Introduction. Transplantation is an effective method of treating patients with end stage liver diseases. Long-term results are determined by two main factors: the development of immunological complications and calcineurin inhibitor nephrotoxity. Application of mesenchymal stem cells (MSCs), which modulate the immune response, is a promising effective method to optimize the treatment results in patients after liver transplantation.

The objective of the study was to evaluate the long-term results of mesenchymal stem cells application in liver transplantation.

Material and methods. A retrospective study was performed, which included 186 patients after liver transplantation (2015–2023). The MSC group (n=93) received MSCs according to four protocols: local, systemic, combined administration, therapy for acute kidney injury; the control group (n=93) received the standard treatment. The median follow-up was 3 (2;5) years, the follow-up period being from 1-8 years. The patient survival, graft and renal function, depth of immunosuppressive therapy, anti-HLA antibody levels, and lymphocyte immunophenotype were assessed.

Results. In the MSC group the incidence of immunological dysfunction of the liver allograft was decreased (22% versus 40%, p<0.05), the development of stage 3 chronic kidney disease (23.4% versus 68.2%, p<0.05) and formation of anti-HLA antibodies (5% versus 20%, p<0.05) were reduced. The use of MSCs made it possible to reduce the Tacrolimus doses (4.15 vs. 5.2 ng/mL, p=0.001) without increasing the risk of rejection. Eight-year survival in MSC group was 87.7% versus 82.9% in the control group. Specific to immunological tolerance changes in the immunophenotype were identified.

Conclusion. Using MSCs in liver transplantation improves long-term outcomes by reducing the incidence of immunological complications, preserves the renal function, and reduces the need for high-dose immunosuppression.

Introduction. Simultaneous kidney and pancreatic transplantation (SKPT) is the most effective surgical method for the treatment of patients suffering from type 1 diabetes mellitus complicated by stage 5 chronic kidney disease. Given the high traumatic nature and duration of this surgery, it is necessary to achieve an optimal depth of anesthesia, a sufficient level of anesthetizing with minimal negative pharmacological effects of drugs on grafts. This study aimed at investigating the efficacy of anesthetic management when using combined general anesthesia with or without an epidural component in SKPT.

Objective. To compare the efficacy of providing anesthesia when using combined general anesthesia with an epidural component and without an epidural component in SKPT recipients.

Material and methods. A retrospective study was performed with the prospective control of 85 recipients who underwent SKPT at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01/01/2008 to 12/31/2024. There were 52 men (61%) and 33 women (39%) among them, the median age was 35 (31;39) full years. The patients were divided into two groups: group I included patients who underwent surgery under general combined anesthesia with an epidural component of anesthetizing, group II included patients who underwent surgery under general combined anesthesia without an epidural component of anesthesia. Intraoperative hemodynamic parameters, acid-base state parameters and electrolytes at the main stages of surgery were analyzed; intraoperative consumption of basic anesthetic drugs, the frequency of extubation of patients in the operating room after surgery, the frequency of postoperative nausea and/or vomiting at the end of surgery were compared between the groups; recovery time was analyzed.

Results. In group I, there was a statistically significant decrease in the total amount of all major anesthetic drugs compared with group II (p<0.001). The rate of patient extubations in the operating room was 37.5%, making 72.2% in group I and being statistically significantly higher compared to 34.7% in group II (p<0.001). The total intraoperative volume of diuresis in patients of group I was 1.5 times higher than in group II, the difference being statistically significant (300 (175;500) ml versus 200 (100;300) ml, respectively) (p=0.029); the median time of intestinal motility recovery in the intensive care unit in group I was 22 (18;26) hours, which was 1.3 times shorter than 29 (26;34) hours in group II (p<0.001).

Conclusion. The use of the epidural component of anesthesia as part of general multicomponent anesthesia for SKPT can significantly reduce the amount anesthetic drugs to be administered. Intraoperative diuresis and the rate of operating room patient extubations after surgery increase statistically significantly, and the time of intestinal motility recovery in the early postoperative period is reduced.

Background. Some of the most common complications following kidney transplantation are urological complications. According to the literature, local tissue ischemia plays a crucial role in their development. Numerous studies have confirmed the effectiveness and safety of fluorescence imaging with indocyanine green (ICG) for assessing organ perfusion. However, this technique has not yet been widely integrated into kidney transplantation practice.

Objective. Improving kidney transplantation outcomes through the implementation of a fluorescent ureteral angiography protocol with ICG for the prevention of urological complications.

