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Мы с Вами переживаем замечательный период в становлении и развитии трансплантологии, нашей нелегкой области науки и практической медицины. Можно с уверенностью сказать, что это период обретения результатов, когда длительные усилия по подготовке, становлению, определению целей и поиску путей их достижения, накоплению опыта etс. начали приносить плоды.

Решение об открытии специальности «трансплантология и искусственные органы» (14.00.41) и создании на базе Научно-исследовательского института трансплантологии и искусственных органов Министерства здравоохранения СССР диссертационного совета, принимающего к защите диссертации на соискание ученой степени доктора и кандидата наук по этой специальности, было принято в 1986 году.

The article discusses the development of solid organ transplantation in the Sverdlovsk Region Clinical Hospital № 1, a practical healthcare center. We have analyzed the clinical results and the practical feasibility of transplantation of donor organs: the kidney, liver and heart in the leading regional multi-profi le clinic. The clinical effi cacy of transplantation in patients with the irreversible decompensated phase of solid organs has been shown. We have substantiated the prospective directions of the development of transplantation practices in the region.

Aim: to analyze the results of embolization of the splenic artery in fi ve patients after orthotopic liver transplantation.

Materials and methods. Embolization of the splenic artery was performed 6 times in fi ve (3.2%) of 158 patients who underwent orthotopic liver transplantation in terms from 2 months up to 10 years after surgery. The indications for embolization in 3 cases were the manifestations of hypersplenism syndrome, in 3 others – splenic artery steal syndrome.

Results. In 3 cases of splenic artery embolization, performed in connection with the manifestations of hypersplenism: 2 – recurrent disease, 1 – splenic infarction. In all these cases a splenectomy was required. In 3 cases when embolization was performed in connection with the display of the splenic artery steal syndrome remission was achieved, splenectomy was not required.

Conclusion. Splenic artery embolization can be considered as a method of treating patients with manifestations of steal syndrome and hypersplenism after orthotopic liver transplantation. The most pronounced effect was achieved in patients with a predominance of manifestations of steal syndrome.

Aim. The development of a prolonged form of acetylsalicylic acid (ASA) encapsulated into polymeric highly porous microcarriers using supercritical carbon dioxide and the subsequent study of ASA release kinetics in vitro and in vivo using high-performance liquid chromatographic (HPLC).

Materials and methods. As polymeric carriers for ASA encapsulation amorphous D,L-polylactides (PLA) and polylactoglycolides (PLGA) of PURASORB PDL02 and PDLG7502 series (PURAC Biochem BV, Netherlands) were selected. The ASA encapsulation was performed using the PGSS (Particles from Gas Saturated Solutions) method of supercritical fl uid formation of microfi ne (20–50 μm) bioresorbable powders of aliphatic polyethers containing 10 wt.% ASA. The release kinetics of ASA from polymeric microparticles into saline solution as well as pharmacokinetic studies in vivo (rabbits) were registered by HPLC.

Results. A method of quantitative determination of ASA and its main metabolite salicylic acid (SA) in model solution and blood plasma by HPLC-UV detection with enhanced sample preparation and selectivity was developed. The method’s analytical range without accounting for dilution was 0.05–5.0 μg/ml for model solution and 0.2–10.0 μg/ml for blood plasma; the degree of extraction of ASA SA from blood plasma – 95.8 and 98.1%, respectively. It was demonstrated that the amount of ASA released from PLA during the fi rst 4 h exceeds the mass of ASA released from PLGA by approximately 25% which may serve as a justifi cation for the selection of PLGA as a carrier for the creation of a prolonged form of ASA. Pharmacokinetic studies (rabbits, n = 3) demonstrated a gradual release of ASA from PLGA microparticles during 24 h after intramuscular implantation of encapsulated form of ASA at the dose of 10 mg/kg.

Conclusion. Test samples of highly porous microfi ne powders of PLGA obtained by PGSS containing up to 10 wt.% ASA may serve as source prototypes for the development and creation on their basis of a prolonged form of ASA.

