Objective. The study objective was to assess the scintigraphy potential in the evaluation of portal hypertension and the severity of liver damage in diffuse diseases and after liver transplantation.

Material and methods. The study enrolled 325 patients suffering from hepatitis and liver cirrhosis of various etiology and severity, including those after liver transplantation, namely, the patients with hepatitis (n=96), patients with liver cirrhosis of Child–Pugh class A (n=24), class B (n=87), and class C (n=118); 11 more healthy volunteers without clinical and laboratory signs of diffuse liver disease were enrolled as controls. The assessment of liver reticuloendothelial system was performed by scintigraphy with (99m)Tc-phytate colloid in a static planar mode and "whole body" mode by SPECT (Infinia II, GE).

Results. In contrast to the control group, significant radionuclide signs of hepatosplenomegaly were revealed with the predominant functional activity of the left lobe; the liver function was found impaired that correlated with the cirrhosis severity evaluated according to the Child–Pugh Сlassification. The analysis of scintigraphy quantitative parameters showed that the most informative of them were the intensity of radiopharmaceutical accumulation in the spleen (S%) and in bone marrow (Вm%), and the radiopharmaceutical uptake by the reticuloendothelial cells of the liver and spleen in percentage from the administered activity (Lwb%, Swb%). Depending on the cirrhosis severity assessed by the Child–Pugh Score, the changes in quantitative parameters were accompanied by a progressive enlargement of the spleen, liver left lobe, the increase of (99m)Tc-phytate uptake by the bone marrow with a decreased radiopharmaceutical uptake by the liver. The study results showed that among the Child–Pugh class C patients, the impairment of liver reticuloendothelial function was more pronounced in the patients with cirrhosis of viral and mixed etiology, when compared to those with alcoholic cirrhosis.

Conclusion. The paper has identified the most informative parameters characterizing portal hypertension and the reticuloendothelial function for all Child–Pugh defined classes of cirrhosis. These parameters include the increase of (99m) Tc-phytate accumulation in the spleen (S%) and bone marrow (Bm%); the liver and spleen uptake of the radiopharmaceutical in percentage from the administered activity (Lwb%, Swb%). The calculation of the remaining parameters is necessary for a detailed description of the organ function and for the assessment of the portal hypertension severity in repeated studies.

Summary. Criteria for the objective assessment of reticuloendothelial function and portal hypertension in diffuse liver diseases, including after liver transplantation, have been developed. Contrary to the control group, in patients with diffuse liver diseases, the radionuclide signs of hepatosplenomegaly (or a decreased liver size) with a predominant functional activity of the left lobe were identified, as were the changes in the quantitative parameters of the radiopharmaceutical uptake by the liver (Lwb%), including the radiopharmaceutical accumulation in the liver left lobe (Ll%), spleen (Swb%), bone marrow (Bm%), and the liver-to-spleen area ratio (Lar/Sar). The informative and reliable (p<0.05) parameters of the function Lwb%, S%, Swb% and Bm% correlating with the cirrhosis classes assessed by Child–Pugh were identified. The radionuclide method, being highly reproducible one, can be recommended for an objective assessment of liver function and the detection of portal hypertension in hepatitis and cirrhosis, as well as for post-transplant monitoring of the liver function to prevent complications in the early and late postoperative periods.

Introduction. In recipients with pre-existing sensitization with incompatible antigens of the main histocompatibility complex, the kidney graft survival after retransplantations directly depends on the level of anti-HLA antibodies. Despite many years of experience in using various methods: plasmapheresis, cascade filtration, immunosorption, intravenous administration of immunoglobulins, the use of polyclonal anti-lymphocytic agents, the search for more acceptable ways to reduce the level of anti-HLA antibodies still remains relevant nowadays.

The purpose of the study was to assess the effect of polymethyl methacrylate membrane-based dialyzers on the decrease in anti-HLA antibody level in renal transplant recipients.

Material and methods. The study included 20 kidney transplant recipients. The main study group consisted of 10 patients who underwent early postoperatoive hemodialysis using polymethyl methacrylate membrane-based dialyzers to decrease anti-HLA antibody level. A total of 53 hemodialysis procedures were performed, an average of 5.3 per patient. The comparison group included 10 recipients in whom plasmapheresis had been performed at similar timing after kidney transplantation aimed at reducing the anti-HLA antibody titers and whose data were studied retrospectively. A total of 38 plasmapheresis sessions were performed, an average of 3.8 per patient.

