Background. Animal experiments play a vital role in modern surgery, enabling the development of new surgical techniques, transplant materials, and more. In addition, modern surgery and transplant medicine utilize robotic systems and artificial intelligence to minimize intraoperative blood loss and wound infections, facilitate donor– recipient matching, and predict graft survival. Objective: to analyze the evolution of in vivo surgical models and evaluate modern strategies for transplantation and explantation. Materials and methods. A literature search was conducted in the SCOPUS, PubMed, and the Russian Science Citation Index (RSCI) databases using the following search terms: «хирургические модели на животных» (meaning «animal surgical models» in English), «трансплантация почки» (kidney transplantation), «ксенотрансплантация» (xenotransplantation), «искусственный интеллект в трансплантологии и хирургии» (artificial intelligence in transplantology and surgery) and «роботизированная хирургия» (robot-assisted surgery). A total of 430 publications from Russian and international journals published between 2006 and 2025 were analyzed. Following the selection process, 87 publications were included in the review. The evolution from anatomical studies to complex surgical systems was traced, with a key milestone being the introduction of kidney transplantation models in large animals (pigs). The current stage is characterized by integration of robotic systems and artificial intelligence, ensuring minimal invasiveness and high precision. Conclusion. Testing on laboratory animals remains essential, particularly for surgical procedures that cannot be adequately modeled mathematically.
Objective: to evaluate changes in the immunogenicity of epoxy-treated xenogeneic bioprosthetic heart valves (BHVs) during in vivo function by detecting human IgG antibodies in the biomaterial of explanted samples.Materials and methods. Fourteen BHVs explanted during repeat valve replacement were examined. Of these, three valves were removed at 1, 20, and 42 days after implantation, while 11 valves had functioned for periods ranging from 3 to 25 years. Histological sections were prepared from the valve leaflets and analyzed by immunohistochemistry using antibodies against human immunoglobulin G (IgG), as well as Russell–Movat pentachrome staining. Selected leaflet fragments were additionally examined by scanning electron microscopy.Results. BHVs removed due to early dysfunction after 1, 20, and 42 days of implantation showed no signs of biomaterial degeneration; however, small thrombi were detected on their leaflet surfaces. In contrast, valves that had functioned for 3 to 25 years exhibited clear features of structural degeneration of the biological tissue, including leaflet tears and extensive calcification. These BHVs were also characterized by moderate macrophage infiltration and a slight increase in pannus on the valve surface. Immunohistochemical staining of histological sections for human IgG revealed intense antibody deposition within the biomaterial of all examined BHVs, irrespective of implantation duration. Positive IgG staining was localized along the fibers of the xenogeneic tissue and was absent in recipient tissues, including thrombi and pannus.Conclusion. The biological component of BHVs retains its immunogenic properties even after long-term (up to 25 years) function in the recipient’s body.
Epigenetics is the study of changes in gene expression that occur without alterations in the primary DNA sequence. These changes are mediated by chemical modifications of DNA, histones, and non-coding RNAs, collectively forming the epigenome, that determines the functional activity of the genome. Epigenetic mechanisms play a fundamental role in cellular differentiation, organismal development, and adaptation to external conditions. In medicine, they have attracted considerable attention due to their involvement in the pathogenesis of oncological, autoimmune, and neurodegenerative diseases. MicroRNAs (miRNAs), as key components of epigenetic mechanisms, play a critical role in controlling immune responses, including those occurring after organ transplantation. This has opened new opportunities for a personalized approach to the management of transplant recipients. Accumulating evidence on the role of miRNAs in solid organ transplantation suggests that integration of omics technologies may expand the existing arsenal of diagnostic criteria, serving as an auxiliary diagnostic tool for monitoring graft function. This systematic review presents a comprehensive analysis of the current literature on the clinical significance of miRNAs in modern transplantology. It highlights the diagnostic and predictive potential of specific miRNAs in relation to the development of complications in recipients of heart, lung, kidney, and liver transplants, and examines current approaches to the use of miRNAs as therapeutic targets.
