ACTUAL ISSUES OF TRANSPLANTATION
An experience of the Moscow Center for Liver Transplantation in the field of antiviral therapy of hepatitis C in recipients of liver grafts has been analyzed. From 2002 to 2012 forty nine courses of treatment were initiated in 42 patients. Eradication of infection caused by the hepatitis C virus (HCV) was achieved in 42% patients who received at least one dose of drugs, and in 56% patients who received at least 80% of doses of drugs for more than 80% of the planned duration of therapy. The rate of decrease of HCV viremia during antiviral therapy in liver transplant recipients is slower than in immunocompetent patients, and this fact justifies the need for a more long-term treatment. Accounting for pharmacogenetic indicators prior to antiviral therapy is able to predict the rate of decline in viremia HCV. The main complication of antiviral therapy after liver transplantation was cytopenia. The use of erythropoietin and filgrastim throughout the whole course of therapy allowed to maintain therapeutic doses of antiviral drugs and did not lead to serious adverse events.
Features of anaesthesiological management in 43 recipients of living relative liver transplantation aged of below 3 years were learned, providing a stable intraoperative circulatory dynamics and metabolic homoeostasis using 2 methods of anaesthesia: total intravenose anaesthesia (30 patients) and gas anaesthesia with isoflurane or sevoflurane (13 patients), as well as features of postoperative intensive therapy (infusion, nutrition and medication therapy, diagnostic algorithm).
Clinical experience of anesthetic management of orthotopic heart transplantation (OHT) gained at the N.V. Sklifosofsky Research Institute for Emergency Medicine up to date, gives every reason to conclude that combining the knowledge and skills acquired through everyday cardioanesthetic activities, with protocols previously developed in leading transplant clinics, could allow to successfully master the anesthetic management of OHT and make this transplant surgery the standard treatment option. We believe that the use of protocols adapted to our own experience and the latest developments in the field of intensive therapy will allow us to successfully implement the OHT program in a multidisciplinary hospital.
REVIEW ARTICLES AND LECTURES
PROBLEMATIC ASPECTS
The authors attempt to summarize views of leading russian experts in bioethics and medical deontology on the moral and ethical issues related to the development of the concept of brain death and its application in modern medicine. A variety of ethical issues associated with the use of the concept of "brain death" in organ donation and clinical transplantation is noted. The official attitude of representatives of the world's major faiths to the problems of brain death and organ transplantation is reflected. Authors express their own attitude to the issues discussed, as professionals facing daily with challenges of brain death in their own clinical practice.
HISTORY OF MEDICINE
DATES AND EVENTS
ISSN 2542-0909 (Online)