Results. In the main study group, a day after the hemodialysis procedure using polymethyl methacrylate membranebased dialyzers the level of anti-HLA antibodies decreased by an average of 28.3% in 6 of 10 patients (60%), and increased in 4 cases. Meanwhile, in the comparison group, the level of anti-HLA antibodies in venous blood after a plasmapheresis session decreased average by 44.6% in 8 patients of 10 (80%), and increased in 2 cases, on the contrary. Of note, there were no significant differences between the patients of the two compared groups either in the number of positive results (p> 0.05, Fisher's exact test), or in terms of the decrease in anti-HLA antibody level (p> 0.05, Mann – Whitney test). On days 2 and 5, in 50% of cases both after the hemodialysis procedure using polymethyl methacrylate membranebased dialyzers and after the plasmapheresis session, the patients showed an increase in the anti-HLA antibodies level compared to the baseline values. In the remaining cases, the level of anti-HLA antibodies in both groups was recorded at a lower range compared to the baseline values.

Conclusion. The use of polymethyl methacrylate membrane-based dialyzers in the renal allograft recipients having a high level of preexisting anti-HLA antibodies seems promising for the period of oligoanuria until the renal allograft function is restored, since both hemodialysis and the sorption of pre-existing (and also newly synthesized) antibodies take place simultaneously.

Introduction. Recent studies have indicated an increased incidence of thrombotic vascular complications after liver transplantation. The reasons may be associated with surgical technique and “unbalanced” hemostasis in patients with diffuse liver diseases. The imbalance is determined by the deficiency of physiological procoagulants and anticoagulants due to a reduced protein-synthesis function of the liver in chronic hepatocyte injury. At the same time, 90% of all spontaneous antithrombin activity is associated with antithrombin III.

Aim. The aim of the study was to evaluate the efficacy of using antithrombin III concentrate in liver transplant patients.

Material and methods. A retrospective study included 46 patients undergoing liver transplantation who had nonocclusive thrombosis in the portal vein system prior to surgery and postoperative venous or arterial thrombosis.

Results. The treatment results were compared between the group with antithrombin III concentrate and the control group in patients with portal vein thrombosis before surgery and postoperative venous or arterial thrombosis; the antithrombin III activity dynamics in the early postoperative period was assessed; the incidence of infectious, and vascular complications and the mortality rates were analyzed.

Conclusion. The antithrombin III concentrate administration during liver transplantation and in the postoperative period contributes to a rapid normalization of antithrombin III activity in blood, the decrease in mortality and in the incidence of infectious and thrombotic complication rates.

On February 7, 2019, a one-day Consensus Conference of the International Liver Transplantation Society was held to discuss oncology issues. Representatives of world's leading clinics gathered in Rotterdam (Netherlands). The presentations made on that day covered the following topics: hepatocellular cancer, bile duct cancer, immunotherapy and its place in the treatment of liver tumors, the possibility of liver transplantation in patients with metastatic liver disease, world trends in pediatric oncohepatology. A separate session in the working groups was allocated to discuss the most actual topics. The Conference identified the main global trends and the most crucial issues in the field of liver transplantation in patients with oncological diagnosis. It is likely that these presentations will “set the tone” for the large Transplantationt Congress in Toronto in May 2019.

Introduction. The need for cranioplasty occurs after the removal of the bony structures of the cranial vault. Craniotomy can be performed both in emergency as in case of increased intracranial pressure, and as a planned operation in the treatment of neoplasms or abscesses. A long-lasting presence of an extensive bone defect is the cause of the "trephined skull" syndrome development. Currently, cranioplasty is performed with materials of synthetic or natural origin. Synthetic materials include hydroxyapatite, tricalcium phosphate, polymethyl methacrylate. The natural materials include the auto-, allo- and xenografts. The main disadvantage of bone autografts is their rapid lysis. The most promising solution to this problem may include a lyophilization method with transplant saturation with growth factors, the source of which can be autoplasma rich in platelets. Of particular relevance is the development of methods for the preparation and preservation of an autograft, its modification in order to increase osteoreparative properties, which will bring the cranioplasty method with natural transplants to a whole new level.

The purpose of research. Combine relevant data and the results of a comprehensive analysis of the advantages and disadvantages of existing bone-plastic materials.

The article describes the key event for Soviet transplantology of the 1960, namely, the Meeting of the Presidium of the USSR Healthcare Ministry Council for the Coordination of Scientific Research and Implementation of the Scientific Achievements. The Meeting held on October 8, 1963, was initiated by V.P. Demikhov's letters addressed to Moscow City CPSU Committee and the USSR Healthcare Ministry. The attendees of the Meeting were 50 leading experts of the USSR in the field of surgery, immunology, and transplantology; the speakers at the Meeting were V.P. Demikhov as the principal speaker, and V.I. Burakovsky as the Chairman of the Committee that had studied V.P. Demikhov's proposals on the issue of organ transplantation and the prospects for scientific research in that area. V.P. Demikhov shared with the audience his ideas, which were well ahead of their time; and the Commission noted the perspective and complexity of the organ transplantation problem, proposing a number of measures to improve the existed situation.