8 апреля 2026 года свой 60-летний юбилей отметил Вячеслав Леонидович Коробка, доктор медицинских наук, профессор, главный врач ГБУ РО «Ростовская областная клиническая больница», заведующий кафедрой реконструктивной, пластической, торакальной, сердечно-сосудистой хирургии и трансплантологии ФГБОУ ВО «РостГМУ» Минздрава России, главный внештатный специалист по хирургии и трансплантологии Министерства здравоохранения Ростовской области.
Background. The technique of redirecting blood flow from the inferior vena cava (IVC) and portal vein during liver transplantation (LT) offers several advantages, the most important of which is the prevention of intraoperative hypoperfusion-related complications.Materials and methods. A literature search was performed in the Scopus, PubMed, and Russian Science Citation Index (RSCI) databases using the following keywords: «liver bypass», «liver transplantation with venovenous bypass/shunting,» «assisted circulation during liver surgery,» «assisted circulation during liver transplantation», and «history of transplantology» from the early 1960s through 2025 were considered. In total, 162 articles from Russian and foreign journals were analyzed, of which 44 met the inclusion criteria and were included in the review.Results. An analysis of Russian and foreign literature reveals a unified concept regarding the use of venovenous bypass (VVB) systems, as well as the general advantages and limitations of existing techniques. VVB remains a relevant method for maintaining hemodynamic stability and improving postoperative outcomes in liver transplant recipients. Particular attention is given to a novel system and technique for performing VVB that incorporates an oxygenator/heat exchanger and a venous reservoir, allowing the simultaneous use of continuous renal replacement therapy (CRRT). Modern cardiopulmonary bypass techniques are characterized by the creation of optimal conditions for surgical intervention, ensuring a high level of patient safety throughout the procedure.
Swyer–James–MacLeod syndrome is a rare disease characterized by emphysematous transformation of an entire lung or lobe. Traditionally, the main treatment method has been surgical resection of the aff ected lung or lobe to reduce compression of adjacent healthy lung tissue and improve vital lung capacity. This article presents a clinical case of successful endoscopic treatment in a patient with emphysematous transformation of the entire lung, who was referred to the transplant center as a potential candidate for lung transplantation.
Dyslipidemia in patients with chronic kidney disease (CKD), particularly those on renal replacement therapy (RRT), is a major risk factor for cardiovascular complications. The pathogenesis of lipid metabolism disorders in this population is multifactorial and infl uenced by the underlying kidney disease, the specific characteristics of RRT, and, in transplant recipients, the effects of immunosuppressive therapy. Despite the high prevalence and clinical significance of dyslipidemia in CKD, therapeutic strategies for its correction remain insuffi ciently studied. This review analyzes current pharmacologic approaches to the management of dyslipidemia and evaluates the potential for their application in patients receiving RRT. Literature search was conducted using electronic databases Medline/PubMed (https://pubmed.ncbi.nlm.nih.gov) and eLIBRARY/Russian Science Citation Index (https://www.elibrary.ru).
