Aim. To estimate the requirement of the population of the Russian Federation for an organ transplantation and donor resource, to offer approach to planning of an effective network of the medical organizations (the centers of transplantation). Materials and methods. The analysis and comparison of statistical data on population, number of the patients receiving a dialysis, data about medical care on an organ transplantation in Russia and foreign countries is made. Results. On the basis of what the assessment of requirement of the population of the Russian Federation in an organ transplantation and donor resource is carried out, approach to planning of an effective network of the medical organizations (the centers of transplantation) and scenarios of development of organ do- nation and transplantation in Russia is offered. Conclusion. To provide the population of the Russian Federation with medical care on an organ transplantation according to real requirement and donor resource, in each region of the Russian Federation have to be organized deceased organ donation and transplantation of a cadaveric kidney. But the transplantation of extrarenal organs is better to develop in the federal centers of hi-tech medical care with donor providing from territories of adjacent regions. 

Aim. Оptimize the treatment of patients with prolonged anuria kidney transplantation due to the introduction of the diagnostic algorithm and treatment of patients at risk. Materials and Methods. 145 renal transplant recipients who had surgery during the period from 2006 to 2011. Of these – 73 (50.3%) patients with anu- ria period exceeding 3 years. An algorithm for the treatment of patients with prolonged anuria kidney trans- plantation, which consists of three stages: pre-operative, peri-operative and post-operative. In the study, two groups. The first group of 47 patients, which were held all three stages of the algorithm evaluation and treat- ment of patients with prolonged anuria in kidney transplantation. The second group of 26 patients with pro- longed anuria without urological examination and treatment. Results. Implementation of the proposed algo- rithm of diagnosis and treatment of patients with prolonged anuria can reduce the risk of adverse outcome of 11. Additional specific urological examination and treatment can reduce the number of urological com- plications, both in the immediate and late postoperative period by 20%. The emergence of severe urological complications in patients with prolonged anuria increases the risk of adverse outcome of 17. The most pre- ferred anastomosis urinary tract in recipients were on long-term renal replacement therapy is an immersion- type anastomosis «drop in». Renal transplant patients with prolonged anuria preferable to perform up to 45 ye- ars, as this reduces the relative risk of an adverse outcome by 14 times compared with the older age group.
Conclusion. Prolonged anuria in a patient with chronic renal failure awaiting a kidney transplant, is not a con- traindication to the operation. The duration of anuria not significantly affect the results of renal transplantation. 

Aim. Ureteral obstruction secondary to ischemia is the most common urologic complication of kidney trans- plantation. Pyeloureteral anastomosis with recipient ureter has shown most satisfactory long-term results in its management. Existing urinary infection and immunosupression determine the high risk of wound complications. We have experience more than 50 reconstructive procedures of urinary tract after kidney transplantation by open surgery during 25 years. Till last time this procedure has been performed through open surgery. Method. We used pyeloureteral anastomosis with recipient ureter in two patients with ureteral stricture after kidney transplantation by laparoscopic approach. The operations lasted 215 and 275 min respectively. In both cases the surgery was per- formed after percutaneous nephrostomy because of deterioration of transplanted kidney function. Internal stent was indwelled laparoscopicaly. No drain tube was left. Results. The nephrostomy tubes were removed after 10 and 7 days respectively. The stents were removed after 27 and 20 days respectively. No complications were seen during the surgery and postoperative period. Now serum creatinine level is 0.12 mmol/l and 0.15 mmol/l after 15 and 12 months after surgery respectively. Conclusion. In spite of some difficulties related with topographic land- marks and severe tissues fibrosis after transplantation laparoscopic pyeloureterostomy in transplanted kidney is safe and feasible procedure. The main advantage is absence of risk of most serious complications related with wound infection in immune compromised patients. Moreover, early recovery to usual activity and diet facilita- tes to prevent pulmonary infections and to normalize intestinal absorbability of the immunosuppressive drugs. 

Aim. The purpose of the research was correlation analysis of iNO, blood levels of NOx, MetHb and lacta- te in patients after LT. Materials and methods. The duration of iNO therapy was ranged from 2 to 4 days, the data of LT were analyzed in 7 patients. Results. There was a significant increase of NOx and lac- tate levels from 1 to 5 days after operation while the concentration of MetHb remained within the normal range. We have found significant positive correlations in patients after LT: between iNO and NOx concen- tration, iNO and MetHb concentration, iNO and lactate concentration, the concentration of NOx and Me- tHb, the concentration of NOx and lactate, the concentration of MetHb and lactate. Conclusion. The ob- tained data indicate that during application of iNO in patients with LT it is necessary to control both the concentration of administered iNO, the concentration of MetHb in blood and the level of NOx in serum. 

