Background. The introduction of upper limb allotransplantation in Russia required the development and implementation of a systematic, multidisciplinary approach to these operations.
Objective. To develop a protocol for the preparation, transplantation, rehabilitation, and follow-up of patients with upper limb loss.
Material and methods. A literature review was conducted covering all theoretical and practical aspects of upper limb allotransplantation using the PubMed, Springer, Scopus, and Web of Science databases from 1998 to 2026, and the long-term outcome of the first successful upper limb allotransplantation in Russia, performed on April 20, 2025 at the N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow City Health Department, was taken into account.
Results. A detailed protocol was developed covering the preparation and selection of patients, the allotransplantation procedure, the postoperative period, rehabilitation, and follow-up of patients with upper limb loss.
Conclusion. The presented protocol confirmed its effectiveness through the success of the first upper limb allotransplantation in Russia and is therefore recommended for practical use.

Introduction. Dyslipidemia is a key risk factor (RF) for cardiovascular diseases (CVDs), with different diagnostic criteria in Europe and the United States. It can occur in 45-90% of kidney transplant patients. Analysis of the incidence of dyslipidemia and the role of lipid-lowering medications in its correction is crucial.
Objective. To determine the incidence of dyslipidemia in patients after kidney transplantation, the prevalence of CVD RFs, as well as the frequency of prescription of lipid-lowering therapy (LLT) and its effectiveness.
Material and methods. A multicenter retrospective cohort study (809 patients) was conducted. We identified patient groups with and without dyslipidemia, the prevalence of CVD RFs, and the immunosuppressive therapy regimens used, as well as the kidney transplant function assessed based on estimated glomerular filtration rate (eGFR). We also identified subgroups of patients receiving and not receiving lipid-lowering therapy, determined previously prescribed lipid-lowering therapy regimens, and assessed their efficacy.
Results. The prevalence of dyslipidemia in kidney transplant patients has been reported in literature as high as 97.4%. Patients with dyslipidemia received two immunosuppressive drugs with proatherogenic properties in 66.4% of cases. In 78.7% of patients, eGFR of the kidney transplant ranged from 30 to 89.9 ml/min/1.73 m2. Ninety percent of patients had arterial hypertension, 42.1% had overweight or obesity class I–III, 15.2% had type I or II diabetes mellitus, 11.4% were smokers, and 43.3% had atherosclerosis in different vascular locations, 81.3% of patients had 1 to 3 CVD RFs simultaneously, 67.3% of patients with dyslipidemia did not receive LLT, and 32.7% were on LLT. Elevated low-density lipoprotein cholesterol (LDL-C) levels were detected in 56.3% of patients with dyslipidemia, elevated LDL-C levels and hypertriglyceridemia were found in 39.1% of cases; and hypertriglyceridemia was found in 1.9%. Among the patients in whom lipid-lowering therapy was administered, 81% received statin monotherapy, 16.7% – a combination therapy (statins and ezetimibe), and 2.3% – ezetimibe monotherapy. Combination therapy and monotherapy were effective in 8.2% of patients.
Conclusion. The high prevalence of dyslipidemia in kidney transplant recipients suggests that lipid metabolism disorders remain underdiagnosed and inadequately controlled. Renal transplant recipients require a complex, comprehensive, systematic approach to the prevention of CVD risk factors and correction of dyslipidemia while using combination immunosuppressive therapy.

Introduction. Differences in structure between two alleles of the same HLA specificity determine their evolutionary divergence, i.e. HLA evolutionary divergence (HED). High evolutionary divergence increases the spectrum of presented antigen peptides and enhances protection against infections and tumors through T cell activation. However, in allogeneic hematopoietic stem cell transplantation high evolutionary divergence is also able to present large amounts of donorderived peptides to T cells, which may increase incidence of graft failure.
The objective of the study was to investigate the impact of HLA evolutionary divergence on the development of primary hypofunction of graft after transplantation of allogeneic hematopoietic stem cells from an HLA-A, -B, -C, -DRB1, -DQB1-identical donor.
Material and methods. The study included 151 patients who had undergone HLA-A, -B, -C, -DRB1, -DQB1-identical allogeneic hematopoietic stem cell transplantation (70 from a related donor, 81 from an unrelated donor). Patients and donors were HLA-typed using high-resolution next-generation sequencing. HLA evolutionary divergence was calculated by using https://txor.shinyapps.io/ched/ and https://clinicaltrials.su/about_ka_hed algorithms.
Results. The frequency of primary hypofunction of hematopoietic stem cell graft was increased in patients with HLA-A evolutionary divergence above the median 7.729 (0;13.044), p=0.015. Evolutionary divergence of HLA genes of both class I, and class II did not correlate with the development of secondary hypofunction of HLA-identical stem cell graft.
Conclusions. High evolutionary divergence of the HLA-A alleles (more then 7.729) in hematopoietic stem cell transplantation from an HLA-identical donor is associated with more frequent development of primary hypofunction of the graft. Evolutionary divergence of HLA genes does not affect the incidence of secondary hypofunction of the HLAidentical graft.

