Objective: to improve the outcomes of liver transplantation (LTx) from expanded criteria donors (ECDs) through hypothermic oxygenated machine perfusion (HOPE).Material and methods. The study included 63 cases of LTx from suboptimal brain-dead donors. Group I (control) consisted of 34 persons in which liver transplant was preserved only by static cold storage (SCS), while group II (main) comprised 29 cases where ex situ HOPE was used after static preservation. We evaluated the efficacy and safety of the latter in a comparative clinical study and by studying ultrastructural changes in the liver using electron microscopy.Results. No statistically significant differences between the groups in terms of baseline characteristics of donors, recipients and several perioperative parameters (p > 0.05) were obtained. Peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in the first week after transplantation were 1,052 (IQR: 712–1,842) U/L and 1,213 (IQR: 613–2,032) U/L in the HOPE group, and 1,943 (IQR: 1,294–5,214) U/L and 2,318 (IQR: 1,032–6,219) U/L in the SCS group (control). The levels were statistically significantly lower (p = 0.002 and p < 0.001, respectively). Median comprehensive complication index (CCI) in the main and control groups was 0 (IQR: 0–22.6) and 27.6 (IQR: 0–100) respectively. The differences were statistically significant (p = 0.001). Similarly, statistically significant differences were noted in terms of recipient time in the intensive care unit (ICU) and overall length of hospital stay (p = 0.042 and p = 0.028) – they were less in the HOPE group. Electron microscopy evaluation of the morphology of liver grafts revealed that hepatocytes sustained less injury during HOPE.Conclusion. Ex situ HOPE is a safe and effective way of preserving liver transplants. Its use in LTx from expanded criteria donors can lessen the severity of ischemia-reperfusion injury (IRI) in the organ and enable additional assessment of the suitability of an organ for transplantation.

Objective: to assess if normothermic ex vivo machine perfusion (NMP) of a kidney from an expanded criteria donor (ECD) is feasible and safe.Materials and methods. NMP of the right kidney from an ECD was performed on a device developed at Botkin Hospital. A solution based on donor’s blood with the addition of Ringer’s lactate solution and human albumin was used for perfusion. The temperature in the circuit was maintained at 37 °C. Perfusion lasted for 203 minutes, after which the renal resistive index was almost halved from 0.33 to 0.16. 120 ml of urine was obtained.Results. The right kidney was successfully transplanted after perfusion. There was immediate function of the right renal graft in the postoperative period. The recipient’s serum creatinine level was 530 μmol/L on day 1 following transplantation and 170 μmol/L on day 14 of discharge. The left kidney was preserved by static cold storage and further transplanted to the recipient.Conclusion. The use of NMP to preserve grafts obtained from ECDs is safe and feasible in clinical practice. Further studies are required to determine the clear indications for its use and to formulate an optimal procedure for its implementation.

Organ transplantation is the best therapy for terminal and irreversible organ failure. The global development of organ transplantation as a type of medical care is inextricably linked to the establishment of neurological criteria for declaring human death (brain death). In the early evolutionary period of transplantation, organs were used, mainly kidneys, obtained from donors whose death was ascertained in accordance with the generally accepted criteria of cessation of blood circulation and respiration. As this type of organ donation developed, numerous terms were used in the world literature to designate it, such as ‘asystolic donors’, ‘non-heart beating donors’, ‘donors after cardiac death’, etc. In Russia, there is an established practice of dealing with donors after cardiac death (DCD), but the active development of Russian transplantology in the last 20 years is primarily associated with brain-dead organ donation. However, countries with the most active and advanced organ donation practices have in recent years been successfully dealing with donors who have suffered sudden out-of-hospital cardiac arrest (OHCA). Previously, this type of donation was considered inaccessible due to the unacceptable warm ischemia time and consequently severe damage to donor organs. Due to the development of new technologies in emergency medical care, it became possible to transport a patient with clinical death that occurred in an outof-hospital setting, to the hospital, while providing cardiopulmonary resuscitation by means of automatic chest compression and artificial ventilation. The article presents historical aspects of donation after cardiac death, and the most actualized definitions and practices of dealing with such donors.

The global development of transplantology faces several objective obstacles. One of the major ones is widespread organ shortage. This is most pronounced in clinical lung transplantation (LT). The development of this area is directly connected with more intensive development of available donor resources and search for new sources of donor organs that are suitable for transplantation. Along with the existing methods of increasing the number of lungs suitable for transplantation, LT with donation after cardiac death (DCD) is attracting increasing attention. The effectiveness of this approach has been confirmed by the International Society for Heart and Lung Transplantation and deserves more attention from Russian specialists.

Objective. The paper aims at demonstrating the efficacy of endovascular interventional techniques in the treatment of rare vascular complications after kidney transplantation.Material and methods. Recipients of renal grafts obtained from a deceased donor developed the following complications: a false aneurysm of the interlobar renal artery after lymphocele puncture in one case and a subintimal hematoma of the external iliac artery with subocclusion of the latter and impaired perfusion of the renal graft in the other one.Results. These complications were successfully managed using X-ray endovascular technologies, which allowed saving the renal grafts in both cases with satisfactory long-term results.Conclusion. Early diagnosis and endovascular technologies made it possible to cope with complications minimally invasively and prevent the development of adverse events in the long term.

