Aim: to calculate number of the centers of transplantation according to real requirement of the population and a donor resource, to prove their geography and the nomenclature, providing with donor organs.

Methods and results. The analysis and comparison of statistical data on population, number of the centers of transplantation, their transplant activity in Russia and abroad are made. Calculation of number of the centers of transplantation is carried out and justification of their geography is offered. The analysis of statistical data on hospitals in the Russia is made, calculation of a rational number of donor hospitals according to need for a donor resource is carried out. Justification of transplant coordination in territorial subjects of the Russia, in federal districts is offered. Justification of the nomenclature of the centers of transplantation and donor hospitals is offered.

Conclusion. Settlement data on a rational number of the centers of transplantation, their geography and the nomenclature, providing with the donor organs, suitable developments for planning of the hi-tech medical care in territorial subjects of the Russia are obtained. 

Aim. The aim of this study was to define the role of preformed anti-HLA antibodies (anti-HLA) in antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV) after heart transplantation.

Materials and Methods. 140 heart transplant recipients were followed after heart transplantation performed for 106 dilated and 34 – ischemic cardiomyopathy. Anti-HLA was determined before transplantation by ELISA.

Results. Recipients were divided into 2 groups: anti-HLA positive (n = 45, 32,1%) and anti-HLA negative (n = 95, 67,9%). The incidence of AMR in anti-HLA positive group was 12 (26,67%) and 11 (11,58%) in anti-HLA negative group. Risk of AMR was significantly higher in anti-HLA positive recipients (RR 2,3: 95% CI 1,02–4,81, р = 0,03). During first three years after transplantation CAV was diagnosed in 9 (20%) of anti-HLA positive recipients and in 7 (6,8%) of patients without anti-HLA. (RR 2,7: 95% CI 1,08–6,82, р = 0,03). Survival in freedom from CAV in anti-HLA negative recipients was much higher than in anti-HLA positive recipients (0,89 ± 0,07, 0,72 ± 0,06, resp. (p = 0,02)).

Conclusions. The presence of preformed anti-HLA antibodies in candidates for heart transplantation increase the risk of AMR and CAV post transplantation in 2,3 and 2,7 times, respectively. 

Aim. To optimize the management of postoperative renal allograft recipients through the introduction of methods for predicting risk of manifestation of cytomegalovirus infection on the basis of a comprehensive assessment of the clinical and immunological status.

Materials and methods. We retrospectively analyzed the medical records of 303 patients with end-stage renal disease, among them – were the recipients of renal allograft – 136, among whom 29 within 2 months after the operation had clinical signs of CMV infection. Assessable "CMV syndrome", laboratory evidence of CMV infection, the incidence of antigens (genes) of HLA A, B and DRB *1, calculated goodness of fit χ2 and relative risk RR, changes MCP-1 in urine.

Results. In renal allograft recipients with clinical and laboratory evidence of CMV infection in the early postoperative period, significantly more (χ2 > 3,8) met antigen B35. A positive association with CMV infection was detected also for DRB1 * 08, B21, B22, B41, A24 (9), B51 (5), DRB1*14 and DRB1*15. Protective effects possessed antigens / alleles of genes A26 (10), B14, B38 (16) B61 (40) and DRB1*16. MCP-1 levels in this group of recipients were raised to 2174,7 ± 296,3 pg/ml with a strong negative correlation with the levels of urea and creatinine in serum (r = 0,9, p < 0.001).

Conclusion. Immunological markers of risk manifestation of CMV infection in recipients of kidneys in the early postoperative period are: the carriage of В35 и В55,56(22), В49(21), В41, DRB1*08 и DRB1*15, an increase of levels of MCP-1 in urine without increasing the levels of urea and creatinine in the serum. 

Aim: evaluation of the incidence and the pattern of vessel complications, efficacy of the prophylactic anticoagulation therapy after kidney transplantation.

Materials and methods. From March 2007 till January 2013 421 patients: 230 men (54,6%) and 191 women (45,4%); mean age 43,07 ± 11,62 undergone 429 kidney transplantations in the department of pancreas and kidney transplantation of the Scientific-Research Institute of Emergency Care named after N.V. Sklifosovsky. In order to evaluate the condition and the function of the kidney transplant ultrasound investigation (daily) andacquisition(weekly) wereused. In cases of kidney dysfunction and assumption of vessel complications we used computerized tomography. Besides, we used daily analysis of biochemical and clinical parameters of blood and urine.

