Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task.The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes.Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed.Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p<0.001; transportation time was 3.5 h (interquartile range : 2.5–4.7 h) and 3.5 h (interquartile range: 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p <0.001, in group 1 and group 2, respectively, the difference being statistically significant for all parameters. Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance.Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.

Currently, an organ rejection is a leading cause of kidney transplants loss. Effective therapy is impossible without a clear understanding of the rejection mechanisms. In this paper, we summarize the views of domestic and foreign authors on the role of T cell activation in kidney transplant rejection.

Aim: to evaluate the effectiveness of coupled plasma filtration and adsorption (CPFA) in reducing the severity of the renal graft ischemic and reperfusion injury. Materials and methods: short-and long-term results of renal transplantation in 33 pairs of recipients were analyzed. The patients were divided into two groups: in 33 recipients of the study group we performed CPFA in the early postoperative period. In the comparison group in 33 recipients with paired grafts CPFA was not performed. Results. The proportion of patients with good initial and delayed graft functions in the two groups was the same. In patients with delayed graft function from the study group a significantly greater rate of creatinine and urea decrease and glomerular filtration rate (GFR) increase than in patients of the comparison group were observed. Among patients with good initial graft function the differences between the groups were not significant. We have also analyzed long-term results of the transplantations: patients who received CPFA in the early postoperative period had lower levels of creatinine, urea and daily proteinuria and higher GFR in 1 year time. Thus, as a result of CPFA in the early postoperative period the improvement of graft function and graft survival prognosis can be expected in the long-term.

Introduction. The development of immunological confl ict in the form of host-versus-graft reaction has always been main problem in transplantation. The worst case is the development of humoral rejection with the presence of circulating immune complexes and antibodies. There are several methods for quick removal of antibodies; among those are traditional plasmapheresis (PA) and double fi ltration plasmapheresis (DFPF). In this paper we present our experience with these two methods and give a comparative evaluation of the effectiveness in the treatment of acute humoral rejection in renal allograft. Aim: to compare the effectiveness of traditional and double fi ltration plasmapheresis while processing different volumes of plasma in the treatment of host-versus-graft disease after kidney transplantation.Methods. The study included 58 patients after kidney transplantation. All patients had increased activity of humoral immunity, which was confi rmed by immunofl uorescence with luminescence C4d complement component. In 26 patients we performed DFPF, in 32 patients – traditional PA. We divided the DFPF patients into 4 subgroups depending on the amount of processed plasma: > 50% (5 patients), 50–100% (8 patients), 100–150% (7 patients), 150–200% (6 patients) of circulating plasma volume. We also divided PA patients into four subgroups depending on the volume of plasma removed: >50% (8 patients), 50–70% (12 patients), 70–90% (7 patients), 90–110% (5 patients) of the volume of circulating plasma. We monitored the immune status with markers of humoral immunity activation IgM, IgG before and after each of the procedures.Results. Each procedure of traditional PA and DFPF was accompanied by a marked decrease in blood concentrations of IgM and IgG antibodies. Their level decreased by an average of 30–55% of the original. However, some patients in both groups showed an increase in the concentration of these immunoglobulins in 1–2 days after the fi rst and the second procedures. The effect of rebound was observed during DFPF if in one procedure less than 100% of the circulation plasma volume was processed and during traditional PA if less than 70% was removed. Upon reaching the target values and increasing the processing volumes we managed to avoid growth of IgM and IgG.Conclusions. DFPF and traditional PA can effectively reduce the high titers of circulating antibodies, which is accompanied by a decrease in the activity of humoral immunity of the recipient. In the case of double fi ltration plasmapheresis at least one volume of circulating plasma should be processed and in traditional plasmapheresis – at least 70% should be removed.

