Aim. The study was aimed to show a possibility of using functional criteria of the allograft left ventricle to assess severity of cardiac vasculopathy. Methods and results. 57 recipients (9 days–15 years after heart transplantati- on) underwent annual follow-up. Left ventricle diastolic function was assessed by determining the velocities of transmitral flow according to echocardiography, coronary state was assessed by coronary angiography. The rela- tionship between the severity of left ventricle diastolic dysfunction and the presence of angiographic evidence of cardiac allograft vasculopathy was revealed. Conclusion. Parameters of left ventricle diastolic dysfunction can be used to determine the severity of pathological changes in myocardium of transplanted heart caused by cardiac allograft vasculopathy. 

The appropriate evaluation and the development of special measures to protect donor lungs are important factors for successful lung transplantation. Aim. To develop and determine the effectiveness of the protocol of morpho- functional assessment of potential lung donor. Methods and results. During the period from May, 2011 to May, 2012, 37 donors with diagnoses of brain death were surveyed. 5 bilateral lung transplantations were performed only in 2 cases donors have been evaluated as «ideal». In the majority of recipients early postoperative period was evaluated as satisfactory. Conclusion. Designed multivariate algorithm of donor with brain death assess- ment, effectively implemented through the selection of donors for lung transplantation with satisfactory results in the early postoperative period. However, compliance with ideal criteria will not allow to effectively provide care for patients with terminal lung disease under conditions of continuous growth of «waiting list». 

Aim. To elucidate the role of cholestasis and menopausal status in the development of osteoporosis in women with primary biliary cirrhosis (PBC) before and after orthotopic liver transplantation (OLT). Methods and re- sults. There were fulfilled 74 estimations of biochemical markers of bone metabolism, estrogen (E2), parathy- roid hormone (PTH) endogenous secretion so as mineral content of lumbar vertebras in 21 women with PBC (10 women before and 17 in different terms after OLT). Bone turnover disturbances were characterized by delay of bone formation associated with hyperbilirubinaemia before OLT while increased bone turnover following OLT. Bone resorption markers correlated inversely with E2 in postmenopausal women and positively with PTH in premenopausal women. Conclusion. Bone wastes degree depended on hard and duration of disease before OLT so as menopausal status after OLT. In postmenopausal women bone wastes were associated with degree of endogenous E2 decreasing, increased bone turnover, and graft dysfunction. 

Aim. Comparative evaluation of two biochemical markers of bone resorption and hormonal regulation of bone metabolism in liver recipients. Methods and results. Bоne densitometry of L2–L4 and neck of femur, serum level of some hormones (PTH, vitamin D3, estradiol, testosterone) regulating osteoclastogenesis as well as com- parative analyses of two bone resorption markers β-crosslaps and tartrate-resistant acid phosphatase type 5b (TRAP-5b) were fulfilled in patients after orthotopic liver transplantation (OLT). In 1 month after OLT bone density reduction of L2–L4 and neck of femur; decrease of vitamin D3, estradiol in women, testosterone in men and increase levels of bone resorption markers were observed. In 1 and 2 years after OLT the rise of bone density, increased levels of PTH, estradiol, testosterone and decreased β-crosslaps levels were revealed, while vitamin D3 and TRAP-5b levels remained stable. Conclusion. TRAP-5b was found to be a more speciffic marker of bone resorption, independent from collagen metabolism in liver. Osteoporosis defined in long-term period after OLT was associated with higher TRAP-5b and revialed in women with low estradiol level. 

Aim. The purpose of our work was to estimate the impact of preconditioning with acetylcysteine and sevoflurane on ischemia-reperfusion injury of cadaveric donor liver with marginal features. Methods and results. In this prospective randomized controlled trial we recruited 21 heart beating donors with brain death. We assigned 11 donors to the study group, and 10 donors to the control group. Morphological characteristics of ischemia- reperfusion injury in both groups were analyzed. Conclusion. Use of pharmacological preconditioning with acetylcysteine and sevoflurane resulted in necrosis and hepatocyte apoptosis reduction as compared to the control group, thereby had a protective effect against ischemia-reperfusion injury. 

Aim. To evaluate dynamic of physical capability (PC) based on bicycle ergometry test data in different post- operation terms after orthotopic heart transplantation (OHT). Methods and results. In 28 patients aged from 19 to 59 (mean 45,9 ± 2,2) years the dynamics of PC values was assessed at 14–36 (mean 20,8 ± 1,6) months after OHT. Prior to surgery, all 28 patients had low exercise tolerance (ET) as well as low maximal oxygen consump- tion (VO2max). A significant increase in ET and VO2max was registered in 6 and 12 months after OHT compared to baseline (р < 0,05), a trend to increasing PC values was noted in 6 to 12 months after OHT compared to baseline, 3 (20%) of 15 patients examined showed myocardial ischemia. Conclusion. The PC decrease revealed in 14–36 months after OHT may be indicative of vasculopathy development or progressive underlying athero- sclerotic process. 

