Objective: to monitor the current trends and developments in organ donation and transplantation in the Russian Federation based on data from the year 2021.  Materials and methods. Heads of organ transplant centers were surveyed through questionnaires. Data control was done using the information accounting system of the Russian Ministry of Health. We performed a comparative analysis of data obtained over years from various federal subjects of the Russian Federation and transplantation centers. Results. Based on data retrieved from the 2021 Registry, 45 kidney, 29 liver and 17 heart transplantation programs were existing in the Russian Federation as of the year 2021. The kidney transplant waiting list in 2021 included about 10.5% of the 60,000 patients receiving dialysis. Organ donation activity in 2021 was 4.5 per million population, with a 78.4% multi-organ procurement rate and an average of 3.0 organs procured from one effective donor. In 2021, there were 9.5 kidney transplants per million population, 4.2 liver transplants per million population and 2.0 heart transplants per million population. Same year, the number of transplant surgeries performed in the Russian Federation increased by 18.3% compared to the year 2020, reaching the level of 2019. In Moscow, organ donation activity was 23.7 per million population, that of 2019. In 2021, the city of Moscow and the Moscow region accounted for 12 functioning organ transplant centers, performing 57.7% of all kidney transplants and 70.5% of all extrarenal transplants in the country. The number of organ recipients in the Russian Federation has exceeded 140 per million population. Conclusion. In 2021, donor activity and volume of transplant care in Russian regions recovered. This was after the decline in 2020 that resulted from the new coronavirus disease (COVID-19) pandemic. In addition, 7 new transplant programs were established. Further development of regional organ donation and transplantation programs, improvement in their efficiency, increase in the activity of transplant centers and development of inter-regional collaboration are expected in the Russian Federation in 2022.

Objective: to evaluate the possible influence of neoadjuvant transarterial chemoembolization (TACE) on development of early arterial complications after orthotopic liver transplantation (OLTx). Materials and methods. The work is based on treatment-related data of 250 recipients. The analyzed group included 21 patients with hepatocellular carcinoma (HCC). In all recipients who underwent primary transplantation (n = 228), possible negative factors influencing the development of early arterial complications were analyzed, such as degree of allograft steatosis, cold and warm ischemia time, revascularization duration, blood pressure level after arterial reconstruction, and exchange transfusion volume. Results. The degree of allograft steatosis did not differ between HCC patients and the general sample (95% CI, p = 0.25). No early arterial complications were revealed during TACE. There was no significant difference in preservation parameters, arterial revascularization time, systolic blood pressure level at blood flow start, and exchange transfusion volume (CI 95%, p > 0.05). The incidence of early vascular complications in the study group was 16.7%, it did not differ from the entire sample (95% CI, p = 0.96). Conclusion. The incidence of early arterial complications of OLTx in patients who underwent TACE does not significantly increase both according to the literature and our own findings. When vascular complications of OLTx occur, image-guided endovascular intervention is the method of choice for treatment.

De novo hepatitis B virus (HBV) infection developing after liver transplantation (LTx) is the development of infection in a patient with liver disease etiologically unrelated to HBV infection and who had no preoperative HBV markers. Objective: to analyze the clinical features and characteristics of de novo HBV infection and evaluate the efficacy of nucleos(t)ide analogue therapy in liver transplant recipients. Materials and methods. The study involved 247 adult patients who underwent deceased donor LTx from 2016 to 2022 at Shumakov National Medical Research Center of Transplantology and Artificial Organs and who had no pre-transplant HBV markers. Results. Twenty-two (7%) of 247 patients had de novo HBV markers from 5 to 69 months. At the time HBV DNA was detected, the mean alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in the patients was 53.3 ± 36.4 IU/L and 54.5 ± 33.0 IU/L, respectively. All patients received nucleos(t)ide analogues (NAs). The therapy led to a statistically significant decrease in the mean ALT level to 31.5 ± 24.2 IU/L (p = 0.049)