Objective : to assess the association between CYP3A5 isoenzyme genotypes and tacrolimus (Tac) dose and whole-blood levels in heart transplant (HT) recipients in the early and long-term post-transplant periods. Materials and methods . The study included 189 HT recipients receiving Tac as part of their maintenance immunosuppressive therapy. CYP3A5 polymorphisms (*1/*1, *1/*3, *3/*3) were determined via real-time polymerase chain reaction. Tac dose and whole-blood concentrations were evaluated at 1 month, 1 year, and at long-term follow-up (>1 year; mean 7.0 ± 3.1 years) after HT. In addition, general and biochemical blood test results were analyzed. Results . The CYP3A5 *3/*3 genotype was predominant among HT recipients (89%), while the *1/*3 genotype was identified in 10% and the *1/*1 genotype in 1% of patients. Carriers of the *1 allele (*1/*3 and *1/*1) required substantially higher Tac doses – approximately twofold or greater – compared with *3/*3 carriers at all follow-up time points: at 1 month post-transplant, median doses were 8.0 [6.0–10.25] mg and 11.0 [9.5–12.5] mg versus 4.0 [3.0–6.0] mg (p < 0.001); at 1 year, 8.0 [6.0–9.0] mg and 10.0 [9.0–11.0] mg versus 3.0 [2.0–5.0] mg (p < 0.001); and at long-term follow-up, 7.0 [6.0–8.0] mg and 9.0 [7.5–10.5] mg versus 3.0 [2.0–5.0] mg (p < 0.001). Tac whole-blood levels did not differ significantly between groups of heart recipients at any time point during follow-up. However, the concentration-to-dose ratio (C0/D) was significantly higher in *3/*3 carriers across all follow-up periods (p = 0.000). At long-term follow-up, patients with the *3/*3 genotype exhibited significantly higher median serum creatinine levels compared with carriers of the *1 allele (107.6 [87.3–142.1] μmol/L vs 90.2 [75.0–99.7] μmol/L; p = 0.001). Correlation analysis revealed significant associations between Tac levels and white blood cell count (r = 0.148; p = 0.027), total bilirubin levels (r = 0.217; p < 0.001), and cholesterol levels (r = –0.274; p < 0.001). Conclusion . The non-expressing CYP3A5 *3/*3 genotype is predominant among HT recipients (89%). Carriers of the functional CYP3A5 *1 allele (*1/*3 and *1/*1) require twofold or higher Tac doses to achieve target whole-blood levels compared with *3/*3 carriers. These findings confirm that CYP3A5 polymorphism is a major determinant of interindividual variability in Tac pharmacokinetics in HT recipients. Pre-treatment pharmacogenetic testing for CYP3A5 may facilitate individualized dosing strategies, enabling more rapid attainment of therapeutic drug levels.
Objective : to evaluate the effect of hemodynamic stress on the functional activity of von Willebrand factor (VWF) in vitro and to assess the potential of these data for predicting thrombus formation during testing of blood-contacting medical devices. Materials and methods . Fresh human platelet-rich plasma (PRP) was used in all experiments. Hemodynamic conditions mimicking vascular stenosis were simulated in a closed-loop system equipped with a peristaltic pump using a narrow channel (diameter 0.7 mm), generating shear rates (γ) of 1000, 3000, and 5000 s –1 . Control experiments were performed under low-shear conditions in a wider channel (diameter 3 mm). von Willebrand factor activity (vWF Act, %) was measured after one and two circulation cycles. Results . Under control conditions, the reduction in VWF activity was minimal, decreasing to 69.2% after two circulation cycles. In stenosis-like channels, a pronounced decrease in VWF activity was observed, with the magnitude depending on shear rate: 65.1% at γ = 1000 s –1 , 63.6% at γ = 3000 s –1 , and 62.6% at γ = 5000 s –1 . The most substantial decline occurred after the first passage through the stenotic segment. At the highest shear rate (γ = 5000 s –1 ), microscopic analysis revealed the formation of platelet aggregates. Conclusion . The study demonstrates that increasing shear rate leads to enhanced activation and proteolytic degradation of VWF, primarily due to the loss of high-molecular-weight multimers. These findings highlight the critical role of hydrodynamic conditions in the development of hemostatic disturbances associated with vascular stenoses and mechanical circulatory support systems. Incorporating the assessment of VWF activity and multimer distribution into testing protocols for vascular prostheses and extracorporeal devices may improve prediction of their hemocompatibility.