Background. It is known that stress-induced cardiac arrhythmias (CA) are a predictor of sudden cardiac death. After heart transplantation (HT), there are risks of developing CA associated with immunosuppressive therapy, allograft rejection, and other factors. Therefore, it is important to identify the incidence, structure and predictors of stressinduced CA in patients in the long-term follow-up after HT.
Objective. To study the incidence, structure and predictors of stress-induced CA development in patients in the longterm follow-up after HT.
Material and methods. Forty eight patients after HT were examined. The follow-up period was 2.6 (2.3;3.5) years and the average age was 49 (40;54) years. No CA at rest was recorded in any of the patients. The patients underwent a cardiopulmonary exercise test (CPET) measuring its main parameters and recording CA. A univariate logistic regression analysis was used to identify factors associated with the development of CA during the stress test. All cases identified as ventricular extrasystoles, of which 58% were single ventricular extrasystoles and 42% were paired
Results. During the CPET, in 25% of cases, ventricular extrasystoles were recorded, of which 58% were identified as single ventricular extrasystoles, the remaining 42% as paired ones. According to logistic regression analysis, the presence of CA during CPET in the long-term follow-up after HT can be associated with a previous 2A-2B and 3A-3B grade transplant rejection reaction: OR 2.1 (95% CI [1.82-3.46]; p=0.001), and/or with the development of chronic kidney disease after HT: OR 2.7 (95% CI [1.81–4.51]; p=0.01).
Conclusions. 1. CA during physical exercise was registered in 25% of patients in the long-term follow-up after HT. 2. Predictors of the stress-induced CA in the long-term period after HT were graft rejection of grade 2A and higher, OR 2.1 (95% CI [1.82–3.46]; p=0.001), as well as the development of CKD, OR 2.7 (95% CI [1.81–4.51]; p=0.01).

Background. Hyperammonemia in the setting of acute kidney injury after orthotopic liver transplantation is associated with the risk of neuronal death and a negative impact on the allograft, necessitating timely and targeted correction in practice.
Objective. To present a clinical case of successful treatment of acute kidney injury associated with hyperammonemia in the early postoperative period after liver transplantation.
Material and methods. The liver recipient was a 48-year-old woman with cirrhosis secondary to viral hepatitis C. The MELD-Na UNOS/OPTN score was 17 points, and Child-Pugh class B was complicated by ascites and hepatorenal syndrome (HRS-2 according to ICA criteria). The clinical observation was described using the results of general clinical and instrumental examinations from the patient's medical history, follow-up records, and organ passport.
Results. This article presents a clinical example of a favorable outcome in a patient undergoing orthotopic liver transplantation who developed a life-threatening complication: acute kidney injury secondary to hyperammonemia as a result of targeted pathogenetic therapy.
Conclusion. The experience of treating this patient demonstrates that bedside monitoring of ammonium concentrations in the early postoperative period in recipients after OLT enables effective pathogenetic, personalized therapy.

Introduction. Continuous ambulatory peritoneal dialysis (PD) is one of the methods of treating patients in the structure of renal replacement therapy (RRT). The most common complications directly related to the peritoneal catheter usually occur during the first weeks and range from catheter dysfunction to dialysis peritonitis. Delayed intestinal perforation with a peritoneal catheter upon termination of peritoneal dialysis (PD) is extremely rare.
Objective. The article describes a rare clinical case and successful treatment of extrusion of the distal end of the peritoneal catheter through the rectum in a patient 9.5 months after the PD discontinuation.
Material and methods. A 68-year-old patient with a non-functioning peritoneal catheter experienced an unusual complication that is rarely mentioned in the literature: extrusion of a dialysis catheter from the rectum during bowel movements. In describing the clinical case, the results of instrumental research methods from the patient's medical history were used.
Results. The clinical presentation of peritoneal catheter perforation of the rectum and the results of this complication treatment have been presented. Diagnostic laparoscopy, PD catheter removal, loop sigmostomy, laparoscopic sigmostomy were performed. The pathophysiology, diagnosis, and treatment of this rare complication have been analyzed based on current literature.
Conclusions. Delayed intestinum perforation with a peritoneal catheter upon PD termination is rare, but poses a potential threat to patients. When peritoneal dialysis is discontinued, the peritoneal catheter should be removed from a patient immediately to prevent mechanical complications such as possible delayed intestinal perforation with the peritoneal catheter.