Aim. To study the profile of IL-6 in the early postoperative period after kidney transplantation and the factors that affect concentration of this cytokine.
Methods and results. 28 kidney recipients were included in the study. It has been found that in most patients after surgery IL-6 was released, and the absence of such a reaction was a poor prognostic sign. Rate of increasing of the concentration and form of its curve within the first postoperative day depended on the length of preservation, warm ischemia time, type of donor, and differed in recipients with normal and delayed initial graft function. Conclusion. Further study of the role of circulating factors in kidney transplantation would improve patient outcomes. 

Aim. The study was aimed to analyze the results of surgical treatment of infectious endocarditis associated with intravenous drug abuse. Methods and results. The study included 53 patients, 36 male and 17 female, 28,7 ± 7 years old. 60 operations were performed: 41 patients underwent tricuspid valve replacement, 7 pts – tricuspid valve repair, 7 pts – tricuspid valve rereplacement, 2 pts – mitral and tricuspidal valves replacement, 2 pts – aor- tic and tricuspid valves replacement, 1 patient – trivalve replacement. Hospital mortality was 1,7%. Conclusi- on. The used principles of surgical treatment of infectious endocarditis in drug abuse patients allow to rich a low mortality and complications rates in the postoperative period in this heavy group of patients. 

Glycogen storage diseases I, III and IV types are congenital disorders, which are commonly associated with severe liver diseases. Liver transplantation has been proposed as a treatment of choise for these disorders. While liver transplantation corrects the primary hepatic enzyme defect, the extrahepatic manifestations of glycogenoses often complicate the posttransplant management. Upon review of the English-language literature, 42 children under 18 years old were discovered to have undergone liver transplantation for complications associated with glycogenoses (18 patients with Ia type, 6 – with Ib type, one patient – with III type, 17 – with IV type). This artic- le represents the pediatric liver transplantation for complications associated with glycogenosis Ia type, analyzed posttransplant period in this recipient. 

Patients with congestive heart failure have an increased incidence of thromboembolic events. The choice of me- dical management in patients with antiphospholipid antibodies and generalized thrombosis due to hypercoagula- bility is complex issue. We report heart transplant outcome in 15 years old patient with dilated cardiomyopathy and secondary anti-phospholipid syndrome. 

Simultaneous pancreas-kidney transplantation is a valid therapeutic option for patients with type 1 diabetes mel- litus (DM) and secondary diabetic nephropathy, which enables to achieve an insulin-independent euglycemic state with normalization of glycosylated hemoglobin levels, prevent the secondary complications of diabetes and consequently improve patients, quality of life. There are various transplantation procedures exist. Although pancreas is transplanted because of its endocrine function, one of the main issues, which prevent the successful development of pancreas transplantation, is an exocrine drainage. The aim of this paper was to summarize our first experience of retroperitoneal pancreas transplantation with the formation of duodeno-duodenal anastomosis for enteric drainage. 

Central pontine myelinolysis (CPM) is the rare, but extremely severe complication after orthotopic liver trans- plantation. The reason for CPM is currently not precisely defined. However, the rapid correction of hyponatremia is considered as the main etiological factor. In this paper we present two clinical cases of CPM in patients under- went orthotopic liver transplantation. We also discuss the pathophysiology, epidemiology, clinical presentation, treatment options and preventive measures of CPM. 

Belatacept is a novel immunosuppressive agent that inhibits T-cell activation by blocking CD28 signaling pa- thway. It was developed based on abatacept (CTLA-4Ig), the first recombinant immunoglobulin fusion protein which contains extracellular part of CTLA-4 molecule and Fc domain of IgG. First clinical trials have shown the comparable patient and graft survival in group of kidney recipients with belatacept-based maintenance im- munosuppressive therapy versus Cyclosporin A-based therapy. Advantages observed with belatacept include superior glomerular filtration rate and improved cardiovascular risk profile. Belatacept is a potential option for maintenance immunosuppressive therapy without calcineurin inhibitors. Concerns associated with belatacept use are higher rates of acute cellular rejection episodes and post-transplant lymphoproliferative disorder cases. 

Global organ shortage is the crucial point of transplantation nowadays. Usage of expanded criteria donors represents reliable source of donor organs, making transplantation more accessible for patients with end stage organs failure. Ischemia-reperfusion injury followed by the activation of programmed cell death scenarios remains the main obstacle in utilization of marginal grafts. Programmed cell death often leads to life threatening complications in posttransplant period. Antisense gene therapy could provide a therapeutic tool, capable to improve quality of grafts and, consequently, transplantation outcomes.