Background . Bardet–Biedl syndrome (BBS) is a hereditary diencephalic-retinal disorder characterized by a combination of clinical features, including obesity, mental retardation, retinal degeneration, brachydactyly, polydactyly, hypogenitalism, and renal dysfunction. Up to 25% of patients develop end-stage chronic renal failure requiring renal replacement therapy or kidney transplant (KT), often during childhood. Objective : to present the treatment outcomes of severe chronic renal failure in a 16-year-old female patient with the rare genetic condition BBS, who previously underwent KT from a related donor at the age of 6. Materials and methods . A retrospective analysis was conducted of the patient’s medical records, including the clinical course of the disease, laboratory and instrumental findings, and details of the treatment provided to the 16-year-old patient diagnosed with BBS. Results . On November 25, 2015, an AB0-compatible related (the patient’s father) KT was performed on the right side. Maintenance immunosuppressive therapy included tacrolimus, mycophenolic acid, methylprednisolone. Immediate graft function was observed after the surgery. At the follow-up consultation on November 13, 2024, the patient was receiving tacrolimus (Prograf) 1.5 mg twice daily, mycophenolic acid 180 mg twice daily, methylprednisolone 4 mg per day orally, as well as Cardiomagnyl and Omeprazole 20 mg orally. Laboratory findings showed a serum creatinine level of 65.9 μmol/L, with an estimated glomerular filtration rate calculated using the CKD-EPI equation of 119.72 mL/min/1.73 m 2 . Conclusion . Despite the presence of severe congenital pathologies associated with BBS, this clinical case presents a successful KT with minimal complications in both the early and long-term postoperative periods.
The treatment of extensive and deep wounds and burns remains a highly pressing issue in modern surgery. Many of the associated challenges are linked to dysfunction of the dermis – the connective tissue matrix of the skin. Without its full restoration, achieving satisfactory long-term wound healing outcomes is difficult. This review focuses on artificial acellular scaffolds for dermal regeneration, as well as the fundamental principles underlying their design. The scaffolds discussed (Integra, Giamatrix, SmartMatrix, and NovoSorb) are already widely used in clinical practice today and have demonstrated high effectiveness. Currently, most commercially available dermal substitute products, as well as tissue engineering solutions in general, are manufactured abroad. Therefore, evaluating international experience and applying it to the development of Russian-made scaffolds could significantly improve their accessibility for patients.
Objective : to determine the prevalence of cardiac allograft vasculopathy (CAV), detected by optical coherence tomography (OCT), in patients after orthotopic heart transplantation (OHT), and to analyze its impact on clinical outcomes. Materials and methods . The single-center retrospective cohort study analyzed data from patients who underwent OHT between 2013 and 2024. Patients who died within 30 days after transplantation were excluded from the analysis. All recipients underwent coronary angiography during the first week after transplantation to detect baseline coronary lesions in the donor heart. Subsequently, routine angiographic screening was performed. When lesion progression or development of de novo stenoses was suspected, additional evaluation using OCT was carried out to assess lesion morphology. Based on OCT results, recipients were divided into two groups: patients with and without CAV. The study endpoints included myocardial infarction, myocardial revascularization, cardiac death, and a decrease in left ventricular ejection fraction (LVEF) during follow-up. Results . The study included 66 patients. Coronary artery disease was detected in 15 patients (22.72%) during angiographic screening. However, subsequent assessment using OCT confirmed CAV in only 10 recipients (15.15%). In all confirmed cases, the left anterior descending (LAD) artery was involved. Among patients with pre-existing coronary lesions, the median time to the first angiographic detection was 3.5 months, compared with 25 months in recipients without baseline lesions. In the CAV group, myocardial infarction occurred in 4 patients (40.0%), whereas no ischemic events were observed in the non-CAV group (p < 0.001). Myocardial revascularization was required in 7 patients (70.0%) with CAV, while in the group without this condition, only one procedure was performed for an initial lesion of the LAD artery (p = 0.005). Median LVEF in the CAV group decreased from 66.0% to 57.5%, whereas no significant changes in left ventricular systolic function were observed in patients without CAV (p = 0.045). Conclusion . OCT enables reliable, early detection of CAV. In all confirmed cases, the lesions were localized around the LAD artery. CAV developed earlier in recipients with pre-existing coronary atherosclerosis. Moreover, the presence of CAV was associated with an increased risk of myocardial infarction and the need for coronary revascularization, which was accompanied by a decline in LVEF and subsequent development of heart failure.
