Introduction. Heart transplantation is an effective way of treating patients with end-stage heart failure. Echocardiography allows for the assessment of the transplanted heart functions at all stages of follow-up. The clinical implementation of myocardial deformation imaging by the speckle tracking echocardiography has made it possible to detect subtle changes in myocardial contractility.

Objective. To study the structural and functional state of myocardium in recipients in the long term after orthotopic heart transplantation.

Material and methods. The study included 13 orthotopic heart transplant recipients (11 men and 2 women) at a mean age of 54.1±9.1 years who underwent orthotopic heart transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The mean follow-up period after orthotopic heart transplantation was 6±0.7 years. All patients underwent transthoracic echocardiography according to the standard protocol, including determination of left ventricular myocardial deformation.

Results. The median volume of the left atrium was 60 (53;76) ml, the left ventricular end-diastolic volume was 76 (70;90) ml, and the end-systolic volume was 30 (24;36) ml. The median ejection fraction of the left ventricle in the studied sample was 64 (57;66)%. The median interventricular septum thickness was 12 (11;13) mm, the left ventricular posterior wall thickness was 9 (8;10) mm. At the same time, the left ventricular myocardial mass and the left ventricular myocardial mass index were within the normal range and amounted to 140 (121;155) g and 65 (58;76) g/m², respectively. The right heart chambers were not dilated, as the volume of the right atrium was 41 (40;56) ml, and the right ventricular enddiastolic dimension was 32 (30;33) mm. The right ventricular systolic function was unimpaired: the tricuspid annular plane systolic excursion was 18 (17;19) mm, and the right ventricular fractional area change was 46 (37.5;47.0)%. The calculated systolic pulmonary artery pressure was within the normal range 24 (21;28) mm Hg. The measurements of left ventricle global longitudinal and circumferential strains were -19.6 (-18.6;-21.2)% and -30.9 (-28.8;-32.0) %, respectively. Patients in the study sample showed a decrease in the left ventricular global function index to 25 (24.2;29.6)%. The diastolic dysfunction of a restrictive type was present in 10 patients (76.9%).

Conclusions. In the long-term period after heart transplantation, the recipients were found to have a low left ventricular ejection fraction and a diastolic dysfunction of the restrictive type. Considering the normal values of left ventricular myocardial strains, we can assume that after 6 years post-orthotopic heart transplantation, the recipients have restored the heart adaptive functions, and a favorable outcome has been achieved. However, long-term monitoring is required.

Introduction. Impaired liver transplant function in the long term often leads to graft loss and the recipient death. There are many causes for the development of a late liver allograft dysfunction and different types of its clinical presentation, but there is no generally accepted definition. This hinders its timely diagnosis, analysis of its prevalence, and also makes it difficult to compare the performance of transplantation programs.

Objective. To determine the clinical and prognostic value of late liver allograft dysfunction.

Material and methods. The study included 103 cases of cadaveric liver transplantation from donors diagnosed with brain death to 100 recipients, of whom 36% were men, aged 48 years old (40;56) (18–68) at the time of transplant, having MELD score 17 (14;21) (7–41). The follow-up period was 52 months (20;77) (8–180). The cases where the graft loss occurred earlier than 3 months were excluded.

The late liver allograft dysfunction was defined as a dysfunction of the transplanted liver, which was manifested by at least one of three following signs and occurred at more than 3 months after transplantation: 1) increased aspartate aminotransferase, alanine aminotransferase and/or gamma glutamyl transferase, alkaline phosphatase, bilirubin; 2) impaired synthetic function (increased international normalized ratio, decreased antithrombin III, cholinesterase); 3) liver cirrhosis complications (signs of portal hypertension, ascites, encephalopathy). The following limits were chosen as a diagnostic threshold for laboratory parameter abnormalities: more than 2 upper limits of normal for total bilirubin, more than 1.5 upper limits of normal for the levels of alanine or aspartic aminotransferases, more than 1.5 upper limits of normal for gamma-glutamyltransferase or alkaline phosphatase, more than 1.6 of normal for international normalized ratio.

