Background. Liver transplantation remains a priority treatment option for hepatocellular carcinoma in the presence of liver cirrhosis; yet precise outcome prediction post-operation continues to be a complex challenge. Existing prognostic model often overlook patient age and donor type. Enhanced models that incorporate these parameters can improve prediction accuracy and treatment efficacy, which is critically important in the dynamically evolving field of transplantation.

Objective. The aim of this study is to develop a prognostic model for liver transplantation outcomes in patients with hepatocellular carcinoma and liver cirrhosis.

Material and methods. This retrospective study included 69 patients with hepatocellular carcinoma on the background of liver cirrhosis who underwent liver transplantation between May 2010 and December 2022. Of these, 42 patients (61%) received organs from living donors, and 27 (39%) from deceased donors. The study involved analysis of alpha-fetoprotein levels in blood, as well as assessment of radiological (maximum tumor nodule size, number of nodules) and histological parameters (maximum tumor nodule size, number of nodules, presence of vascular invasion). Cox regression model was used to predict recurrence-free survival, and the results for five-year recurrence-free survival, recipient age, and donor type were reused in the Cox model to predict overall survival.

Results. Four models for predicting recurrence-free survival and overall survival based on histological and radiological data were developed, demonstrating high prognostic value with C-indexes on training/test data of 0.76/1; 0.73/1; 0.78/0.8; 0.6/0.8 respectively. All models showed recurrence-free survival prediction accuracy comparable to the Milan criteria. The model outcomes are available as a calculator on the website https://nadit.ru/calculate_HCC.

Conclusion. The developed prognostic models are vital tools for personalized outcome prediction after liver transplantation for hepatocellular carcinoma. To enhance the accuracy of these models, further amalgamation and validation of data from various medical centers, as well as open scientific collaboration, are necessary.

Introduction. Pulmonary hypertension is a common complication among patients with end-stage renal disease and has a significant impact on the outcome of kidney transplantation, including during kidney transplantation from a living related donor.

Objective. To study the prevalence of pulmonary hypertension among patients with end-stage renal disease and to determine its impact on the development of early renal graft dysfunction.

Material and methods. The study was based on the analysis of treatment results in 650 patients who underwent kidney transplantation from a living related donor. Depending on the graft function, 2 groups of patients were identified: group I consisting of patients with early renal graft dysfunction (n=82); group II (n=79) that included the patients with a primary graft function who were selected by demographic and clinical laboratory data statistically comparable to patients of group I (p>0.5). This allowed us to equalize the chances of achieving the study endpoint (early graft dysfunction). Transthoracic echocardiography was performed in all patients, with the calculation of the mean pulmonary artery pressure. The relative risk of early renal graft dysfunction was calculated depending on the presence of pulmonary hypertension and its severity.

Results. Among group I patients, pulmonary hypertension was detected in 97.56% of cases (mean pulmonary artery pressure 48.26±18.63 mmHg), versus 86.08% in patients with a primary graft function (mean pulmonary artery pressure 31.92±16.11 mmHg) (p<0.001). The presence of mild pulmonary hypertension increased the relative risk of early graft dysfunction by 2.58 times (95% CI [0.698-9.547]; p=0.174), moderate by 3.18 times (95% CI [0.860-11.764]; p=0.064), severe by 5.91 times (95% CI [1.644-21.241]; p<0.001) compared with patients without pulmonary hypertension.

Conclusions. When performing kidney transplantation from a living donor, the presence of severe pulmonary hypertension in the recipient is associated with an increased risk of early graft dysfunction. This suggests that pulmonary hypertension may be one of the modifiable risk factors for this complication.

Background. Vibroacoustic therapy is used as a non-drug method of correcting respiratory disorders in various diseases, including acute poisoning. The effect of vibroacoustic therapy on blood cells currently remains unexplored.

Objective. To evaluate the impact of vibroacoustic therapy on the morphofunctional rate of erythrocytes and platelets in patients with acute poisoning in patients with acute poisoning.

