Introduction. The transplantation of primary infected grafts poses a significant challenge in the field of kidney transplantation. This issue is not adequately addressed in the existing medical literature. In our country, no systematic studies of the results of such transplants have been conducted.Objective. To evaluate the frequency of primary infected kidney transplants and the types of microorganisms isolated from positive bacterial cultures of perfusates; to study the frequency of clinically significant infectious complications in this category of patients and their outcomes; to identify factors that had a statistically significant impact on the outcomes.Material and methods. Between 1 January 2015 and 31 December 2024, 1,923 kidney transplants from deceased donors were performed. The study group consisted of 87 patients who tested positive for bacterial perfusion culture. Of these, 42 (48.3%) were men and 45 (51.7%) were women. The average age of the patients was 47±11.9 years. Patients were divided into two groups to assess the impact of clinically significant infectious complications on treatment outcomes: group I consisted of 15 patients with such complications and group II consisted of 72 patients without. Patients in both groups were comparable in terms of key characteristics.Results. The frequency of initially infected kidney transplants was 4.5%. The microorganisms causing perfusion contamination were as follows: 88 bacterial strains and one fungal strain. Of these bacteria, 51 were Gram-positive, 36 were Gram-negative and one was anaerobic. Clinically significant infectious complications occurred in 17.2% of cases, with a median time to development of 9 (4;12) days. The development of infectious complications significantly reduced kidney transplant survival. Significant factors included clinically significant infectious complications, the detection of Klebsiella pneumoniae in the perfusate and type 2 diabetes mellitus in patients.Conclusion. The frequency of primary infected kidney transplants, as well as the frequency of clinically significant infectious complications, is consistent with data from other transplant centers. Algorithms for diagnosing and treating infectious complications enabled fatal outcomes to be avoided in this patient group.
Background. One of the late complications of liver transplantation is postoperative hernia of the abdominal wall, which occurs in 5–46% of recipients. An incisional hernia reduces the quality of life, and is accompanied by various complications, such as adhesive disease, intestinal passage disorder, entrapment. In addition to other factors affecting the formation of an abdominal scar, traumatic surgical approaches are reviewed as predictors of herniation.Material and methods. The results of treatment of 77 recipients after liver transplantation in the period 2018-2025 were evaluated. Related living donor transplantation was performed in 5 and cadaveric one in 72 patients. J-shaped approach was provided to 75 (97.4%) and “Mercedes” was used in 2 (2.59%) recipients.Results. An incisional hernia of the abdominal wall complicated the late postoperative period in 38.9% of cases. Hernial defect was diagnosed 0.5–7 years after transplantation, and in 50% of cases, the diagnosis of incisional hernia was made within 6 to 12 months after surgery. The locus minoris resistentiae of the J-shaped access is the white line and angle of the postoperative scar, where hernial defects appear more often.Conclusion. One of the factors of herniation after liver transplantation is the multidirectional, relatively traumatic J-approach, which implies the optimal methods for strengthening "weak" points or the use of other, mainly transverse approaches.
Background. Hyperammonemia is a rare but potentially life-threatening condition that can occur in patients following lung transplantation. Elevated blood ammonia levels are associated with impaired nitrogen metabolism leading to severe neurological symptoms, including confusion, seizures, and coma. Given the growing number of lung transplants, the problem of hyperammonemia is particularly important, as timely diagnosis and treatment can significantly reduce the risk of mortality.Objective. To present a case of acute hyperammonemia in a patient after bilateral lung transplantation, describing the treatment and successful outcome.Material and methods. A 58-year-old lung transplant recipient with chronic obstructive pulmonary disease (GOLD IV, extremely severe course, with pronounced clinical symptoms (mMRС>3, CAT test more than 10 points), emphysematous phenotype, high risk of exacerbations, class E, severe exacerbation). The clinical case description was based on the results of general clinical and instrumental studies from the recipient's medical history and observation card.Results. This article describes a clinical presentation of hyperazotemia and hyperammonemia, its successful treatment in a recipient following bilateral lung transplantation. By selecting an optimal treatment strategy, an adverse outcome was avoided and graft function was preserved.Conclusion. Although the pathophysiological mechanism for elevated blood urea levels and hyperammonemia could not be determined, a multimodal treatment approach enabled the clinicians to select the best management strategy for this patient and achieve a favorable outcome.
