Editor-in-Chief’s Column.

The paper describes the first lung transplantation at the N.V. Sklifosovsky Research Institute of Emergency Care in a female patient with endstage pulmonary lymphangioleiomyomatosis, which has shown a good result during a 6-month follow-up.

Deficit of donor organs is main critical factor limiting of organ transplantation. In article highlighted the organ donation practice in SaintPetersburg with accent on unsuccessful attempts of the increasing of number deceased organ donors. Given by analyses of neurosurgical and neurological rates of mortality last three years, the authors tried to ground the urgency of the putting in clinical practice the optimization of the transplant algorithms, organ donor’s audit, and the implementation of new approach to define organ donor’s process stages. In article are presented the results worked out of the metrics coefficients for estimating donation potential of emergency hospitals. There was done the study of involvement and education in organ donation practice, legislative issues among critical care professionals, neurologists and critical care nurses. In articles is presented the first attempt of estimate of economical aspects of donation process in donor’s hospitals. There was done the recommendation for national organ donation network creating.

Comment on the paper “Analysis of reasons for organ donor shortage and the main directions of its overcoming”.

The paper describes two clinical examples of successful related liver fragment transplantation for type 1 glycogenosis in a one-year-old boy and a 6-year-old girl. The given first successful clinical experience suggests that liver fragments for type 1 glycogenoses can be transplanted from live related donors and offers promise for the radical treatment of patients with this pathology.

Monitoring the serum redox potential (RP) in posttransplant liver patients has previously shown that the early noninvasive diagnosis of acute graft dysfunction could be made by recording the changes in the potential measured. The changes in the steady-state potentials of a platinum electrode were studied in the treatment of patients after kidney transplantation. It has been established that the serum RP change of > 25 mW is indicative of the onset of graft dysfunction and it may be also associated with other complications or drug overdosage. An association was found between the changes in RP values and the results of treatment with plasmapheresis in the above group of patients.

A comprehensive examination, involving ultrasonography (US) in 55 potential related donors of liver fragments, revealed no signs of diffuse liver lesion (DLL) in 45 cases (Group A), these were found in 10 cases (Group B).

Liver fragment taking surgery was performed in Group A patients 1–2 weeks after US. All the 45 patients in this group were found to have a normal US pattern of the liver, as verified by its histological studies in all the cases; all these patients had also a mass body index (MBI) of lower than 25 kg/m2 . In Group B, all the 10 patients had the US signs comparable with mild or moderate DLL (increased liver parenchymal echogenicity, worse visualization of the small branches of the intrahepatic veins and diaphragm, and altered patterns of blood flow in the right hepatic vein) generally concurrent with a higher MBI. After 3–4-month treatment to reduce weight (conditioning), the liver US pattern normalized in 9 of the 10 Group B patients; only one patient with a MBI of 31.6 kg/m2 preserved the signs of mild DLL (histological studies of liver biopsy specimens revealed 10% steatosis in this patient, 2 % steatosis in 2 female patients; this condition was absent in the other 7 patients). All the patients in Group B were also operated on 1–2 weeks after the last US. The recipients from Groups A and B donors had no posttransplantation parenchymal complications.

US in the tints of a gray scale along with the determination of blood flow patterns in the hepatic veins rather significantly shows the normal liver in its potential donors and reduces the need for serial diagnostic liver biopsies and other instrumental studies.

The paper analyzes the results of a prospective survey of the outcomes of 729 cadaveric kidney transplantations for 25 years: from April 1983 to later 2009. It shows that allograft survival is related to the influence of immune (HLA tissue compatibility, a recipient’s sensitization) and non-immune factors. The currently accessible possibilities for further enhancing the efficiency of cadaveric kidney transplantation, by prolonging graft survival, are discussed.

Several protocols have been developed to overcome the blood group barrier in renal transplantation. In the evolution of these protocols, one of the latest steps was the combination of anti-CD20 treatment with antigen-specific immunoadsorption (IA) and intravenous immunoglobulin (IvIg). This protocol has been widespread used for AB0-incompatible transplantation in Europe. We report our first experience of five successful AB0-incompatible kidney transplantation using anti-CD20 + IA + IvIg pretransplant conditioning protocol and tacrolimus + MMF + steroids as maintenance immunosuppression. Initial anti-A/B-antidody titers were 1:16 to 1:1024. The transplantation could be performed in all cases and the grafts showed primary function.

Bacterial infections are considered to be a serious complication in patients with immunodeficiency after kidney transplantation. Bacterial respiratory tract infection has been most common after kidney transplantation in recent years. The paper analyzes the results of kidney allotransplantation in 55 patients followed up for one week to 12 months. The recipients were found to have all known species of the bacterial flora. All the patients were postoperatively given broad-spectrum antibiotics. Antibiotic therapy was corrected after isolating the strains of microorganisms and determining their susceptibility. The therapy was continued within 7-10 days postoperatively.