Results. Late liver allograft dysfunction was diagnosed at least once in 64% of recipients. Through the postoperative course, the proportion of patients with late dysfunction varied from 22% to 40%.  The etiology of late liver allograft dysfunction was viral (38%), unknown (25%), biliary (19%), immune (17%), and vascular (1%). Late liver allograft dysfunction was reversible in 75% of cases, persistent in 17%, progressive in 8% of cases. Progressive late liver allograft dysfunction led to a graft loss in all cases observed.

Recipients with late liver allograft dysfunction were found to have had a 33% higher incidence of early allograft dysfunction (OR 4.7, 95% CI [1.8–12.3]); the incidence of biliary dysfunction was 3.1 times higher with distant choledochojejunostomy (OR 3.9, 95% CI [1.1–13.9]); in patients with autoimmune and cholestatic disease, the incidence of immune dysfunction was 4.8 times higher (OR 5.8, 95% CI [1.7–20.3]).

Conclusion. The progressive nature of late liver allograft dysfunction negatively affects the results of transplantation and therefore should be considered as an indication for retransplantation. Reversible and persistent variants of late liver allograft dysfunction have favorable) prognosis. If the etiology of late dysfunction is not established, the regular surveillance with monitoring for fibrosis and repeated attempts to clarify the diagnosis should be continued.

Background. Аnesthesia for carotid endarterectomy can be used as a combined endotracheal anesthesia, regional anesthesia, and also a combination of combined endotracheal anesthesia with regional anesthesia. Studies have shown that the combination of endotracheal anesthesia with regional anesthesia significantly reduces the need for analgesics after surgery, and the use of levobupivacaine as a local anesthetic reduces the incidence of adverse events.

Aim. To compare the advantages and disadvantages of the combined anesthesia (the combination of endotracheal with regional anesthesia) and the regional anesthesia with sedation using levobupivacaine.

Material and methods. In a prospective single-center study, patients were allocated into 2 groups. In group 1 (n=40), a general anesthesia was performed using desflurane in combination with the regional anesthesia of the superficial cervical plexus. In group 2 (n=40), a blockade of the superficial cervical plexus and deep cervical plexus was achieved. Levobupivacaine was used as a local anesthetic in both groups.

Results. The study showed a significantly (p<0.05) greater number of intraoperative hypertension (BPsys more than 170 mm Hg) episodes in patients of group 1 making 10(25%) versus 4(10%) in group 2, and the presence of hypotension defined as blood pressure less than 90 mm Hg in 5 (12.5 %) patients of group 1 during surgery. In addition, tachycardia (heart rate more than 90 beats per minute) was significantly (p <0.05) more often recorded in group 1: in 8 patients (20%) versus 4 (10%) in group 2. In both groups 1 and 2, adverse events were noted: pain in the intervention area in 4 (10%) patients of group 2, positional discomfort in 3 (7.5%) patients of group 2, sensation of shortness of breath and anxiety in 1 (2.5%) patient of group 2, postoperative nausea in 3 (7.5%) patients of group 1, and postoperative vomiting in 2 (5%) patients of group 1. The time spent in the operating room was significantly longer (p<0.05) in group 1 than in group 2: 110±15 minutes versus 75±12, respectively.

Conclusion. Regional anesthesia reduces the patient's time in the operating room, but the presence of "operating room effect" reduces patient satisfaction compared to general anesthesia in combination with regional anesthesia. Levobupivacaine is effective and safe for both the isolated regional anesthesia and as a component of the combined endotracheal anesthesia for carotid endarterectomy.

