Background. Glomerular filtration rate is the main parameter characterizing the kidney functional condition. The evaluation of glomerular filtration rate is of significant importance, since in addition to an objective indicator of the kidney functional capacity, it is also a predictor of various pathological conditions, including cardiovascular complications.

The aim of the study was to assess creatinine levels and glomerular filtration rates before and after orthotopic liver transplantation in clinical practice.

Material and methods. A retrospective analysis of data obtained at different stages of the postoperative period in patients (n = 89) who underwent orthotopic liver transplantation in Research Institute – Regional Clinical Hospital № 1, Krasnodar, was performed. The creatinine level and glomerular filtration rate were studied before and at 6, 12, 24, and 36 months after liver transplantation, taking into account gender and age differences. Statistical analysis of the study results was made using Statistica 10 software.

Results. The creatinine level was 82.9 ± 19.8 mmol/L before liver transplantation; creatinine increased by 20.4% (p = 0.004) at 6 months, by 24.8% (p = 0.00001), 24.4% (p = 0.0004), and 26.0% (p = 0.0005) at 12, 24 and 36 months after transplantation, respectively statistical significant in all cases. Compared to the baseline, the glomerular filtration rate decreased by 14.2% (p = 0.0005), 18.8% (p = 0.00001), 20.2% (p = 0.00003), and 22.6% (p = 0.00006) at 6, 12, 24, and 36 months, respectively statistical significant in all cases. Significant differences in kidney functional condition between men and women, as well as between the recipients younger and older 50 years were observed only at one year after transplantation.

Background. The diseases leading to the need for lung transplantation include chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1-antitrypsin deficiency, idiopathic pulmonary hypertension, histiocytosis X, and sarcoidosis. Primary lung transplant dysfunction is a frequent complication after transplantation and represents a multifactorial injury of the transplanted lung, its pathogenesis being associated with a severe hypoxemia of the lung transplant and diffused damage to the alveoli. The clinical presentation is in many ways similar to an acute respiratory distress syndrome, which pathogenesis is primarily effected by the activation of immune system cells. The cytokine production by immunocompetent cells, the synthesis of reactive oxygen and nitrous oxide, being the mediators of inflammation, trigger inflammatory processes in the lungs; the immunoglobulin synthesis derangements also lead to the development of inflammatory abnormalities in the lungs and a poor transplantation outcome.

The objective was to study the immunological response in the lung transplant recipients suffering from the underlying disease of various etiology and to determine the immunological predictors of adverse outcome in the early period after bilateral lung transplantation.

Material and methods. Twenty nine patients were examined within 2 weeks after lung transplantation: Group 1 comprised 10 patients with cystic fibrosis (6 women, 4 men) aged 27.8 ± 2.7 years; Group 2 included 19 patients (7 women, 12 men) at the age of 38.5 ± 10.4 years having other lung diseases. Mortality was 10% (1 patient) in Group 1, and 52.5% (10 patients) in Group 2. The patients were followed-up according to the standard protocol of postoperative treatment and immunosuppression therapy shemes. Immunological monitoring included the lymphocyte phenotyping, and the assessment of phagocytic activity of neutrophils, the HCT-test, the blood levels of immunoglobulins (Ig) A, M, G, circulating immune complexes, and C-reactive protein. Statistical significance was assessed at p <0.05.

Results. On day 5, the T-lymphocyte count in patients of Group 1 was 674 cells/μL (Me), which was 26.7% lower than lower limit of the reference range, but 2.5 times higher than that in patients of Group 2 (266 cells/μL). The number of T-lymphocytes in patients of the 2nd group was recorded at 71.1% below the lower limit of the reference interval (p < 0.05). The blood level of IgA (Me) in patients of Group 1 was within the normal range (Ме – 1.9 g/L), the blood level of IgA (Me) in patients of Group 2 was 1.4 g/L, which was 26.3% lower than below the lower limit of the reference values and lower than in Group 1 (p < 0.05).

By day 13, the count of T-lymphocytes in Group 1 had increased 2.2 times compared to day 5, reaching the reference values (Me), and made 1479 cells/μL. In the 2nd group, there was a 1.5-fold increase in T-lymphocyte count (Me 408 cells/μL), which was 3.7 times lower than the lower limit of the reference range and lower than in the 1st group (p < 0.05). The level of IgA in patients of the 1st group increased by 20.8% and amounted to 2.4 g/L (Me), and in patients of the 2nd group, the level of IgA for 2 weeks remained almost unchanged (Me 1.5 g/L ) and was 1.7 times lower than in the 1st group (p < 0.05).

