Aim. The aim of the study was to investigate the endoscopic diagnostic and treatment techniques for biliary complications after orthotopic liver transplantation, their efficacy and safety. Material and methods. The study was based on the results of endoscopic treatment of 29 patients with biliary complications occurred after orthotopic liver transplantation in N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from December 2001 to January 2017. Conclusions. The state-of-the-art methods of therapeutic endoscopy enable a successful treatment of most cases of biliary strictures and biliary-biliary anastomosis incompetence, thus achieving good long-term results using a minimally invasive methodology.

The article analyzes the system of organ transplantation in the Nizhny Novgorod Region in order to determine the ways to optimize the use of donor resource. The authors found that the most difficult are the program activities, the success of which depends on the attitude of health care employees and the population of the region. In this regard, a questionnaire survey was conducted; its results indicated a lack of awareness among doctors and the public about the transplantation role in modern medicine and the legislation in this sphere of relations. The authors come to the conclusion on the importance of the outreach and promotion of the posthumous organ donation program among health care employees and all population groups to optimize the use of donor resource of the region. 

An important role in assessing the transplanted kidney function recovery and diagnosing posttransplant complications belongs to angionephroscintigraphy allowing a qualitative and quantitative assessment of renal perfusion, filtration, and excretion. The aim of the study was to evaluate and monitor the allograft function after cadaveric kidney transplantation by using angionephroscintigraphy with 99mTc-Pentatech and studying the obtained results in relation to pre-existing HLA sensitization. We analyzed the results of radionuclide tests of 55 patients in the early postoperative period in time from 5 days to 3 months after transplantation. In most patients, the higher was the blood anti-HLA antibody levels in the recipient before the kidney transplantation, the more pronounced decrease in the function was noted in them according to angionephroscintigraphy results. In the treatment of patients with a primary allograft function, the function of the transplanted kidney had gradually improved by the 3–4th week, reaching normal values in a number of parameters. In patients with a delayed allograft function, only partial recovery of function was observed after 3–4 weeks. In that case, when a high level of preexisting anti-HLA antibodies had been noted, an abrupt decline in perfusion typical for an acute rejection crisis, and the filtration impairment were seen, often there was an impaired excretion, indicating a concomitant severe ischemic injury of the kidney or acute tubular necrosis. Thus, angionephroscintigraphy enables to assess the recovery of the graft function thanks to a separate evaluation of the function components, and in combination with the test for preexisting anti-HLA antibodies, helps to make a differential diagnosis of an acute rejection crisis and acute tubular necrosis allowing the choice of an adequate treatment tactics.

Seeking to develop immunosuppression regimens that would take into account the patient's level of sensitization to the antigens of the main histocompatibility complex, we studied 123 patients after kidney transplantation. Depending on the choice of immunosuppressive therapy, two groups were formed. The study group included 55 patients who received the immunosuppression regimen adapted to their HLA sensitization level. In the comparison group, 68 patients received baseline immunosuppression, including calcineurin inhibitors, mycophenolic acid preparations, and corticosteroids. AntiHLA antibody detection was performed by assessing the mean fluorescence intensity (MFI) on the Luminex platform when patient's placing on the transplant waiting list. It was found that highly HLA-sensitized recipients should receive antithymocyte polyclonal antibodies with or without plasmapheresis immediately after surgery in order to prevent the rejection reaction. The moderately HLA-sensitized patients should receive the baseline immunosuppression in combination with administration of monoclonal antibodies (simulect); the polyclonal antibodies should be administered only if necessary (in decreased diuresis rate, increased creatinine, etc.). In unsensitized patients, the baseline immunosuppression is enough to induce tolerance. Thus, the administration of immunosuppressive therapy adapted to the pre-existing HLA-sensitization level can significantly improve the treatment oucomes in kidney transplant recipients in the post-transplant period.

The article deals with medical and organizational issues of individually-adapted immunosuppressive therapy in renal allograft recipients. In the recent years, the basis of nephroprotective therapy schemes includes m-TOR inhibitors. The accessibility of these drugs for those in need is limited. Meanwhile, a more widespread use of these drugs in clinical transplantation would both increase the life span of a transplanted kidney, and reduce the risk of viral infections and cancer in the long-term after kidney transplantation, and would also allow a rational use of budget funds for the treatment of such patients.

Arrhythmias in heart transplant recipients remain an important but under-studied issue in transplant medicine. One of the most common arrhythmias, atrial fibrillation can cause cardioembolic complications in transplant recipients, in the same way as in general population and, accordingly, affect the quality of life and the prognosis. This review discusses epidemiology, classification, mechanisms of development, and therapy of atrial fibrillation after heart transplantation.

The article (the last of five) presents the analysis of the final (6th and 7th) chapters from V.P. Demikhov's monograph "Experimental Transplantation of Vital Organs" (Medgiz State Press for Medical Literature in Moscow, 1960), where he described the experimental development of the mammarocoronary bypass(anastomosis) surgiclal techniqiue and the experiments to study the physiology of blood circulation.