Background. Despite a complex diagnostic evaluation, the cause of ischemic stroke (IS) remains unidentified in 23-40% of cases. The implementation of endovascular thrombectomy has created the opportunities for morphological analysis of thrombotic masses.Objective. To compare the histological structure of thrombi in patients (pts) with different subtypes of acute IS.Material and methods. For analysis, thrombotic masses were extracted from 107 pts with IS during aspiration thrombectomy. The relationships with clinical and procedural parameters were assessed.Results. Fractions of erythrocytes, fibrin, detritus and leukocytes in the extracted thrombi were comparable in patients with different subtypes of IS. In pts with cardioembolic IS and IS of undetermined etiology, the plasma cell count in thrombi was statistically significantly higher than in pts with atherothrombotic IS (10 (6;13) vs. 6 (4;9) number of cells, p=0.020; 10 (5;18) vs. 6 (4;9) number of cells, p=0.035, respectively).Conclusions. Quantitative examination of clot content may be used to distinguish between different IS subtypes. We suppose on the notion that the majority of IS of undetermined etiology was associated with cardioembolic source.
Introduction. Portal hypertension (PH), traditionally regarded as a consequence of liver cirrhosis (LC), in recent decades become the focus of new conceptual frameworks describing its development in non-cirrhotic liver diseases. These observations have led to the identification of a new nosological entity termed a porto-sinusoidal vascular disease of the liver (PSVD), and first proposed by the VALDIG expert group in 2019.Case report. This report describes a clinical case of a 34-year-old female patient with PSVD complicated by severe PH, who underwent living donor liver transplantation (LDLT). The presented case highlights the diagnostic challenges and clinical heterogeneity of PSVD, emphasizing the importance of timely recognition of this condition and the need for an individualized approach to determining indications for liver transplantation.Discussion. Despite the emergence of the new PSVD concept, many key aspects of management remain controversial. In particular, there is ongoing debate regarding the selection criteria for liver transplant candidates and the effectiveness of existing therapeutic algorithms. The applicability of standard scoring systems such as Child–Turcotte–Pugh and MELD 3.0 in this pathology also remains uncertain.Conclusion. The diagnosis of PSVD presents significant challenges, largely due to limited awareness among clinicians, as well as the lack of standardized diagnostic criteria and clinical guidelines. Furthermore, indications for liver transplantation in PSVD have not yet been fully standardized. This report aims to discuss these issues and raise awareness about PSVD, which we believe may contribute to improving the quality and effectiveness of patient care.
Introduction. Extracorporeal perfusion of transplants is proposed as one of the areas to expand the pool of donor hearts. Important aspects are the establishment of optimal perfusion parameters, which is of particular importance in prolonged perfusion.Objective. To present the results of the development of a perfusion module for extracorporeal anti-ischemic protection of donor hearts.Material and methods. A perfusion module for extracorporeal anti-ischemic protection of donor hearts was developed on mature outbred male rats. After 12-hour hypothermic extracorporeal perfusion of the heart in the perfusion module with +8°С oxegenated HTK solution, its function was studied.Results. In the hypothermic perfusion group on the module, sinus rhythm was observed with a heart rate of 268.5 (256.2;279.0) beats/min; the left ventricle-developed pressure (LVDP) was 65.5 (65.0;70.7) mm Hg, by the end of the 1st hour, the LVDP was 73.0 (70.5;75.0) mm Hg, after 90 minutes the LVDP was 82.0 (80.5;83.5) mm Hg, by the end of the 2nd hour, the LVDP was 82.5 (80.5;84.0) mm Hg, which indicated the cardioprotective potential of hypothermic perfusion. The hearts of the control group had sinus bradycardia with a heart rate of 113.5 (90.0;124.7) beats per minute. The LVDP was 27.5 (25.5;30.0) mm Hg by the end of the 30-minute cardiac stabilization period; by the end of the 1st hour, LVDP was 22.0 (20.5;23.7) mm Hg; by the 90th minute the contractile function of the hearts was absent, which indicated the development of myocardial damage.Conclusion. Obtained data indicate that the module can maintain the viability of the donor heart for 12 hours by hypothermic perfusion with +8°С oxygenated HTK solution at flow rate of 0.3 ml/min and pressure of 10 cm H2O and pO2 600-700 mm Hg, which is accompanied by heart rate of 325.0 beats/min and LVDP of 82.5 mm Hg, compared to non-perfusion conservation.