The use of novel technologies in surgery increases liver transplantation surgical activity. However, this does not reduce the incidence of postoperative infectious complications. The growing microbial resistance to antibiotics and the increasing role of fungi in the etiology of nosocomial infections remain to be a cause of purulent complications. In this connection it is urgent to study the causes of infectious complications during transplantation of the liver and other vital organs.

The paper describes a case of posttransplantation fibrosing cholestatic hepatitis C (PFCHC) in a female patient whose transplant was preserved due to timely antiviral therapy (AVT). Its differential diagnosis primarily required that chronic graft rejection and biliary anastomotic stricture be excluded as a cause of dysfunction. PFCHC was proposed to be a possible cause of graft dysfunction on the basis of the clinical course of the disease, the presence of a very high viral load, intervals after orthotopic liver transplantation, the results of histological studies, and no signs of biliary hypertension. Antiviral monotherapy was initiated using pegylated interferon α-2a (Pegasys), which resulted in a considerable improvement and yielded complete early virological and biochemical responses to AVT. This allows one to hope to obtain a sustained virological response and to eliminate hepatitis C infection in the patient after termination of a 48-week course of therapy.

Background. Posttransplantation acute tubular necrosis (CTN) is mainly an ischemic injury caused predominantly by reperfusion syndrome, impaired microcirculation, and worsening hypoxia of a transplanted organ. Hyperbaric oxygenation (HBO) making possible the delivery of oxygen to organs and tissues, by dissolving it in the body’s fluids, is one of the methods for combating systemic and regional hypoxia underlying the development of ischemic graft injury.

Objective: to evaluate the efficiency of HBO in the combination therapy of patients with severe ischemic kidney graft injury in the early postoperative period.

Subjects and methods. The early postoperative period after kidney transplantation was comparatively analyzed in 2 patient groups: study (29 patients were given HBO sessions in the combination therapy) and control (24 patients receiving traditional therapy) ones. HBO sessions were carried out in single-person medical altitude chambers at 1.2-1.6 ATA for 40 min. A correlation analysis was made between cold graft ischemia time and indicators, such as recovered water excretory function, normalized azotemia level, the level of creatinine and urea, and the number of hemodialysis sessions in the above comparison groups.

Results. The performed analysis has shown that there is a direct correlation between the parameters under study. In the study group, renal graft function recovered in the earlier periods than that in the control group.

Conclusion. The early incorporation of HBO into combination treatment after kidney transplantation contributes to prompter recovery of graft function. The conducted study permits one to consider that HBO should be incorporated as soon as possible into the combination treatment performed in the early period after kidney transplantation.

Objective: the patients after liver transplantation often develop psychic disorders, requiring the psychotherapeutic treatment. The aim of the study was to estimate the efficiency оf psychotherapy (PT) on the patients after liver transplantation.

Subjects and methods: PT in terms of the multimodal PT was performed on 15 patients with the mental disorders: disorder of adaptation (DA) and posttraumatic stress disorder (PTSD). A choice of PT modality depended on dominating psychic disorder, psychotherapeutic need and personal peculiarities of patients.

Results: after performed PT the patients showed clinical improvement of emotional condition, reduction of PTSD symptoms, some reduction of pain syndrome. Also was diagnosed the reliable diminution of situational anxiety (р < 0,001) and depression (р < 0,01) level.

Conclusion: PT in terms of the multimodal PT is effective on the patients after liver transplantation.

Introduction: Electric burns of the head are rare, and presents technical problem for reconstruction. Electric trauma leads to the formation of necrosis of the skin and bones, that with their small thickness of the head and the imminent accession of infection has no prospects of selfhealing and threatens to damage the brain and other intracranial structures. In such cases, use the traditional method autodermoplasty is impossible – necrotic bone will not allow the growth of granulation tissue. Reconstruction should be performed as early as possible with usage of vascularized flap. The tactics of early microsurgical reconstruction is the best.

Materials and methods. Patient with fourth-degree electric burn of the head and face treated with method of free microsurgical flap autotransplantation in our Burn Center in 2011. Fasciocutaneous flap on radial artery and veins were successfully transferred.

Results and discussion. Operation is performed on day 7 after injury. The donor site healed by primary intention. This flap allowed to closetemporo-mandibular joint, parotid gland, temporal and parietal bones. The ear canal are formed In the graft.

Conclusions. Microsurgical reconstruction is the method of first choice in case of electric burns of head and face with necrosis of the skull bones.

V.A. Vishnevsky’s Anniversar.

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