Material and method. This retrospective study analyzed the treatment outcomes in 294 kidney transplant recipients. Group I included 233 patients who underwent transplantation between 2018 and 2021. Neoureterocystoanastomosis was performed in all cases using Barry’s extravesical anti-reflux technique. The incidence and risk factors for urological complications were assessed. Based on these findings, a fluorescence-guided approach to forming the Neoureterocystoanastomosis was developed and implemented into clinical practice. If fluorescence imaging confirmed satisfactory ureteral perfusion, the anastomosis was performed using the standard method. If fluorescence findings were unfavourable, an excessive ureteral length was resected within the well-perfused zone, and a non-tunneled anastomosis was performed. Group II included 61 kidney transplant recipients operated on between 2022 and 2023, who underwent transplantation using this fluorescence-guided method.

Results. The incidence of urological complications in Group I was 12.0% (28/233). No significant correlation was identified between complications and potential risk factors. In seven cases in Group II, unfavourable fluorescence findings required extended ureteral resection and non-tunneled anastomosis. A comparative analysis demonstrated that the use of fluorescence angiography reduced the risk of urological complications three-fold (12% vs. 3.3%, p=0.045).

Conclusions. Fluorescence angiography of the transplanted kidneу ureter is a safe and effective imaging technique that contributes to preventing urological complications. This approach ensures anastomosis formation within well-perfused tissues, reducing postoperative risks and improving transplant outcomes.

Background. Platelet-rich plasma (PRP) can be used in the treatment of knee joint defects, including relief of complications in the early postoperative period after arthroscopic repair of the anterior cruciate ligament. Low-pulse laser radiation (LPLR) with wavelength 635 nm stimulates the platelet activity in PRP and increases their realization of reparative potential.

Objective. To evaluate the clinical effect of injectable autologous platelet preparations in patients in the early postoperative period after arthroscopic repair of the anterior cruciate ligament.

Material and methods. The study included 45 patients, who underwent arthroscopic prosthetics of the anterior cruciate ligament or its fixation to the place of attachment. The patients were divided into 3 groups: in the 1st group (15 people) the operation was performed without using platelet preparations (the comparison group); in the 2nd group (15 people), non-activated autologous PRP was intraoperatively administered; in the 3rd group (15 people), LPLR-activated autologous PRP was intraoperatively administered. The PRP was exposed to LPLR with wavelength 635 nm and power 2 W for 10 minutes. Two ml of the autologous platelet-rich preparation were injected intra-articularly; additionally 1 ml of the same preparation was applied in a fan-like pattern to the surrounding soft tissues.

Results. After surgery patients in comparison group had moderate acute pain syndrome, while patients in main groups did not complain about severe pain in the area of surgery. The use of autologous PRP-preparations significantly reduced pain assessments by Visual Analogue Scale by 1.5 times in the 2nd group and 3 times in the 3rd group, comparing to patients without PRP treatment (p<0.001). The administration of analgesics was required in 14 patients of the 1st group, 4 patients of the 2nd group, and 2 patients of the 3rd group. The formation of edema and intra-articular hematoma at surgical site in the 2nd and 3rd groups was less pronounced than in the 1st group.

Conclusions. Intra- and periarticular administration of non-activated and LPLR-activated PRP allowed to reduce pain and the incidence of hemarthrosis after knee surgery. The use of LPLR-activated PRP demonstrates more pronounced anti-inflammatory and hemostatic effects comparing to non-activated PRP.

Background. Dilated cardiomyopathy (DCM) accounts for more than 50% of all forms of cardiomyopathy and is one of the main causes of chronic heart failure, heart transplantation and the development of life-threatening arrhythmias.

Some patients with DCM who do not have rhythm disturbances at rest remain at risk for their development during physical exertion.

Objective. To study the structure of rhythm disturbances in patients with DCM with indications for heart transplantation and to identify predictors of the occurrence of ventricular extrasystoles (VEs) according to cardiopulmonary exercise testing (CPET).

Material and methods. The study included 82 male patients with DCM who were on the waiting list for heart transplant and admitted for examination and conservative treatment aimed at compensating for heart failure. Their mean age was 45 (37;54.2) years old. All patients underwent clinical and instrumental examinations, as well as CPET with the analysis of peak oxygen consumption, anaerobic threshold level, minute ventilation volume, ventilatory equivalent for carbon dioxide, oxygen pulse, threshold load power (W), and load duration.

Results. CPET conducted at baseline to patients with DCM demonstrated the presence of rhythm disturbances in the form of atrial fibrillation, VEs, and left bundle branch block in 63.4%. Newly occurring rhythm disturbances in the form of single and paired VEs were recorded in 19.5% of cases. The logistic regression analysis of echocardiography data showed that the linear size of the right atrium, the indexed parameters of the left ventricular end-systolic and enddiastolic volumes were directly correlated to VEs occurrence during CPET: OR 2.41 (95% CI [1.85–5.82], p=0.01), OR 2.26 (95% CI [1.34–7.51], p=0.03), OR 1.84 (95% CI [1.09–5.42], p=0.02), respectively.) Oxygen pulse was inversely related to VE occurrence during CPET, OR 0.52 (95% CI [0.11–0.76], p=0.02).