Results. The most common vessel complication was the thrombosis of the microvasculature of the kidney transplant due to acute humoral and combined rejection resistant to antirejection therapy (n = 9; 2,1%); in 4 cases there was a breakage of the transplant due to the acute rejection and the urgent transplantatectomy in an effort to save the patient; thrombosis of the transplantat artery occurred in 1 case (0,23%); we observed 2 cases (0,46%) of the artery stenosis and 2 cases (0,46%) of venous thrombosis.

Conclusion. Summary frequency of vessel complications in our clinic, including thrombosis due to rejection, was 3,49%. It fully corresponds with data obtained from the global medical community. The incidence of great vessel thrombosis was less than 1% which indicates the adequate prophylactic anticoagulation therapy. For the benefit of early diacrisis of complications Doppler sonography is needed. In case of assumption of vessel complications urgent acquisition, computerized tomography and/ or angiography are to be held. 

Aim. The study microecology of the large intestine of children with cirrhosis before transplantation of the share liver.

Materials and methods. Studied the flora of the colon 157 children of 1 to 17 years admitted to hospital for liver transplantation fragment from a related donor. Identification was carried out using microbial panels BD Crystal and databases BBL Crystal MIND. Methicillin-resistant staphylococci were determined by their sensiti- vity to oxacillin and cefoxitin. Beta-lactamase activity was tested using discs with ceftazidime and ceftazidime/ clavulanic acid.

Results. Microecological revealed deep irregularities in the large intestine transplantation in children up lobe of the liver on a spectrum and composition of the microflora. Among the resident microflora decreased levels of bifidobacteria, lactobacilli and coliform bacteria, especially in children under one year. A sig- nificant portion of the children surveyed (over 60–70%) had an increase of frequency of finding stateally bacteria, especially Klebsiella and enterobacteria in third children – non-fermenting bacteria – Pseudomonas and Acine- tobacter spp. Revealed the spread of strains of gram-negative bacteria with extended-spectrum betalaktamaz.

Conclusion. Expressed microecological violations in the large intestine in children with higher levels of bac- teria are conditionally risk factor reeks of infectious complications in the postoperative period and require are complex tools to assist in eliminatsii.s given antibiotic resistance of bacteria. 

Aim of the work. Сlinical and morphological research of the features of biliary atresia at children-recipients of liver, to whom a portoenterostomy was made in comparison with patients to whom such surgery wasn't carried out.

Materials and methods. Clinical records and histological research of liver of 49 children suffering a bili- ary atresia are analyzed. Two groups were created: the 1st group – 21 children without portoenterostomy before liver transplantation and 2nd group – 28 children with portoenterostomy before liver transplantation.

Results. Pathomorphology of liver the characteristics in structure of proliferation bile ducts are established: hypostasis and dystrophic changes of cholangiocytes at patients of the first group (p = 0,035) and sclerosis of bile ducts with disappearance of an epithelium at patients of the second group (p = 0,01). In first group of children activity of inflammatory process in liver were significantly higher than in second group (p = 0,02).

Conclusion. Our experi- ence has demonstrated that portoenterostomy doesn’t prevent fibrosis of intrahepatic bile ducts and development of fibrosis, and then a development of cirrhosis. 

The aim of this study was to define influence of completeness heart revascularization on a functional condition of myocardium at ischemic cardiomyopathy.

Materials and methods. 61 men and 5 women aged from 46 till 73 years with the diagnosis an ischemic cardiomyopathy were investigated before and after coronary angioplasty (EDV LV – 256,1 ± 7,4 ml, EF LV – 36,1 ± 1,1%). 46 patients had at receipt CHF with NYHA functional class 4, 20 – CHF with NYHA functional class 3. Functional status (6-minute walking test) – 109,7 ± 20,5 m. Chronic total occlusion was the major type of coronary artery disease (92 of 176 epicardial branches). By means of echocardiography and quantitative gated SPECT estimated dynamics of systolic and diastolic function, change of perfusion, thickening and myocardial movement.

Results. The full revascularization managed to be executed to 32 patients, incomplete – to 34 patients (34 occluded arteries didn't manage to be opened). In the whole group the 6-minute walking test incre- ased to 268,2 ± 19,9 m (p < 0,001), EF LV grew to 39,9±1,1% (p < 0,01) due to reduction of end systolic volume, degree of mitral regurgitation decreased from 1,6 ± 0,1 to 1,2 ± 0,1 (p < 0,007), pulmonary artery pressure decreased from 39,1 ± 1,7 to 32,1 ± 1,2 mm Hg (p < 0,01). Distinctions in dynamics of the main functional indicators between groups of complete and incomplete revascularization it isn't revealed. The factor of expressiveness of collateral blood flow in the region of occluded arteries probably compensates violation of an antegrade blood flow and defines a myocardial condition.

