Monitoring of a condition and prospects of organ donation and transplantation development in Russia in the form of the National Registry is carried out under the auspices of the Profile commission on transplantology of Minis- try of Health of Russia and the Russian Transplant Society. According to the registry in 2012 the indicator of do- nor activity decreased, but the indicator of transplant activity remained at the level of the last years. Decrease the number of deceased donors managed to be compensated by means of increase of efficiency of donor programs: by increase of the number of donors after brain death and multi-organ explantation, by increase in average of the organs received from one deceased donor. In 2012 the number of transplantations of heart and liver increased. The main funding mechanism for organs transplantation in Russia is the state task to the transplant centers (fede- ral financing), its role increases. For increase of stability of donor providing it is necessary to continue to develop legal base in the organ donation and transplantation sphere. 

Aim of our clinical study was evaluation own initial experience of high-urgency ortotopic heart transplantation (OHT) in recipients, who were bridged on peripheral Vena-Arterial Extracorporeal Membrane Oxygenation (VA ECMO).

Materials and methods. In this study was included 17 patients (14/3 M/F, age 16–66 (40.1 ± 

4.2 yrs)) who underwent OHT while on peripheral ECMO support. In all cases we used peripheral surgical can- nulation technique via femoral vessels – arterial cannula 15–19 Fr, venous cannula – 21–25 Fr, arterial cannula or vascular catheter 8–10 Fr for anterograde leg’s perfusion.

Results. Duration Vena-Arterial Extracorporeal Membrane Oxygenation before OHT was 81 ± 17 h. VA ECMO support was blood flow 4.8 ± 0.6 l/min or 2.63 ± 0/04 l/min/m2, gas flow 4.8 ± 0.6 l/min, FiO2 0.86 ± 0.07. Vena-Arterial Extracorporeal Membrane Oxygenation support was continued in “protective mode” (blood flow 1.9 ± 0.2 l/min) 4.3 ± 0.5 days after OHT. Thirteen pa- tients (76.4%) were weaned from VA ECMO successfully and survived to be discharged. ICU and hospital LOS after orthotopic heart transplantation was respectively 6.7 ± 0.8 and 32.3 ± 4.6 days in group of survived patients. The reasons of a lethal outcome (n = 4, 23.5%) were sepsis and multiorgan failure (n = 3), sudden cardiac arrest (n = 1).

Conclusion. Vena-Arterial Extracorporeal Membrane Oxygenation is a favorable short-term method of circulatory support in patients who needed in high-urgency heart transplantation. 

Aim of study. The demonstration of our own experience in heart transplantation after valve reconstruction. Methods and results. From May 2012 to March 2013 3 mitral valve annuloplasties were performed to recipi- ents, requiring urgent HT and having extremely unfavorable prognosis of survival without HT. The recipients were classified as United Network for Organ Sharing (UNOS) IB, and all of them were on inotropic support. In one case, HT was performed after reconstruction of rheumatic mitral stenosis, in two other cases – after dege- nerative mitral regurgitation. The technical aspects are reviewed of ex-vivo mitral and tricuspid valves repair with concomitant heart transplantation. All patients were discharged from the hospital having excellent postope- rative recovery. Conclusion. Taking into consideration the demonstrated satisfactory result of surveillance and presence of significant experience in performing of reconstructive valve surgery among no-HT cardiosurgical patients, an increase in the pool of suitable donor organs is expected due to the liberalization of the selection criteria and the possibility of the innovative valve reconstruction procedures ex vivo. 

Aim. To determine the relationship between CD34/CD45 positive cells number in peripheral blood before and after heart transplantation (HTx) and plasma level of the biomarkers. Materials and methods. We studied 27 pts. (23 men; 40 ± 13 years) with heart failure caused by dilated (17 cases) or ischemic cardiomyopathy (10 cases) before and after HTx. CD34/CD45 positive cells were measured in peripheral blood before and 2–4 days after the operation by flow cytometry and expressed in number of the cells per 106 events, plasma level of the biomar- kers – by ELISA. Results. The number of CD34/CD45+ cells in pts. with heart failure (224 ± 166) was similar to those in healthy individuals (233 ± 120) and there was no significant difference in the cell number between pts. with dilated (253 ± 188) and ischemic cardiomyopathy (169 ± 100). The cell number did not correlate with age, sex, body weight, blood cells counts and preoperative levels of the biomarkers: PlGF, sCD40L, PAPP-A. In 2–5 days after HTx the cell number decreased to 103 ± 102. The cell number after HTx did not correlate with demographic and laboratory parameters, anesthesia, operation, ischemia and hypothermia duration, blood loss volume and preoperative levels of PlGF and PAPP-A but correlated with sCD40L level in pts. with ischemic cardiomyopathy. Conclusion: Circulating HSC number in patients with heart failure does not differ from those in healthy individuals and decreases after HTx. In patients with ischemic cardiomyopathy the cell number after transplantation associates with preoperative level of sCD40L – the negative predictor of vasculopathy. 

