Aim: To assess the Eculizumab effect on the allografted kidney function in the immediate and early postoperative period.

Materials and methods: In kidney transplantation, 33 patients received Eculizumab in combination with Alemtuzumab (group 1). Other 38 patients (group 2) were enrolled for a comparative analysis. They received their induction immunosuppressive therapy with Alemtuzumab and plasmapheresis sessions. The following parameters were used for analysis: the urine output in the first 24 hours after surgery, the period of creatinine level drop to 3 mg/dL, a 24-hour protein excretion at day 30 after surgery, a glomerular filtration rate at day 30 after transplantation, histology of kidney allograft biopsy at 1 month post surgery.

Results: A comparative analysis has demonstrated much lower values of 24 hour proteinuria in group 1 than in group 2. As to the glomerular filtration rate, it was 1.9 times higher in group 1 than in group 2. The period of blood creatinine subnormalization was significantly shorter in group 1. The differences were statistically significant in all studied parameters (p=0.002–0.003).

Conclusion: The allografted kidney function was much better in group 1 than in group 2. Thus, the combination of Eculizumab + Alemtuzumab had a more favorable effect on the function and morphology of allografted kidneys in the immediate and early postoperative periods compared to that of Alemtuzumab + plasmapheresis combination.

The article presents the experience of direct-acting antiviral (DAA) drug treatment for hepatitis C in the patients after liver transplantation. The end-stage liver disease caused by hepatitis C is the main indication for orthotopic liver transplantation (OLT). In 2013, the first agent in the class of antiviral drugs directly acting on hepatitis C virus (HCV) was introduced into clinical practice. That was sofosbuvir, a HCV polymerase inhibitor, that could be used without interferon alfa.

Materials and methods. The study enrolled 33 liver transplant recipients with recurrent hepatitis C. Thirty-five courses of antiviral therapy (AT) were conducted with sofosbuvir being one of AT components.

Results. By the time of analysis, 21 patients had completed the antiviral therapy. All the patients showed an initial response to the antiviral therapy, HCV aviremia was achieved. In 3 patients, with the evaluable sustained virologic response (SVR), a renewed HCV replication was observed in the first weeks after the AT completion.

Conclusion. The new direct-acting antiviral drugs offer an effective antiviral therapy to all liver graft recipients with recurrent HCV.

Hepatopulmonary syndrome is a liver disease complication characterized by the clinical triad of an advanced chronic liver disease, a pulmonary vascular dilatation, and a reduced arterial oxygenation (hypoxemia: PaO2 less than 70 mm Hg at rest) in the absence of intrinsic cardiopulmonary disease. Precapillary vasodilatation, intrapulmonary angiogenesis and hyperdynamic circulation lead to arteriovenous shunting and reduced gas diffusion. In case of detecting macroscopic shunts, the pulmonary artery branch embolization could be performed. However, the hepatopulmonary syndrome can be cured nowadays by means of liver transplantation only. A 5-year survival in these patients is about 70%. The observed mortality is the highest during the surgery or early after, especially in patients with PaO2 lower than 50 mm Hg. It ranges from 8.5 to 29%. A prolonged oxygenation support is often required after liver transplantation using invasive or non-invasive ventilation, or even extracorporeal membrane oxygenation. In this review, we have focused on the recent advances in this field as described in available literature and have presented a case report of successful liver transplantation in a patient with a severe hepatopulmonary syndrome.

Vascular complications (VCs) comprise one of the most serious problems in liver transplantation. This is the next reason of graft loss after primary graft non-function, with the majority of complications being arterial by etiology. VCs significantly decrease the graft and patient survival, contribute to the incidence of retransplantation. This review focuses on the epidemiology, etiology, diagnostics, and treatment of VCs.

Despite the fact that the key role of the liver in the formation of the immune response to injury is not in doubt, the mechanisms of weakening the immune response to infectious and noninfectious lesions in patients with hepatic failure remain unclear. We propose an original hypothesis of forming the ways to limit the amplitude of the systemic inflammatory response in patients with the end-stage liver disease. The basis of the hypothesis is the idea that as a result of reducing the intensity of the natural stimulation of membrane mCD14 receptors by the ligands of infectious nature, the basic mechanism of the systemic immune response induction by liver macrophages (Kupffer cells) is interrupted. According to the proposed hypothesis, in condition of liver failure, the synthesis of lipopolysaccharide-binding protein by hepatocytes is reduced. This leads to a decreased amplitude and intensity of the protective immune responses. This fact explains a number of clinical phenomena observed in patients with liver failure/dysfunction that consist in a reduced reactivity of the organism to the damage inflicted by infectious and noninfectious agents. The authors consider it possible to use this hypothesis in the search for new trends to prevent the immune system hyper-reactivity in sepsis, and to improve the therapeutic strategies for the management of patients at high risk of infectious complications after liver transplantation.

The article (the first one of five) presents the analysis of the 1st and 2nd chapters from V.P. Demikhov's monograph "Transplantation of vital organs in experiment" (MedGIz Publisher, Moscow, 1960), the chapters presenting a brief literature review and methodological background of the problem. In his review, the author reported the available literature data on the subject of his research, and focused his attention rather on substantiating the ways of biological regulation of the transplant immunity in homoplastic graft transplantations than on the technical aspects of homoplastic organ and tissue transplantation that were a passed stage for him. The study of the methodological approaches used by V.P. Demikhov has shown that he well-mastered all previously developed methods of organ transplantation considering the views of contemporary immunology, and also offered his own scientific and practical solutions for various aspects of vascular suture, the ways to overcome the biological tissue incompatibility, the issues of cardiac anesthesiology and cardiac critical care.