Background. Pulmonary edema is a common complication in critically ill patients. The liberal tactics of fluid therapy and pathological accumulation of extravascular lung water increase the risks of mortality in Intensive Care Unit patients. Timely and non-invasive diagnosis of pulmonary edema is a primary goal in the intensive care of patients in the Critical Care Unit. We prefer to use lung ultrasound with the registration of B-lines to diagnose lung edema. However, in our country, this method is not validated due to the lack of a sufficient number of clinical studies and necessary regulatory framework.

Objective. To assess the potential of diagnostic ultrasonography for pulmonary edema in critically ill patients.

Material and methods. A retrospective study was conducted on 27 patients, including 15 males and 12 females aged from 43 to 67 years old (mean age 45.05±17.2 years). All patients were in critical condition due either to acute liver failure, or acute-on-chronic liver failure, or early post-transplant liver graft failure, or posthepatectomy liver failure. Some patients had a systemic inflammatory response syndrome with the development of multiple organ failure and clinical signs of redistribution shock. All patients underwent ultrasound examination of the lungs, and had hemodynamic parameters measured using the transpulmonary thermodilution technique. The data obtained by the two diagnostic modalities were compared.

Results. A significant correlation (p<0.05) was found between the extravascular lung water index and the presence of lung edema. We identified a significant correlation (p<0.05) between the number of B-lines and the presence of pulmonary edema. In assessing the relationship between the "B-line" parameter and the "EVLWI" parameter, a strong positive correlation was identified. The area under the ROC curve (AUC) was 0.9±0.06 with a 95% CI [0.77–1.00].

Conclusions. Ultrasound data in diagnosing pulmonary edema have a significant correlation with the level of extravascular pulmonary water. Lung ultrasound is an accurate, non-invasive method for assessing extravascular lung water. It can be used for the rapid and accurate diagnosis of pulmonary edema.

Introduction. Histoplasmosis is not an endemic form of fungal infection in Russia; its sporadic cases are mainly associated with the import of the fungus from endemic countries. We consider it necessary to demonstrate a rare case of the disseminated histoplasmosis development in a kidney transplant recipient.

Objective. Demonstration of a case of the disseminated histoplasmosis development in a kidney transplant recipient.

Results. The clinical manifestations of the disease were described; the affected organs were macroscopically and histologically studied, which made it possible to diagnose disseminated histoplasmosis.

Conclusions. This case prompts being on alert to potential occurrence of fungal infections, including non-endemic ones, in patients receiving immunosuppressive therapy.

Background. Simultaneous pancreas and kidney transplantation is a gold standard in the treatment of diabetes mellitus complicated by stage 5 chronic kidney disease as a result of diabetic nephropathy. One of the main problems of clinical pancreas transplantation is the pancreas graft exocrine drainage. In order to preserve the advantages of the retroperitoneal graft location and avoid the main disadvantage of duodenal drainage, namely, fatal complications potentially arising in case of necessary graft removal, we have proposed a modified method of retroperitoneal pancreatic transplantation with exocrine drainage via a modified Roux-en-Y duodenojejunostomy. It reduces the number of severe surgical complications and increases the recipient survival rate. When this method was used in previous years, it was not possible to assess the condition of donor duodenum mucosa and interintestinal anastomoses.

Objective. To demonstrate the possibility of endoscopic assessment of interintestinal anastomoses when performing retroperitoneal pancreas transplantation with small intestine drainage of exocrine secretions.

Results. The article presents the initial experience of endoscopic assessment of the interintestinal anastomoses and the mucous membrane of the donor duodenum after retroperitoneal pancreas transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy.

Conclusion. The presented case demonstrates the feasibility of diagnostic endoscopic interventions when performing retroperitoneal pancreas transplantation with small intestine drainage of pancreatic secretions.

Introduction. In conditions of the Emergency Cardiology Department, a timely and differential diagnosis of myocardial pathology is especially important in the absence of visible focal changes and significant coronary artery stenosis. This group of patients includes recipients of a transplanted heart, when it is difficult to count on the high sensitivity of perfusion images alone. This can be explained by the diffuse, balanced distribution of ischemia.

