Introduction. Sarcopenia is a common complication of chronic liver disease. Today many studies are devoted to sarcopenia impact on the course of liver diseases. At the same time, many studies are being performed on the correlation of sarcopenia in patients with cirrhosis of the liver and the incidence of early complications after liver transplantation. In this regard, we conducted our own retrospective study of the correlation relationship of sarcopenia in patients with chronic liver diseases.

Aim. To determine the correlation between the severity of sarcopenia and the incidence of complications of liver cirrhosis in patients on the waiting list for liver transplantation.

Material and methods. In our own retrospective observational study, 87 patients suffering from chronic liver diseases and treated at the Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology were included. The assessment of sarcopenia was carried out using the CT technique for assessing indexed parameters of the patient's muscle mass. Mathematical processing was performed using the FDA-approved OsirixTM software. The study was conducted within the framework of the project "ClinicalTrials: NCT04281797"

Results. Body mass index was significantly correlated with the presence of sarcopenia (rpb=-0.48, 95% CI [-0.65;-0.27]). At the same time, the groups of patients with and without sarcopenia differed significantly (p<0.0001), (Hedges g=-0.93, 95% CI [-1.37;-0.48]). In groups of patients with various etiological factors of chronic liver diseases, sarcopenia occurred

most often among patients with autoimmune hepatitis, while the uneven distribution of the incidence of sarcopenia in different nosological groups was significant (p=0.028; 2=14.1).

Conclusion. Body mass index plays an important prognostic role in muscle mass loss among patients with clinically advanced liver disease. However, skeletal muscle index and Body Mass Index differ significantly between patients with and without sarcopenia. In addition, our study showed a significant difference in the occurrence of sarcopenia in patients on the waiting list of different etiological groups. Thus, further extensive randomized studies in this direction are needed today.

Background. The recurrence of autoimmune liver diseases can lead to reduced survival of recipients and grafts.
Aim. To study the incidence and impact of the recurrence of autoimmune liver diseases on graft survival; the effect of maintenance immunosuppression on the recurrence of autoimmune diseases in liver transplant recipients
Material and methods. Transplantation outcomes in 111 recipients (21 recipients operated on for autoimmune hepatitis, 50 recipients operated on for primary biliary cirrhosis, and 40 recipients operated on for primary sclerosing cholangitis) were analyzed retrospectively.
Results. The recurrence of autoimmune hepatitis is observed in 5%, the recurrence of primary biliary cirrhosis is in 10%, and the recurrence of primary sclerosing cholangitis is in 17% of cases. Among patients with recurrence of autoimmune diseases, men accounted for 54%, while for only 31% in the subgroup of patients without relapse (p=0.004). The followup for recipients with relapse (64.5 (42.8;82.0) months) was comparable to the follow-up for recipients without relapse (46.5 (17.9;103.5) months, p=0.54). A ten-year graft survival was significantly higher in the group of recipients with recurrent autoimmune diseases compared with recipients without autoimmune diseases recurrence (p<0.0001).
Conclusions. The recurrence of autoimmune diseases leads to a decrease in graft survival. The effect of immunosuppression components on the risk of recurrence of autoimmune diseases in the graft has not been established.

Introduction. The search for methods to reduce the time of treatment of burns and wounds of the donor sites currently remains relevant.
Aim. Objective of this retrospective study was to evaluate the effectiveness of local treatment of II–IIIA degree burns and donor site wounds with dressings based on allogeneic type I collagen.
Material and methods. The study included 434 patients hospitalized in 2018–2021. Collagen dressings were used in 280 patients (234 with II–IIIA degree burns and 46 with donor site wounds); 154 patients of the comparison group received traditional treatment in accordance with the standards of care for burns. Patients did not differ statistically significantly in age and the area of burns (general, superficial, deep). Lyophilized, sterile dressings based on type I collagen (RC No. FSR 2009/06370 December 8, 2014) were manufactured in accordance with TU No. 9393-002-01967081-2008 by the Department for Tissue Preservation and Graft Manufacturing of our Institute. We compared the timing of wound epithelialization when using collagen dressings versus the conventional treatment, and the pain intensity in the donor sites as assessed by the visual analogue scale for pain.
Results. The terms of complete epithelialization of II–IIIA degree burn wounds made 10 (7;12) days when collagenbased dressings were used, and 18 (14;20) days without collagen, the difference being statistically significant (p<0.001). Epithelialization of the donor site wounds took 9 (8;10) days with using collagen dressings, and 11 (10;12) days with conventional treatment (p<0.001). The visual analogue scale assessed pain intensity in the donor site wounds after collagen application was statistically significantly lower on days 1, 4, and 7 than in patients on conventional treatment (p<0.001, p<0.001, p=0.003, respectively).
Conclusion. The use of dressings based on type I allogeneic collagen for the treatment of superficial burns and the donor sites reduces the time of re-epithelialization, decreases the pain intensity in the donor site wounds, which proves the greater efficacy of this treatment method.

