Introduction. Early extubation at the end of surgery has a beneficial effect on the postoperative recovery of patients. Prolonged and highly traumatic surgery in recipients with severe initial pathology and tension(al) homeostasis doesn’t allow for safe procedure of early extubation in simultaneous kidney and pancreas transplantation (SKPT). This article aims at assessing the impact of recipient-related factors and intraoperative clinical factors on the possibility of successful extubation in the operating room after SKPT.

Objective. To develop and substantiate a prognostic model for determining the probability of successful extubation in the operating room after SKPT depending on the impact of recipient-dependent factors and intraoperative clinical factors.

Material and methods. A prospective single-center non-randomized study was conducted, enrolling 85 recipients who underwent SPKT in the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01.01.2008 to 31.11.2024. Among the recipients included in the study, there were 52 men (61%) and 33 women (39%); their median age was 35(31;39) full years. All patients were allocated in two groups. Group I included the patients who were successfully extubated at the end of surgery; group II included the patients non-extubated at the end of surgery who were transferred to the intensive care unit for prolonged mechanical ventilation. Using the binary logistic regression method, a prognostic model was developed for the probability of successful extubation of patients in the operating room after SKPT taking into account the presence of recipient-dependent factors and intraoperative clinical with their step-by-step exclusion according to Wald statistics.

Results. The prognostic model of the possibility of successful extubation in the operating room was found statistically significant (p<0.001), with a sensitivity and specificity of 76.7% and 73.8%, respectively. Among recipient-dependent factors, an adjusted statistical significance was shown by body mass index (p=0.003) and the history of renal replacement therapy duration (p=0.037). Among intraoperative clinical factors, an adjusted statistical significance was shown by the epidural component of anesthesia (p<0.001), mean blood pressure >90 mmHg on reperfusion (p=0.048), the surgery duration factor (p=0.029), a total amount of fentanyl (p<0.001), and a total amount of cisatracurium (p=0.044).

Conclusion. The prognostic model makes it possible to determine the tactics of intraoperative management of patients and optimize the strategy of anesthesiological support in order to ensure possible successful extubation of patients after the SKPT surgery.

Background. Renal dysfunction is common in liver transplant candidates and recipients. However, despite more than 30 years of experience with liver transplantation in Russia, this problem has not been systematically studied in large cohorts of patients.

The objective was to evaluate the prevalence and severity of renal dysfunction before liver transplantation (LT), during the first postoperative week, at discharge, and one year after surgery.

Material and methods. A single-center registry study included data on 550 LTs from living (73%) and deceased (27%) donors performed consecutively between May 2010 and July 2024. Estimated Glomerular filtration rate (eGFR) was calculated using the 2021 CKD-EPI Creatinine formula. Acute kidney injury (AKI) was diagnosed and staged according to RIFLE criteria between 12 hours and day 7 after LT.

Results. The median eGFR before LT (n=550), at discharge (n=472) and one year after surgery (n=257) were 107 (86;119), 103 (75;116) and 79 (62;100) mL/min/1.73 m2, and the proportions of patients with eGFR < 60 mL/min/1.73 m2 were 7.1%, 12.7%, and 22.2%, respectively. AKI complicated 33.0% of LTs, including 16.6% cases with RIFLE > I. Renal replacement therapy was used in 7.3% recipients. For the combination of AKI RIFLE > I and early allograft dysfunction (EAD), the 30-day graft survival was 26%, 95%CI: [14–39%].

Recipient age (Hazard ratio (HR) 1.07, p<0.001), arterial hypertension (HR 2.2, p=0.010), eGFR at discharge < 60 mL/min/1.73 m2 and tacrolimus trough level (HR 1.18, p<0.001) were independent risk factors for eGFR < 60 mL/min/1.73 m2 one year after LT. The medians of eGFR decline during the first year after LT in cases of de novo administration or conversion to everolimus-based regimens were 11 and 23 mL/min/1.73 m2 (p=0.115) and were not significantly different from the median eGFR decline among recipients never receiving everolimus: p=0.485 and p=0.132, respectively. Five-year survival of recipients with eGFR < 60 mL/min/1.73 m2 at one year after LT was 89.0%, while for eGFR > 60 ml/min/1.73 m2, it was 88.7%, p=0.760.

Conclusions. Renal function assessment should be an obligatory part of the follow-up of patients on the waiting list and after LT. Particular attention should be paid to elderly patients, with arterial hypertension, reduced baseline eGFR, post-LT AKI RIFLE > I (especially in combination with EAD). Irrespective of the time after LT, excessive exposure to calcineurin inhibitors (tacrolimus trough level > 10 ng/mL) should be avoided, using combinations with mycophenolates or everolimus if necessary.

Background. The functional status of the parathyroid glands (PTG) in patients with chronic kidney disease (CKD) before and after kidney transplantation (KT) is interrelated. The preoperative optimal blood level of parathyroid hormone (PTH) for the prevention of the post-transplant hyperparathyroidism (HPT) development is unknown.

The objective was to study the function of the PTG after KT during the first postoperative year depending on the pretransplant serum PTH level in the target range (150–600 pg/mL).

Material and methods. The retrospective cohort single-center study included 157 patients with preoperative blood PTH levels of 150–600 pg/mL who had undergone primary successful KT for CKD G5-G5(D) at least a year before inclusion in the study. Serum concentrations of PTH, calcium, adjusted for albumin, phosphorus, and creatinine were studied before KT and at 3 and 12 months after it. Blood PTH no more than 130 pg/mL was a target level after KT.