Objective. To present the possibilities of perfusion myocardial single photon emission computed tomography synchronized with electrocardiography for a detailed assessment of the functional condition of both ventricles of the transplanted heart

Material and methods. We have presented three clinical case reports of the patients with different pathology of the transplanted heart who referred themselves to the emergency cardiology clinic and underwent electrocardiographysynchronized perfusion myocardial single photon emission computed tomography for diagnostic purposes.

Results. In all the cases presented, the radionuclide study influenced making the diagnosis and changing the treatment tactics. In the first case, it was possible to identify focal myocardial changes, for which coronary angiography and percutaneous coronary intervention with thromboextraction were immediately performed. In the second case, the image analysis reflecting the function of the myocardium (polar maps of wall movement and systolic thickening) allowed us to note a low efficacy of treatment for the transplanted heart rejection. In the third clinical case, the initial single photon emission computed tomography suggested the inflammatory nature of changes in the myocardium, which was verified by the results of endomyocardial biopsy.

Conclusion. In the presented clinical cases, the urgently performed electrocardiography-synchronized perfusion myocardial single photon emission computed tomography made it possible to perform invasive interventions in time and thereby contribute to the recovery of the graft functional state and patient's condition improvement.

Background. Living donor liver transplant is an effective method of treatment in patients with different types of endstage liver diseases. Unfortunately, patients undergoing such a complex treatment sometimes develop various vascular complications. Splenic artery steal syndrome has emerged as a cause of graft ischemia in living donor liver transplant recipients and may lead to high liver enzyme levels, cholestasis, hepatic artery thrombosis, and even a graft loss in some severe cases.

Objective. Evaluation of the first results in the experience of our center with a routine intraoperative ligation of the splenic artery during the procedure of right lobe living donor liver transplantation in adult recipients for the prevention of the steal syndrome development in the postoperative period.

Material and methods. Living donor liver transplant recipients with known hepatic arterial flow impairment were retrospectively studied. Patients were allocated into groups with regard whether the splenic artery had been ligated or not during the transplant procedure. Arterial complications were reviewed in both groups.

Results. None of 30 patients with ligated splenic artery developed splenic artery steal syndrome after living donor liver transplant. splenic artery steal syndrome occurred in 60% patients with non-ligated splenic artery. Surgical technique of performing arterial anastomosis was not related to the splenic artery steal syndrome development (p<0.01 There was no local ischemic necrosis noted in the spleen in patients with the ligated splenic artery.

Conclusion. Based on the analysis of our own experience and literature data, the splenic artery ligation appears to be an effective and safe method for preventing a splenic artery steal syndrome in patients following right lobe liver transplantation, with a minimal risk of ischemic complications for the spleen. However, further studies with larger sample sizes are needed to obtain more reliable results. Ultrasound examination and endovascular intervention are the primary tools for an early detection of abnormalities and rapid restoration of arterial blood flow in the hepatic artery of the graft.

Background. Liver transplantation is currently the most effective method to treat diseases with end-stage liver failure. Complications are most often associated with the initially severe patient condition, imperfect organ preservation methods, the surgical management per se, and immune system incompetence. The most common complications of transplantation include ischemic reperfusion injury, which occurs to some or another extent in each transplanted organ and worsens the course of the postoperative period. The process is based on complex pathophysiological mechanisms of cell damage due to ischemia and inflammation caused by reperfusion.

Objective. To summarize current data on the mechanisms of the ischemic reperfusion injury development in liver transplantation and to find the ways to reduce adverse effects.

Material and methods. The analysis of data from foreign and homeland experimental and clinical studies on the pathogenesis of ischemic reperfusion injury in liver transplantation has been performed. The search for literature data was carried out in international databases (PubMed/MedLine, ResearchGate, as well as in the scientific electronic library of Russia (eLibrary.RU) for the period from 2020-2024.

Conclusion. The analyzed publications have provided various algorithms for the preservation of donor organs, including those using machine perfusion.