Aim. The aim of this study focuses on the first experience with self-expandable stents, analysis of its efficacy and safety in the treatment of anastomotic strictures after liver transplantation. Materials and methods. There’re 136 liver transplantations performed from 2004 till 2012. To correct anastomotic strictures we’ve used only the self-expandable coated nitinol stent. We performed stenting in 7 recipient. Result. In 131 liver transplant recipients incidence of biliary strictures has been 5.3%. All of 5 patients have been managed by retrograde or antegrade way. Conclusion. Our first experience demonstrate efficacy and safety of the used tecniques up to 24 months. The analysis of more long-term results is required. 

Aim. To study the clinica-morphological features of syndromatic and nonsyndromatic paucity of intrahepatic bile ducts in pediatric liver transplant recipients.

Methods and results. The clinical records were analyzed and histological studies of native livers of 20 children, who had suffered from paucity of intrahepatic bile ducts and to whom liver transplantation were made, were completed. The obtained data indicate higher levels of AST in patients with nonsyndromatic paucity of intrahepaticbile ducts (p = 0,023). Ductopenia was the more frequent indication of syndromatic form of paucity of intrahepatic bile ducts (p = 0,01), while ductular proliferations, which form «ductular structure», were discovered more often in nonsyndromatic paucity of intrahepaticbile ducts (p = 0,03). The extent of inflammatory-destructive changes was more expressed in nonsyndromatic pauci- ty of intrahepatic bile ducts (p = 0,01). Fibrosis or cirrhosis was formed more often in nonsyndromatic paucity of intrahepatic bile ducts (p = 0,008).

Conclusion. Our results indicate more severe clinical and morphological manifestations in nonsyndromatic paucity of intrahepatic bile ducts. These findings may suggest about heavier liver condition in patient with nonsyndromatic form of paucity of intrahepatic bile ducts. 

Aim is to develop a method for a prolonged support of recovery processes in damaged liver. Materials and me- thods. It was carried out 3 groups of experiments on Wistar rats with the modeling of chronic fibrotic liver injury (n = 70): I group control (n = 20); in the II group (n = 20) a suspension of liver cells was transplanted into liver; in the III group (n = 30) cell-engineering designs (CED), which contained liver cells and BM MMSC, enclosed in a heterogeneous biodegradable gel “Sphero®GEL-long” were transplanted into damaged liver. The activity of recovery processes was evaluated by using biochemical and morphological methods in dynamics on 30, 60, 90 and 180 days. Results. It was shown that in the II and III gr. significantly accelerated the recovery processes in damaged livers compared with the I gr. The normalization of biochemical parameters took place in II and III du- ring 30 days instead of 90 days in the I group. However, the normalization of morphological signs of hepatocytes theirs viability and a degree of defibrotic changes in liver were more pronounced and prolonged in the III group. A study showed integration of CED by liver structures with formation of new bile ducts after 90 and 180 days. Conclusion. Higher levels and prolonged periods of recovery processes in damaged liver after CED transplanta- tion were due to the creation of biologically appropriate conditions for prolonged cell activity, included in their structure (donor liver cells and BM MMSC). 

Aim. To study with scanning electron microscopy an interaction between structural elements of “Rosa” filters (a component of HEMOFENIХ) with erythrocytes during membrane plasmapheresis and under the effect of la- ser irradiation performed during plasmapheresis. Materials and methods. Using scanning electron microscopy and morphometry, blood cells and plasma-filter components were studied in patients with myasthenia gravis. Results. It has been revealed that the percentage of pathologic forms of erythrocytes increased in peripheral blood of patients with myasthenia gravis. Plasmapheresis leads to an increase in the number of pathologic forms of erythrocytes in peripheral blood as well as on plasma-filter components. Conclusion. Laser irradiation, in turn, promotes the significant reduction of pathological forms of erythrocytes number in peripheral blood and on plasma-filter components. 

In vivo endoscopic microscopy aims to provide the clinician with a tool to assess architecture and morphology of a living tissue in real time, with an optical resolution similar to standard histopathology. To date, available microendoscopic devices use the principle of fluorescence confocal microscopy, and thereby mainly analyse the spatial distribution of specific endogenous or exogenous fluorophores. Fluorescence microendoscopes devoted to respiratory system exploration use a bundle of optical fibres, introduced into the working channel of the bron- choscope. This miniprobe can be applied in vivo onto the bronchial inner surface or advanced into a distal bron- chiole down to the acinus, to produce in situ, in vivo microscopic imaging of the respiratory tract in real time. Fluorescence confocal microendoscopy has the capability to image the epithelial and subepithelial layers of the pro- ximal bronchial tree, as well as the more distal parts of the lungs, from the terminal bronchioles down to the alveolar ducts and sacs. Potential applications include in vivo microscopic assessment of early bronchial cancers, bronchial wall remodelling evaluation and diffuse peripheral lung disease exploration, as well as in vivo diagnosis of peripheral lung nodules. The technique has also the potential to be coupled with fluorescence molecular imaging. This chapter de- scribes the capabilities and possible limitations of confocal microendoscopy for proximal and distal lung exploration. 