Aim. To study the effect of hemofi ltration and coupled plasma fi ltration adsorption on tacrolimus blood concentration in renal transplant recipients.Methods and results. The study included 8 renal transplant recipients. In these patients immediately after the operation was performed the coupled plasma fi ltration adsorption with hemofiltration using a cartridge Mediasorb to reduce the severity of reperfusion injury. We have found that during this extracorporeal blood correction procedure there was statistically not signifi cant decrease of tacrolimus blood concentration. However, concentration of tacrolimus remained in the therapeutic range even after the procedure and it was not signifi cantly different from the control point С0.Conclusion. Coupled plasma fi ltration adsorption is safe in renal transplant recipients and has no signifi cant impact on tacrolimus blood concentration. However, the downward trend in the concentration of tacrolimus in the course of these procedures, especially in continuous or semicontinuous mode, as well as in patients with low hematocrit and hypoalbuminemia, requires individual monitoring.

In the article first experience with the usage of coupled plasmafiltration and adsorption in the treatment of sepsis in patients after kidney transplantation has been presented. Aim: to make a comparative assessment of the impact of hemofiltration and coupled plasmafiltration and adsorption (CPFA) on systemic hemodynamics and alveolar-capillary diffusion, as well as the dynamics of the pro- and antiinflammatory cytokines in patients with sepsis after renal transplantation. Methods and results. The study included 24 recipients. In the main group (n = 14), we used a combination of CPFA and hemofiltration. The patients of the comparison group (n = 10) we used an isolated hemofiltration. In patients of both groups we observed improvement of hemodynamics and lung function. In doing so by the fifth day after the second procedure in patients of the main group the results were significantly better. This effect we mainly associate with a reduction in the activity of the systemic inflammatory response and the rate of progression of sepsis. This is confirmed by the fact that circulating pro- and anti-inflammatory cytokines were expressly removed during the CPFA.Conclusion. As a result of the CPFA and the hemofiltration we observed an increase in mean arterial blood pres- sure, improving gas exchange in the lungs, as well as reducing the need for vasopressor support. In this case, the additional sorption removal of circulating inflammatory mediators reduces the activity of the systemic inflam- matory response, which can significantly increase the effectiveness of the therapy.

In the article fi rst experience with the usage of coupled plasma fi ltration and adsorption in the treatment of sepsis in patients after kidney transplantation has been presented. Aim: to make a comparative assessment of the impact of hemo fi ltration and coupled plasma fi ltration and adsorption (CPFA) on systemic hemodynamics and alveolar-capillary diffusion, as well as the dynamics of the pro- and antiin fl ammatory cytokines in patients with sepsis after renal transplantation. Methods and results. The study included 24 recipients. In the main group (n = 14), we used a combination of CPFA and hemo fi ltration. The patients of the comparison group (n = 10) we used an isolated hemo fi ltration. In patients of both groups we observed improvement of hemodynamics and lung function. In doing so by the fi fth day after the second procedure in patients of the main group the results were signi fi cantly better. This effect we mainly associate with a reduction in the activity of the systemic in fl ammatory response and the rate of progression of sepsis. This is con fi rmed by the fact that circulating pro- and anti-in fl ammatory cytokines were expressly removed during the CPFA. Conclusion. As a result of the CPFA and the hemo fi ltration we observed an increase in mean arterial blood pres- sure, improving gas exchange in the lungs, as well as reducing the need for vasopressor support. In this case, the additional sorption removal of circulating in fl ammatory mediators reduces the activity of the systemic in fl am- matory response, which can signi fi cantly increase the effectiveness of the therapy.

Introduction. One of the current tasks of transplantology is to overcome "graft-host" immune conflict. Partially this conflict is caused by the presence of circulating pre-existing antibodies. Highly sensitized patients have a greater risk of rejection and subsequent graft loss. There arc several methods to remove the antibodies, one of which is a double filtration plasmapheresis (DFPF). This report presents our experience of DFPF in recipients of high immunologic risk. Aim: to compare the effectiveness of traditional and double filtration plasmapheresis in desensitization of patients with high risk of immunological complications. Methods. The study included 30 patients after kidney transplantation. All patients were classified as high-immunologic risk group. In 15 patients of study group we performed DFPF, in 15 patients of comparison group - traditional plasmapheresis. We monitored the immune status: markers of humoral immunity activation - IgG, IgM, IgA before and after the procedures. DFPF procedure was performed on OctoNova (MeSys, Germany) with a plasmafilter and plasma components separator. Protocol biopsies were performed on days 30 and 90. Results. The concentration of antibodies be effectively reduced with DFPF. Total IgM and IgG antibodies were reduced by 30 55 of the original le There was a less albumin loss in case of DFPF application. There is I patient with antibody-mediated rejection with graft dysfunction in study group. There are no signs of rejection in 30-and 90-day biopsy in study group. But there were three patients with subclinical antibody-mediated rejection in the comparison group. Conclusion. DFPF can safely and effectively reduce the high titers of antibodies that are responsible for Immoral rejection of renal allograft. Reduction of antibodies in sensitized patients immediately after transplantation may improve graft function.