Background. Paracetamol poisoning is common all over the world, including in Russia. In 20–25% of cases, a massive dose of the drug is observed: more than 30–40 g of paracetamol at a time.
The aim of the study was to demonstrate the efficacy of using an increased doses of acetylcysteine in the treatment of a massive paracetamol admission.
Results. Patient G., 22 years old, took 70 tablets (35 g) of paracetamol for suicide 3 hours before admission to the hospital. The blood level of paracetamol 4 hours after taking it was 694.94 µg/mL. Upon admission to the hospital, acetylcysteine administering was started according to a 12-hour scheme. Subsequently, the administration of acetylcysteine was continued according to a 20-hour regimen with an increased dosage at the 2nd stage. Laboratory parameters, including aspartate aminotransferase and alanine aminotransferase, remained within the reference values during hospital stay. Conclusion. The case report we have presented shows the efficacy and expediency of using an increased doses of acetylcysteine in case of massive admission of paracetamol, which contributes to the prevention of the development of severe complications and a favorable course and outcome of the disease.

Aim. To evaluate the effect of continuous intravenous infusion of alprostadil solution on the dynamics of the peripheral resistance to arterial blood flow and renal graft function in the early postoperative period.

Material and methods. From June 2018 to May 2022, 278 kidney transplants from a deceased donor were performed at the City Clinical Hospital n.a. S.P. Botkin. In 179 recipients operated from June 2018 to May 2021, we evaluated the significance of the intraoperatively determined resistance index of blood flow in the segmental arteries of the renal graft as a predictor of the development of its delayed function. The study of the effect of alprostadil included 32 patients divided into 2 groups comparable in patient age, gender, body mass index. The resistance index in both groups was more than 0.85. In the second group patients received a continuous intravenous infusion of alprostadil solution in the first 3 days after surgery.

Results. Retrospectively we found that in patients with a high resistance index (more than 0.85), the risk of developing delayed graft function was 6.9 times higher, that was statistically significant (p=0.001). In the alprostadil group, a delayed graft function developed in 5 of 18 patients (27.8%), compared with the control group, where delayed graft function developed in 9 of 14 (64.3%) patients, however, without reaching the level of statistical significance (p=0.072). The median time to normalization of graft function in group II was 4 (interquartile range: 3–4) days, while in group I it was 7 (interquartile range: 5–8) days (p=0.05). The median hospital length of stay in the alprostadil group was significantly lower than in the control group and amounted to 13 (interquartile range: 8–15) versus 17 (interquartile range: 15–19) days (p=0.032).

Conclusion. The use of continuous intravenous infusion of alprostadil solution after kidney transplantation in patients with a high intraoperative resistance index can safely and effectively lead to a decrease in resistance index to normal rates, accelerate the recovery of graft function and significantly reduce the incidence of delayed graft function. However, further research is needed.

The article has summarized the available data about regulatory T cells, describing in-detail the stages of their studying, their development, classification, mechanisms of immunosuppression in general terms and also in the context of allogeneic hematopoietic stem cells transplantation. The effect of immunosuppressive agents on this cell population is considered.

The role of regulatory T cells in the pathogenesis of both acute and chronic graft-versus-host disease has been revealed. The possibilities of clinical use of regulatory T cells (including modified regulatory T cells) in the prevention and treatment of these complications are described in detail.