Clinical case of successful treatment of severe immune hemolytic anemia after liver transplantation is represen- ted in this article. The cause of complication was so-called passenger lymphocyte syndrome (a type of graft- versus-host disease). Two plasmapheresis sessions and Ig (0.5 g/kg) in combination with increased maintenance immunosuppression with a short course of oral methylprednisolone in a total dose of 150 mg during 12 days were effective. The patient was discharged from hospital 34 days after transplantation in a satisfactory condition with a stable hemoglobin level. 

Herein we present the clinical case, which demonstrates the difficulties of the differential diagnosis of renal allograft damage. The importance of using of modern methods of diagnosis and treatment of urinary system in- fection after cadaveric kidney transplantation: computed tomography, graft tissue biopsy and timely application of the extracorporeal endotoxin selective adsorption are emphasized. 

During the last decade an increasing number of reported cases with ECMO application, was described as a «bridge» to heart transplantation (HTx). Herein we present a case with successful long-term EСMO application with further HTx in a 24 y.o patient. Three years after the atrial septal defect plasty the patient developed acute myocarditis, and was connected to ECMO. The total duration of еру observation was 24 days. After switching off – the ejection fraction was less than 20%, the 6-minute walking test was less than 150 meters, left ventricular end-diastolic dimension was 65 mm. In 28 days we successfully performed HTx according to bicaval method. The patient was discharged on the 30th day after HTx. His total hospital stay was 114 days. Conclusion: ECMO as a «bridge» to HTx can be successfully applied as a short-term circulatory support. 

The authors prove variants of immune reacting of an human organism in organ transplantation by existence of individual specific programs of reacting on alloantigens which, using natural activatory and inhibitory mecha- nisms, form various degree of stability of two physiological stereotypes of “behavior of immune system” – ef- fectoric and tolerogenic. For identification of an individual predominant stereotype of recipient immune reacting on a graft and for forecasting changes of an immunological homeostasis in a human organism, authors suggest to use indexes of reactance of immune system – conservatism and plasticity which can be taped by selection of the conforming biomarkers. Now the system of markers characterizing inflammatory reactions (infections/ inflammation) for recognition organ rejection and related complications, is widely used. For forecasting of an individual dominant stereotype of reacting in immunologically quiet post-transplant follow-up authors suggest to study a system of informative cellular markers of adaptive immunity and to use them for a formation of complex informative diagnostic immuno-cellular modules. 

The paucity of intrahepatic bile ducts is characterized by reducing the quantity of interlobular bile ducts in re- lation to portal tracts of the liver. There are two defined forms of paucity of intrahepaticbile ducts: syndromatic, which is associated with various extrahepatic abnormalities and nonsyndromatic, being the heterogeneous group of disorders, including congenital infections, metabolic, endocrine, immune disorders, congenital infections and various other disorders. In many instances paucity of intrahepatic bile ducts remains idiopathic. The review contains terminological issues, the description of the classification and the morphological characteristic, the dif- ferences of syndromatic and nonsyndromatic forms of paucity of intrahepatic bile ducts, and also the description of principles of differential diagnosis of paucity of intrahepatic bile ducts and biliary atresia. 

Statins are widely used in the treatment of heart transplant recipients. It is assumed that the effectiveness of statins after heart transplantation is due not only to hypolipidemic effects, but also to non-lipid effects, including anti-inflammato- ry. In the review are presented the recently published results of the pro-and retrospective studies on the role of statins in the treatment of post-heart transplant recipients. Also there were analyzed the immunomodulatory and anti-in- flammatory mechanisms based on reduced levels of C-reactive protein, decreased concentration of cytokines (TNF-α, IL-6, IL-2R), suppression of tissue factor expression by monocytes etc. Another important factor is the role of statins in reducing the risk of cancer for transplant recipients. The use of statins in the treatment with immunosuppressive agents is an important factor in optimizing the long-term outcomes, reduction in the incidence of acute rejection and coronary artery disease of transplanted heart, increasing the duration and quality of life for heart transplant recipients. 

This article provides an overview of new approaches to the prevention of infectious complications of bacterial nature after the high-technology operations in the abdominal surgery, first of all, after liver transplantation. At- tention is drawn to the first positive results of randomized studies on the use of biological preparations - probi- otics, prebiotics and synbiotics in patients after liver transplantation. The authors prove the prospects of further development of this subject based on successful model experiments on animals and various operational interven- tions in abdominal surgery. 

Outcomes of myocardium revascularization in patients with chronic left ventricular systolic dysfunction due to coronary artery disease are still unclear. The identification of dysfunctional myocardial with residual viability that can improve after revascularization are very important for further patient treatment. Hibernating myocardium can be identified by different methods and its presence and extent can predict functional and structural recovery after revascularization. New medical treatments and devices, have improved the prognosis of this patients and their use is supported by a number of clinical trials. The prognostic benefits of coronary revascularization for patients with chronic left ventricular dysfunction on optimal medical therapy and novel devices a randomized trial is still needed. 

ANNIVERSARY Eduard Mihailovich Balakirev 

ANNIVERSARY Boris Vasilievich Fadin 

On scientific and medical personnel training courses at Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs 

In memory of Veniamin Vladimirovich Gorbunov