Objective: to conduct a comparative analysis of the effectiveness of two methods – endoscopic band ligation (EBL) alone and in combination with nonselective beta blockers (NSBB) – used for prevention of variceal bleeding (VB); to evaluate their impact on patient survival in severe ascites during long-term stay on the liver transplant waiting list (LTWL). Materials and methods. A retrospective comparative study of two groups of patients with decompensated liver disease, ascites and varices included in the LTWL, who received EBL (n = 41, group 1) and EBL + NSBB (n = 45, group 2). Results. The groups being compared did not differ in demographics, clinical parameters, MELD and Child–Turcotte–Pugh scores. There were no significant differences in the incidence of severe ascites, particularly diuretic-resistant ascites. The study groups did not differ in the incidence of mediumand large-sized varices. Incidence of bleeding did not differ in both groups. Overall mortality was significantly higher in the EBL + NSBB group than in the EBL group. Patient survival was lower, while mortality was higher in the EBL + NSBB group. The combined therapy group had a significantly higher number of acute kidney injury (AKI) than the EBL group. Conclusion. The compared methods are equivalently effective in preventing VB in patients with decompensated cirrhosis with a prolonged stay on the waiting list. Survival rate is significantly lower, while mortality is significantly higher in the EBL + NSBB group than in the EBL group.

Objective: to demonstrate the experience of using complex hemodynamic monitoring by means of prepulmonary thermodilution (PPTD) and transpulmonary thermodilution (TPTD) – PiCCO – in lung transplantation (LTx). Materials and methods. Presented is a clinical case study of a 51-year-old patient with the following diagnosis: severe bronchiectasis and type 3 respiratory failure. Bilateral lung transplantation was performed at Sklifosovsky Research Institute for Emergency Medicine, Moscow. Intraoperative hemodynamic monitoring was performed using PPTD and TPTD techniques. Conclusion. The case study presented shows that simultaneous use of PPTD and TPTD for hemodynamic monitoring during lung transplantation achieves better treatment outcomes. This hemodynamics monitoring strategy is highly informative, allows for continuous measurement of necessary hemodynamic parameters and for timely and targeted correction of identified disorders by influencing the basic pathogenesis links of cardiovascular disease.

Objective: to study the incidence of splenic artery steal syndrome (SASS) in our own series of liver transplant surgeries and to determine diagnostic and therapeutic tactics. Materials and Methods. During the 3.5 years of existence of the liver transplant program in the Republic of Tatarstan, 77 cadaveric liver transplantations (LTx) have been performed. Postoperative SASS occurred in 4 cases (5.2%). Among the patients were 3 women and 1 man; mean age was 38 years. Doppler ultrasonography of the liver vessels and celiacography were used for diagnosis. Proximal splenic embolization was used as a way to correct the syndrome. Results. In all clinical cases, SASS was timely diagnosed and corrected by endovascular image-guided intervention. The patients were discharged with good hepatic graft function. The complication did not affect the length of hospital stay. Conclusion. SASS remains a severe vascular complication of LTx, which can lead to graft dysfunction and possible loss. Timely detection and treatment prevent severe consequences for the liver recipient.

Amidst the shortage in viable donor hearts, the use of hearts from expanded criteria donors, including those with prolonged ischemic time, remains one of the real ways to increase the donor pool and number of heart transplantations (HTx) performed. The study included 38 recipients (33 (86.8%) men and 5 (13.2%) women) aged 11 to 66 (44.7 ± 12.0 years, median 48.0 years), who underwent primary (n = 37; 97.4%) or repeat (n = 1; 2.6%) HTx (retransplantation). Donor hearts (n = 38) with ischemic time ranged from 362 (6 hours 2 minutes) to 571 (9 hours 31 minutes) or 407 ± 52 minutes (median 400 minutes). In 33 (86.8%) of 38 recipients, the early posttransplant period was characterized by satisfactory initial graft function. Five (13.1%) recipients developed severe primary graft dysfunction, requiring post-transplant venoarterial extracorporeal membrane oxygenation (VA-ECMO) (n = 4; 10.5%) or prolongation of pre-transplant VA-ECMO within 8 days of HTx (n = 1; 2.6%). In-hospital mortality was 7.9% (n = 3). Thirty-five (92.1%) of 38 recipients were discharged from the hospital. Three recipients died in the post-hospital period at day 734, 944, and 2146 after HTx. Thirty-two (84.2%) of the 38 recipients remained alive at the end of the study. Our own experience shows that HTx from donors with prolonged ischemic time could be effective.