Background . The development of adhesive wound dressings with regenerative properties for restoring the integrity of damaged skin and mucous membranes is currently a priority area in regenerative medicine and tissue engineering. Objective : to develop a homogeneous, multicomponent collagen-based biopolymer adhesive hydrogel (MCBAH) and to evaluate its safety and efficacy. Materials and methods . Sterile samples of MCBAH were analyzed. The content of volatile organic compounds (VOCs) was determined using a Chromatec-Crystal 5000 gas chromatograph (Chromatec SKB CJSC, Russia). Osmolarity was measured using the Osmometer K-7400 liquid analyzer (Knauer, Germany), and pH was determined with the pH-150MI pH meter (Izmeritel’naya Tekhnika LLC, Russia). Biological safety was assessed in accordance with GOST ISO 10993 and included evaluation of cytotoxicity, pyrogenicity, material-mediated effects, general toxicity (acute and subchronic), as well as sensitizing and irritant effects. In vitro cytotoxicity was assessed using cultures of NIH/3T3 fibroblasts (ATCC® CRL-1658™). The efficacy of MCBAH was evaluated in a rat thermal burn model. Histological examinations were performed on tissues from the heart, lungs, thymus, liver, spleen, kidneys, adrenal glands, gonads, and cerebral cortex. Results . VOCs concentrations did not exceed permissible limits. Osmolarity was 334 ± 20 mOsm/kg, and pH was 7.18 ± 0.11. In vitro studies demonstrated the absence of cytotoxicity. Acute toxicity testing revealed no toxic effects in laboratory animals. Similarly, subchronic toxicity studies showed that exposure to MCBAH did not cause intoxication or mortality. No delayed-type hypersensitivity reactions were observed, indicating the absence of a sensitizing effect. Intradermal administration of MCBAH and its application to the mucous membranes of the hamster cheek pouch, rabbit vagina, and rabbit rectum produced no detectable response, with an irritation index of 0. Following intravenous administration of extracts from MCBAH samples to rabbits, increase in body temperature in all three animals did not exceed 0.1 °C, indicating that the biomimetic hydrogel does not induce a pyrogenic response. Conclusion . In a rat thermal burn model, application of an adhesive biomimetic hydrogel mimicking the extracellular matrix (ECM) immediately after burn induction and daily until complete wound closure significantly accelerated wound healing in the experimental group by 15.3 ± 7.7% (34.9 days) compared with the control group (40.2 days, p < 0.01). Treatment also promoted the formation of a fully developed epithelial layer and accelerated restoration of the original histological structure of the damaged skin. These findings support further investigation of the efficacy of this hydrogel in experimental models of damaged mucous membranes.
Kidney transplant recipients face a significantly higher risk of developing malignant tumors. For certain tumor types, incidence rates are hundreds of times higher than in the non-transplant population. Overall cancer incidence and patterns vary significantly across countries, reflecting geographically specific risk factors. This literature review examines the epidemiological characteristics of post-transplant malignancies occurring in kidney transplant recipients worldwide.
Background and aim . Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare liver malignancy, which comprises clinical and morphological features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) and corresponds to 1–4.7% of cases of primary liver carcinomas. At present, Liver transplantation (LT) is not routinely recommended for known cHCC-CCA due to concerns regarding aggressive behavior and recurrence risk. However, incidental diagnoses after LT performed for presumed HCC raise questions regarding post-transplant outcomes. Material and methods . We conducted a retrospective single-center study including patients who underwent LT between 2000 and 2025. Patients with incidentally diagnosed cHCC-CCA on explant pathology were matched 1 : 2 with HCC controls according to age, year of transplantation, donor type, tumor burden at explant (number and size), lymphovascular invasion, locoregional therapy, and BAR score. Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan–Meier estimates and compared with the log-rank test. Results . After matching, 9 patients with cHCC-CCA were matched with 18 HCC controls. Five-year OS was 41.7% in the cHCC-CCA group and 81.5% in the HCC group (p = 0.26) and Five-year DFS was 70% versus 85.9%, respectively (p = 0.25). Recurrence occurred in two patients in each group. To date, this 25-year study represents one of the most rigorously matched European analyses, uniquely incorporating lymphovascular invasion and BAR score as matching variables. Conclusions . Despite the fact that no statistically significant differences were demonstrated in post-transplant survival or recurrence between the groups, worse results could be observed in the studied group, which is consistent with the current non-indication of LT for cHCC-CCA. This study was substantially underpowered, so the absence of statistical significance should not be interpreted as clinical equivalence.