The aim of the work was detailed morphological investigations of donor pancreas (DP) for the study of possibilities of maximal selection of islet tissue suitable for transplantation to a patient of diabetes mellitus type 1.

Materials and methods. Eight DPs were received as a result of multiorgan donation. Morphological investigations were performed by means of histological and special immunohistochemical methods.

Results. The Majority of islets were revealed in the tail part of the DP. Besides typical Langerhans islets with predominance of mosaically located beta cells, the accumulations of islet cells forming so-called interlobular (perilobular) islets were revealed in the layers of interlobular connecting tissue. In addition, in the cells of ductal epithelium nestin which is a marker of progenitor cells was revealed.

Conclusion. To obtain the maximal potential of islet tissue from DP it is necessary to use interlobular located islets as well as to use progenitor cells of pancreas, which have the ability to transdifferentiate into islet cells.

Aim. The main aim of our research is to evaluate the process of rat lung decellularization and recellularization as the initial step of tissue-engineered organs creation.

Materials and methods. Rat lung decellularization was performed by perfusion with detergents and enzymes with concomitant atmospheric air ventilation through the trachea. The quality of decellularization was analyzed with routine histological and immunohistochemical staining techniques, DNA content was determined quantitatively by spectrophotometer. For static and whole organ reseeding as a model of cells’ behavior mesenchymal multipotent stromal cells were used. Recellularization was followed by assessment of the cellular metabolic activity by colorimetric method; cell viability was analyzed by calcein and ethidium homodimer staining. Matrix qualitative evaluation after recellularization was performed using immunohistochemical staining methods.

Results. 92% of allogeneic DNA was eliminated after decellularization. Histological staining revealed no residual cells and cell nuclei; preservation of the fibers of extracellular matrix was confirmed by immunohistochemical staining for laminin, elastin, fibronectin, collagen types I and IV before and after decellularization. The scaffold does not exhibit toxic properties after reseeding; cell viability and metabolic activity were proved after cultivation.

Conclusion. The experience of rat lung decellularization and recellularization can be the prospective basis for protocols of organ recellularization and tissue engineered lungs creation.

Aim: to study of infl uence of various doses of autologous BM MSCs on the development of chronic transplant nephropathy in a decentralized kidney using kidney autotransplantation model (KAT).

Materials and methods. Five groups of experiments were performed on 105 Wistar rats. The model of kidney autotransplantation by means of surgical decentralization (denervation – delymphatization) and infl ammation induction with kidney antigen and Freund’s adjuvant was created in groups I, II and III. Group I served as a decentralization control (control 1). In groups II and III autologous BM MSCs were injected intravenously once 35–40 days after surgery – a high dose in group II: 3.0–5.0×106 cells; a low dose in group III: 0.3–0.5×106 cells; group IV served as intact control; group V served as intact control with the injection of the same dose of BM MSCs as in group II. Kidney excretory functions (diuresis, creatinine, urea, protein in blood and urine, sodium excretion) and morphology were examined during months 3, 5 and 7–10.

Results. In all five groups over the study duration nitrogen excretion was not disrupted. High doses of BM MSCs after KAT modeling resulted after month 3 in pronounced proteinuria in all rats (3–3.5 times more than in group I) and gradually decreased diuresis; histologically severe focal cell infiltration and the accumulation of protein masses in lumina of glomeruli and tubules were observed. By month 10 glomerular and tubulointerstitial focal sclerosis was developed. Low doses of BM MSCs after KAT modeling led to gradual decrease of proteinuria after month 3 reaching the initial values by months 5 and 7 of observation; histologically rare foci of cellular infiltration around glomeruli were observed.

Conclusion. A single application of low doses of BM MSCs is capable of protective desensitizing infl uence on the tissue of decentralized kidney and can prolong the duration of kidney function without signs of pronounced damage, while under the same conditions high doses of autologous BM MSCs lead to accelerated development of severe chronic transplant nephropathy.