Material and methods. Thirty eight patients with complicated acute poisoning transferred to the Toxicology Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine were examined. In 19 patients, along with the standard therapy, a vibroacoustic therapy was performed using a VibroLUNG device (the main study group); the other 19 patients received only standard therapy (the comparison group). Vibroacoustic therapy began on the 2nd day after the patient admission to the Toxicology Department. The course of vibroacoustic therapy consisted of 2–9 procedures. Morphofunctional analysis of erythrocytes and platelets in all cases was performed before the start of the vibroacoustic therapy (before treatment) and before discharge from the hospital (1–2 days after completing the vibroacoustic therapy course).

Results. In both groups, before treatment, we noted normal morphofunctional rate of erythrocytes and normal level of platelets with granules in the circulating blood. The level of severely damaged or altered platelets was only slightly higher than normal and did not differ between the groups. Meanwhile, in 50% of patients, platelets had a tendency to spontaneous activation and hyperactivation. Before discharge, the morph functional parameters of erythrocytes and platelets did not significantly change in both groups, while treatment with vibroacoustic therapy allowed to eliminate or reduce spontaneous platelet activation in 7 of 9 patients in the main study group. In the comparison group spontaneous platelet activation was absent in only 3 of 10 patients. In parallel, the time till pneumonia resolution turned statistically significantly reduced, by 1.5 times.

Conclusions. In acute exogenous poisoning with complicated course, the risk of spontaneous platelet activation and hyperactivation increases. Vibroacoustic therapy does not violate the structural integrity of circulating erythrocytes and platelets. Vibroacoustic therapy, using the VibroLUNG device, reduces the tendency of platelets to spontaneous activation and hyperactivation, reduces the time for resolving pneumonia.

Background. The significance of the problem of treatment of acute pancreatitis is due to an increase in the incidence with an increase in the number of necrotizing forms, accompanied by a high incidence of severe complications and high mortality.

Objective. To identify the impact of regionally used extracellular microvesicles of mesenchymal stromal cells on the endogenous intoxication markers in acute necrotizing pancreatitis in the experiment.

Material and methods. Acute pancreatitis was induced by the introduction of a 0.3 ml of 5% solution of non-ionic polyethylene glycol octylphenol ether detergent into the caudal part of the rat pancreas. The study was conducted on 42 adult Wistar rats, which were randomly divided into 4 groups. Group I (n=6) included intact animals, Group II (control group) (n=12) included rats with pancreatitis without treatment, Group III (n=12) consisted of rats with pancreatitis treated with analgesia + infusions of 0.9% sodium chloride solution (saline), Group IV (n=12) included rats with pancreatitis treated with analgesia+ saline infusions + regional application of extracellular microvesicles of mesenchymal stromal cells. Cells were obtained from the bone marrow of healthy animals. Microvesicles were obtained by differential centrifugation under sterile conditions. Microvesicles were administered one day after the pancreatitis induction through the catheter installed into the pathologically altered part of the pancreas. The dose of microvesicles was calculated as equivalent to (derived from) 1 million mesenchymal stromal cells. The hematological parameters, markers of the systemic manifestation of the pathological process (alpha-amylase, aspartate aminotransferase, alanine aminotransferase), the endogenous intoxication markers (lipid peroxidation activity, nitric oxide level), the systemic inflammatory response markers (tumor necrosis factor-alpha, interleukin-6) were studied on the 3rd and 7th day from the start of disease modeling.

Results. Regional use of extracellular microvesicles of mesenchymal stromal cells in the treatment of acute experimental necrotizing pancreatitis at an early stage helped to normalize the level of blood platelets, reduce enzymeemia, elements of endogenous intoxication (interleukin-6, tumor necrosis factor-alpha), and the nitric oxide level.

Conclusion. The early application of extracellular microvesicles of mesenchymal stromal cells in the treatment of acute necrotizing pancreatitis in an experiment has a positive effect on parameters, which are key links of pathogenesis and leading markers of this disease severity.