Background. Unlike solid organ transplantation, upper limb allotransplantation outcomes, especially functional results, can only be fully assessed in the long-term. Current bionic prostheses have significant disadvantages and cannot provide patients with a high quality of life.
Objective. To assess the long-term (>1 year) outcome of the first successful hand allotransplantation in Russia performed on April 20, 2025.
Patient and methods. A 52-year-old man who had lost his right forearm and hand to a mine-blast injury, underwent right forearm-hand allotransplantation in 2022 under triple immunosuppression (tacrolimus, mycophenolate mofetil, prednisolone) with thymoglobulin induction. Long-term outcome was assessed using photographic and video documentation, ultrasound, radiography, CT angiography, needle biopsy, and histology examination.
Results. The patient returned to work after 3 months. By more than one 1 year, the transplanted hand was fully usable in daily life, work, and sports, with complete restoration of his original handwriting and of superficial and deep sensitivity. Laboratory and instrumental examinations after 1 year confirmed the absence of complications and the patient's healthy status.
Conclusion. The long-term outcome of the first hand allotransplantation in Russia in terms of motor function, sensitivity, and overall health is one of the most successful in the world, supporting further implementation of the method for treating patients with the loss of one or both hands.

Introduction. Uterus transplantation is one of the most innovative technologies in reproductive medicine, offering women with absolute uterine factor infertility the possibility of achieving reproductive function. Accumulated international clinical experience demonstrates the feasibility of this technology; however, its implementation requires addressing a range of medical, ethical, organizational, and legal issues.
Aim of the study: To summarize current global experience in uterus transplantation and to analyze the prospects and barriers to implementing this technology in the Russian Federation.
Material and methods A literature review was conducted using PubMed/MEDLINE, Web of Science, and Scopus databases with the following keywords: “uterus transplantation”, “absolute uterine factor infertility”, “MayerRokitansky-Küster-Hauser”, “vascularized composite allograft”, “immunosuppression in uterus transplantation”, and “pregnancy after uterus transplantation”. Original studies, systematic reviews, and meta-analyses published преимущественно after 2013 were included. Additional data were obtained from the International Society of Uterus Transplantation (ISUTx) registry and the 5th ISUTx Congress (2025), as well as from Russian regulatory documents and epidemiological reports.
Results. Uterus transplantation has evolved from an experimental procedure to a clinically feasible treatment for absolute uterine factor infertility. More than 200 procedures have been performed worldwide, resulting in at least 90 live births. Selection criteria for donors and recipients, surgical techniques, immunosuppressive protocols, and rejection monitoring strategies have been developed. The overall technical success rate reaches approximately 70–75%, and the live birth rate among recipients with a functioning graft exceeds 80%. However, significant risks remain, including vascular complications, rejection episodes, and obstetric complications. Key organizational, legal, ethical, and economic barriers to implementation in the Russian Federation have been identified.
Conclusion. Uterus transplantation is a promising treatment option for absolute uterine factor infertility, enabling gestational motherhood. With further accumulation of clinical experience and improvement of the regulatory framework, stepwise implementation of this technology in the Russian Federation is feasible.

Introduction. The early detection of pressure ulcers remains a clinically significant challenge, especially in patients with limited mobility. Visual skin assessment has limited sensitivity to preclinical tissue changes, which drives interest in non-invasive instrumental diagnostic methods. 
Objective. To evaluate the diagnostic and prognostic significance of non-invasive instrumental methods for detecting early-stage pressure ulcers in adult patients.
Material and methods. A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. A literature search was performed in the PubMed/MEDLINE, Cochrane Library, and eLIBRARY.RU databases for the period from 2015 to 2025. The review included diagnostic and prognostic studies involving adult patients that evaluated non-invasive methods. The risk of bias was assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies – 2) and QUIPS (Quality In Prognosis Studies) tools.
Results. Seventeen studies were included in the review. Quantitative synthesis (meta-analysis) was not performed due to pronounced clinical and methodological heterogeneity. Most diagnostic studies were characterized by a moderate-to-high risk of bias. All prognostic studies had a high risk of bias. Despite this, a number of studies demonstrated the ability of non-invasive methods to detect tissue changes before the clinical manifestation of a pressure ulcer.
Conclusion. Non-invasive instrumental methods have the potential for the early detection of pressure ulcers and risk stratification; however, the existing body of evidence remains limited. Standardized measurement protocols and prospective studies with clearly defined outcomes are necessary for the implementation of these technologies into clinical practice.