Introduction. Despite the advances in antibiotherapy and critical care management, infectious complications remain among the leading complications after liver transplantation related with mortality and morbidity. This study analysis the incidence and pattern of infections and possible prognostic factors of infectious compli- cations retrospectively in a single center. Patients and Methods. Results of 30 consecutive patients with a primary liver transplantation history in a single center between August 2011 and August 2012 and a positive culture result in the first month in the ICU were analysed retrospectively. Results. During the first 1 month stay in the ICU postoperatively 30 (13,63%) patients had at least 1 infection. Total number of infections were 68. Mortality rate of the infected patients was 53,3% (n = 16). Among these infections, 25 (36,76%) of them were in deep surgical sites. Eighteen of the 30 patients (60%) were infected with a single microorganism. Eleven patients (36,66%) had a single infection episode. Microorganism were gram negative in 52 (76,47%) of the infections, gram positive in 14 (20,58%) of the infections, rest of the 2 (2,94%) infections were due to Candidiasis. Among the possible risk factors contributing to mortality, there was a statistically significant dif- ference (p < 0,001) between the platelet counts of the mortality and surviving groups of the patients. Conclu- sion. Infections are among the preventable risk factors for mortality and morbidity after liver transplantation. Our data reveals a significant relation between trombocytopenia and mortality among the infected patients. Further studies focusing on this relation would expose the mechanisms and any possible contribution in cli- nical management of the patients. 

Aim. The goal of this study was to demonstrate the possibility of in vitro formation of tissue-engineered const- ruct of cartilage on the basis of cell-engineered construct composed of biopolymer hydrogel matrix and human adipose-derived mesenchymal stromal cells. Materials and methods. As a biodegradable matrix, the hetero- geneous composition of the implantable gel Sphero®GEL (Biomir Service, Krasnoznamensk, Moscow Region) was selected. To generate cell-engineered construct of cartilaginous tissue human adipose-derived mesenchy- mal stromal cells were mixed with biopolymer matrix Sphero®GEL and cultured in chondrogenesis medium. 

Results. It was revealed that human adipose-derived mesenchymal stromal cells with biopolymer matrix under chondrogenic conditions generate three-dimensional structures and produce cartilaginous extracellu- lar matrix components: collagen type II and glycosaminoglycans. Conclusion. It was discovered that 3-D structures formed in the process of culture of cell-engineered constructs, began to synthesize the components of the cartilage extracellular matrix. This indicates the initial stage of in vitro formation of tissue-engineered cartilage construct. 

Aim. To compare the effectiveness of MSC with different degree of ontogenetic maturity (MSC bone marrow – MSC BM and MSC umbilical cord – MSC UC) on regenerative processes in injured liver. Methods. In 4 groups of experiments on Wistar rats (n = 80) with a model of fibrotic toxic liver damage (FLD) it was studied the effect of MSCs with different degree of ontogenetic maturity on recovery processes at the regeneration of damaged liver: 1 gr. – Control, 2 gr. and 3 gr. introduction of MSC BM, included in Sphero®GEL-long in doses of 2.5 ×106 and 5.0 x 106 cells, respectively, and 4 gr. – introduction of MSC UC in the form of cell-spheroids (8–10 × 105 cells). The cells were injected into the damaged liver in 7 days after the end of FDL-modeling. The effect of cell therapy was studied during 180 days. The effectiveness of corrective therapy was evaluated by the results of functional and morphological investigations of livers (histological control of parenchymal and nonparenchy- mal liver tissue). Results. MSC BM in both doses and MSC UC contributed to a more rapid normalization of liver enzyme indices compared with the control (1 gr.), but the differences in the rate of recovery of disturbed enzymatic liver functions between groups 2, 3 and 4 – were absent. In 90 days after the cell application it was determined a more pronounced recovery activity of cells in groups 3 and 4; in 180 days the more pronounced activation of recovery processes was observed in group 3; but in group 4 the sclerotic processes were more pro- nounced in this period. Conclusion. For the induction of recovery processes in damage liver it is advisable not to use the MSC UC, but to use MSC BM in the Sphero®GEL, because MSC BM exert not only local but also systemic immune-regulatory effect, increasing the pool of T-reg. cells, which are additional carriers of regenera- tion information in organism. 