Kidney transplant is inevitably subjected to ischemic and reperfusion injury. In many cases, this is due to a violation of intraorgan hemodynamics. Severity of such damage can be reduced using different methods of extracorporeal hemocorrection. The aim of the study was to examine the intraorgan blood flow of kidney transplant and assess the impact of plasmapheresis on its primary function in the early postoperative period. Plasmapheresis with replacement from 1,25 to 3,5 liters of plasma was applied in 40 recipients of the Group 1; in 40 recipients of Group 2 plasmapheresis was not performed. High resistance index (Ri > 0,9) at low flow velocities in the interlobular arteries at the first day after surgery is an informative criterion for the diagnosis of acute tubular necrosis and indicates the inadequate blood supply of kidney. Plasmapheresis has promoted the normalization of renal hemodynamics. Immediate graft function in patients of Group 1 was observed in 36 patients, whereas only in 19 patients of Group 2. In the Group 1, there were no patients with primary non-functioning graft, while there were three such patients in Group 2. Thus, plasmapheresis in the early postoperative period, no later than 3-5 h after reperfusion of the graft, has a positive effect on the functional status of the transplanted kidney.

This review highlights current concepts of sepsis pathogenesis and the efficacy of modern methods of extracorporeal hemocorrection.

Ватазин, А. В. Влияние экстракорпоральной сорбции эндотоксина на функциональное состояние почечного трансплантата / А. В. Ватазин, А. Б. Зулькарнаев, М. Крстич // Экстракорпоральная гемокоррекция в интенсивной терапии критических состояний : тезисы докладов 6-й Междунар. науч.- практ. конф. (23 мая 2013 г., Минск) / Белорус. гос. мед. ун-т; под ред. В. В. Кирковского. - Минск : БГМУ, 2013. - С. 33-37.

Septic complications represent a significant portion of all complications after kidney transplantation. Many of the specific and nonspecific factors predisposing to the development of serious bacterial infections in kidney transplant recipients and gram-negative infection remains one of the most frequent. Endotoxin of gram-negative bacteria is the important factor in the initiation of the systemic inflammatory response. In recent years, one of the most perspective ways of treatment of mixed and gram-negative severe septic complications is the selective adsorption of endotoxin. However, current research applications of this method in patients after renal transplantation are very few.

The review of literature presents the current view of domestic and foreign authors on the frequency of infectious complications after kidney transplantation, their etiology, timing of emergence, and the spectrum of bacterial pathogens. Data on the effects of bacterial complications on the function of renal transplant and recipient survival are also demonstrated.

Сочетанная плазмофильтрация и адсорбция в коррекции синдрома ишемии/реперфузии при трансплантации почки / А. В. Ватазин [и др.] // Экстракорпоральная гемокоррекция в интенсивной терапии критических состояний : тезисы докладов 6-й Междунар. науч.- практ. конф. (23 мая 2013 г., Минск) / Белорус. гос. мед. ун-т; под ред. В. В. Кирковского. - Минск : БГМУ, 2013. - С. 28-33.

The study is devoted to analysis of microflora spectrum in various biological materials in patients after renal transplantation. The character of the flora is strongly dependent on the infectious process localization. Gram-positive and gram-negative bacteria are found in approximately equal proportions with a slight predominance of gram-positive flora. Isolated bacteria in most cases had pronounced polyvalent antibiotic resistance. The performed analysis substantiated recommendations for rational antibiotic therapy of various bacterial infections.