Background. Long-term immunosuppression in standard regimens, though preventing a rejection, simultaneously increases morbidity and mortality in liver transplant recipients. Minimization or discontinuation of immunosuppressive drugs may reduce this burden; however, the permissible limits, safety, tolerability, clinical outcomes, and long-term results of this strategy remain undefined and require thorough study and clarification.Objective. To develop a clinical protocol and investigate the feasibility and clinical safety of personalized immunosuppression minimization in the long-term period after liver transplantation.Material and methods. Forty stable liver recipients, at 74±7.21 months (range: 6–182 months) post-transplantation, were included in a retrospective single-center study on tacrolimus minimization/discontinuation. Mean age at enrollment was 56.3±1.4 years. Twenty-two (55%) patients were on tacrolimus monotherapy, and 18 (45%) on a combination tacrolimuseverolimus therapy. Tacrolimus dose was gradually reduced over 8 (4;11) months.Results. Graft dysfunction developed in 32.5% of cases (n=13) with dose reductions of 25–95%. Rejection was diagnosed in 7 (17.5%) patients based on laboratory and morphological data, 3–9 months after starting minimization. All dysfunction episodes were reversible. The median duration of subsequent dysfunction-free graft period in all intolerant patients was 28 (26;33) months. Twenty-seven (67.5%) patients tolerated minimization: 15 (37.5%) completely discontinued tacrolimus, and 12 (30%) achieved a 40–87.5% dose reduction (mean 62.7%). Median follow-up for tolerant patients after completing the minimization was 26 (20;30) months. Control biopsies performed 1–33 months (median 15 months) after completing the minimization showed no negative dynamics in histological patterns. Comparison between the everolimus group and the monotherapy group revealed significant differences: tolerant patients to immunosuppression minimization accounted for 83% vs. 55% (p=0.053); tacrolimus discontinuation was achieved in 72.2% vs. 9.1% (p<0.001); the dose reduction extent was 100 (90.3;100) % vs. 56 (42.5;78.8) % (p<0.001). In the whole cohort, the estimated GFR increased from the baseline of 62 (50;70) mL/min/1.73 m2 to 66.5 (54;80) mL/min/1.73 m2 by the end of the follow-up (p=0.011).Conclusion. Controlled immunosuppression minimization in the long-term post-transplant period is successful in a significant proportion of carefully selected recipients. The procedure being safe with strict protocol adherence. A maximal tacrolimus dose reduction is achieved more frequently and with lower rejection risk in patients on everolimus. A positive effect of minimization on kidney function has been confirmed.