Aim. Evaluation of long-term results of drug therapy and intramyocardial administration of a mononuclear fraction of bone marrow cells in CHD patients with chronic cardiac insufficiency. Materials and methods. 109 patients were randomized into two groups by using an envelope method. Intramyocardial administration of a mononuclear fraction of autologous bone marrow cells and cardiac insufficiency therapy were performed for the 1st group (n = 55), while the 2nd group (n = 54) received drug therapy only. All patients underwent clinical examination at admission and at 6 and 12 months after the onset of the study. Results. In the 1st group the angina functional class was reliably lowered (from 3.3 ± 0.2 at the onset of the study down to 2.5 ± 0.1 after 12 months). The distance covered during a 6-minute walk test increased from the initial 185 ± 39 meters up to 359 ± 69 me- ters by the end of the 12th month. The angina class decreased from 3.1 ± 0.4 at the onset of the study down to 1.6 ± 0.4 by the end of the 12th month. Minnesota Life Quality Index reduced from 65.3 ± 21 points down to 22.4 ± 6 points in the first group, while in the control one it decreased down to 59.9 ± 16 points. On the contrary, cardiac insufficiency in patients of the second group tended to continually progress: from NYHA FC 3.5 ± 0.1 at the beginning of the study up to 3.9 ± 0.1 in the course of 12-month observation. The angina class remained the same (3.5 ± 0.5 at the beginning and 3.5 ± 0.4 after 12 months respectively). Conclusion. Intramyocardial implantation of a mononuclear fraction of autologous bone marrow cells is a safe method that contributes to the improvement of the left ventricular function, clinical data and prognosis. 

First russian national congress «Transplantation and organ donation» 

Aim of our experimental study was evaluation of the first domestic implantable axial pump as a left ventricle assist device in calves. Materials and methods. 18 calves 90–120 days of age, weighing 95 ± 5 kg were exposed to implantation of an axial pump under the scheme «left ventricular – aorta» in paracorporeal and implantable in chest cavity versions. Two models of the pump were tested. Model 1 is a pump with cylindrical bearings and elongated straightener, model 2 had ball bearings and modified design of impeller and straightener. Results. In the first series (n = 12) the pump model 1 was tested. The duration of experiments was 4,9 ± 5,3 days, maximal duration was 16 days. The experiments were finalized due to intraoperation cardiac fibrillation (n = 3), uncrop- ped acute bleeding (n = 3), lowering of blood flow through the pump of 60 ± 15% (n = 6) because of thrombo- sis of the pump (n = 5) and outlet line (n = 1), in 3 cases of 5, combined with mechanical wear of bearings. In the second series (n = 6) the pump model 2 was tested. In 4 experiments of 6 the duration was 74,5 ± 29 days. One experiment was finalized due to intraoperation cardiac fibrillation. Another one experiment was finalized on 8 day as planned. In 5 experiments there was absence of either thrombosis or mechanical wear of bearings. 
Morphological and histological examination of the kidneys, liver and lungs in the 5 experiments of second series did not reveal the presence of zones of ischemia or thromboembolia. Conclusion. The results of the second series can be treaded as preclinical testing of the first domestic implantable axial pump as a left ventricle assist device in calves. 

Aim. The presented research uncovers the using of mathematical modeling methods for cardio-vascular system and axial blood pump interaction analysis under heart failure with combined valve pathology. The research will pro- vide data for automated pump control algorithm synthesis. Materials and methods. Mathematical model is build up by using experiments results from mock cardio-vascular circulation loop and mathematical representation of Newtonian fluid dynamics in pulsing circulation loop. The model implemented in modeling environment Simulink (Matlab). Results. Authors implemented mathematical model which describe cardio-vascular system and left-ven- tricular assistive device interaction for intact conditions. Values of parameters for intact conditions were acquired in the experiments on animals with implanted axial pump, experiments were conducted in FRCTAO. The model was verified by comparison of instantaneous blood flowrate values in experiments and in model. Conclusion. The paper present implemented mathematical model of cardio-vascular system and axial pump interaction for intact conditions, where the pump connected between left ventricle and aorta. In the next part of research authors will use the presented model to evaluate using the biotechnical system in conditions of heart failure and valve pathology. 

The paper describes the first clinical experience in RF of successful application of domestic circulatory support device based on implantable axial pump for two stage heart transplantation. This case demonstrate the effec- tiveness and safety of our device (АВК-Н) for a longtime (270 days) left ventricular bypass and the ability to perform a successful transplantation of donor,s heart after application of this system. 

The shortage of donor organs results in the search for alternative ways to increase the donor pool. One of these is the expansion of marginal donor criteria. The use of liver grafts from donors in this group is associated with a high risk of primary non-functioning graft which lies at the basis of ischemia-reperfusion injury of the liver. In this regard, in this review, we examined the main stages of the pathogenesis of liver disturbances as well as modern methods of prevention and treatment. 

Ludmila Viacheslavovna Beletskaya