Conclusion. The patients with DCM having indications for heart transplantation are characterized as a group of a potential risk for developing VEs during physical exertion. During CPET, newly identified single and paired VEs were registered in 19.5% of cases. The linear size of the right atrium, the indexed parameters of the end-systolic and enddiastolic volumes of the left ventricle in patients with DCM are directly related to VE occurrence during CPET. The oxygen pulse parameter is inversely related to VE occurrence during CPET.

Background. An abrupt increase in the length of the rehabilitation period for acute poisoning (AP) is usually associated with concurrent pneumonia. In AP with psychopharmacological agents (pPPAs) we found a decreased tendency of platelets to spontaneous activation and hyperactivation, the pathology course being more favorable course against the background of vibroacoustic therapy (VAT). However, there are no detailed clinical and laboratory studies of VAT in various APs.

The objective was to improve the efficacy of patient treatment for acute respiratory viral infection in a toxicological hospital by including VAT in the complex of therapeutic measures.

Material and methods. Thirty two patients with pPPAs, with neurotoxicants (pNTs) and corrosive substances (pCSs) complicated by pneumonia were studied. The main group consisted of 19 patients in whom VAT was used (2–9 daily sessions of 5 minutes each); and 13 who received only the basic therapy made the comparison group. Hemorheology parameters, morphofunctional status of erythrocytes and platelets, as well as endotoxicosis were assessed in the blood of all patients before VAT initiation and 1–2 days after VAT completion.

Results. In the main group, VAT made a moderate positive effect on hemorheology: a decrease in the initially increased (relative to normal) aggregation of red blood cells in motion (by 1.2 times) and an increase in the initially reduced (relative to normal) blood viscosity at shear rates of 2.5 s-1 and 62.8 s-1 (by 1.15 and 1.1 times, respectively); the impedance aggregometry revealed a statistically significant (p<0.05) 1.5-fold increase in platelet aggregation; their count increased (1.1-fold). At the same time, a statistically significant decrease (by 1.3 times) in the count of platelets with damaged membranes (p=0.03) and the elimination of the platelet tendency to spontaneous activation (p=0.04) were revealed. Among the standard indicators of endotoxicosis, there was a decrease in the leukocyte intoxication index (1.3 times) and blood leukocyte count (1.2 times). The VAT effect on the endotoxicosis severity was the greatest when assessed in terms of toxemia cellular component parameters: a statistically significant (p<0.05) decrease in the relative number of dead leukocytes (1.4 times) with the stabilization of their absolute count and an increase in the blood content of CD14+HLA-Dr+-monocytes (1.3 times). The VAT use significantly improved the AP course: in general, the length of pneumonia period decreased statistically significantly (p<0.05) (by 1.7 times) and the treatment duration was shortened (by 1.6 times); the length pneumonia period also decreased for PPPAs (by 1.2 times), and statistically significantly (p<0.05) decreased for PNTs (by 1.9 times); the treatment duration was reduced by 1.3 and 1.4 times, respectively.

Conclusion. An evidently increased efficacy of rehabilitation treatment with VAT has been demonstrated. Further enhancement of VAT capabilities is expected through optimizing the VAT regimen and combining it with other treatment methods. It is important to study the morphofunctional properties of platelets along with the determination of their aggregation activity.

Background. Surgical site infections (SSIs) following solid organ transplantation pose grave risks, including the potential loss of the transplanted organ and mortality of the recipient. The management of these infections is highly intricate and necessitates ongoing research and the refinement of treatment protocols to enhance outcomes.

The objective of this study is to illustrate a successful treatment approach for retroperitoneal infection in the surgical area following combined kidney and pancreas transplantation, with a particular focus on the region where the pancreas graft is located.

Material and methods. A 31-year-old female recipient of a kidney and pancreas transplant was diagnosed with type 1 diabetes mellitus, complicated by diabetic nephropathy, which had progressed to a terminal stage of chronic kidney disease. The clinical case was described using data from the recipient's medical history, observation card, and organ passport, along with the results of general clinical and instrumental investigations.

Results. The clinical picture of the course of bacterial infection of the retroperitoneal space in the area of pancreas graft location and its successful treatment in a recipient after simultaneous pancreas and kidney transplantation is presented. Due to the choice of optimal treatment tactics, it was possible not only to avoid the development of sepsis, but also to preserve the function of both grafts.