Primary cardiac sarcoma is a rapidly progressive, aggressive cardiac tumor that is very rare in the general population. Conservative treatment for this tumor is not very effective. The only effective treatment is radical surgical removal of the malignancy. However, if sarcoma removal cannot be performed, heart transplantation (HT) becomes the only treatment option. The median survival of heart recipients with preoperative cardiac sarcoma is 8.5 months. Globally, such operations are performed in a small number of cases. This paper presents the first experience of HT for a patient with primary cardiac sarcoma in the Russian Federation.

Surface modification of polymer vascular matrices is a promising development for preventing vascular graft thrombosis, improving long-term patency and accelerating remodeling. Objective: to study the outcomes of long-term patency of PHBV/PCL/GFmix grafts with iloprost (Ilo) and heparin (Hep) implanted into the carotid artery of sheep. Materials and methods. Matrices ∅4 mm were fabricated by electrospinning from a polymer composition of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and poly(ε-caprolactone) (PCL) with incorporation of endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and chemoattractant molecule (SDF-1α). The fabricated matrices were then modified with Ilo and Hep by complexation via polyvinylpyrrolidone (PVP). Synthetic Gore-Tex grafts were used as a comparison group. The physical and mechanical properties of the studied matrix groups were evaluated, the surface structure of vascular grafts before and after implantation was assessed. Vascular grafts were implanted into the carotid artery of a sheep. The explanted samples were studied via histological and immunofluorescence analysis, the elemental composition of the obtained vascular graft samples was also assessed, and the gene expression profile was evaluated. Results. One day after implantation, the patency of PHBV/PCL/GFmix^Hep/Ilo vascular grafts was 62.5%, whereas synthetic Gore-Tex grafts had thrombosis in 100% of cases. At the same time, after 18 months of implantation, the patency of biodegradable PHBV/PCL/GFmix^Hep/Ilo vascular grafts decreased to 50%. Permeable drug-coated polymer grafts were completely reabsorbed after 18 months of implantation, and aneurysmally dilated newly-formed vascular tissue was formed in their place. Conclusion. Modification of the surface of PHBV/PCL/GFmix polymer grafts with Hep + Ilo coating improved long-term patency outcomes compared to synthetic Gore-Tex grafts.

Fibrosis is one of the causes of kidney allograft loss, especially late after transplantation (up to 65% incidence after 2 years). The purpose of this literature review is to analyze studies examining noninvasive monitoring techniques for renal graft fibrosis.

The objective of the study was to investigate the evolution and trends in liver donation in the city of Moscow, with special focus on the expansion of liver donor selection criteria for transplantation. Materials and methods. The study included 1,548 effective donors (EDs) in the period from January 1, 2012 to December 31, 2020. Their basic characteristics – age and cause of death – are presented. The dynamics of changes in the age groups of donors and the dynamics of the number of ≥60-year-old liver donors were studied. The influence of expanded liver donor selection criteria over the dynamics of the number of transplant surgeries and patient flow on the waiting list was assessed. Results. During the study period, the number of effective liver donors (ELDs) in Moscow increased 4.7-fold. The average age of ELDs increased from 37.1 in 2012 to 48.8 in 2020. There was an absolute prevalence of donors who died from cerebrovascular accident compared with donors who died from traumatic causes, 83.4% vs 16.6%, respectively. Since 2016, there has been a progressive increase in ≥60-year-old liver donors; the number of such donors in 2020 reached 39, accounting for 13.6% of the total pool of EDs. The progressive growth in the number of liver transplants has significantly influenced patient movement on the waiting list. In 2012, there was a 25.2% increase in the number of liver transplants per 100 patients on the waiting list; by 2020, it had reached 86.6%. Conclusion. The results reasonably indicate an increase in liver donation and liver transplantation (LTx) in Moscow. Comparison of Russian data with those of leading foreign donor programs shows that the trends in the donor pool in the context of older age, including ≥60-year-old donors, and shifting causes of donor death towards cerebrovascular diseases are similar. An overall increase in donor activity and expansion of liver donor criteria contributed to an increase in the number of transplants performed per 100 patients on the waiting list, which, in turn, reduced the waiting time for a donor organ and increased the intensity of patient flow on the waiting list.

