Biological, biometric, radiological, histological, immunohistochemical, morphometric, statistical methods were used to evaluate the results.

Conclusion. Reparative regeneration and osteohistogenesis at extrafocal placement of artifi cial matrix structures are able to reconstruct independently mandibular fragments due to natural regeneration. Reparative regeneration and osteohistogenesis at intrafocal placement of artifi cial matrix structures are able to reconstruct independently mandibular fragments due to bone and periosteum tissue-engineered composites forming. Four-fold advantage of mandibular reconstruction dynamics by tissue-engineered composites being equal in functional effi ciency with natural regeneration results testifi es to their availability for usage in clinical practice.

Aim. To study the stability of biocompatible microemulsion composition-based bromokain transdermal therapeutic systems (TTS) in order to confi rm the original shelf life and to identify the most appropriate TTS composition for storage.

Materials and methods. The stability test using accelerated aging method was performed on the samples of TTS containing 50 and 100 mg of bromokain. Physicochemical properties of TTS were analyzed at the end of the 1st, 2nd, 3rd, and 6th month of storage. The physical confi guration of the dosage form, the content of bromokain in TTS, and drug release were evaluated at each stage of the study. The content of bromokain in the samples was recorded using high performance liquid chromatography (HPLC). As a control for each method, the newly manufactured TTS forms were used.

Results. Unlike the samples containing 50 mg of bromokain, TTS with 100 mg of the anesthetic demonstrated changes in the physical confi guration and deterioration of the functional properties after the 6th month of storage. The quantitative content of the substance in TTS containing 50 and 100 mg of bromokain met the requirements of regulatory documentation (RD) at all
phases of the experiment and was within 50,0 ± 5,0 mg and 100,0 ± 10,0 mg, respectively. The release profi le of TTS with 50 mg of bromokain has remained unchanged during storage and complies with the RD. TTS with 100 mg of bromokain after the 3rd month of storage had a deviation from the release profi le indicated in the RD.

Conclusion. The shelf life of 2 years at t = 25 °C preset by us for samples of TTS containing 50 mg of bromokain has been confi rmed. According to the test results, samples of TTS with the content of bromokain of 100 mg were declared unstable and unfi t for storage under the selected storage conditions.

Right heart catheterization (RHC) should be performed on all candidates in preparation for listing for cardiac transplantation. Patient, 64 y. o., with chronic heart failure NYHA III class, had developed a rare complication while performing that procedure – a rupture of segmental branch of pulmonary artery (PA) with pulmonary haemorrhage. The episode of pulmonary bleeding was stopped conservatively without surgical management. There was a pseudoaneurysm formation of segmental branch of PA 2,7 × 2,8 cm with signs of thrombosis. After
fi ve months the patient underwent heart transplantation without severe complications in perioperative period. No more recurrent episodes of pulmonary haemorrhage were identifi ed.

Acute right ventricular failure in the early period after orthotopic heart transplantation is a severe complication and can often lead to a fatal outcome. This is especially important in patients with high pulmonary arteries resistance. Drug therapy has shown effectiveness only for the treatment of primary pulmonary hypertension. Patient K., 23 years old with signifi cant pulmonary hypertension (mean pulmonary artery pressure of 60 mm Hg, PVR – 6 Wood units) underwent orthotopic heart transplantation. Acute right ventricular failure occurred at early postoperative period which required multicomponent inotropic support. In order to reduce resistance of the pulmonary circulation the patient received sildenafi l (daily dose 50 mg) in combination with inhaled Ventavis (5 mcg a dose every 3 hours) and receipt of Tracleer (bosentan) (at a dose of 125 mg per day). Complex drug therapy resulted in reduction of right ventricular failure, normalization of biochemical parameters. Invasive pulmonary artery pressure decreased to 30 mm Hg and pulmonary vascular resistance was 1.1 Wood units at the moment of discharge. We also revealed right ventricle end-diastolic volume reduction from 70 ml to 62 ml and ejection fraction of the right ventricle (RV EF) increased from 47,7% to 62% in 2 months. Our clinical observation demonstrates the high effi ciency of acute right heart failure complex therapy including inotropic agents in combination with drugs that reduce the pulmonary vascular resistance.

Situs inversus is a rare congenital abnormality that affects approximately 0.005% of all live births. Traditionally, this condition is considered as a contraindication for liver donation, primarily due to the peculiarities of the vascular anatomy and the diffi culties in graft placement in the abdominal cavity. Review of the world literature testifi es to fi ve cases of use of the whole liver from deceased donor with situs inversus in adult recipients, and to just one case of inverted right lobe transplantation from living donor to 53-year-old man. Thus, transplantation of an inverted left liver lobe from a living related donor in pediatric patients was performed for the fi rst time. The article presents a successful experience of liver transplantation in child with tyrosinemia type 1 from AB0-incompatible living donor with situs inversus.

We report the case of successful renal allogeneic transplantation and treatment in a 56-year-old patient with haemophilia B at Hematology Research Center. He has received replacement therapy by factor IX since 2010. The transplant is marked with good renal function during 13 post-transplant months without episodes of rejection or bleeding complications. The complicated surgical interventions are possible in patients with haemophilia В аnd end-stage chronic renal failure in the presence of replacement therapy of IX factor for the purpose of achievement of optimum hemostasis.

Despite the fact that the study of endocardial infi ltrates (Quilty effect) in the transplanted heart has been going on for more than 30 years, the etiology, morphology and clinical signifi cance of this phenomenon are not yet fully understood. The article presents the facts of the available literature on the possible causes and mechanisms of the effect of Quilty, as well as on its impact on the function of the transplanted heart

Aim. The main purpose of this work is to evaluate the Hemolung pumping ability and gas exchange effectiveness while using the catheters of smaller diameter and blood fl ow rates, applied in pediatrics.

Material and methods. The bench testing of the device with pediatric catheters has been performed. The bovine blood and carboxymethylcellulose water solution were used as a model. The device operation data, blood gas analysis and hydrodynamic pressure data were collected.

Results.The pump curve results show that at the maximum rotation rate the Hemolung device was able to achieve blood fl ow rates substantially greater than targeted 280 ml/min that is used in pediatrics. The calculated operating curve plotted against the observed pressure-fl ow relationships shows that the device could be able to operate against pressure heads of 80 and 100 mm Hg. In general, carbon dioxide elimination rate increased along with increase of the rotation rate, reaching maximum levels of 168 ± 0.3 ml CO2/min at 1750 RPM and a blood fl ow rate of 670 ± 42 ml/min. As a passive oxygenator, the small gas exchange fi ber surface area of the Hemolung resulted in oxygen saturations of 81% and 78% at 1.5 and 2.0 L/min, respectively.

Conclusion. The results of this study show the prospect of application of the Hemolung system in pediatrics.

Transplantation of endocrine organs and tissues is often considered as an alternative therapy which has a number of advantages compared to regular injections for replacement of a missing hormone or another factor. During the last two decades, accumulating evidence demonstrates that adipose tissue is an endocrine organ that plays a pivotal role in the key physiological processes, and this raises a possibility of its potential use in transplantations aimed to correct inborn metabolic defi ciencies. In this review, we provide examples of the factors, secreted by adipose tissue, and which may be responsible for particular human pathologies when missing. We discuss practical aspects of fat transplantation, such as availability of donor tissue, its susceptibility to rejection, rationality of immune suppression, and possible ways to achieve medication-free tolerance.