Introduction. Over the past five years, small bowel transplantation (SBT) has undergone significant changes, evolving from an experimental procedure into a life-saving standard of care for patients with irreversible chronic intestinal failure. Analysis of data from the International Intestinal Transplant Registry (IITR) confirms a gradual decline in the number of procedures performed, attributable to improvements in alternative treatment modalities. Nevertheless, SBT remains the only chance for survival in patients with life-threatening complications of parenteral nutrition.Objective. The aim of this review is to summarize current knowledge and describe the present status of small bowel transplantation. Specifically, the review covers key aspects of modern SBT, including epidemiology, diagnostic criteria, indications for transplantation, immunosuppression regimens, and potential complications. Particular attention is paid to improved survival outcomes, persistent challenges related to chronic rejection, as well as novel approaches and emerging directions in the field.Material and methods. The review is based on an analysis of scientific literature published between 2010 and 2025, including clinical guidelines, meta-analyses, randomized controlled trials, and major registry datasets. Both international and Russian publications were taken into account.Conclusion. Clinical small bowel transplantation remains a complex and evolving field of medicine. Ongoing research and technological advances will continue to shape its future. Significant progress has already been achieved in both conservative and surgical management of transplant recipients. Survival rates are now comparable to those observed with long-term home parenteral nutrition; therefore, intestinal transplantation should be considered for all patients with irreversible intestinal failure.
Introduction. Donor organ quality is critical for maintaining current and long-term graft function. More effective and diagnostically relevant tools for assessing the quality of a donor organ under transplantation will help optimize posttransplant monitoring, select appropriate clinical management strategies, and increase graft survival. MiRNAs can be used as such tools for early, non-invasive diagnosis of donor organ viability. Circulating miRNAs are found in various biological fluids; they are relatively stable and tissue-specific. Furthermore, precise laboratory methods for analyzing the expression of specific miRNAs are now available.Objective. The aim of the review is to identify the prognostic value of microRNA in kidney or liver transplant recipients for the analysis of the donor organ status in the pre-transplant period.Material and methods. This paper presents the results of studies identifying specific microRNAs for assessing donor organ quality. To analyze and structurize the literature, we searched the electronic databases MIRBase, PubMed, MedLine, eLIBRARY, and Google Scholar for the period from 1995 to 2025. This review includes 60 publications from Russian and international sources.Conclusion. Current scientific data confirm the feasibility and potential of using microRNAs as biomarkers. Further research is needed to develop and optimize a diagnostic algorithm for organ transplantation.
Background. Coronary artery disease of the transplanted heart (CADTH) is the most frequent complication and cause of death in patients living more than a year after heart transplantation (HT). The development of effective methods for CADTH prevention remains one of the urgent tasks of transplantology. Up-do-date methods of ex vivo machine perfusion, which allow the CADTH prevention and ensure longer cardiac allograft survival and function.Objective. To make a review of promising methods for CADTH prevention to prolong the cardiac allograft survival and function.Material and methods. Sources from 2000 to 2024, retrieved from PubMed, Google Scholar, eLIBRARY.RU.Conclusion. Prevention of cardiac graft vasculopathy at early stages, namely during ex vivo machine perfusion, allows reducing the risk of the disease onset in the postoperative period. Machine perfusion of the cardiac graft is not only a way of CADTH prevention, but possibly the key way of prolongation of the graft functioning.
Introduction. Structural degeneration of biological prosthetic heart valves is an inevitable complication in the long term, requiring repeated surgery. Repeated open surgery is associated with a high risk in comorbid patients. Valve-in-Valve (ViV) transcatheter technology has become a minimally invasive alternative.Objective. To demonstrate the effectiveness and safety of a two-stage ViV strategy on tricuspid and mitral valves.Material and methods. A clinical case of a patient born in 1947 with mitral valve (MC) and tricuspid valve (TC) bioprostheses 7 years after the initial open prosthetics is presented. The calculated risk of EuroSCORE II was 21.8%. A two-stage strategy was applied: on 09.29.2025, transcatheter implantation of the MyVal 30.5 mm bioprosthesis was performed in the tricuspid valve position, and on 10.10.2025, MyVal 27.5 mm was performed in the mitral valve position.Results. The postoperative period was uneventful. Control echocardiography showed a significant improvement in hemodynamic parameters: the average gradient on TC decreased from 6.0-7.2 to 3.1 mmHg, regurgitation decreased from 2 to 0-1 art. On MC, the average gradient decreased from 9.0-10.5 mmHg to 6.7 mmHg, regurgitation was minimal. The patient's condition was satisfactory upon discharge, FC regressed from III-IV to II.Conclusion. Two-stage transcatheter valve implantation using valve-to-valve technology is a highly effective and safe method of treating bioprosthesis dysfunction in high-risk surgical patients, which avoids repeated sternotomy and reduces rehabilitation time.