Conclusion. The development of SSIs in the form of retroperitoneal infection in a recipient without primary infection of the pancreas graft, in the context of adequate surgical intervention, in conjunction with etiotropic antimicrobial therapy and a reduction in immunosuppression, is a condition that can be effectively treated, resulting in a positive outcome for the recipient.

Background.Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is critical in the life support of patients with severe cardiovascular insufficiency, especially when traditional methods are not effective enough. There is no data on the full peripheral ECMO application during air transportation of patients with terminal heart failure in the Russian literature.

Objective.To demonstrate the features of air medical transportation of a patient with terminal heart failure using VA-ECMO.

Material and methods. Patient I., 41 years old with congenital heart disease (bicuspid aortic valve), aortic stenosis, acute heart failure with a left ventricular ejection fraction (LVEF) of 3% after the valve replacement operation. He underwent a surgery to replace the aortic valve with a mechanical prosthesis combined with aortic root reconstruction, which required VA-ECMO connection during the surgery and further medical evacuation by specialized flight IL-76 from Kaliningrad to Moscow for heart transplantation.

Results. During the evacuation, the patient's condition remained extremely severe, but could be corrected by a team of intensive care specialists. In transportation, the following interventions were performed: full peripheral VA-ECMO with a blood flow of 6.6-6.81 L/min and an oxygen flow of 3 L/min, mechanical lung ventilation (MLV) 20 (FiO₂ of 0.4; PEEP 6; Ps 20; respiratory rate of 14/min; respiratory volume 540 ml, respiratory minute volume 7.8 L/min), druginduced depression of the central nervous system, temporary electrocardiostimulation, fluid and antibacterial therapy, vasopressor support with titration of inotropic drug infusion rate, monitoring of vital functions. The patient tolerated transportation satisfactorily and was transferred to the Intensive Care Unit of the Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs in a stable severe condition for assessing the chances of heart transplantation.

Conclusions. The present clinical case confirms that air evacuation using ECMO is a promising strategy for patients with end-stage heart failure. The success depends on the arrangement of medical evacuation, pre–transport treatment, the medical staff qualifications and skills of working with mobile life support equipment. The use of air ambulance and mobile ECMO teams, especially in remote regions, can be a step towards creating a nationwide system of emergency medical care for patients with critical life support disorders.

Background. Living related donor (LRD) kidney transplantation is the most effective strategy of renal replacement therapy for patients with stage 5 chronic kidney disease. LRD organs are used due to the shortage of organs from deceased donors. One of the key problems still remained is the anesthetic management of laparoscopic donor nephrectomy (LDNE) and its impact on the graft condition.

Objective. Analysis and generalization of the results obtained in the studies of anesthetic management of LDNE and its impact on the graft condition.

Material and methods. The literature search was performed in the PubMed, eLibrary, The Cochrane Library, MedLine, EMBASE databases using the search queries: "laparoscopic donor nephrectomy", "nephrectomy", "anesthesia for donor nephrectomy and kidney transplantation", "renal graft condition during anesthesia", which made it possible to find and analyze 445 works published in foreign and Russian journals from 2020 to 2025. As a result of the selection, 51 publications were included in the review, including 10 randomized clinical trials, 1 experimental study, 16 observational studies, 2 meta-analyses, 10 systematic reviews, 1 single-center retrospective controlled study, 5 single-center prospective controlled studies, 4 clinical guidelines, 2 clinical case reports.

Conclusion. In the world literature over the recent five years, we have hardly found a large number of reports covering the issue of perioperative anesthetic management of LDNE. The available data indicate that general, combined and regional anesthesia are of interest and can be effectively used in LDNE.

Introduction. Erectile dysfunction (ED) and associated reproductive disorders (RD) are a significant medical and social problem, especially in patients with chronic kidney disease (CKD). In this category of patients, the frequency of erectile and reproductive disorders is significantly higher than in the general population, which negatively affects their quality of life and psychoemotional state.

Objective. The purpose of this review is to systematize current data on the prevalence, pathogenetic mechanisms and consequences of ED in patients with CKD and in kidney transplant recipients, as well as to analyze the effect of kidney transplantation (KT) on the restoration of sexual and reproductive function.

Material and methods. The review includes homeland and foreign studies mostly published in the recent 5 years, which have devoted to the assessment of erectile function in patients with CKD and after KT. Particular attention is paid to the use of standardized assessment methods, such as the International Index of Erectile Function (IIEF-5), as well as the analysis of data on hormonal background, psychoemotional and social aspects.

Conclusion. ED is a common complication of CKD caused by vascular, hormonal and psychoemotional factors. Effective treatment requires an interdisciplinary approach taking into account the somatic and psychological state of the patient. KT improves sexual function, but in some patients ED persists due to immunosuppression and concomitant diseases. Further research is needed to optimize diagnostics, therapy and improve the quality of life of such patients.