Aim. To prove approaches to the organization of the system of registration in the field of organ donation and transplantation. Materials and methods. The analysis of the existing experience of the organization and carrying out the registration in the field of organ donation and transplantation in the Russian Federation is conducted. Results. The list of events in connection with which there are data which are subject to the registration is offered. The list of sources containing the data which are subject to the registration is offered. Statistical forms are developed for the system of registration on all main stages of medical care on transplantation. The order and the terms of data submission by the medical organization for the system of registration are offered. The list of administrative tasks to the completion of which the system of registration can be applied, and the list of users of the system of registration are defined. Conclusion. Approaches to the organization of the system of registration which allow solving a wide range of administrative tasks on the basis of retrospective reporting of the medical organizations are offered. The prepared material can be used for elaboration of the normative legal acts regulating the registration in the field of transplantation and organ donation, for preparation of the technical requirement for development of the information system itself. 

Introduction. The Quilty Effect (lymphoid-cellular infiltration of the endocardium) is a frequent finding in biopsies of the transplanted heart. The role of this phenomenon in the rejection of the transplanted heart remains unclear. Aim. Retrospective analysis of endomyocardial biopsies of the transplanted heart and assessment of the relationship between acute cellular rejection and Quilty Effect. Methods and results. 112 endomyocardial biopsies with Quilty Effect were identified out of 883 studied biopsies during the period from January 2010 to June 2014. The frequency of Quilty damage occurrence in acute cellular rejection is significantly higher than in its absence (17.7% and 5.6%; р < 0.001). The combination of acute cellular rejection with acute antibodymediated rejection significantly increases the frequency of Quilty damage (р = 0.039). Isolated acute antibodymediated rejection of the transplanted heart does not affect the frequency of Quilty Effect occurrence and is not a direct etiologic and pathogenetic factor of this phenomenon. In the absence of acute cellular rejection, Quilty Effect is a predictor of its later development. Mild acute cellular rejection in conjunction with the Quilty Effect causes the risk of more severe degree of rejection. Quilty Effect type B occurs much less frequently than type A (1.9% and 10.8%; р = 0.001) and is observed primarily in acute cellular rejection of grade G2R (р = 0.001); the frequency of these morphological types at various periods after heart transplant was not significantly different (р > 0.05). Conclusion. The Quilty Effect is a kind of manifestation of acute cellular rejection of the transplanted heart when immunosuppressive therapy with calcineurin inhibitors is used. 

Aim. To identify new predictors of heart transplant rejection by using speckle-tracking echocardiography technique. Materials and methods. 117 recipients were included into research. The follow-up period in S.V. Ochapovsky Region Clinical Hospital No 1 was from March 2010 to April 2015. The groups were allocated based on results of the retrospective analysis of biopsies: group 1 (n = 68), recipients without signs of cellular and humoral rejection (AMR0 ACR0); group 2 (n = 28), recipients with ACR1; group 3 (n = 16), patients with ACR2; group 4 (n = 5), patients with chronic rejection. The analysis of the results was carried out with endomyocardial biopsy, coronary angiography, transthoracic echocardiography (TTE), tissue Doppler imaging, speckle-tracking echocardiography. Results. Early complications include infections and rejection of heart transplant. Cellular rejection is diagnosed in 70% of cases, humoral rejection in 30% of cases. The disease of coronary arteries is a kind of late complications. It was diagnosed in 13.7%. Fraction rejection sensitivity was 63%, specificity was 97% in recipients with ACR1 while carrying out TTE for the purpose of identification of early diagnostic criterion of rejection; recipients with ACR2 had 75% and 96%, respectively. While carrying out PW sensitivity and specificity Е/А in recipients with ACR1 were 83% and 53%, respectively; recipients with ACR2 had 85% and 52%, respectively. While carrying out PW-TDI sensitivity and specificity Е in recipients with ACR1 were 83% and 58%, respectively; recipients with ACR2 had 88% and 60%, respectively. The assessment of myocardial deformation of the left ventricle is as follows: global peak systolic strain in recipients without rejection (GLPS LV) – (–17.54 ± 3.71%), р = 0.0012; recipients with (ACR1, AMR1) had GLPS LV (–10.52 ± 1.8%), p = 0.0012; recipients with ACR2 had (–6.44 ± 1.8%), p = 0.002; recipients with chronic rejection had (–9.43 ± 1.8%), p = 0.002. The STE GLPS LV parameter (–10.52 ± 1.8%), p = 0.0012, which estimates longitudinal function of myocardium can be considered as early diagnostic criterion of myocardium rejection. The correlation coefficient between CD 3, CD 20, CD 68 and parameter GLPS LV% for groups ACR1-ACR2 was 0.54, 0.86 and 0.26, respectively. Conclusions. The parameters of deformation and cardiac mechanics being estimated by means of speckle-tracking echocardiography can be used as diagnostic monitoring of recipients with rejection of heart transplant. 