Introduction. The diffuse form of takotsubo cardiomyopathy is extremely rare and even less frequently differentiated from other syndromes. Nevertheless, prompt identification of this condition and a correct emergency care protocol will facilitate proper treatment and minimize complications.Objective. To describe a case of successful use of veno-arterial extracorporeal membrane oxygenation in a patient with cardiogenic shock due to a rare biventricular form of takotsubo cardiomyopathy.Material and methods. The patient, a 55-year-old man, without previous history of chronic disease, was admitted for an abruptly arising atypical form of takotsubo syndrome. The clinical Case Report description utilized laboratory and instrumental tests results from the patient's medical record.Results. The characteristics of the clinical course of the atypical takotsubo syndrome complicated by cardiogenic shock, and the treatment outcomes have been presented.Conclusions. This clinical case review has demonstrated that the Takotsubo syndrome can manifest itself as a diffuse biventricular dysfunction, leading to a life-threatening cardiogenic shock. A multimodal approach using echocardiography, coronary angiography, and cardiac magnetic resonance imaging played an important role in differential diagnosis to distinguish the disease from an acute coronary syndrome and myocarditis. Mechanical circulatory support served as a successful strategy for a rapid and adequate restoration of cardiac contractility. There is a need for heightened vigilance regarding atypical forms of takotsubo syndrome in patients with cardiogenic shock and non-obstructive coronary arteries.
Background. Thrombocytopenia is a frequent complication of liver cirrhosis that significantly increases the risk of hemorrhagic complications and limits the possibilities of invasive diagnostic and therapeutic procedures. Currently, two fundamentally different approaches are used to correct this condition: pharmacological therapy with thrombopoietin receptor agonists and invasive methods such as partial splenic artery embolization (PSAE). This study presents a comparative analysis of the efficacy and safety of these methods in patients with liver cirrhosis and severe thrombocytopenia.Objective. A comparison of the efficacy and safety, and optimal indications for eltrombopag versus partial splenic artery embolization in the management of thrombocytopenia in patients with liver cirrhosis and hepatic failure.Material and methods. A single-center prospective study was conducted at Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin involving 59 patients with liver cirrhosis and thrombocytopenia (<50×109/L). Noniclusion criteria included oncological diseases, severe renal failure (GFR <45 mL/min), and active infectious processes. Patients were divided into two groups: Group 1 (n=28) received eltrombopag therapy at a dose of 50 mg/day for 14 days; Group 2 (n=31) underwent PSAE. Efficacy was assessed by platelet count dynamics, compensation duration, and complication rates. The literature search was conducted in the following databases: PubMed/MedLine, ResearchGate, and the Russian Scientific Electronic Library (eLIBRARY.RU), covering publications from 2010 to 2024.Results. Eltrombopag therapy achieved target platelet levels (>50×109/L) in 78.6% of patients, but the effect lasted only 6 weeks on average. In the PSAE group, platelet count normalization was observed in 100% of patients 1 month after the procedure, with subsequent increase to 110±17.37×109/L by week 12. The median compensation duration in this group was 50.35±9.12 weeks. Complications after PSAE were recorded in 41.9%, though mortality remained low (3.2%).Conclusions. The study results demonstrate that PSAE provides a more sustained thrombocytopenia correction compared to the drug therapy and may be considered the method of choice for patients with hypersplenism. Eltrombopag remains preferable for short-term preparation for planned invasive procedures. While PSAE complications require careful patient selection, they do not outweigh the method's long-term benefits.
