The purpose of this paper is to analyze the data available in the literature on the problems associated with the identification of the hepatopulmonary syndrome (HPS), its diagnosis, pathogenesis, clinical features, and possible treatment options. According to the current literature, HPS is a complication of liver diseases, which leads to impaired lung perfusion and decreased blood oxygenation. Recognition of this syndrome requires that there should be a triad of the following signs: chronic liver disease, dilated intrapulmonary vessels, and lower arterial blood oxygenation. Today investigators' views of the causes and pathogenesis of dilated pulmonary vessels and abnormal blood gas composition differ in HPS. To date, its clear diagnostic algorithm and treatment policy for patients with HPS have not been elaborated.

The mechanisms of the action of immunosuppressive agents and the risk factors for the development of posttransplantation diabetes mellitus and its complications are described.

Objective: to study the effect of selenium on the course of a postoperative period in patients after orthotopic liver transplantation (OLT).

Subjects and methods. The prospective controlled randomized study enrolled 30 patients after OLT. Selenium (Selenase, Biosyn) was administered in Group 1 (n = 15) within 5 days operatively. The agent was not used in complex therapy in Group 2 (n = 15).

Results. After OLT, the plasma levels of selenium were much more than the normal value. In Group 1, the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower on day 3 after OLT and those of urea and creatinine significantly decreased by day 7. A significant difference was found in scores on day 7, as shown by the analysis of the patients' condition by the SOFA scale. The patients who needed venovenous hemodiafiltration (VVHDF) were more than in those who did not use selenium.

Conclusion. Selenium levels considerably decrease after liver transplantation. Selenase has a hepatoprotective effect, alleviates the manifestations of a systemic inflammatory response, and reduces the frequency of VVHDF use.

Variants of vascular anastomoses in related donor kidney transplantation with multiple vascular blood supply and the parameters of intrarenal hemodynamics and renal graft function in this group of recipients in the postoperative period are described.

Today orthotopic liver transplantation is the only radical treatment of patients with end- stage chronic diffuse liver diseases. In Russia, liver transplantation is currently made in 8 transplantation centers of Moscow, Saint Petersburg, Yekaterinburg, Belgorod, Nizhni Novgorod, and Samara. The paper describes the first experience of liver transplantation in the multidisciplinary regional hospital of Yekaterinburg.

Clinical laboratory results were analyzed in patients on one- and two-component suppression in the late period after liver transplantation.

Objective: to study the impact of one-component immunosuppression with calcineurin inhibitors on clinical laboratory parameters in the late period after liver transplantation.

Subjects and methods. Examinations were made in 3 groups of patients receiving various immunosuppressive therapy regimens: 1) 15 took cyclosporine; 2) 10 had tacrolimus; 3) 8 received a calcineurin inhibitor and a mycophenolic acid preparation. Their peripheral blood samples were biochemically and immunologically studied.

Results. Hyperglycemia was detected in 5 (38.5%) patients receiving tacrolimus and 3 (15%) patients taking cyclosporine. Hypertension was observed in 11 (55%) patients on cyclosporine and in 3 (23%) on tacrolimus. The above complications were seen in 50% of the patients on two-component immunosuppression. Two cases of acute rejection were noted in Groups 1 (6.7%) and 3 (12.5%). The most pronounced biochemical and immunological changes were observed in the two-component immunosuppression group.

Conclusion. The use of one-component immunosuppression with calcineurin inhibitors in patients after liver transplantation is effective and adequate; however, the etiology of liver cirrhosis should be taken into account on switching to one-component suppression.

Cell transplantation becomes a mode of correcting the functional failure of organs and tissues in injury and a number of diseases. The paper considers the issues concerning the biological safety of therapy with differential cells: in vitro cultured fibroblasts. The Russian line M-22 derived from the skin and muscle of diploid human embryonic cells has persisted just for more than 40 years and successfully used to treat patients with severe burns.

As of now, clinical stabilization during the time required for the spontaneous regeneration of the liver or its orthotopic transplantation is the optimum treatment strategy. The use of artificial hepatic function support systems reduces mortality in severe hepatic failure from 85 to 60%. According to the used technologies, these systems can be divided into biological, non-biological (artificial or cell-free technologies), bioartificial or hybrid devices. The positive and negative aspects of these technologies are shown in this review.

Stem cell transplantation is a major tool of modern renegerative medicine. Stem cells can be obtained from the bone marrow (BM) of dead subjects.

Objective: to provide a morphofunctional characterization of the cells obtained from the bone marrow of dead donor tissues by aspiration methods.

Materials and methods. BM samples were taken from 17 adult cadaver subjects, who had suddenly died from myocardial infarction or pulmonary artery embolism, not later than 6 hours after sudden death. BM was simultaneously taken (from the iliac bones on different sides) in 10 donors by aspiration and aspiration-washing methods within an hour. In 7 donors, BM sampling was made by the aspiration method (for 30 min) and then by the aspiration-washing (Valeri Borisovich khvatov khvatov@yandex.ru) method (for the following 30 min).

Results. The count of CD45lowCD34+-cells obtained by the aspiration and aspiration-washing methods for taking BM differs insignificantly. The morphological pattern of the BM taken from live donors and cadavers is similar. When the aspiration and aspiration-washing methods are concurrently used, the total yield of viable hematopoietic stem cells averaged 99.8±25.0 × 106 cells.

Conclusion. BM sampling from donor tissues in the first 6 hours of death yields viable, functionally active hematopoietic stem cells. Both the aspiration method and the aspiration-washing one may be used to sample BM from dead donor tissues. The successive use of aspiration and aspiration-washing is most efficacious. This combination of the methods enables one to obtain a BM suspension containing the therapeutic dose of hematopoietic stem cells.

Orthotopic liver posttransplantation biliary complications are a serious problem. Due to the development of surgical techniques, the incidence of biliary complications has decreased by several times over the 40-year history of liver transplantation, but achieved 10-35% up to the present, by inducing 2-9.6% mortality. The review presents a classification of biliary complications, defines risk factors of their development, a possibility of their prevention, and correction options.

The emergence of new immunosuppressants, such as the macrolide drug tacrolimus (prograf), has recently become one of the most important advances in transplantology. Tacrolimus belongs to calcineurin inhibitors and differs from cyclosporine in a rapider and uniform bile acid-independent absorption, causing a reduction in the individual variability of the blood concentration of the active ingredient. On renal transplantation in sensitized patients and/or repeated allografting, the use of tacrolimus makes it possible to reduce the percentage of hormone-resistant crises by more than twice and to prevent intractable acute rejection crisis.

Transplantology is one of the objective indicators of development of both surgery and medicine as a whole in any country. In due time, it was Soviet scientists who became pioneers in experimental transplantology. Soviet surgeons' works made a great contribution to develop transplantology.