Aim: to evaluate the effectiveness of coupled plasma filtration and adsorption (CPFA) in reducing the severity of the renal graft ischemic and reperfusion injury. Materials and methods: shortand long-term results of renal transplantation in 33 pairs of recipients were analyzed. The patients were divided into two groups: in 33 recipients of the study group we performed CPFA in the early postoperative period. In the comparison group in 33 recipients with paired grafts CPFA was not performed. Results. The proportion of patients with good initial and delayed graft functions in the two groups was the same. In patients with delayed graft function from the study group a significantly greater rate of creatinine and urea decrease and glomerular filtration rate (GFR) increase than in patients of the comparison group were observed. Among patients with good initial graft function the differences between the groups were not significant. We have also analyzed long-term results of the transplantations: patients who received CPFA in the early postoperative period had lower levels of creatinine, urea and daily proteinuria and higher GFR in 1 year time. Thus, as a result of CPFA in the early postoperative period the improvement of graft function and graft survival prognosis can be expected in the long-term. 

The paper presents the renoprotective properties of sevoflurane and propofol in kidney transplantation. In order to study these properties microdialysis technology was used. The study included 40 patients. The patients were randomized in two groups. Sevoflurane had more effective renoprotective properties than propofol. 

Аim of this work was to study the influence of intravenous injection times of bone marrow allogeneic multipotent mesenchymal stromal cells (BM MMSCs) on kidney function and morphology in modeled ischemicreperfusion injury of kidney (IRIK). Materials and methods. The study was conducted on 90 male Wistar rats. On the original IRI model of a single kidney (60 min, warm ischemia) 4 groups of experiments were performed: in the first group the dose of 5 × 106 of BM MMSCs was administered intravenously 14 days before IRIK modeling; in the second group, the same dose of BM MMSCs was administered 7 days before IRIK; in the third group, the same dose of BM MMSCs was administered during kidney reperfusion after IRIK modeling; the fourth group served as the control group (IRIK without BM МMSCs). The study duration was 21 days since the start of IRIK modeling. In all groups the nitrogen secretory function of kidneys was examined and the histological condition of kidneys during the entire recovery period was evaluated. Besides, blood of rats of the first and the fourth groups was examined for proand anti-inflammatory cytokine levels and phagocytosis indices using the suspension of inactivated St. aureus. The significance of differences in these two groups was evaluated by Student's test at p < 0.05. Results. It has been demonstrated that the pretreatment with BM MMSCs (1 and 2 weeks before IRIK modeling) increased the anti-ischemic resistance of kidney while the administration of BM MMSCs on the day of IRIK modeling (during reperfusion) enhanced kidney damage, characterized by increased mortality, elevated levels of urea and creatinine in blood and structural injury of renal tissue, as compared to other groups. The comparative analysis of the first and fourth groups shows that BM MMSCs decrease the levels of pro-inflammatory cytokines and increase the levels of anti-inflammatory cytokines, as well as enhance potential of antimicrobial protection. Conclusion. Intravenous injection of BM MMSCs 1–2 weeks prior to IRIK modeling increases the kidney resistance to ischemia, reduces the severity of the systemic inflammatory response as well as the risk of infectious complications. However, considering the possibility of the summation of the injuring influence of ischemia and the stress of the adapting doses of BM MMSCs on ischemic kidney tissue during reperfusion, the search for the optimal concentrations of BM MMSCs needs to be continued. 

