Aim. To carry out monitoring of the organization and development of the organ donation and transplantation in theRussian Federationaccording to 2015.

Materials and methods. Questioning of heads of all the centers of transplantation is carried out. The comparative analysis of the obtained data in dynamics by years, between certain regions of theRussian Federation, the transplantation centers is done.

Results. According to the register in2015 inthe Russian Federation 36 centers of renal transplantation, 17 centers of liver transplantation and 10 centers of heart transplantation were functioning. The waiting list of kidney transplantation in 2015 included 4167 potential recipients that make 13% of the total number of the patients (31 500) receiving a dialysis. The rate of donor activity in 2015 made 3.0 pmp. Efficiency of donor programs in 2015 continues to increase: the share of multiorgan retrievals made 57.8%, average number of organs, received from one effective donor, made 2.7. In 2015 the rate of kidney transplantation made 6.5 pmp; the rate of liver transplantation made 2.2 pmp; the rate of heart transplantation made 1.2 pmp. The number of transplantations of liver and heart in theRussian Federationcontinues to increase. The number of transplantations of kidney remains approximately at one level in the range of 950–1050.Moscowcapital region continues to be the center of stability and development of the organ donation and transplantation in the country, in which 10 centers of transplantation are functioning and nearly a half from all kidney transplantations and more than 65% of all liver and heart transplantations are carried out.

Conclusion. The potential for further development of the transplantation care in theRussian Federationcontinues to persist. In particular, at the expense of increasing efficiency of regional donation programs, expanding practices of multiorgan recuperation and transplantations of extrarenal organs, through interregional transplant coordination. It is critical to keep the volumes of the state order to deliver transplantological medical care to the population and to implement federal funding to conduct donation programs.

The paper analyzes the nature of psychological adaptation and rehabilitation of patients, recipients of solid organs. The results of the clinical and psychological work with patients, recipients of donor organs, carried out in theSverdlovskRegionalClinicalHospital№ 1 are shown. Special attention has been paid to the study of motivation as the main psychological factor in the process of adaptation and rehabilitation. We have also shown the infl uence of body image and self-evaluation on the emotional state of patients after the operation. Special stress is laid on the significance of psychological factors which improve the quality of the patient’s life. The main principles and the system of psychological rehabilitation are presented. 

The aim of the study was to determine the value of extracorporeal photochemotherapy (EPCT) in the induction of tissue tolerance in renal transplantation. EPCT was applied to 24 renal transplant recipients in early postoperative period, the control group consisted of paired transplant recipients. In the group using EPCT over a three-year period of observation no clinical or histological signs of rejection were observed. In the control group, histologically confirmed rejection was observed in 4 cases, in 2 cases transplantectomy due to acute rejection. The reducing incidence of infectious complications in the study group compared with the control one (4 and 19 cases, respectively) and decreasing number of hospitalizations on various reasons (8 and 47 cases in the study and control groups, respectively) were also noted. Three-year graft survival was 100% and 83.3% in the study and the control groups, respectively. Using immunological tests in 30 days after transplantation the stable number of cells expressing coactivation molecules (57.7 ± 18.2 and 52.7 ± 23.2%, respectively, p > 0.05) and the density of their co-expression (22.7 ± 6.0 and 19.6 ± 7.0 units, respectively, p > 0.05) were demonstrated, while in the study group, the pronounced and statistically significant reduction both in the amount of cells expressing co-activation receptors (from 57.7 ± 18.2 to 34.5 ± 11.4%, p < 0.05) and in the density of these receptors on naive helper T-lymphocytes (from 22.7 ± 6.0 to 16.8 ± 5.1 units, p < 0.05) was revealed. Thus, it is noted that EPCT provides induction of tolerance to MHC antigens in kidney transplantation due to reducing expression of coactivation molecules which promote the second signaling pathway to T-cell receptor activation. 

Aim: to analyze the dynamics of the microflora and its sensitivity to antibiotics in patients of dialysis and transplantation center.

Materials and methods. We have examined the bacteriological test results of 1282 patients with chronic kidney disease, stage 5 (renal transplant recipients and dialysis patients) in 1998–2015: 1998–2003 («2003» period), 2008–2011 («2011» period) and 2012–2015 («2015» period). Biomaterial: urine, blood, wound effluent, sputum.