Background. Current treatment of patients with myocardial infarction is based on the strategy of early invasive coronary intervention in combination with dual antiplatelet therapy - with acetylsalicylic acid and a P2Y12 blocker of platelet adenosine diphosphate receptors. In patients with thrombosis of the infarct-related artery, the phenomenon of “slow/ no reflow” (slowing of blood flow due to distal embolization of the artery), inhibitors of glycoprotein IIb/IIIa platelet receptors are administered as additional disaggregant therapy. In patients undergoing standard antiplatelet therapy in combination with glycoprotein IIb/IIIa inhibitors, there is a risk of hemorrhagic complications, therefore, monitoring of hemostasis parameters is necessary. Currently, there are no standard approaches to monitor the antiplatelet therapy.

Objective. To study the dynamics of hemostatic system parameters in patients with acute myocardial infarction during antiplatelet therapy.

Material and methods. We assessed platelet aggregation with 10 µmol of adenosine phosphate as an inducer in patients with ST-segment elevation myocardial infarction with different options of standard antiplatelet therapy in combination with GPIIb/IIIa inhibitors. Group 1 included 20 patients on dual antiplatelet therapy (clopidogrel 75 mg + acetylsalicylic acid 100 mg) + GPIIb/IIIa inhibitor (tirofiban). Group 2 included 15 patients on dual antiplatelet therapy (ticagrelor 180 mg + acetylsalicylic acid 100 mg) + GPIIb/IIIa inhibitor.

Results. While on antiplatelet therapy the patients in both groups 1 and 2 demonstrated a decrease in platelet aggregation ability under the impact of adenosine phosphate, relative to the norm: 38 (21;43) % and 14 (11;15) %, respectively, the norm being 79 (73;84) % (p<0.05). Meantime, no thrombotic events in the form of stent thrombosis were noted, which indicated antiplatelet therapy efficacy. In an intragroup comparison, the decrease in the platelet aggregation ability was most pronounced in group 2 (p<0.05). By the 7th day of myocardial infarction, the platelet aggregation had continued to decrease to 26 (17;43) % in group 1, to 10 (7;11) % in group 2. The most pronounced effect of antiplatelet therapy was observed in group 2 (p<0.05), which was manifested by a statistically significant decrease in platelet aggregation ability under the impact of 10 µmol of adenosine phosphate.

Conclusions. While studying the hemostasis system changes over time in patients with myocardial infarction receiving antiplatelet therapy, we have found that making the platelet aggregation ability assessment with 10 µmol of adenosine phosphate as an inducer is possible to identify the effect of medications. However, further studies including larger patient groups are needed to determine the target values of platelet aggregation with 10 µmol of adenosine phosphate and assess the therapy efficacy.

Introduction. Urological complications make up a significant percentage in the structure of kidney graft loss and patient death in the early and long-term period after transplantation. The most common urological complication in the long-term period is ureter or anastomotic stricture, which, according to various authors, occurs in 0.9–34%. However, now there is no consensus in the treatment for recurrent strictures.

Case report. We have presented a clinical case of successful treatment for the stricture of the ureterovesical anastomosis after kidney transplant from a brain-dead donor. During the first year after kidney transplantation, after two reconstructive surgeries and repeated placement of plastic stents, the patient was diagnosed with recurrent stricture of the ureterovesical anastomosis, and therefore a coated nitinol ureteral stent was implanted.

Conclusion. This clinical case report demonstrates the feasibility of effectively using a nitinol stent in the treatment of recurrent strictures of the ureterovesical anastomosis after kidney transplantation. In some cases, this technique can be considered as an alternative to repeated surgical interventions. Further studies are needed to determine a more precise treatment algorithm.

Background. The number of heart transplant patients makes 1 per 100,000 in the Russian Federation, 1.2 per 100,000 population in the Tambov Region. The medical community is poorly informed about the specific features of managing such patients during non-cardiac surgical interventions. The article presents a case report of the management of a patient with a transplanted heart undergoing surgery for acute appendicitis. Preoperative preparation, anesthesia management, surgery, and postoperative care and rehabilitation were provided taking into account the presence of a transplanted heart in the patient, according to the Guidelines developed by the experts of the V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs where the heart transplant had been performed to the patient, and standard clinical recommendations.