Aim. To evaluate in-hospital and long-term results of surgical treatment of patients with infective endocarditis of the tricuspid valve, to compare the effectiveness of valve repair and valve replacement techniques, and to identify risk factors of mortality and reoperations. Materials and methods. 31 surgical patients with tricuspid valve infective endocarditis were evaluated. Patients were divided into 2 groups. In Group 1 (n = 14) repairs of the tricuspid valve were performed, in Group 2 (n = 17) patients had undergone tricuspid valve replacements. Epidemiological, clinical, microbiological and echocardiographic data were studied. Methods of comparative analysis, the Kaplan–Meier method, and Cox risk models were applied. Results. The most common complication of in-hospital stay was atrioventricular block (17.7% of cases in Group 2). In Group 1, this type of complication was not found. Hospital mortality was 7.14% in Group 1, and 0% in Group 2. Long-term results have shown the significant reduction of heart failure in general cohort and in both groups. In Group 1 the severity of heart failure in the long term was less than in Group 2. No significant differences in the severity of tricuspid regurgitation were found between the groups. In 7-year follow up no cases of death were registered in Group 1. Cumulative survival rate in Group 2 within 60 months was 67.3 ± 16.2%. No reoperations were performed in patients from Group 1. In Group 2, the freedom from reoperation within 60 months was 70.9 ± 15.3%. Combined intervention was found as predictor of postoperative mortality. Prosthetic valve endocarditis was identified as risk factor for reoperation. Conclusion. Valve repair and valve replacement techniques of surgical treatment of tricuspid valve endocarditis can provide satisfactory hospital and long-term results. Tricuspid valve repair techniques allowed reducing the incidence of postoperative atrioventricular block. In the long-term, patients after tricuspid valve repair have shown less severity of heart failure as well as better rates of survival and freedom from reoperation. Combined intervention and prosthetic endocarditis were found to be main risk factors for adverse outcome. 

Aim. To evaluate the achievability of recommended convection volumes in hemodiafiltration (HDF) and impeding factors. Materials and methods. In short interventional one-center study among 67 stable prevalent dialysis patients we succeeded in achieving convection volume of more than 24 l/session in 60 patients (90%). Results. Substitution volume rose in the whole group from 21.1 ± 1.6 to 23.8 ± 1.2 l/session (p < 0.01). 12 patients, who didn`t achieve target volume had similar age, duration of renal replacement therapy and ultrafiltration rate as those who did. They differed from 55 patients who achieved target volume by substitution volume at first session in evaluation period (22.2 ± 1.7 vs. 23.6 ± 1.5 liters, р = 0.004), by transmembrane pressure (170 ± 40 vs. 146 ± 24 mmHg, р = 0.009) and by session duration (248 ± 15 vs. 262 ± 17 min, р = 0.0017). Blood flow rate also differed at the start of the study between the achievers and non-achievers: 353 ± 21 vs. 339 ± 19 ml/min, р = 0.035. The pressure in venous segment was lower in the achievers (154 ± 25 vs. 176 ± 36, р = 0.02) as well as transmembrane pressure (144 ± 24 vs. 164 ± 36, р = 0.014) which has been rising session by session in nonachievers. In non-achievers the membrane surface area was lower: 1.75 ± 0.2 vs. 1.91 ± 0.2 m2 (p = 0.02). In the multiple binary logistic regression model the session duration and membrane surface area were positive factors while the transmembrane pressure was negative one. Session prolonged by 15 min was associated with increase in relative chance to achieve target volume by 39% (95% CI 5–82%; р = 0.02). The membrane surface area enlarged by 0.1 m2 was linked with increase of chance by 4.2% (95% CI 0.2–8.4%; р = 0.04). The transmembrane pressure increased by 10 mmHg was associated with decreased chance to achieve target volume by 17% (95% CI 0–70%; р = 0.05). Conclusion. To achieve convection volume of 24 l/session one needs to afford effective blood flow rate, to increase the session duration and membrane surface area, avoiding high transmembrane pressure; severe comorbidity can hamper achieving target volume. Accumulating data of different studies are rather divergent in conclusions with regard to required target volume and ways to ensure its achievability, so study continuation is mandatory. 

