Rationale. Lung transplantation is the only definitive treatment in end-stage pulmonary disease. Extracorporeal membrane oxygenation (ECMO) has been used during surgery in recent years as a replacement for respiratory function; ECMO, however, has some drawbacks: the presence of an extracorporeal circuit, the need for heparinization, potential thrombogenicity that underlies the risks of developing specific complications that worsen the transplantation prognosis. In this regard, it is relevant to study the factors that make it possible to predict the need in intraoperative ECMO in order to avoid its unjustified use.

Purpose. To identify predictors for intraoperative use of ECMO in lung transplantation.

Material and methods. The medical records of patients who underwent lung transplantation in the Sklifosovsky Research Institute for Emergency Medicine from May 2011 to July 2017 were retrospectively reviewed. Forty nine bilateral lung transplantations were made where 15 patients (30.6%) had lung transplantation performed without ECMO, and 34 (69.4%) underwent lung transplantation and ECMO. A central veno-arterial connection was used in all patients. The study analyzed various factors of patient condition at baseline and identified the most significant of them that enabled to predict the need of ECMO use at surgery with a high degree of probability, avoiding episodes of gas exchange and hemodynamic impairments, the prolongation of surgery, and, therefore, the graft ischemia time.

Results. As assessed in this study, pulmonary hypertension was the only predictor of an increased likelihood of using ECMO. The probability of connection to ECMO statistically significantly increased in the patients with systolic pulmonary artery pressure higher 50 mm Hg (p<0.05).

Conclusion. The presence of pulmonary hypertension > 50 mm Hg determines the preventive use of ECMO during lung transplantation, which should reduce the number of uncontrolled emergencies during the main stages of surgical intervention; in all other cases, ECMO should be connected basing either on the pulmonary artery compression test results or when indicated. 

Introduction. Accurate blood pressure (BP) measurements are the mainstay for the efficient management of abrupt changes of hemodynamics and perfusion during orthotopic liver transplantation (OLT).

Material and methods. The prospective study included 39 patients. We compared the BP values measured in the femoral and radial arteries during the different phases of the OLT.

Results. The central systolic arterial pressure (SAP) and mean arterial pressure (MAP) measured invasive in the femoral artery were significantly higher than those measured in the peripheral artery during the anhepatic phase (95.1±10.6 vs. 84.5±9.9 mm Hg, and 66±8.8 vs. 59.7±7.1 mm Hg, respectively), after 5 minutes of reperfusion (91.1±17.3 vs. 78.5±18.4 mm Hg, and 63.9±13.1 vs. 57.7±13.6 mm Hg, respectively), and after 15 minutes of reperfusion (102.2±16.8 vs. 88.1±14.4 mm Hg, and 67.7±10.7 vs. 62.5±10.4 mm Hg, respectively). We found a strong correlation between the differences of SAP and MAP and the dose of norepinephrine administered during the anhepatic phase (r=0.76 and r=0.77 for SAP and MAP, respectively), and after 5 minutes of reperfusion (r=0.71 and r=0.52 for SAP and MAP, respectively). The difference between central and peripheral BPs after 15 minutes of reperfusion mainly depended on the changes in the potassium concentration (r=0.55 for SAP and MAP) and base deficiency (r=0.73 and r=0.82 for SAP and MAP, respectively).

Conclusion. Thus, it was proved that the invasive measurement of BP in the femoral artery is a more accurate method compared with that in the radial artery as it is less exposed to high doses of vasopressors and variations in the acid-base state during OLT. 

Introduction. Monitoring of redox potential (platinum electrode open circuit potential) in biological media (serum, blood plasma) is one of the promising methods for diagnosing and predicting the development of complications in patients in the early post-transplantation period. The study of the diagnostic capabilities of this technique in patients after lung transplantation is highly relevant.

The objective was to assess the diagnostic and prognostic capabilities of monitoring platinum electrode open circuit potential in blood plasma of lung transplant patients.

Material and methods. The data obtained at monitoring of platinum electrode open circuit potential in blood plasma and clinical laboratory test results of 14 patients after double lung transplantation surgery were analyzed. The platinum electrode open circuit potential value in the blood plasma was measured by the potentiometric method.