Background. Kidney transplant recipients have a significantly increased risk of developing malignancies compared with the general population. Moreover, recipients living in different regions of the world have different rates and patterns of cancer incidence.Objective. To determine the characteristics of risk factors and pathogenesis of malignant neoplasms in kidney transplant recipients.Material and methods. The study was based on materials from Russian and international databases, including PubMed, Scopus, eLIBRARY.RU, CyberLeninka, Google Scholar, Web of Science, using the search queries «transplanted kidney,» «malignant neoplasms,» «pathogenesis,» and «risk factors.» From the initial selection of 154 publications, 60 of the most relevant studies from 2020–2025 were selected.Conclusion. Kidney transplant recipients are at increased risk of developing malignancies due to specific oncogenic factors absent in the general population. These factors are conventionally divided into three groups: donor-related, recipient-related, and kidney transplant-associated. Furthermore, there are additional factors associated with the development of post-transplant cancer that are specific to certain regions of residence, leading to different patterns of incidence. Understanding the risk factors and pathogenesis specific to renal transplant recipients in a specific population may allow for the identification of risk groups and the development of regional malignancy screening programs.
Background. Kidney transplant (KT) recipients are a high-risk group for atherosclerotic cardiovascular disease (CVD), closely linked to dyslipidemia.Objective. To demonstrate the efficacy and safety of a novel proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, inclisiran, for hyperlipidemia correction in and reduction of the risk of developing CVD in KT recipients.Material and methods. A series of clinical cases included five patients (two men, three women, mean age 56±10 years) with high cardiovascular risk, dyslipidemia, and persistently elevated low-density lipoprotein (LDL) levels, despite ongoing statin and ezetimibe therapy. Inclisiran targeted therapy was prescribed for secondary (4 patients) and primary (1 patient) CVD prevention. Subcutaneous inclisiran injection (284 mg in 1.5 mL solution) was administered in KT department, repeat injection was made after three months, the next injections were performed after 6 months. Dynamic studies of blood LDL, creatinine, tacrolimus levels were performed using standard methods.Results. Adjunctive inclisiran therapy led to a reduction in blood LDL levels by an average of 32% at two weeks, 40% at one month, and 55% at three months. Continued treatment maintained target LDL values. Inclisiran treatment caused no adverse effects and had no negative impact on transplanted kidney function.Conclusion. KT recipients with high risk of atherosclerotic CVD represent a promising group for lipid-lowering therapy including inclisiran.
Background. Late post-transplant diseases can be latent or present as late graft dysfunction.The objective was to assess the nature of pathological changes in liver transplant recipients in the long-term based on the severity of graft dysfunction.Material and methods. The results of a histological examination of the liver performed no earlier than one year after transplantation in 168 recipients were studied. The median follow-up was 57.8 (26.3; 94.9) months. Graft dysfunction was defined as overt if alanine aminotransferase (ALT), aspartate aminotransferase (AST), or alkaline phosphatase (ALP) increased to more than 1.5 times the upper limit of normal (n=73). Borderline dysfunction was defined as an increase in at least one of these parameters to more than 1 but less than 1.5 times the upper limit of normal, or an increase in gamma-glutamyl transferase (GGT) to more than 1.5 times the upper limit of normal (n=37). Graft dysfunction was absent in 58 recipients.Results. In the subgroup of recipients without graft dysfunction, a slight increase in body mass index (BMI) (+1.1 kg/ m2) was noted compared to BMI at transplantation. Recipients with the borderline graft dysfunction had a lower BMI (25.4 kg/m2), and those with the overt dysfunction had an even lower BMI (23.7 kg/m2), than the subgroup without graft dysfunction (26.8 kg/m2; p=0.015). Clinical signs of the graft dysfunction were absent in 34.5% of recipients at the time of examination; however, only 22.4% of these recipients showed no significant abnormalities on histological examination. Among the remaining recipients with normal liver tests, there was evidence of chronic hepatitis (19%), fatty liver disease (31%), or intralobular fibrosis (25.9%), and in one case, graft cirrhosis. Graft fibrosis was observed in 60.3% of recipients without graft dysfunction. Marked fibrosis (classified by the Liver Allograft Fibrosis (LAF) scoring system as LAF > 2) was detected in 31%, and significant portal tract fibrosis (assessed as the meta-analysis of histological data in viral hepatitis (METAVIR) score >2) was found in 20.7% of recipients without signs of graft dysfunction. In the subgroup of recipients with overt graft dysfunction, ductopenia was the only pathological finding in 11.1% of recipients. More than two-thirds of cases of fatty liver disease and intrahepatic fibrosis do not manifest with clinically significant abnormalities in functional liver tests. Histological examination allowed for the clarification of the cause of overt graft dysfunction in 69.4% of cases.Conclusion. Protocol biopsies in long-term liver transplant recipients enable the detection of pathological changes of varying severity, as well as the assessment of hepatitis activity, fibrosis stage, and the cause of graft dysfunction, and the identification of autoimmune disease recurrence.
