Seven years' experience in obtaining hepatic fragments from 104 live related donors (RD) is pooled to perform orthotopic transplantations in patients with terminal stages of chronic and diffuse diseases of the liver. The main principles in the selection of RD are outlined. Surgical techniques and a spectrum of postoperative complications, such as bleeding [n = 1 (0.95%)], herniation [n = 1 (0.95%)], and bile leakage [n = 3 (2.85%)], are described. All RDs operated on were sociomedically rehabilitated entirely.

Experience of Institute of Emergency Medicine n.a. Sklifosovski in management of liver transplantation waiting list is analyzed. International protocols are described and applied to the treatment of 324 pts. with end stage liver diseases. Authors stressed the importance of dynamic evaluation of severity of liver disease as well as treatment of different complications such as resistant ascites, esophageal varicose, encephalopathy and gastrointestinal bleeding. Prophylactics and treatment of viral hepatitis takes important place in the management of liver transplant recipient pts.

Grafted kidney abnormalities include a wide spectrum of diseases that differ in their nature, mechanisms of development, and rates of progression. In the early period after renal transplantation, the most important cause of graft dysfunction remains to be acute rejection that results from a recipient's immunological response to a donor's transplantation antigens and develops with the activation of both cellular and humural immune responses. In the late periods, one of the main causes of late graft losses is chronic graft dysfunction, the morphological substrate of which is progressive nephrosclerosis. The development of graft nephrosclerosis is generally associated with the combined effects of a large variety of both immune and nonspecific factors; however, the morphological features make it possible to identify the preponderance of this or that mechanism in its origin and, in this connection, individual nosological entities. The latter include chronic rejection, calcineurin inhibitorinduced nephrotoxicity, and nephrosclerosis caused by rejection-unassociated conditions, such as ischemic-reperfusion lesion, obstructive nephropathy, viral graft damage, etc. Moreover, as more time elapses after renal allotransplantation (RAT), there is a higher incidence of recurrent and de novo diseases, the most common types of which are IgA-nephropathy, focal segmental glomerulosclerosis, membranous nephropathy, diabetic nephropathy, etc. Puncture biopsy using immunofluorescence and electron microscopy is the gold standard of the diagnosis of graft kidney abnormalities since only the morphological verification of the diagnosis permits adequate immunosuppressive therapy, by improving the long-term results of RAT. The paper presents diagnostic criteria and morphological features of different types of renal graft diseases.

Cell replacement therapy is regarded as a way of correcting functional incompetence of organs and tissues in their injury. This area has been identified as an independent clinical discipline. Intensive studies of the biological stem cells (SCs) have provided strong evidence for the universal flexibility of these cells that were able to repopulate damaged tissues. Today's capabilities have substantially kept ahead of the level of our knowledge about the biology of SCs. However, incontrovertible warranties as to the biological safety of grafting of these cells have not been obtained so far. In this connection, it is proposed to stimulate resident SCs of adult tissues in injury, by creating conditions for realizing their regeneration potential.

Shortage of donor organs is a major factor that limits the use of orthotopic liver transplantation in cirrhosis. In this connection, the use of various methods for surgical correction of portal hypertension continues to be urgent.

Subjects and methods. One hundred and seven patients with portal hypertension caused by hepatic cirrhosis were surgically treated. Before surgical treatment, gastroesophageal hemorrhages were noted in 64 (59.8%); 27 (35.5%) patients had more than 2 episodes of gastroesophageal hemorrhages. The mean MELD score was 8.54±3.31. Distal splenorenal anastomosis (DSRA) was performed in 46 patients; different modes of partial bypass surgery were made in 61 patients. The rate of plasma indocyanine green elimination was estimated. Liver biopsy specimens were histomorphometrically examined.

Results. First-to-second degree encephalopathy developed in 15.2 and 15.1% of cases after DSRA and partial anastomoses, respectively. Postoperative mortality was 9.3%. Early postoperative relapses of gastroesophageal hemorrhages were observed in 12 patients. Survival was comparable in patients who had undergone portocaval or partial anastomoses. The median lifetime was 60±5.1 months. Conclusion. Following portocaval anastomosis, the lifespan in patients after portocaval shunting is determined by the degree of hepatic decompensation. Major risk factors, such as the degree of the edematous-ascitic syndrome, the level of serum albumin, total bilirubin, international normalized ratio, and residual indocyanine concentrations at minute 15, were identified. The sensitivity and specificity of this group of criteria are 84.2 and 70.0%, respectively.

Objective: to assess the first results of transjugular intrahepatic portocaval shunting (TIPS) as a technique for preventing portal hypertension complications in patients in the period of waiting for a donor liver.