Results. The study demonstrated the differences in the dynamics and values of platinum electrode open circuit potential in the blood plasma between the lung transplant patients with a favorable outcome and those with a fatal outcome. Wave-like segments on the relationship curves of the platinum electrode open circuit potential in blood plasma to time coincided with inflammatory markers (C-reactive protein, stab neutrophils, erythrocyte sedimentation rate) activation. Statistically significant correlations between platinum electrode open circuit potential values in blood plasma and clinical laboratory test results were revealed.

Conclusion. The informative value and diagnostic capabilities of the technique of the platinum electrode open circuit potential measurement in blood plasma of lung transplant patients have prospects of using its results as a criterion for assessing the patient’s condition and improving the quality of therapy. 

Introduction. Tuberculosis is one of the most common infections in the general population, as well as among the recipients of solid organs. In kidney transplant recipients, the diagnosis of tuberculosis is often extremely difficult to make because of unclear clinical and radiological symptoms, and a highly frequent atypical (extrapulmonary) localization. The tuberculosis treatment in patients on drug immunosuppression is a significant problem.

Clinical case. At five years after renal transplantation, the patient noted the onset of fever up to 38 degrees C. It was suspicious of respiratory infection. Chest X-ray, computed tomography, and ultrasound examination of the graft revealed no pathology. Antibacterial and antiviral therapy brought stable improvement. A repeated computer tomography demonstrated an enhanced pulmonary pattern in S6 of the left lung with visualization of small grouped lesions located peribronchially, the terminal ileitis in the abdominal cavity: (an intensive contrast accumulation in the mucosa of the affected part of the small intestine, the mesentery hypervascularity at this level). A colonoenteroscopy with a ileum intestine biopsy was performed; the findings were highly consistent with a tuberculous process. A targeted treatment of tuberculosis was carried out, which had a marked positive trend.

Conclusion. Thus, the diagnosis of tuberculosis in kidney transplant recipients is complex; the clinical signs and instrumental test results are often ambiguous, which greatly complicates the timely diagnosis. An integrated approach with the use of modern diagnostic methods is required. 

The purpose. Using clinical observation, to study the feasibility of applying a coagulant and to assess its efficacy in the treatment of patients with post-burn erosion of the cornea.

Material and methods. The treatment was carried out in the Department of Trauma and Reconstructive Surgery, the Helmholtz Moscow Research Institute of Eye Diseases, Russia. Based on clinical test results, the patient, was diagnosed with post-burn persistent erosion of the cornea with sub-total cornea conjunctivization and: limbal stem cell deficiency (LSCD) in the right eye. The keratoprotective therapy conducted for several months turned ineffective. In order to activate the cornea regeneration process, the erosion site was covered with autologous thrombofibrin clot that had been obtained from the stabilized blood. Following a two-stage centrifugation of patient's stabilized blood, the plasma with the platelets were collected into a round-bottomed test-tube; and the chloride calcium activator was added. The clot was formed in the thermostat at a temperature of 37 С. The patient was given a local anesthesia, and the thrombofibrin clot was placed on the cornea surface and covered with an amniotic membrane. The membrane was fixed with a circular stitch along the limbus of the cornea.

Result. The patient was followed-up and showed positive changes over time in the form of a diminished erosion area at day 5 and a complete corneal epithelialization at day 14.

Summary. Our methodaimed at enhancing the reparative and regenerative processes in the cornea, reducing swelling, accelerating epithelialization, expanding transparency, and improving the optic characteristics thanks to less intensive opacity formation showed a high efficacy. 

The article describes and analyzes the circumstances related to the translation of V.P. Demikhov's book Experimental Transplantation of Vital Organs into English by Basil Haigh in 1962, its publication in the USA and an ambiguous response of foreign readers and surgeons to it. At that time, V.P. Demikhov continued actively preparing for human heart transplantation and declared that in the foreign press. He was granted a gratitude and a cash prize for completed research for the year of 1962 in the Sklifosovsky Research Institute for Emergency Medicine. The results of the preparatory work were summarized. The fact of V.P. Demikhov's readiness to perform heart transplantation on clinic was stated, including that one to harvesting and revitalizing a cadaveric organ, but there were no permission to transplant it to a human.