Conclusions. On day 5 after transplantation, the patients with cystic fibrosis demonstrated the increase in the T-lymphocyte count and IgA level by 2.5 and 1.4 times, respectively, compared to the patients with other lung diseases. By the end of week 2, T-lymphocyte and IgA values in patients with cystic fibrosis, unlike patients with other lung diseases, had reached the reference range. The T-lymphocyte count and the concentration of IgA below the reference range in the first 2 weeks after lung transplantation were the immunological predictors of adverse outcome.

Background. Infectious complications remain a serious post-transplant problem and make a major cause of poor outcome. Given the active development of transplant services at a regional level, the problem of infectious complications becomes increasingly important and requires monitoring of the etiological structure and level of antibiotic resistance in each hospital dealing with this problem.

The purpose was to analyze the changes over time in the structure and antimicrobial resistance of the most common pathogens in various nosology, including in patients after organ transplantation, regardless gender and age.

Material and methods. The study included 37,103 patients, of whom 8,091 (21.8%) were treated in the Intensive Care Unit (ICU) of the Vitebsk Regional Clinical Hospital (VRCH) for the period from 2015 to 2017; infectious complications after organ transplantation made 3%. The clinical samples were studied for bacteriology in the Republican Scientific and Practical Center "Infection in Surgery"; 20,280 clinical isolates were investigated.

Results. Staphylococcus aureus (20.96%) dominated in the general structure of microorganisms cultured mainly from the wound surface in thermal burns; meanwhile, in the ICU, gram-negative microflora dominated and was presented with Acinetobacter spp. (22.75%) and Pseudomonas aeruginosa (22.74%) in the majority of cases. By 2017, there had been an increase in resistant isolates of Klebsiella spp. (22.87%) and Acinetobacter spp. (23.09%) and a reduction of P. aeruginosa (13.31%) and S. aureus (18.88%) seeding. The protocol of the antibacterial therapy initiation was set up in the ICU of Vitebsk Regional Clinical Hospital, based on the obtained results demonstrating that all S. aureus isolates were sensitive to linezolid, vancomycin and teicoplanin, while P. aeruginosa was sensitive to colistin. All isolated Acinetobacter spp. were sensitive to colistin and 80% of the isolates were sensitive to sulbactam. More than 95% of K. pneumonia isolates were sensitive to colistin and tigecycline.

Conclusion. The current epidemiology is characterized by the prevalence of S. aureus (20.96%) in the overall structure of microorganisms, while Acinetobacter spp. (22.25%) and P. aeruginosa (22.74%) dominate in the ICU. Based on the microbiology study results, the protocol of antibacterial therapy initiation was established in the ICU of Vitebsk Regional Clinical Hospital. It is necessary to monitor the resistance of common microorganisms to certain antibiotics in order to develop algorithms for rational antibacterial treatment in each hospital.

The aim of the study was to evaluate the efficacy of various approaches to correcting and preventing hypotension episodes in patients on maintenance hemodialysis (HD).

Material and methods. The study included 35 patients on maintenance hemodialysis in the Dialysis Center "MCHTP No. 1", which is a part of "B. Braun Avitum" network centers in the Russian Federation. All patients underwent an automatic blood pressure (BP) measurement using a machine-inbuilt option device for noninvasive blood pressure measurement. Prior to the study, all patients underwent a clinical test with a "dry weight" assessment and a bio-impedance analysis. The study had a cross-over design: first, all patients were treated using the standard methods for correcting hypotension episodes (at 4 initial procedures). Then, in the following 4 procedures, in addition to standard methods, a computer algorithm was used to automatically regulate the ultrafiltration (UF) rate: the automatic pressure monitoring system (biologic rr comfort) with continuous monitoring of blood pressure throughout the procedure; BP was recorded before and after the HD procedure, as well as at least once every 5 minutes during 3 initial procedures; and starting from the 4th procedure, the intervals were determined by the algorithm automatically. The average blood pressure values were analyzed during the dialysis procedures for the entire observation period. The duration of the study was 3 weeks for each patient.