T cells not only provide cellular immunity, but also exert control over the proliferation, differentiation, and maturation of cells across diverse target tissues, thereby regulating both physiological and reparative regenerative processes. Evidence demonstrates that these cells contribute to the restoration of parenchymal organ structures, promote osteogenic differentiation of mesenchymal stem cells, activate neurogenesis, and modulate myogenesis and angiogenesis. This review focuses on the mechanisms by which T cells regulate reparative processes within the vascular system, highlighting key aspects such as cell–cell interactions between T cells and endothelial cells, the role of chemokine receptors in mediating T-cell adhesion to the endothelium, and their capacity to synthesize angiogenic growth factors including interferon-γ (IFN-γ), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), tumor necrosis factor-α (TNF-α), insulin-like growth factor-1 (IGF-1), amphiregulin, and a broad range of interleukins. The review also describes the ability of T cells to control post-transcriptional regulation of gene expression in endothelial cells through small non-coding RNA molecules (miRNAs). Specifically, information is provided on the angiogenic roles of miRNAs previously identified in T cells: miR-16, miR-21, miR-25, miR-150, miR-155, miR-181, and miR-451, and the mechanisms through which they mediate these effects.
Objective : to present a clinical case of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity following liver transplantation (LT). Materials and methods . A female patient (born 1968) with primary biliary cirrhosis underwent orthotopic LT in 2019. Three years later, she required anterior abdominal wall repair for a postoperative hernia. Subsequently, progressive weight gain and deterioration in quality of life were observed. Despite significant intra-abdominal adhesions, LSG was performed. The postoperative period was uneventful. Results . The patient demonstrated significant weight loss, improved quality of life, and preserved graft function. Conclusion . LSG is an effective treatment for morbid obesity and its associated complications following LT.
Objective : To evaluate the in vitro cytotoxicity, adhesion, and proliferation of fibroblasts on film coatings made of Bombyx mori silk fibroin, wild silk (Tussah) fibroin, and their chitosan composites. Materials and methods . Four types of film coatings were investigated: Bombyx mori fibroin, wild silk fibroin, and their respective chitosan composites. The coatings were fabricated by casting aqueous polymer solutions followed by drying. Cytotoxicity was assessed in accordance with GOST R ISO 10993-5 using the extract assay method. NIH 3T3 fibroblast adhesion was evaluated 1 hour after seeding, while proliferation was assessed on days 1, 2, and 3 of culture. Cell quantification was performed following nuclear staining with 4′,6-diamidino-2-phenylindole (DAPI) using fluorescence microscopy combined with automated image analysis. Culture dishes containing sterile medium and medium supplemented with ethylenediaminetetraacetic acid or dimethyl sulfoxide served as control groups. Results . All tested coatings supported fibroblast viability, with metabolic activity levels comparable to those observed on standard culture plastic. Fibroblast adhesion and proliferation were consistently higher on wild silk fibroin coatings compared with Bombyx mori fibroin coatings at all time points. The incorporation of chitosan further enhanced both cell adhesion and proliferation. The most pronounced cellular response was observed on composite coatings based on wild silk fibroin and chitosan. Conclusion . Film coatings based on wild silk fibroin demonstrate an enhanced ability to support fibroblast adhesion and proliferation in vitro – more than twice as high as that of Bombyx mori fibroin with chitosan. Composite systems incorporating chitosan further enhance these properties, making them promising candidates for the development of functional biomedical coatings.