Subjects and methods. TIPS was performed in 6 patients on the list of waiting for orthotopic liver transplantation (OLT). The indications for TIPS were current (n=1) or high-risk recurrent hemorrhages from the esophageal varices and stomach (n=4) and diuretic-resistant ascitis (n=1).

Results. TIPS was successfully carried out in all the patients. The portovenous gradient was reduced by 2—3 times (to 9—12 mm Hg). A further follow-up revealed recurrent varicose hemorrhage or ascitis in none patients. Doppler study indicated that the shunt showed a good function. OLT was successfully made in 3 patients 2, 8, and 19 months after TIPS; one female patient had been waiting for OLT for 5 months; 2 patients died from sepsis and hepatic failure following 1 and 5 months, respectively.

Conclusion. The first results suggest that in patients with hepatic cirrhosis complicated with portal hypertension, TIPS can be regarded as a safety bridge while waiting for a donor liver.

Ligation of the inferior vena cava (IVC) during classical orthotopic liver transplantation (OLT) may be followed by pronounced hemodynamic changes and may provoke renal dysfunction. The authors have examined the impact of IVC ligation during OLT without venovenous bypass grafting on early postoperative renal function in 6 patients. The Cockcroft-Gault formula was used to evaluate renal function from the creatinine clearance on postoperative days 1, 3, 7, and 10. The endogenous creatinine clearance was diminished within the first 24 hours after surgery; this was 68.2±18.1 (24.3—146) ml/min and significantly correlated with that before OLT, with the mean blood pressure (BPmean) in the icteric period, and with age. At the same time, icteric BPmean was in the normal range — 77.2±1.59 (71.6—81.6) mm Hg and clinical renal failure developed in a female patient with significant preoperative renal dysfunction. Thus, IVC ligation at OLT with IVC interposition in the study contributed to a lower endogenous creatinine clearance within the first 24 postoperative hours, but results in no clinical renal function aggravation.

The kidney cannot be successfully grafted without immunosuppressive therapy. A unicenter retrospective study has evaluated the efficiency of immunosuppression with daclizumab (Zenapax) versus alemtuzumab (Campath).

Subjects and methods. After renal allotransplantation, 64 patients, including 34 and 30 patients, were treated with daclizumab and alemtuzumab, respectively. The absolute count of peripheral blood lymphocytes was measured. Renal grafts were morphologically assessed as described by Banff.

Results. After administration of alemtuzumab, there was a more pronounced decrease in the absolute count of peripheral blood lymphocytes and the rate of acute rejection crisis was 1.5 times lower than that after use of daclizumab.

Conclusion. During the study, alemtuzumab demonstrated a more marked immunosuppressive activity than did daclizumab and the ability of the former to generate donor-specific immunotolerance in renal-allograft recipients.

Objective: to analyze the causes of acute renal failure (ARF) and to study the efficiency of renal replacement therapy (RRT) in the treatment of this condition after liver transplantation.

Materials and methods. Eighty liver transplantations made at the N.V. Sklifosovsky Research Institute of Emergency Care from 2000 to 2008 were analyzed. The patients were divided into 2 groups: 1) 29 patients with evolving ARF who received RRT in the postoperative period; 2) 51 patients who had no indications for RRT.

Results. Postoperative RRT was performed in 29 (36.3%) patients. Of them, 23 patients had been identified to have the hepatorenal syndrome in the preoperative period. Renal function recovered in 20 (72.4%) of the 29 patients who needed RRT during the performed treatment and they were discharged from the clinic. Due to the conducted treatment, these patients showed stabilization and their ARF resolution occurred within 12.7±6.2 days. The mean number of performed sessions required to restore renal function was 8.8 (range 1 to 56).

Conclusion. Preoperative hepatorenal syndrome is a predictor of ARF in the postoperative period. At the same time ARD has a good prognosis after liver transplantation. With a primary non-functioning graft, extracorporeal techniques are ineffective and maintenance therapy used prior to liver retransplantation.

The paper describes a case of successful cadaveric orthotopic liver transplantation (OLT) in a patient with hepatic B virus (HBV)-induced liver cirrhosis. It considers preoperative antiviral therapy with nucleoside analogues, including the occurrence of limivudine-resistant mutation in HBV (YMDD mutations) during long-term Zeffix therapy, the necessity of converting to entecavir (Baraclude). A combined immunoprophylaxis scheme using specific immunoglobulin (HB Ig, Neohepatex) and entecavir (Baraclude) is given for liver graft infection with HBV. The result of treating the patient was that the liver graft was not infected with HBV within 420 days after OLT.

The Istanbul Declaration.