Results. The average predialysis blood pressures in the group with the standard approach to hemodynamic correction were 124.6 ± 27.7 and 74.5 ± 21.1 mm Hg, the postdialysis blood pressures were 114.4 ± 24.4 and 71.3 ± 16.3 mm Hg. With the use of automatic pressure monitoring system, the predialysis and postdialysis blood pressures were significantly higher than those with the standard approach: 133.2 ± 21.3 and 79.3 ± 15.8 mm Hg (p < 0.001 and p = 0.009), vs. 125.7 ± 23.9 and 75.9 ± 18.3 mm Hg (p < 0.001 and p < 0.001), respectively. Upon closer examination of the intradialysis pressure variations, the intradialysis blood pressures were 110.2 ± 17.3 and 68.3 ± 13.9 mm Hg when measured by using the standard approach, and significantly higher: 124 ± 20.5 and 75.9 ± 14.2 mm Hg when the automatic pressure monitoring system was used (p = 0.03; p = 0.02). Also, higher mean arterial pressures were noted: 82.5 ± 13.9 with the standard approach vs.91.5 ± 15.6 mm Hg (p = 0.01) with the automatic pressure monitoring system. Studying UF rates, we found that the UF rate was slightly higher without using the automatic pressure monitoring system (8.0 ml/kg/h vs. 7.9 ml/kg/h). Thus, the new approach used in addition to the standard methods of correcting hypotension was effective and safe. No significant differences were seen in Kt/V values. However, when automatic pressure monitoring system was used in patients, the target phosphate levels were achieved: the inorganic phosphorus value was 1.5 mmol/L when using the UF control algorithm vs. 1.8 mmol/L with a standard dialysis program. However, these data did not reach the statistical significance (p = 0.07).

Conclusion. Intradialysis hypotension and high UF rates remain frequent and potentially dangerous complications of HD procedure, which worsen the long-term prognosis of patients on HD, mainly due to the increase in cardiovascular morbidity and mortality. The new approach to the prevention and correction of hypotension by using the automatic pressure monitoring system allows one to reduce the UF rate in a timely manner, preventing the development of hypotension episodes, reducing their rates, and improving the achievement of target blood pressure values, both preand postdialysis, as well as intradialysis blood pressure variations.

Worldwide, there is a trend towards an increase in the number of patients waiting for liver transplantation, despite an increase in the total number of liver transplantation operations. Solving the problem of donor organ shortage is possible through the use of organs from marginal donors: organs removed after cardiac arrest, organs with a high percentage of steatosis, organs from donors over the age of 60 years. The main reason for refusing to use them is the risk of severe complications and an unfavorable outcome of the operation. Static cold preservation today is the main method of protecting donor organs from thermal damage, which possesses rather effective protective properties. At the same time, the duration of cold preservation has a limited time interval. There is always uncertainty about the viability of the organ. Modern methods for assessing donor organs such as donor history, laboratory data, visual examination and morphology, do not reliably predict liver function after transplantation. In this regard, the development of methods for preserving the organ after removing, which do not degrade the quality of the organ or even are capable of restoring the lost functions, is relevant. The machine perfusion of the liver is one of the new concepts aimed at solving this problem. The article highlights the international experience of using the machine perfusion of the donor liver over the past 15 years. Machine perfusion is a promising trend of transplantation development, which allows reducing the shortage of donor organs and improving their quality.

The article has analyzed the world experience and main trends in the preparation of cadaveric skin for use in the treatment of patients with wounds of various etiologies. The history of the question is described from the first attempts of transplantation of the native skin to the creation of specialized banks of allogenic decellularized tissue grafts. Presented are the modern approaches of donor material conservation, specifically, to the principle and topical question: whether the viability of the cells should be preserved in the graft, or it is more efficient to transplant the skin devoid of cellular elements. The advantages and disadvantages of lyophilized grafts have been described, namely the possibility of longterm storage, but loss of elasticity, after rehydration. The methods of cryoconservation of cutaneous allografts, their properties, and acceptable methods of sterilization have been discussed. A perspective technology of graft decellularization has been assessed and the methodologies of their manufacturing have briefly been presented.

The article describes the results of V.P. Demikhov's working at N.V. Sklifosovsky Institute for Emergency Medicine in 1961. We have presented a brief report of his laboratory activities and a prospective working plan that included preparing for vital organ transplantations in clinic, conducting immunological and morphological studies, resolving resuscitation issues, all aimed at: 1) revitalizing dead people and their organs for transplantatio, and 2) preserving the vitality of the isolated organs before transplantation. For the first time in the history of national surgery, the question of "brain death" was raised as a criterion for the possibility of organ harvesting. However, the documents we have reviewed demonstrated that such a plan was impossible to be realized with the efforts of a single institution. V.P. Demikhov was advised to revise the plan, abridge it, and bring it into line with the modest potential of the Institute to organ transplantations.