Case Report. An 18-year-old patient diagnosed with acute phlegmonous appendicitis with a heart transplanted in 2021 for dilated cardiomyopathy underwent laparoscopic appendectomy 3 years after heart transplantation. Anesthesia was provided taking into account the presence of a denervated donor heart, a high risk of myocardial ischemia and heart ailure (low cardiac output syndrome), and the need for a timely correction of hypovolemia and hypotension. Anesthesia
management was a general combined multicomponent anesthesia.

Conclusion. This clinical case has shown the possibility of providing medical care to a patient with a transplanted heart at a modern level in an urban multidisciplinary hospital. Non-cardiac surgery was performed in accordance with recommendations of specialists of V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs and clinical recommendations in order to achieve optimal results and the fastest possible rehabilitation in the postoperative period.

Background. Unexpected transmission of an infectious disease agent with a kidney graft to a recipient is a rare event but it is associated with significant morbidity and mortality, especially when exposed to multidrug-resistant bacteria that have not been eliminated by standard antibiotic prophylaxis.

Objective. To demonstrate the need for immediate removal of a primary infected kidney graft in the event of local purulent complications due to the rapid development of sepsis in immunocompromised patients.

Results. The paper describes a clinical course of the infectious process in two kidney recipients each of whom underwent transplantation of a primary infected graft from a single donor, taking into consideration the transplantectomy timing and the treatment outcomes.

Conclusion. The Case Report shows the need for immediate transplantectomy in a kidney graft recipient when local purulent complications are detected with confirmed primary infection of the graft due to a high risk of the rapid development of sepsis and threat to life.

Introduction. Graft revascularization in deficient arterial blood flow is usually performed by X-ray endovascular stenting procedure and/or by reconstruction of vascular anastomosis. The most serious complication of catheter intervention is a hepatic artery rupture and the critical ischemia of the liver graft.

Objective. To discuss the successful treatment of a hepatic artery rupture which occurred during X-ray endovascular revascularization of the liver graft.

Case report. A 48-year-old female patient with advanced alveococcosis underwent orthotopic cadaveric liver transplantation. After restoring the blood flow, it was found to be of low-velocity with RI 0.4 in the common hepatic artery. The gastrointestinal duodenal and splenic arteries were ligated. On the second day, a relaparotomy was performed because of intraabdominal bleeding originated from the parenchyma of the 7th–8th segments. Bleeding was arrested. After 18 hours, a selective angiography revealed stenosis up to 90% in the native hepatic artery. After balloon predilatation, stenting was performed, which accidentally caused the artery rupture. The further treatment included relaparotomy and reanastomosing. The patient was discharged from hospital on Day 19 after transplantation.

Conclusion. Low velocity blood flow in the hepatic artery did not meet an adequate level even after the ligation of the gastrointestinal duodenal and splenic arteries. We performed the reconstruction of anastomosis. Another possible approach could be a catheter revascularization. The decision should be made considering the specific disorders of regional blood flow, their origin, and the vascular anatomy. The rupture of the artery in the reported case was caused by disproportionate diameters of the stent and vessel.

Introduction. Almost 60 years have passed since the first liver transplant performed by Thomas Starzl. During this time, medical technologies have gradually improved, which has made it possible to use more and more new methods and approaches in this type of medical care. One of the new techniques of recent decades is robotic surgery, which is gradually being introduced into medical practice, including in the field of transplant medicine.

Objective. The purpose of writing this review was to summarize knowledge and describe the current status of development of robotic surgery in the aspect of liver transplantation, namely: liver resection in donors, as well as graft implantation in the recipient.

Material and methods. The review includes foreign and domestic publications on minimally invasive donor liver surgery. Publications on the topic of robotic liver resection in the aspect of liver transplantation were also processed.

Conclusion. Robotic surgery using advanced robotic systems represents the next step in the development of minimally invasive technologies in liver transplantation. Robotic systems provide more precise and dexterous control of instruments, allowing surgeons to perform complex procedures with greater precision and less risk to patients. However, the robotic approach is still very limited in geographical distribution and requires much more experience than laparoscopy. The upcoming introduction of new robotic systems that support haptic feedback or cavitronic ultrasonic surgical aspirators will further promote a widespread adoption of robotic liver resection in liver donors and liver recipients.