Results. The incidence (share of all samples) of gram «–», gram «+» and fungi was 38, 56, 7% for «2003» period; 48, 69, 13% for «2011» period; 61, 54, 18% for «2015» period. The incidence of gram «–» in blood has significantly increased: 22% in «2003», 13% in «2011», and 45% in «2015», respectively. The incidence of Candida fungi is growing in sputum and urine: 15, 33, 41% and 8, 14, 18% (in 2003, 2011, 2015 respectively). The species composition of the fl ora has also significantly changed. In «2003» the shares of Staphylococcus spp. and Enterococcus spp. were 50 and 33%, in «2015» – 34 and 53% respectively. The shares of E. coli, Klebsiella spp., P. aeruginosa and Acinetobacter spp. were in «2003» 32, 21, 15, 11% respectively, and in «2015» – 17, 32, 9, 22%, respectively. The share of a «problem» genus of Candida: C. glabrata and C. krusei has significantly increased. Their combined share increased from 26 to 38% (2003–2015). There was a significant increase in antibiotic resistance, which is mostly pronounced in Enterococcus spp., Klebsiella spp. and Acinetobacter spp. All gram «+» bacteria in «2003» were susceptible to vancomycin and linezolid, but in «2015» 6% of Enterococcus were resistant to vancomycin.

 Conclusion. Bacterial profile has significantly changed. Regular analysis of the bacterial fl ora is necessary due to the growing antibiotic resistance. 

The article describes the technology of remote patient monitoring and the parameters of circulatory assist device AVK-N as well as the advantages of said technology to improve the efficiency of personalized medicine in diagnosis and treatment of patients with AVK-N in the postoperative period. Authors show the capabilities of remote monitoring technology to determine the location of the patient by satellite navigation in the case of emergency call for medical and technical services, and present the structure and modes of the displayed information for mobile devices and Web-server. Doctor-patient interaction based on remote monitoring technology via mobile/ satellite/wired Internet is also shown. 

Aim. To evaluate the effect of local vitamin D injections into parathyroid glands on laboratory markers and survival in refractory hyperparathyroidism.

 Materials and methods. A comparison of the dynamics of secondary hyperparathyroidism laboratory markers and survival was performed in 37 patients with local vitamin D injections into the parathyroid glands under ultrasound guidance and in 62 patients with PTH higher than 600 pg/ml without reduction in PTH levels by more than 10% during 6 months, who continued to receive available conservative therapy. The mean duration of follow-up for groups was 40.5 and 33.2 months, respectively.

Results. In the local injection group (LIG) PTH level reduced by 347 ± 360 pg/ml (38%) during the first month after injection course, and by 214 ± 255 pg/ml (28%) between annual average levels before and after injection course, while in control group (CG) it rose by 84 ± 277 pg/ml (11%). In LIG phosphate level significantly reduced by 0.18 ± 0.24 mmol/l (9%) after injection course and annual average level did not change. In CG annual average phosphate level significantly rose by 0.15 ± 0.37 mmol/l (7%). Cumulative survival by Kaplan–Maier was significantly higher in LIG (p = 0.025). Differences in survival in univariate and multivariate Cox regression models were significantly associated only with the fact of local injections course (p =0.04 inboth models).

Conclusion. In current clinical practice the application of ultrasound-guided local vitamin D injections into parathyroid glands in patients with refractory hyperparathyroidism leads to a better control over laboratory markers and to significantly improved survival.

Aim. Clinical and instrumental assessment of long-term results of autologous bone marrow cells (BMC) implantation in laser channels in surgery of ischemic heart disease with diffuse and distal coronary disease.

Materials and Methods. In the period of 2007–2008 35 CHD patients with diffuse and distal coronary disease underwent BMC implantation in laser channels during coronary artery bypass grafting (CABG). The control group consisted of 29 patients. All patients in this group underwent only direct myocardial revascularization (DMR). In the long-term period we examined only 30 patients of the first group. Clinical and instrumental assessment of the method efficacy was carried out in 2 weeks, 6 months and 6 years after surgery.