The experience of horseshoe kidney transplant operations is significantly restricted. Transplant surgeons often refuse to use horseshoe kidney due to a number of serious abnormalities of vessels and upper urinary tract in these organs. However, the constant shortage of donor organs and an increase in patients on the waiting list for kidney transplantation make us reconsider our approach to the selection of donor organs. The aim of this work was to demonstrate our result of horseshoe kidney transplantation. 

Transplantation of liver left lateral section (LLS) firmly established itself as a radical and effective method of treatment of advanced diffuse and unresectable focal liver diseases in pediatric patients. At the same time surgical community faced the challenge of matching the size of the adult donor’s graft to the volume of the child’s abdomen. Review of the literature presents historical aspects of transplantology, some approaches to measurement of the required liver parenchyma functional mass and methods to prevent complications associated with the usage of large LLS grafts in infants. In addition, the latest data on estimation of intra-abdominal pressure and development of intra-abdominal hypertension syndrome are also presented. 

This review summarizes the current literature devoted to the analysis of prognostic role of ST2 biomarker in rejection of the transplanted heart. ST2 is one of the most promising diagnostic markers of the development and severity of heart failure as well as the mortality risk in patients with cardiovascular diseases. ST2 is expressed in cardiomyocytes in response to a variety of pathological processes and mechanical damage to the heart, which allows diagnosing cardiovascular diseases before clinical manifestations. Presumably, measuring the level of ST2 in heart transplant may have diagnostic and prognostic value in the assessment of graft and risk of rejection. Currently, accumulated clinical data on the role of given biomarker in heart transplantation are not enough, and further research on the relation of ST2 levels with different clinical and laboratory parameters in heart recipients is necessary. 

The pathogen of toxoplasmosis called Toxoplasma gondii is able to persist for a long time in various human tissues. Toxoplasmosis is referred to as an opportunistic disease, since it presents a danger to the life of the patient for the immune dysfunction. Reactivation of latent infestation in HIV infection and transplantation procedures is a serious problem for healthcare. If a dominant clinical form in patients with HIV infection is represented by cerebral toxoplasmosis, then a broader range of lesions is observed after organ transplantation. Toxoplasmosis myocarditis and pericarditis are reliably more frequently observed. This paper analyzes mortality rate in transplantation of various organs, timing of invasive reactivation in the postoperative period and relation between reactivation and withdrawal of preventive drugs. Objectively it is rather difficult to diagnose the disease due to inaccessibility of the pathogen, atypical clinical picture and low sensitivity of laboratory indication methods. In this regard, there is a useful experience of foreign and domestic research studies in searching and using clinical, instrumental, immunological and molecular criteria of reactivation of toxoplasmosis in human immunodeficiency. The given facts convincingly demonstrated the danger of toxoplasmosis; the role of the disease is shown for various fields of medicine, particularly in transplantation of organs and tissues. 

Immunological allograft rejection is based on the process of recognition of donor antigens by T-cell receptors. Antigens are generally represented by molecules of major hystocompatibility complex (MHC), expressed by the donor organ tissue cells. Immune response to allogeneic transplant in its activity is greatly higher than response to conventional infection wherein the basic mechanisms of recognition of infectious antigens and alloantigens seem to be similar. In this review we have analyzed three main pathways of recognition of alloantigens. Those pathways are differentiated by the nature of antigen presenting cells, kinetics and duration of its influence on the formation of alloimmunity: direct, indirect and semidirect. Establishing the relationship between mechanisms of allorecognition and manifestations of graft rejection is of great clinical importance. 

Adipose tissue is widely used in transplantology to fill up volume deficiency as well as the source of cells to treat dysfunctions. Despite the long experience of adipose tissue autotransplantation there is still no guarantee of optimal result in late postoperative period. All these are the reasons to search for new techniques, supplementary factors preventing lysis and fibrosis of graft, and for the most appropriate adipose depots. Study of the current literature allows us to consider orbital adipose tissue as a unique fat depot, having the great potential for transplantology.