Objective: to evaluate the technical feasibility as well as functional, metabolic and structural integrity of donor heart myocardium after 4 hours of direct intracoronary oxygen persufflation in an experiment. Materials and methods. Mini-pig siblings aged 3 months with a body weight of 23–36 kg were used as the experimental model. In the control group (n = 8), donor hearts were cold preserved by injecting 2 liters of Bretschneider cardioplegic solution (Custodiol®, Germany, HTK) into the aortic root. In the experimental group (n = 8), modified HTK solution (with 40 mg/L hyaluronidase added) was used to initiate cardioplegia, then moistened carbogen (95% O₂, 5% CO₂) was injected into the ascending aorta, maintaining 40–45 mm Hg aortic root pressure. The hearts were stored in an mHTK solution at 0–4 °С. After 3 hours of donor heart preservation, orthotopic heart transplantation (OHTx) was performed. In the post-transplant period, we studied central hemodynamic parameters, myocardial oxygen consumption, level of myocardial ischemia markers (troponin I, TnI; creatine phosphokinase-MB, CPKMB; lactate dehydrogenase, LDH), and histological signs of structural cellular injury. Results. Sixteen OHTx surgeries were performed during the study. At 120 minutes after restoration of spontaneous cardiac activity, cardiac output was 2.99 [4.85; 3.17] L/min and 2.48 [2.04; 2.92] L/min (p > 0.05) in the control and experimental groups, respectively. Changes in LDH, TnI and lactate levels in the blood flowing from the coronary sinus were significantly higher in the early reperfusion period. However, there was no statistically significant difference between the groups (p > 0.05). Myocardial oxygen consumption in the control and experimental groups was 8.2 [7.35; 9.35] ml-O2/min/100 g and 7.7 [6.75; 10.12] ml-O₂/min/100 g, respectively (p > 0.05). Morphological examinations also showed no significant myocardial ischemia injury in the persufflation group compared to the control group. Conclusion. The experiment showed the technical feasibility and safety of direct intracoronary oxygen persufflation for 4 hours at the ex vivo donor heart conditioning stage. At the same time, experimental data showed no significant advantages of coronary persufflation over the standard protocol of cold preservation of donor heart with Bretschneider cardioplegic solution.

Dissecting aortic aneurysm is one of the most dangerous diseases of the aorta, often leading to severe complications or death. Currently, due to the increased level of diagnosis and the speed of care for patients with aortic diseases, there is now a need to improve approaches to the treatment of this condition. This paper presents the outcomes of a technique developed at our center, Shumakov National Medical Research Center of Transplantology and Artificial Organs, for selective antegrade cerebral perfusion (SACP) when performing prosthetic replacement of the aortic arch under circulatory arrest. Surgical treatment is performed on an emergency basis. During these surgeries, we focused on preventing neurological complications. Analysis of the efficacy and safety of our SACP technique shows that we obtained positive outcomes. In the analysis of 10 cases of aortic arch replacement, there was no evidence indicating the presence of any neurological complication. This technique allows for more adequate monitoring of perfusion during reconstructive interventions on the ascending aorta and aortic arch than the classical perfusion technique.

Cardiac valvular surgery in patients after lung transplantation is a challenging procedure, reports are scarce. We report a 29-year-old patient who underwent concomitant mitral valve reconstruction and implantation of a decellularized aortic homograft two years after bilateral lung transplantation.

The paper presents the clinical case of successful treatment of giant oleogranuloma of the external genitalia in a kidney recipient. The relevance of the problem, which has not diminished over time due to identification of new cases, is presented. Stages involving pathological tissue removal and reconstructive plastic surgical intervention to restore the anatomical form and functionality of the penis are described and illustrated in detail. The authors conclude that reconstructive plastic intervention for penile oleogranuloma can be effectively performed in a patient with end-stage chronic renal disease treated via renal transplant and who is receiving triple immunosuppressive therapy.