Conclusion. The volume of myocardial revascularization at patients with ischemic cardio- myopathy isn't defining factor in a clinical condition of them after executed percutaneous coronary intervention. 

Aim. Evaluation of the possibility heart valve replacement in renal transplant recipients from a position of safe- ty for graft function.

Materials and methods. 5 patients, heart valve replacement was performed with a func- tioning kidney transplant at a satisfactory its function. The average age of patients at the time of cardiac surgery was 38,8 ± 12,6 years, among whom were two (40%) men and 3 (60%) women. The interval between renal transplantation and heart surgery was 40,3 ± 44,1 (2 to 120) months. Prior to kidney transplantation, all patients were on renal replacement therapy with hemodialysis program for 50,2 ± 48,6 months. In 4 of the 5 patients of heart disease was the cause of infective endocarditis.

Results. Average time IR was 81,2 ± 21,7 minutes , the average time of aortic clamping 63,6 ± 20,9 minutes and hypothermia during CPB 29,2 ± 3,2 °C. All patients were implanted with double-leaf mechanical prostheses "MedEng-2" and "SarboMedics". All 5 patients in sa- tisfactory condition were discharged from the hospital. The average duration of the postoperative period was 14,2 ± 3,4 days. All patients had relatively smooth flow after surgery, no infectious complications, a satisfactory renal transplant function and prosthetic heart valves. In the late period in four patients and transplant graft func- tion is satisfactory in terms of the observation of 5 years, 3 years and 6 months after surgery.

Conclusion. Our experience shows the possibility of successful correction of heart defects in IR in renal transplant recipients. 

Purpose. A comparative morphological analysis of adult pancreas and newborn rabbits as acceptable model for obtaining of islet cell cultures having a low immunogenicity was agoal of this study.

Materials and methods. Pancreas from adult and newborn rabbits and islet cell culture was examined by histological and immunohistochemical techniques.

Results. Shown, the pancreas of adult rabbits contains great amount of exocrine tissue and culturing it does not allow to obtain the purified islets of impurities. By contrast, pancreas of newborn rabbits in which the ratio of the islets and the exocrine tissue is much higher, it is possible to obtain highly purified cultures of islet cells.

Conclusion. Morphological features of newborn rabbit pancreas can use it as a model for obtaining cultures of islet cells having low immunogenicity. 

Aim. Peripheral VA ECMO is effective method of circulatory support in heart transplant candidates with life th- reatening CHF. However this type of extracorporeal life support may be complicated by pulmonary congestion (“white lung”) as a result of left ventricle (LV) dilatation and volume overload. Difference approach proposed for LV unloading following VA ECMO circulatory support. We report our experience of LV unloading by percutaneous introduced of supplement drainage cannula in the left atrium (LA ) through the femoral vena and interatrial septum.

Material and methods. In this study was included 33 heart transplant candidates (6/27 F/M, age 46.2 ± 3.7 yrs) on peripheral VA ECMO support. For LV unloading we used supplement standard venous ECMO-cannula (15–19 F) percutaneous introduced in LA through the femoral vena of conterlateral leg and connected to the venous line of ECMO circuit.

Results. To 20 (60.6%) from 33 patients needed of early (n = 10) or delayed (n = 10) LA drainage. After beginning of LV drainage we noted of significant (p < 0.05) decreasing of PAWP from 31 ± 3 to 14 ± 3 mm Hg and resolution of pulmonary edema. Mean blood flow on LA cannula was 1.5 ± 0.2 l/min. To 18 (90%) from 20 patients was successfully bridged to heart transplantation. Duration VA ECMO before OHT was 8.6 ± 1.7 days. 16 (88.9%) recipients were discharged from hospital.

Conclusion. Active LA drainage is as effective tool of LV un- loading and protection of pulmonary congestion and edema in patients bridged to heart transplantation by peripheral VA ECMO. 

The aim of investigation isestimation of mechanical heart support system «INCOR» implantation efficacy.

Materials and methods. The Institute of Circulation Pathology has clinical experience of mechanical circulatory support systems «INCOR» (Berlin Heart AG) implantation in 12 patients (10 men and 2 women) with severe heart failure during the period from November 2006 to October 2012. The main indication for the use of mechanical support of the left ventricle was a left ventricular failure with marked dilatation of the left heart: end-diastolic volume (EDV), LV – 283 ± 58 ml, end-systolic volume (ESV) – 233 ± 57 ml, ejection fraction (EF) – 16 ± 7%, with preserved function of the right ventricle (RV) (RV ejection fraction 35 ± 12%).

Results. All patients showed a significant improvement in central hemodynamics in early postoperative period, reducing the volume of the heart chambers: LV EDV from 283 ± 58 to 183 ± 94 ml; LV ESV with 234 ± 57 to 157 ± 65 ml, increased right ventricular ejection fraction (RV EF ) (from 35 ± 12 to 43 ± 17%). Improve the function of the right ventricle oc- curred mainly due to the expense of left ventricular unloading and pulmonary circulation. In addition, there was a significant improvement in clinical status of patients – regression of symptoms of heart failure, a recovery of the liver and kidney function. Despite the ongoing anticoagulation and antiplatelet therapy under constant parameters of coagulation, there was some complications. Uterine bleeding occurred in 1 patient (16.6%), which required the abolition of anticoagulants and antiplatelet, uterine artery embolization, and as a result has led to thrombosis and stop system «INCOR». Four patients (33.3%) had severe thromboembolic complications – acute cerebrovascular accident (CVA). In 1 patient (8%) there was a hemorrhagic stroke due to rupture of intracerebral aneurysms with a breakthrough into the lateral ventricle of the brain. In 3 patients (25%) the late period (3–6 months after implan- tation) was accompanied by a purulent-septic complications, which required of antibiotic therapy administration. Time of INCOR functioning ranged from 17 to 948 days. Six patients (50%) underwent successful orthotopic car- diac transplantation at 180–948 days after left ventricle bypass system implantation. The remaining patients died from various complications: three patients from severe thromboembolic stroke, one patient died from hemorrha- gic stroke due to rupture of intracerebral aneurysms with a breakthrough into the lateral ventricle of the brain, one patient death was due to progressive right heart failure, another death occurred on background of chronic sepsis.

Conclusion. Thus, implantable system for circulatory support «INCOR» using achieves significant regression of heart failure manifestations. But sadly, holding a mechanical heart support is associated with the risk of severe complications, such as thromboembolism, hemorrhagic stroke, sepsis and increase biventricular failure. 

Aim. To study the ability of hospital-associated strains isolated from the biological substrates of patients oper- ated on under extracorporeal circulation, to form biofilms on the surface of medical materials and products.

Materials and methods. The formation of biofilms of strains of Staphylococcus aureus, Serratia liquefaciens, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. isolated from the biological substrates of patients operated on under extracorporeal circulation, on different surfaces (politetraftorotilen, medical poly- ethylene, Polyoxybutirate-to-valerate, silicone, polyvinyl chloride), was studied by a modified method for the surface of the medical materials and products.

Results. The influence of the material nature, as well as hydrophi- lization of the surface, on the ability of hospital-associated strains, isolated from the biological substrates of pa- tients operated on under extracorporeal circulation, to form biofilms is studied. It is shown that that certain strains exhibit an increased tendency to biofilm formation on more hydrophobic surfaces, e. g., Acinetobacter spp. At the same time the activity of Staphylococcus aureus on silicon surface (hydrophobic surface) is minimal. Other strains almost equally form biofilms on hydrophilic and hydrophobic surfaces e.g. Serratia liquefaciens. It was also shown that the surface hydrophilization of PEG to 50% for all the studied strains leads to dramatic reduc- tion of biofilm formation.

Conclusion. The tendency to form biofilms of a particular hospital-associated strain is individual and depends on the nature of the medical material and physical-chemical characteristics of its surface. Hydrophilization of the surface of the medical material is accompanied by a lowered risk of biofilm formation. 

We report the case of a young woman who underwent liver transplantation for epithelioid hemangioendothe- lioma with diffuse intraperitoneal metastases. We observe the 1-year survival without tumor progression on everolimus-based immunosuppression. The different therapies and the results of surgery for this disease are discussed in short literature review. 

In this review article the necessity of adaptation and introduction into clinical practice of simultaneous monitoring of immune blood cells and cytokines in patients with grafted organs for a choice of individual tactic of immuno- suppressive therapy, determination of its efficiency and forecasting is proved. It is emphasized, that with the spe- cial attention it ought to concern to characteristic of CD4 + T-lymphocytes and to definition of an interrelation of their separate populations in peripheral blood (Treg, Th17, Tact memory cells – CD4+CD25hiCD127hiCD45RO) since they are the basic participants of immune system reaction on grafts. 

The paper presents a review of the problems of mechanical circulatory support with left ventricular bypass in total cardiac failure. Dysfunction of right ventricular defines the high mortality on left ventricular device. One of the effective methods for solving this problem is the use of right ventricular assisted devices. There are considered of the basic physiological mechanisms of interaction between the right and left ventricles of the heart, affecting on the function of the right heart. Shows the need to assess right ventricular function before deciding on mechanical circulatory support. Provides examples of the estimation the predictors of the right ventricular failure. The basic methods and devices of biventricular circulatory support were con- sidered.