In recent years the success of transplantation is associated primarily with extensive use of calcineurin inhibitors (CNIs) – cyclosporine and tacrolimus which became the basis of the various immunosuppressive therapy protocols. These drugs despite their effectiveness in the prevention of transplant rejection have serious side effects. Nephrosclerosis due to chronic nephrotoxic effect is recognized as the most important of them. But along with chronic nephrotoxic effects there are cases of acute kidney injury on the background of calcineurin inhibitors usage. The article presents a clinical case demonstrating the development of severe reversible nephropathy in a patient after heart transplantation receiving tacrolimus in standard dose.

Sequence based typing was used to identify human leukocyte antigen (HLA)-A, -B, -C, -DRB1 alleles in 1,064 recruited volunteers in the Republic of Bashkortostan of the Russian Federation for unrelated hematopoietic stem cell registry. During the carried out research two new alleles were identified in the studied population; one was registered in the WHO Nomenclature Committee for Factors of the HLA System, the other one was submitted for registration. In this population 17 HLA-A, 29 – HLA-B, 13 – HLA-C, 13 – HLA-DRB1 groups of alleles were selected. Allele frequencies of more than 10% included HLA-A*02 (29.37%), 24 (12.92%), 01 (11.84%), 03 (11.61%), HLA-B*35 (11.51%), 07 (10.76%), HLA-C*07 (22.56%), 06 (15.51%), 04 (13.06%), 03 (10.43%), 12 (10.24%), HLA-DRB1*07 (17.25%), 15 (12.73%), 13 (11.98%), 01 (11.84%), 04 (11.61%). 711 HLA-A-B-C-DRB1 four-locus haplotypes were determined using the software Arlequin v.3.1. The most frequently observed four-locus haplotypes were A*02-B*13-C*06-DRB1*07, A*03-B*35-C*07-DRB1*15, A*02- B*07-C*07-DRB1*15 with frequencies of 2.89%, 2.18% and 1.93%, respectively. The distribution of alleles and haplotype analysis allowed comparing the populations of the Republic of Bashkortostan with the other Russian populations.

Liver transplantation is a life-saving procedure for many forms of end-stage liver disease in pediatrics. Cytomegalovirus (CMV) is the most common and signifi cant posttransplant infection after pediatric liver transplant (PLT) with developing an episode of CMV infection or disease. It is well known that CMV increases risk of graft loss. The review presents aspects of etiology and epidemiology of CMV after PLT, approaches employed in diagnostics and prophylaxis of CMV, algorithms for valganciclovir dosing and methods to prevent complications associated with CMV. The latest data on current prevention strategies in pediatric liver transplantation centers in the world are also presented.

Combined heart-kidney transplantation may be performed in carefully selected patients with end-stage heart disease and renal failure. There are two types of combined transplantation of heart and kidney: 1) simultaneous heart-kidney transplantation (SHKT) from the same donor; 2) staged transplantation of heart and kidneys from two genetically different donors. The ISHLT registry in 2014 reported an increase in the number of SHKT over the years: from 22 in 1994 to 97 in 2012. World experience demonstrated excellent results of SHKT. Recipients of SHKT had superior survival, lower rates of acute cardiac and renal rejection compared to heart recipients. This article discusses the indications for simultaneous or staged heart-kidney transplantation in patients with dialysis-independent or dialysis-dependent renal failure, results and posttransplant survival of SHKT recipients. The author describes his own experience of 2 staged combined heart-kidney transplantations.

It provided data on the prevalence, clinical signifi cance and methods of laboratory diagnostics for occult forms of blood-borne viral infections (BBVIs). It considered causes of such forms of infection and their signifi cance for clinical transplantation. We analyzed the existing algorithm of laboratory screening of a potential organ donor for BBVIs in Russia. It is shown that the current screening algorithm doesn’t allow detecting hidden forms of BBVIs.

Congratulation to Vladimir Yevgenievich Fortov.

Congratulation to Ivan Ivanovich Dedov.

Приглашаем Вас принять участие в работе VIII Всероссийского съезда трансплантологов, который состоится 27–29 июня 2016 года в ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России по адресу: г. Москва, ул. Щукинская, д. 1.

On scientific and medical personnel training at V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation.