Introduction: The expansion of the criteria for donor organ retrieval contributes to an increase in the number of kidney transplantations to elderly recipients; but in view of reduced requirements to donor organ quality, a further analysis of transplantation outcomes is needed. The aim was to analyze and compare the outcomes of kidney transplantation to elderly patients depending on the donor organ quality.

Material and methods. The study was based on the analysis of the kidney transplantation outcomes in 61 elderly recipients, including 51 transplantations performed from expanded criteria donors (group 1), and other 10 from standard donors (group 2). Based on clinical, laboratory, histological, and instrumental diagnostic data, we compared the graft function recovery rates, graft/recipient survival rates, the causes of graft loss in the early posttransplant period.

Results: Patients of group I had significantly higher delayed graft function rates (37.3% vs. 10%), graft non-function rates (15.7% vs. 0%), and lower early posttransplant survival rates (72.5% vs. 100%). Graft function recovery rate was 58.8% in group I, and 100% in the patients of group II. The most common cause of the graft loss and the renal graft removals performed in the early posttransplant period was the poor graft quality due to the donor's existing pathology.

Conclusion. The study demonstrated a statistically significant deterioration of the initial graft function, significantly increased graft non-function rates, and decreased graft survival rates in the early posttransplant period in the elderly recipients after kidney transplantation from expanded criteria donors.

Rationale. There have been only single studies conducted in the Russian Federation to characterize the posthumous donor population.

Objective: Identifying the main characteristics of the donor pool in N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department and in the State Research Center – A.I. Burnasyan Federal Medical Biophysical Center, FMBA, for the period from 2008–2017.

Material and methods. The clinical records of 429 actual and effective posthumous donors were analyzed retrospectively. The following characteristics were studied: gender, age, permanent place of residence, cause of death, the duration of mechanical lung ventilation, type of donation, total number of harvested organs, and number of organs recovered per donor.

Results. There were 281 male and 148 female donors. The increase in the mean age of donors from 37 to 48.5 years was noted. Cerebrovascular disease and traumatic brain injury became the main causes of death. Since 2012, the rate of cerebrovascular diseases as the cause of donor death has increased from 30% to 70%. Of 429 actual donors, the brain death was diagnosed in 366 (85.3%). Four hundred eight deceased became effective donors. A total of 1,247 donor organs (744 kidneys, 220 livers, 42 pancreas, 2 intestines, 180 hearts, 58 lungs, and 1 facial vascularized composite allograft) were obtained. The mean number of donor organs recovered per donor was 3.06.

Conclusions. The results obtained can be used to develop unified protocols and results of posthumous donors and to assess the possible volume of transplant care. In the period 2008–2017 an increase in the average age of posthumous donors (from 38.1 to 48.7 years) due to the proportion of donors in the 18–29 age group (from 29 to 4%) and an increase in the proportion of donors in the age group over 60 (from 3 to 15%). From 2012 to 2017 (from 68 to 29%) due to an increase in the number of donors who died as a result of cerebrovascular diseases (from 30 to 71%). Among the posthumous donors delivered by ambulance teams directly to the intensive care units, 69% of the consciousness level was depressed to 5 and lower on the Glasgow coma scale.

Introduction. The total number of patients with chronic heart failure in Russia had reached 15 million by 2016, including 6 million of those with the end-stage heart failure. Currently, heart transplantation (HT) provides the only possible method of a definite treatment of the disease, which allows a significant steady and long-term improvement of patient's quality of life.  The purpose of this article was to review the experience of heart transplantation in a multidisciplinary medical institution over an 8-year period.

Material and methods. Since September 2009, more than 300 patients have been studied for the presence of indications for heart transplantation in the Department of Urgent Cardiology, Assisted Circulation and Heart Transplantation of the Sklifosovsky Research Institute for Emergency Medicine. Eighty of all the screened potential recipients were included in the waiting list, and by the end of 2017, heart transplantations had been performed in 70 of them; the mean waiting time for transplantation was 93 ± 79 days.

Results. The graft ischemia time averaged 174 ± 28 minutes (97 to 250 minutes). The graft ischemia time was 187 ± 36 minutes with the biatrial technique and 169 ± 24 minutes with bicaval technique. That parameter made 184 ± 23 minutes for a distant organ retrieval, while for a local organ retrieval it was 155 ± 29 minutes. By the end of 2017, of 70 cardiac transplant recipients enrolled in the analyzed group, 31 patients (44%) had died, 12 of whom during their hospital stay (hospital mortality was 18%). The main cause of death was the multiple organ failure syndrome in the early postoperative period, and infectious complications in the later period.

Conclusion. The advantage of establishing the organ transplantation center (particularly for heart transplantation) in a multidisciplinary medical care facility lies in reduced donor organ ischemia time and starting treatment of complications without delay. The number of infectious complications, as well as complications associated with acute cellular rejection and coronary artery disease of the transplanted heart can be reduced by creating a regional system ensuring the targeted work with post transplant patients. 