Results. FC (NYHA) mean value in indirect revascularization group significantly decreased from 2.57 ± 0.61 preoperatively to 1.77 ±0.66 in6 months after surgery (p = 0.043). After 6 years FC (NYHA) was not significantly changed – 1.84 ± 0.42 (p = 0.053). Perfusion scintigraphy revealed a slight decrease of stable perfusion defect (SPD) in the immediate postoperative period, a more pronounced reduction of SPD in 6 months after surgery. The average value of SPD before surgery was 20.46 ± 10.75%, in 2 weeks after the operation – 19.07 ± 9.69%, in 6 months after surgery – 15.22 ± 9.49%. In the long-term period (6 years) SPD was 14.8 ± 8.43% (p = 0.047). A similar pattern was observed in the analysis of transient perfusion defect: baseline – 30 ± 2.2%, in 6 months – 15 ± 1.3%, in the long term period – 20 ± 6.1% (p = 0.047). The average value of left ventricular ejection fraction (LVEF) before surgery was 55 ± 10.4%, in 2 weeks after the operation – 55.7 ± 9.3%, in 6 months – 56.7 ± 10%, after 6 years – 54 ± 12%. The dynamics is unauthentic (p = 0.068).

Conclusion. BMC implantation in laser channels in addition to CABG is a safe and effective method of surgical treatment in case of CABG inability. The effect of indirect revascularization is formed in the first 6 months after surgery and remains at the same level for 6 years. 

For correspondence: Konoplya Alexander Ivanovich. Address: 3,K. Marx St.,Kursk, 305041,Russian Federation. Tel.: job. (4712) 58-81-76; mob. (910) 317-87-88. E-mail: konoplya51@mail.ru.

Aim. To study the corrective effects of allogeneic and xenogeneic hepatocytes on metabolic disturbances in acute liver toxicity.

Material and methods. Investigations were carried out on 75 adult male Wistar rats weighing 120–160 g, 15 rats and 25 mice on the 5–6th days after birth. Acute toxic hepatitis (ATH) was modeled by intramuscular injection of carbon tetrachloride at a dose of 3 ml / kg as a 50% solution in olive oil, five times at 24-hour intervals. Isolating xenogeneic (mouse) and allogeneic hepatocytes was performed by method of Berry M.N., Friend D.S. The cell suspension was prepared daily and administered at a concentration of 2 × 106 /kg in recipients with ATH intraperitoneally, five times at 24-hour intervals, simultaneously with the first injection of hepatotropic poison.

Results. Intoxication by carbon tetrachloride causes development of the biochemical syndromes of liver damage, activation of the functional metabolic activity of peripheral blood neutrophils and free-radical oxidation, breaks intraerythrocytic metabolism. The introduction of allogeneic hepatocytes in recipients with toxic hepatopathy is more efficiently compared with xenogeneic hepatocytes, it corrects local and systemic metabolic disturbances arising due to the impact of hepatotropic poison. Conclusion. Transplantation of xenogenic hepatocytes, and, to a greater extent, of allogenic hepatocytes in ATH conditions is an effective means to restore the functional metabolic activity of hepatocytes, neutrophils and erythrocytes. 

Aim: to evaluate the biomechanical remodeling of polymer grafts modified with vascular endothelial growth factor (VEGF) after implantation into rat abdominal aorta.

Materials and methods. Vascular grafts of2 mmdiameter were fabricated by electrospinning from polycaprolactone (PCL) and a mixture of poly (3-hydroxybutyrate-co-3-hydroxyvalerate) and PCL. The grafts were modified with VEGF by biphasic electrospinning. Morphology of the grafts was assessed by scanning electron microscopy. Physico-mechanical properties of PCL and PHBV/PCL grafts were estimated using uniaxial tensile test and physiological circulating system equipped with state-of-theart ultrasound vascular wall tracking system. Physico-mechanical testing of PCL/VEGF and PHBV/PCL/VEGF was performed before and after implantation into rat abdominal aorta for 6 months. The modeling of coronary artery bypass grafting (CABG) was performed by finite element analysis for modified grafts.

