Background. Kidney transplantation is the most preferable definitive treatment for the end-stage renal disease. Often, patients who need an organ transplantation have peculiar anatomical features that require a non-standard approach to performing this surgery.

Objective. To present a clinical case of orthotopic kidney transplantation in a patient with occlusive thrombosis of the external iliac veins.

Material and methods. A 31-year-old patient with stage 5 chronic kidney disease and occlusive thrombosis of the external iliac veins being prepared for a related donor kidney transplantation.

Results. Orthotopic kidney transplantation was performed. In order to ensure a sufficient length of the donor kidney artery and the convenience of its anastomosis, a segment of the recipient's splenic artery was used. The venous and ureteral segments of the graft were anastomosed end-to-end with the recipient's renal vein and ureter, respectively. After the surgery completion, the graft function was immediate. In the postoperative period, three-component immunosuppressive therapy was used. At the time of discharge, plasma creatinine was 0.15 mmol/L.

Conclusion. Orthotopic kidney transplantation should be considered as an alternative solution in case of obliteration, thrombosis or atherosclerotic lesion of the recipient's iliac vessels. The method can be used in recipients with two or more previous transplants.

Background. Seventh-Day Syndrome following liver transplantation is a rare but serious complication characterized by a sudden deterioration of the graft function after initial normalization, often leading to death. The peak occurrence of this syndrome is in the late first or early second week post-transplant. Currently, there are no established treatment standards for Seventh-Day Syndrome, and its natural course usually results in a graft loss.

Objective. To present a clinical case of Seventh-Day Syndrome after liver transplantation and analyze strategies for early diagnosis and treatment.

Results. A patient who underwent liver transplantation for viral cirrhosis and hepatocellular carcinoma was diagnosed with Seventh-Day Syndrome on the eighth day post-surgery, which was accompanied by acute deterioration in the graft function and the development of fulminant liver failure. Despite a timely diagnosis and immediate treatment, including high doses of methylprednisolone, immunoglobulin administration, and plasmapheresis, the patient's condition persistently worsened, resulting in death on postoperative day 11.

Conclusion. Despite a timely diagnosis and treatment, the prognosis for Seventh-Day Syndrome remains poor, underscoring the need for further research.

Objective. To evaluate the efficacy of mechanical support (extracorporeal membrane oxygenation + intra-aortic balloon pump) in patients with acute myocardial infarction complicated by heart failure.

Results. The timely use of the venoarterial extracorporeal membrane oxygenation system in combination with intraaortic balloon counterpulsation in left ventricular failure in patients with acute myocardial infarction, developing as a result of volume overload is an effective, easily available, cost-effective method actively implemented in clinical practice. A rational use of venoarterial extracorporeal membrane oxygenation + intra-aortic balloon counterpulsation leads to a decrease in the intensive care unit length of stay and decrease in mortality in patients with complicated acute myocardial infarction.

Conclusion. The use of extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation is an easily available and effective method for the prevention and relief of the left ventricular failure developing due to the volume overload in the course of peripheral venoarterial extracorporeal membrane oxygenation in patients with acute myocardial infarction.

Introduction. Resistant ascites after liver transplantation is a relatively rare complication. At the same time, its presence significantly affects the prognosis and quality of life. Early diagnosis and successful treatment of resistant ascites can improve the long-term outcome. However, the aetiology of post-transplant ascites is heterogeneous, and the identification of the aetiological factor and the choice of treatment method in most cases is a significant problem for clinicians.

Objective. To present the review on methods of diagnosis and treatment of resistant ascites in liver recipients in the early posttransplant period.

Material and methods. The authors have reviewed the publications covering the main causes of ascites development after liver transplantation, the efficiency of instrumental diagnostic methods and surgical interventions in liver recipients with resistant ascites. The article has also discussed the authors' own observations of severe clinical cases of posttransplant ascites.

Conclusions. The preoperative status of the patient, the characteristics of the donor organ and the peculiarities of the surgical intervention should be taken into account in diagnosing the post-transplant ascites aetiology. In the absence of obvious predisposing factors, the patient should be evaluated sequentially to exclude vascular, intrahepatic and extrahepatic causes of ascites. The understanding of the main mechanisms of post-transplant ascites development and a consistent patient evaluation may help clinicians in choosing the treatment method.

Background. A surgical site infection caused by bacterial flora of a bacteria-contaminated kidney graft is an exceedingly rare occurrence and is poorly described in the literature. However, such cases entail the risk of resulting in a graft loss and recipient death, and therefore should be attended to by a specialized team of experts.

Objective. This Case Report presents a rare instance of a surgical site infection in a kidney recipient following the transplantation of an unintentionally Klebsiella pneumoniae-infected graft.

Material and methods. The clinical case was a 49-year-old male suffering from stage 5 chronic kidney disease who underwent a kidney transplantation from a cadaveric asystolic donor. The clinical case was described using the results of laboratory tests, instrumental and pathomorphologic investigations obtained from the recipient medical history and observation chart, and the organ donor's passport.