Introduction. One of the fundamental prerequisites for the creation and the development of a scientific school is the leading, fundamental role of its founder, a major, outstanding scientist. The School of Transplantologists founded by the RAS Academician, Prof M.Sh. Khubutiya has been one of such school which activity has not been paid due attention in scientific publications.The purpose of the study was to analyze the activities of the scientific school founded by the RAS Academician M.Sh. Khubutiya over a 20-year period in a historical context, to assess its contribution to the development of Russian Transplantology.Material and methods. In the course of this study, a bibliographic search was performed in available specialized biomedical homeland and foreign electronic databases (DBs): Russian State Library (https://www.rsl.ru/ru/about/funds/disser); Central Scientific Medical Library, including RusMed (https://medj.rucml.ru/quest); PubMed/MEDLINE (https://www.pubmed.ncbi.nlm.nih.gov). Patent documentation was verified on the websites of the Federal Institute of Industrial Property (https://www.fips.ru/) and Google Patents (https://patents.google.com/patent). To collect information on M.Sh. Khubutiya's publications, the resources of the scientific and medical library of the N.V. Sklifosovsky Research Institute of Emergency Care (RIEC) were also utilized. Its collections, catalogs, and card indexes formed the basis for further in-depth research, in which its staff provided significant assistance. Documentary and photographic materials from the HR Department and the Scientific and Organizational Department of the N.V. Sklifosovsky Research Institute of Emergency Care were also utilized.Results. The Scientific School of Prof. M.Sh. Khubutiya, the Academician of the Russian Academy of Sciences is a large and respected national school of versatile transplantologists in Russia, whose research continues and develops the ideas, views, and methodological approaches proposed by the teacher. The scientific achievements of M.Sh. Khubutiya's School are highly relevant and innovative. A number of the scientific school studies and research are of a fundamental and applied nature. A distinctive feature of the scientific School of M.Sh. Khubutiya is its extensive scientific and organizational activities aimed at the establishment and development of Transplantation Programs in the Moscow Healthcare System, significantly increasing the accessibility of this type of socially significant and high-tech medical care for residents of the world's largest megapolis. The School's work is particularly important in creating public structures such as the Scientific Society of Transplantologists and the scientific and practical journal of «Transplantologiya», which are powerful tools for introducing new knowledge and technologies into the country's healthcare system.Conclusion. M.Sh. Khubutiya's scientific School is characterized by its broad scope of research on organ and tissue transplantation, donation, and artificial organ creation, as well as the effective implementation of these findings through active training of specialists, targeted scientific and organizational activities, and the preparation of necessary regulatory documents. The School's work has significantly influenced the development of such a new and priority scientific field as organ and tissue transplantationy within the N.V. Sklifosovsky Research Institute of Emergency Medicine, the Moscow healthcare institution, and also far beyond.