Results. Durability of PCL and PHBV/PCL grafts did not differ from that of human internal mammary artery; however, elasticity and stiffness of these grafts were higher compared to internal mammary artery. Viscoelastic properties of the grafts were comparable to those of native blood vessels. Modification of the grafts with VEGF reduced material stiffness. Six months postimplantation, PCL/VEGF and PHBV/PCL/VEGF were integrated with aortic tissue that induced changes in the physico-mechanical properties of the grafts similar to the native vessel. Biomechanical modeling confirmed the functioning of modified grafts in bypass position for CABG.

Conclusion. PCL/VEGF and PHBV/PCL/VEGF grafts have satisfactory physico-mechanical properties and can be potentially used in the reconstruction of blood vessels. 

Cystic fibrosis (CF) is the third most common indication for lung transplantation. The recipients with CF have shown the best early and late survival rates after surgery. The special group of CF patients consists of those, whose airways were infected with Burkholderia cepacia (B. cepacia), since the recurrence of B. cepacia infection after transplantation are coupled with extremely high risk of death. Up to the present, the question whether the patients in such conditions should be included onto the lung transplant waiting list is still unanswered. We describe a case of lung transplantation in the patient with late postoperative complication in the form of severe pyoseptic infl ammatory process caused by the recurrence of B. cepacia infection. The success of the treatment of this patient was achieved thanks to combined multidisciplinary approach. This therapeutic approach could be considered as a standard treatment protocol in case of its validation by further clinical experience.

Diagnostic criteria and treatment protocols for acute antibody-mediated rejection (AMR) of kidney allograft remain controversial. We report the case of early severe AMR after primary kidney transplantation. The graft removal was considered in the absence of treatment efficacy and in the presence of systemic infl ammatory response syndrome. However, at surgery the graft looked normal and it was not removed. The repeated treatment course (plasmapheresis, antithymocyte globulin, intravenous immunoglobulin and rituximab) was effective. The patient has good and stable graft function in 1 year after transplantation. 

Quality of Life is a new promising area of clinical medicine that provides the opportunity to assess the state of health of the patient using the data stored across a joint professional approach of physicians and subjective point of view of patients. Review of the data of foreign and domestic literature on quality of life of living donor liver transplantation is done. A method for evaluating quality of life of the most commonly used questionnaires in the study of quality of life is described. The article deals with the history of the study of the quality of life in medical practice. Research results into the quality of life of living donor liver transplantation conducted in different countries are presented. Factors affecting the change in the quality of life of living donor liver transplantation are shown.

The number of patients with transplanted heart is continuously increasing; therefore, the number of patients requiring heart retransplantation grows. Analysis of the results of published studies focused on safety of cardiac retransplantation and risk factors for adverse events in perioperative, early and late postoperative periods is presented in our review. The results of published studies suggest that heart retransplantation is the main radical treatment option for cardiac allograft dysfunction, but the results of heart retransplantation are slightly worse than those of primary cardiac transplantation. On the other hand, the favorable long-term prognosis after heart retransplantation should be expected in carefully selected recipients. 

The paper presents the common methods employed in recent years for enhancing transdermal delivery of drug substances when applying transdermal therapeutic delivery systems. The chemical, physical and mechanical methods to enhance the transport of macromolecular compounds through the skin are considered in details. 

This article contains analysis of current combination treatment regimens for chronic hepatitis C after liver transplantation. Antiviral therapy with long-acting interferons and ribavirin is of low efficiency and high costs. The clinical and economic benefits of interferon-free treatment regimen for patients infected with genotype 1 HCV using dasabuvir, paritaprevir boosted with ritonavir, ombitasvir (Viekira Pak) and ribavirin have been shown. Registration and introduction into clinical practice of new direct-acting antiviral drugs will significantly expand the arsenal of tools for the treatment of recurrent HCV infections, in particular in patients infected with hepatitis C virus genotypes 2 and 3. 

Statins should be used as a part of standard therapy in patients after heart transplantation. The effectiveness of statins is associated not only with their hypolipidemic action, but also with their immunomodulatory and antineoplastic properties. Statin therapy initiated early after heart transplantation improves the shortand long-term prognosis and outcomes, leading to a reduction in the incidence of cardiac allograft vasculopathy, acute rejection, and cancer. 

To the 70^th anniversary