Introduction. Diagnosis of the kidney transplant cellular rejection in the long-term after transplantation remains a challenge. Usual surrogate markers are not enough sensitive and specific. Rejection is an immune reaction to donor alloantigens. The kidney transplant biopsy to diagnose a dysfunction is an invasive procedure with the incidence of complications about 12.6% and can lead to transplant loss. In this regard, the search of immunological biomarkers for early noninvasive and accurate diagnosis of kidney transplant rejection is an actual task.

Material and methods. This is a report of the observational retrospective single-center, comparative case-control study in two groups involving 44 patients who underwent kidney transplantation. The first group (REJ) included the patients with the chronic graft dysfunction caused by a biopsy-confirmed late cellular rejection (22 patients). The second group (STA) included the recipients who had no dysfunction in the posttransplant period (22 patients). Flow cytometry of peripheral blood cells was performed to identify immunophenotyping markers of late cellular rejection after kidney transplantation (we determined subpopulations of T, B lymphocytes, and dendritic cells).

Results. As a result of our work, we found significant differences in the absolute count of effector memory T cells making 0.147 (0.115–0.260) × 10⁹ cell/L in REJ group, and 0.106 (0.067–0.136) × 10⁹ cell/L in STA group (р = 0.0167).  Relative and absolute counts of myeloid dendritic cells were also different between the groups: 0.65 (0.36–0.73) vs. 1.05 (0.67–1.4) % and 0.039 (0.028–0.056) vs. 0.063 (0.049–0.076) × 10⁹ cell/L, respectively (р = 0.0009, р = 0.003). The numbers of plasmacytoid dendritic cells were also different between the study groups: 0.0038 (0.0021–0.0054) vs. 0.005 (0.0035–0.007) × 10⁹ cell/L for an absolute count (р = 0.0414), and 0.055 (0.04–0.085) vs. 0.09 (0.05–0.12) % for a relative count (р = 0.0197).

Conclusion. The obtained data showed that the blood level of dendritic cells, which are the main “professional” initiators of immune reaction, and the level of effector helper T memory cells, which constitute the main lymphocyte subpopulation posing a destructive impact on the kidney transplant, can be considered as diagnostic markers of kidney transplant cellular rejection in the long-term after surgery.

The epidemiological situation with tuberculosis in Russia continues to be strained. The issues of accurate diagnosis and treatment remain unsolved; these issues are particularly urgent for the patients after solid organ transplantation because of a higher risk of the disease development while on drug immunosuppression. This article has described the clinical case of a patient with a clinical presentation of disseminated pulmonary tuberculosis that emerged in a steroidresistant rejection. The issues of drug therapy and drug interactions with anti-tuberculosis and immunosuppressive agents have been discussed.

Background. Kidney transplantation efficacy is limited by immunosuppression nephrotoxicity, antibody-mediated and chronic rejection. Avoiding immunosuppression nephrotoxicity is a promising strategy to improve long term outcomes. Belatacept, a synthetic immunoglobulin which blocks CD28-B7 pathway of T-lymphocyte costimulation, is considered as an alternative to calcineurin inhibitors in maintenance immunosuppression since it has no nephrotoxicity. Purpose: to evaluate belatacept efficacy and safety for maintenance immunosuppression therapy after kidney transplantatin based on the clinical experience.

Material and methods. From March 2017 to May 2018, we used belatacept in five kidney transplant recipients (one female and four males aged from 4 to 21 years) in the Kidney Transplantation Department of Petrovsky National Research Centre of Surgery Three kidneys were taken from related living donors, two kidney grafts were from deceased donors. Conversion from CNI to belatacept was performed between 6 and 112 month after transplantation. Patients were followed-up for average 12 months after conversion. We have described here these five cases, providing individual indications and the outcome of conversion.

Results. The conversion failed in two children switched to belatacept with the purpose to improve compliance. Three patients switched to belatacept because of tacrolimus toxicity demonstrated good results in one year follow up.

Conclusion. Belatacept demonstrated good results if was used instead of calcineurin inhibitors when the latter were poorly tolerated. The use of belatacept in multidrug immunosuppression in noncompliant patients was ineffective.

The article has covered the first 5 months of V.P. Demikhov's working at N.V. Sklifosovsky Research Institute for Emergency Medicine (since June 1960), and described the Institute Scientific Session held in November 1960 and dedicated to the 150th anniversary of the Sheremetev hospital foundation. Among the issues at that session, the topic of coronary artery failure and its treatment was discussed. However, V.P. Demikhov's presentation on his original technique of direct myocardial revascularization by means of forming the anastomosis between the internal mammary and coronary arteries was greeted coolly. The author believes that, probably, at that time, in November 1960, the idea of making such an operation in clinic could occur to Dr. V.I. Kolesov, one of the Session participants from Leningrad, and he embodied the idea in 1964 after he had mastered the V.P. Demikhov's technique in the experiment.