Introduction. Simultaneous pancreas and kidney transplantation (SPKT) is an effective method of surgical treatment for patients suffering from type 1 diabetes mellitus (DM 1) in combination with end-stage renal disease as a result of diabetic nephropathy. Mean arterial pressure (MAP) of at least 90 mmHg improves hospital survival of grafts and recipients after SPKT. This paper presents the study investigating the effect of intraoperative MAP on long-term outcomes after SPKT.Objective. The study objective was to evaluate the impact of the factor MAP at reperfusion in patients undergoing SPKT on the 15-year survival of kidney grafts, pancreas grafts and recipients.Material and methods. A retrospective study of the effect of the MAP value at the stage of transplant reperfusion on the long-term treatment outcomes of 86 patients who underwent SPKT from 01.01.2007 to 12.31.2024 at the Kidney and Pancreas Transplantation Department of N.V. Sklifosovsky Research Institute for Emergency Medicine. There were 52 men (60%) and 34 women (40%), with a median age of 35 (31;39) years. Initially, the ROC analysis divided the patients into two groups: group I consisted of patients with MAP of <90 mmHg (n=23); group II consisted of patients with an average MAP of >90 mmHg (n=63). The primary point was to study the effect of a combination of factors, including the MAP value on reperfusion, on the 15–year survival rate of kidney grafts, pancreas grafts and recipients after SPKT. The end point was to analyze the 15–year survival rate of kidney grafts, pancreas grafts and recipients depending on the level of MAP during reperfusion.Results. There was a statistically significant increase in the risk of a fatal outcome in recipients over the next 15 years after surgery, with a 5.66-fold increase in the duration of renal replacement therapy for each year (p=0.018), a 1.067-fold increase in BMI per 1 kg/m2 (p=0.036), and a 1.782-fold decrease in the mean arterial pressure during reperfusion below 90 mmHg (p=0.021). The influence of the other factors was statistically insignificant. There was a statistically significant dependence of the risk of 15-year loss of a kidney graft (p=0.017), a pancreatic graft (p=0.042) and the lethality of recipients (p=0.005) on the level of mean arterial pressure during reperfusion. The 15-year survival rate of renal allografts was 42.3% in the group with MAP>90 mmHg, and 38.2% in the group with MAP<90 mmHg; the survival rate of pancreatic allografts was 60.8% and 48.9%, respectively; and the survival rate of recipients was 78.8% and 57.4%, respectively.Conclusion. The MAP value of > 90 mmHg during the reperfusion is a statistically significant factor of the increase in the 15-year survival rates of a kidney graft (p=0.017), pancreas graft (p=0.042), and recipients (p=0.005) after SPKT.
Background. Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. Up to 80% of patients with primary sclerosing cholangitis have concomitant inflammatory bowel disease. Liver transplantation is the only curative treatment for end-stage chronic diffuse liver diseases. Treatment of UC is challenging, especially in patients who underwent liver transplantation and receive immunosuppressive therapy. Microbiota plays an important role in the pathogenesis of UC, although data on the efficacy of antibiotics in the treatment of UC are limited. We describe the effect of oral vancomycin treatment in three liver transplant recipients with UC refractory to conventional and biological therapy. All three patients achieved clinical remission and mucosal healing with oral vancomycin orally. Oral vancomycin treatment was well tolerated and resulted in sustained clinical and endoscopic remission in all three patients.Objective. To demonstrate the efficacy of oral vancomycin in the treatment of refractory ulcerative colitis in liver transplant recipients.Material and methods. The article presents observations of three liver transplant recipients with ulcerative colitis refractory to standard and biological therapy, who received vancomycin orally for 6 months.Results. Remission of refractory ulcerative colitis in liver recipients was achieved by taking vancomycin orally.Conclusion. Oral vancomycin administration in some cases lead to clinical and endoscopic remission of ulcerative colitis in recipients in whom standard and biological therapy for UC have not been effective.