Results. This Case Report has described a clinical presentation of the surgical site infection with K. pneumoniae bacteria in a recipient of the infected kidney graft, and the treatment outcome.

Conclusions. In the event of infection developing in a bacteria-contaminated kidney graft, it is imperative to be suspicious of a deep infection. In the event of progressively developing abscesses, phlegmon in the graft bed and other related localizations, or the course of infection by the type of necrotizing cellulitis/fasciitis with no effect from antibacterial therapy, it is imperative to perform urgent surgical intervention with a wide opening of the foci and removal of the kidney graft as a source of the infectious process. This should be combined with an adequate antibacterial therapy and the withdrawal of immunosuppression.

Background. Despite the advances achieved in transplantation, the problem of septic infection in this field still remains crucial. This can largely be attributed to the immunocompromised status of patients, and the constant growth in the number of resistant strains of pathogens causing septic infection.

The objective of the study was to identify the spectrum of septic infection pathogens and their antibiotic sensitivity in patients of the Liver Transplantation Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine.

Material and methods. The microbiology study results of 2,324 samples obtained from 236 patients who had been treated from 01.01.2023 to 30.06.2024 were analyzed. A total of 879 strains of microorganisms were isolated. In cases when carbapenem-resistant strains were isolated from the blood of patients, the carbapenemase genes were identified using an immunochromatography method.

Results. Among pathogens, Gram–negative rods accounted for 54% of the total number of strains, Gram–positive bacteria accounted for 43%, yeasts of Candida spp. made 3%. Enterobacterales dominated among Gram-negative bacteria. Klebsiella pneumoniae strains were the absolute leader (33.0% of the total number of strains). Non-fermenting rods accounted for 11.3% of the isolated strains. Among the Gram-negative pathogens, the prevailing ones were the strains multidrug-resistant to the main classes of antibacterial drugs used in medical practice. Of all K. pneumoniae strains, the percentage of strains resistant to amikacin, ciprofloxacin, imipenem, and meropenem made 72.4%, 95.5%, 89.3%, and 87.9% respectively. Coagulase-negative staphylococci (18%) and enterococci (19.5%) prevailed among the Gram-positive cocci flora. Vancomycin, linezolid, and daptomycin retained antistaphylococcal effect. In carbapenemresistant K. pneumoniae and E. coli strains isolated from patients' blood, the NDM metallo-beta-lactamases and serine carbapenemases of the OXA-48 group prevailed.

Conclusion. The prevailing pathogens that cause septic infection in patients with surgical diseases of the hepatobiliary zone include K. pneumoniae strains among the Gram-negative microflora, and coagulase-negative staphylococci and enterococci among Gram-positive ones. The study results have confirmed the global trend towards an increase in the number of resistant strains among the pathogens of septic infections.

Background. Patients with deep burns require surgical treatment, but the timing and scope of surgical interventions have not yet been defined.

Objective. To analyze the world experience of surgical treatment of deep burns.

Material and methods. The literature sources on the topic were searched for in the electronic databases: PubMed, Scopus, CrossRef for the period from 1947–2023. The work includes some early basic publications on the surgical treatment of deep burns; the current state of the problem has been analyzed in articles over the past 20 years.

Conclusion. Data from foreign literature sources show that in low-income countries, the efficacy of early necrectomy has not been confirmed, which can be attributed to the lack of burn departments, donor blood, wound dressings. In developed countries of Europe, the USA, Japan, active surgical tactics are currently used and it is a rule to perform necrectomy on the first days of the patient's admission at the hospital. In numerous studies, the authors claim that the results of early necrectomy and skin grafting are better than those with delayed operations, but the data on mortality are ambiguous. The authors point out that high mortality is attributed to the elderly age of patients, a larger area of deep burns and the presence of inhalation injury. At the same time, none of the developed prognostic indices that include the above mentioned predictors of a fatal outcome of burn injury have been used for planning a surgical intervention.

Background. The therapeutic efficacy of skin grafts and various tissue equivalents in the treatment of many diseases is known. Special clinical biobanks are engaged in the procurement of such products, their processing, storage, provision of their safety measures, and preparation for use. The purpose of such biobanks is both the storage of tissues and cells and their subsequent delivery to medical institutions for the clinical use. The production-based biobanks allow the use of biomaterial for the manufacture of drugs and medical devices and are also an important component in the organization of medical care in many countries of the world.

Objectives. To summarize the current concepts on the role of clinical and production-based biobanks in the system of providing medical care to the population in various countries of the world; to present the organizational and legal mechanisms of the tissue banking system using the example of the USA and the EU; to present solutions for creating the first biobanks of viable tissues in the Russian Federation using the example of a skin biobank.

Material and methods. The review includes world literature publications on tissue banks, references to legal acts and documents regulating tissue donation in Russia and other countries, as well as issues of organizing the work of biobanks.

Conclusion. This article introduces an overview of biological banking practices, the main types of grafts and tissue equivalents of skin, the areas of their possible use and the peculiarities of processing and storage technology. The discussion presents an opinions on what types of tissue banks can be created now to meet urgent medical needs, what products can be processed and stored in such banks, and what regulatory framework is required for their creation and operation.