With the increase in the population of patients with transplanted organs, the risk of developing oncological diseases has become proportionally high, which may be the cause of poor quality of life, and also of a high mortality among the patients with transplanted organs. The review examines the risk factors, incidence, and the impact of malignant neoplasms on the survival in patients with transplanted organs. The rapid development of clinical transplantology, the use of new drugs and immunosuppression regimens poses new challenges for oncologists and transplantologists. The analysis of oncopathology incidence in patients with transplanted organs allows us to conclude about its impact on the long-term life prognosis and the need to include preventive measures in transplantation practice.

Allogeneic hematopoietic stem cells transplantation is one of the effective methods of treating patients with diseases of the blood system.

Establishment of complete (100%) donor chimerism is among of the main indicators of successful transplantation in such cases. Monitoring chimerism makes it possible both to assess the graft acceptance, and also potentially predict the risk of developing primary/secondary graft failure, relapse, and graft-versus-host disease.

The purpose of this review is to summarize the main concepts associated with chimerism after allogeneic hematopoietic stem cell transplantation; consideration of the need to study chimerism in various cell populations, as well as the relationship between chimerism and the development of various immunological complications.

On the eve of the anniversaries of two historical events: the 145th anniversary of the experiments in which Eck's fistula was performed and the 55th anniversary of the successful clinical approbation of the selective distal splenorenal anastomosis, a retrospective analysis of the key historical stages in the development of portal hypertension surgery was performed: from the first attempts to describe the anatomy of the hepatic vascular system, explaining its purpose in the body, the development of direct portacaval anastomosis, and the widespread use of selective splenorenal anastomoses, to the Transjugular Intrahepatic Portosystemic Shunt procedure and orthotopic liver transplantation. Meantime, the emphasis has been focused on the most colorful characters of researchers and clinicians who passed this path. The expediency of an integrated approach in solving the problems of portal hypertension with the development of both fundamental and applied clinical and organizational aspects has been substantiated. It is shown that the discoveries born from summarizing the results achieved by numerous researchers have contributed to a better understanding of this field of medicine, have become a solid foundation for what we have today and are a reliable platform for a successful start into the future.

With the involvement of archival documents, the results of research performed by V.P. Demikhov and the employees of the Organ Transplantation Laboratory at the N.V. Sklifosovsky Research Institute for Emergency Medicine (further – Institute) in 1969–1970 have been analyzed. At that time, under V.P. Demikhov's guidance and his personal participation, the Laboratory carried out the following developments: (1) an anatomical method of heart and lung transplantation in experiment and on human cadavers; (2) a method of revitalizing the heart and the whole human body using direct cardiac massage and a portable mechanical heart connected to auricles; (3) the method of liver transplantation in experiment and its anatomical rationale for clinical implementation in liver failure; (4) a method for assessing the function of a transplanted heart using electrocardiography; (5) the method of transplantation of the small intestine fragments; (6) a method of transplanting the pancreas, isolated or in combination with the duodenum and liver, to the renal vessels; (7) a method of replanting the cardiopulmonary complex on peripheral vessels for the treatment of terminal cardiopulmonary insufficiency, and a number of others. For experimental studies, the methods of an anatomical X-ray investigation of the main vessels and X-ray vasography of a transplanted heart were used. For heart transplantation, V.P. Demikhov's anatomical technique and biatrial Lower-Shumway technique were applied. To conduct a series of studies, V.P. Demikhov managed to attract large third-party organizations: the Krasnoyarsk Research Institute of Physics of the Siberian Branch of the USSR Academy of Sciences (creation of a mechanical heart), the Pyatigorsk Machine-Building Plant (creation of a portable thermostat to preserve revitalized organs), Central Research Institute of Tuberculosis of the Ministry of Health of the USSR (development of a method for implanting a cardiopulmonary complex to peripheral vessels), Research Institute of Poliomyelitis (operations on monkeys). We emphasize that all methods developed were recommended by the author for their implementation in clinic. A list of operations performed in the organ transplant laboratory in 1969–1970 is given. Most of the operations performed were transplantations (implanting) of the cardiopulmonary complex, isolated heart, and cadaveric heart revitalizations. It was noted that, in addition to the Research Topics included in the Working Plan of the Institute, V.P. Demikhov developed many individual, search topics, including transplantation of halves of the body, head, liver, uterus, kidney, and sternum. All of them, after their completion, were planned for implementation in the clinic.