Results. Patients were allocated into three groups: 82 patients with blood PTH of 150–300 pg/mL were included into the 1st group; 41 patients with blood PTH of 301–450 pg/mL comprised the 2nd group, and 34 patients with blood PTH of 451–600 pg/mL made the 3rd group. Three months after KT, blood PTH decreased to 128 (98;169) pg/mL, 180 (121;222) pg/mL, and 247 (154;299) pg/mL (p<0.001) in the 1st, 2nd, and 3rd patient groups, respectively; the target blood PTH level was observed in 58.5%, 34.1%, and 20.6% of patients in the respective groups (p<0.001). No differences in the in PTG values were seen between the groups by the end of the year. A decrease in phosphorus and stable normal blood calcium were recorded. The graft function was similar in the patients of all groups throughout the year. A direct close correlation was established between blood PTH before KT and three months after KT, a less close one after one year; the relationship between blood PTH and graft function was weak after three months and a close one after one year.

Conclusion. The process of normalization of PTG function in the early stages after successful KT depends on the preoperative blood PTH level.

Background. Improving treatment outcomes for acute necrotizing pancreatitis (ANP) remains the most difficult and unresolved problem for surgeons and intensive care specialists.

Objective. To evaluate the effect of mesenchymal stromal cells (MSCs), MSC-derived microvesicles (MSC MVs) and platelet-rich plasma (PRP) on morphological and immunohistochemical characteristics of the pancreas in ANP in rats with regard to the route and timing of PRP administration, as well as separate and combined application.

Material and methods. The effects of MSCs, MSC MVs and PRP on the morphological and immunohistochemical characteristics of the pancreas in ANP in rats were studied, taking into the account the route (intraperitoneal/ intravenous) and time of administration (6 and 24 hours from the start of disease modeling), as well as their separate or combined use (PRP and MSCs, PRP and MSC MVs). The study was conducted on 72 adults Wistar rats. Acute pancreatitis was induced by the administration of a 0.3 ml of 5% solution of non-ionic polyethylene glycol octylphenol ether detergent into the caudal part of the rat pancreas. Organ and tissue sampling was performed on the 3^rd day from the beginning of the disease modeling. Histological changes in pancreatic tissues were studied by hematoxylin and eosin staining the preparations. Immunohistochemical staining of pancreatic tissue with anti-TGF- â1 and anti-SCARD1 primary monoclonal antibodies was performed followed by studying the nature of their expression.

Results. A comparative assessment of the effects of MSCs, MSC MVs and PRP on the histomorphological and immunohistochemical changes in pancreatic tissue in ANP in rats, found that more pronounced regeneration and neoangiogenesis processes were observed with the intravenous delivery of MSCs and MSC MVs, regardless of the timing of administration (6 or 24 hours from the onset of the disease). The obtained data suggested the immunomodulatory and pro-regenerative effects of MSC and MSC MVs produced by potentiating the polarization from inflammatory M1 macrophages to anti-inflammatory M2, as evidenced by a pronounced immunohistochemical reaction to TGF- â1, which is secreted predominantly by macrophages of the M2 phenotype.

Conclusion. The experimental use of MSCs and MSC MVs to treat АNP at early stages of the disease provides more pronounced processes of repair and neoangiogenesis in pathologically altered pancreatic tissue.

Background.Liver transplantation is a life-saving surgery for patients with chronic end-stage liver diseases and individual patients with fulminant liver failure. Over the years, the procedure of the operation has undergone major changes. Recent advances in this field, including improved surgical techniques and the introduction of new immunosuppressive agents, have made it possible to achieve a 5-year survival rate of 87.6%.

Objective. To analyze the current scientific literature on arterial complications after liver transplantation, their diagnosis and treatment methods.

Material and methods. The scientific articles, reviews and other literature on the topic of arterial complications after liver transplantation for the period from 2015 to the present, published in the databases Pubmed, Google Scholar, Medline, have been studied.

Conclusion. Arterial complications remain one of the most dangerous consequences of orthotopic liver transplantation, accompanied by a high risk of graft loss and death. The diagnosis and treatment of these complications is a significant challenge that requires a further search of approaches to improve the efficacy of liver transplantation.

Background. Currently, there is no doubt that orthotopic liver transplantation increases life expectancy compared to standard treatment methods in patients with decompensated liver cirrhosis. In recent years, diagnostics and treatment of hyperammonemia have attracted increasing attention in various liver diseases, and also after liver transplantation. At the same time, there are few studies with a high level of evidence establishing a relationship between the blood level of ammonia and the severity of patient condition in the early period after liver transplantation.

Objective. To summarize current data on the problem of hyperammonemia after liver transplantation, to analyze the mechanisms of appearing high ammonia concentrations in blood serum and their pathogenetic role in the development of complications after orthotopic liver transplantation, and also to investigate the methods for monitoring the blood ammonia levels.

Material and methods. The analysis of data from world experimental and clinical studies on the pathogenesis, diagnostics, and treatment methods of hyperammonemia after orthotopic liver transplantation has been made. The literature search was conducted in international databases (PubMed/MedLine, ResearchGate), as well as in the scientific electronic library of Russia (eLIBRARY.RU) for the period from 2019–2024.

Conclusion. In the analyzed publications, the issues on the problem of hyperammonemia after liver transplantation are worthwhile to be addressed to. Despite advances in understanding the pathogenesis of hyperammonemia and its impact on the development of hepatic encephalopathy and disorders on the part of other body organs and systems, many unresolved issues remain both in diagnosis and in choosing the most effective treatment methods.