Kidney transplantation (KT) remains the best treatment for patients with chronic kidney disease (CKD) stage 4–5. It helps patients live longer, have better quality of life, and undergo improved medical and social rehabilitation. This paper examines the outcomes of KT performed between 2019 and 2023.Materials and methods. There were 1,106 KTs deceased donor KTs performed between January 1, 2029, and December 31, 2023. The recipients had a median age of 45 (37–54) years, with 664 (60%) males and 442 (40%) females. Donors were mainly males (n = 706, 63.8%), with the median donor age being 50 (43–57) years. Induction immunosuppressive therapy (IST) with monoclonal antibodies was administered to 859 (77.7%) recipients, with polyclonal antibodies to 122 recipients (11%), and induction without antibodies to 125 recipients (11.3%). Triple-drug baseline IST consisted of a combination of calcineurin inhibitors, antimetabolites and glucocorticoids. Tacrolimus was the most often utilized calcineurin inhibitor (n = 961, 86.9%), while cyclosporine was used less often (n = 145, 13.1%). Mycophenolic acid (n = 1041, 94.1%) was used as the second medication in most recipients, while everolimus (n = 54, 4.9%) and azathioprine (n = 11, 1%) were used less often.Results. Primary initial renal graft function was noted in 714 patients (64.6%) and delayed in 392 recipients (35.4%). Overall incidence of surgical complications was 11.6% (n = 130), and immunological complications 9.9% (n = 109). At hospital discharge, 768 recipients (69.4%) had satisfactory kidney allograft (KAG) function, while 276 recipients (25%) were discharged with graft dysfunction; median serum creatinine and blood urea levels were 158 (120–204) μmol/L and 11 (8–16) mmol/L, respectively. Twenty-six recipients (2.4%) were discharged to continue renal replacement therapy; 28 recipients (2.6%) underwent in-hospital graft nephrectomy. Twelve individuals passed away during the hospitalization phase. The cumulative uncensored in-hospital graft and recipient survival rates were 97.5% (n = 1078) and 98.9% (n = 1094), respectively.Conclusion. KT is an effective and safe transplant modality for stage 4–5 CKD. Our KT outcomes are consistent with those of reputable transplant centers around the globe.

Introduction. The high prevalence of chronic kidney disease (CKD) has a negative impact on the length and quality of life of patients, especially in the older age group. Renal replacement therapy is required when the disease progresses to end-stage renal failure. In elderly patients with comorbidities, dialysis therapy has its own peculiarities and challenges, often prolonging life for a short period. The increase in the number of patients aged ≥70 years requesting to be placed in the kidney transplant waitlist (KTWL) at Sklifosovsky Research Institu- te of Emergency Care has led to the need to evaluate kidney transplant (KT) outcomes in this patient cohort.Objective. To analyze the early and long-term outcomes of deceased-donor KT in recipients aged ≥70 years.Materials and methods. The retrospective study included 23 kidney recipients aged ≥70 years who underwent a deceased-donor KT in the period from 2014 to 2023 at the Kidney and Pancreas Transplantation Department, Sklifosovsky Research Institute of Emergency Care. Recipient survival was computed using the Kaplan–Meier estimate.Results. Sixteen recipients (69.6%) had primary function and 7 (30.4%) had delayed function. Nineteen recipients (82.6%) showed a drop in blood creatinine below 200 μmol/L after KT. Hospital, 1- and 3-year survival were 96% (n = 22), 84.8% [95% CI 72–95] and 79% [95% CI 65–92], respectively; 1- and 3-year graft survival were 84.8 [95% CI 72–95] and 73% [95% CI 59–87], respectively.Conclusion. KT for patients aged ≥70 is a feasible treatment option for CKD stage 5.

Objective: to determine the efficacy and safety of an integrated strategy aimed at preventing delayed renal graft function (DGF). Materials and methods . From June 2018 to December 2022, 478 deceased-donor kidney transplants were performed at Botkin Hospital, Moscow. The patients were divided into two groups: Group I consisted of 128 patients who did not use the integrated strategy; Group II included 67 patients in whom the DGF prevention strategy was used at the perioperative stage. The integrated strategy involved the use of hypothermic oxygenated machine perfusion (HOPE) using expanded criteria donors, the use of a second warm ischemia (SWI) elimination device, personalized initial calcineurin inhibitor (CI) dosing, and use of alprostadil for high vascular resistance in renal graft arteries. Results. DGF occurred in 5 of 44 patients (11.4%) that used the integrated strategy, and in 13 of 44 patients (29.5%) in the control group. The differences were statistically significant (p = 0.034), there was a medium strength relationship between the traits (V = 0.225). The use of the integrated DGF prevention approach reduced the chances of developing DGF by a factor of 0.3 (95% CI: 0.1–0.95). The risk of DGF in the integrated strategy group was 61.3% of the risk of DGF in the non-strategy group, thus the relative risk (RR) is 1.63 (95% CI: 1.1–2.4). Median duration of graft function normalization was statistically significantly lower in group II: 5 (IQR: 3–9) versus 15 (IQR: 7–19) days (p = 0.012). Mean length of hospital stay was 19.1 ± 4.2 (95% CI: 14.5–26.1) bed-days in group I and 13.9 ± 3.4 (95% CI: 9.3–17.2) bed-days in group II. Differences in this indicator were also statistically significant (p = 0.043). Conclusion. The set of DGF prevention measures, developed at Botkin Hospital, evidence-based and implemented in clinical practice, can reduce the burden of modifiable risk factors of this complication significantly, thereby improving treatment outcomes for kidney transplant recipients considerably.

Objective : to present the successful experience with a donor with out-of-hospital cardiac arrest (OHCA) in whom a set of modern perfusion techniques was used to obtain kidneys suitable for transplantation. Materials and methods . Automatic chest compression was resumed in an OHCA donor (after biological death has been confirmed in the hospital) to maintain minimal perfusion under mechanical ventilation with 100% FiO 2 . With femoral vein cannulation, an extracorporeal circuit with a centrifuge pump and oxygenator was connected and abdominal normothermic regional perfusion was initiated. After 215 minutes, kidney was explanted under normothermic machine perfusion. Next, the left kidney was placed in the LifePort Kidney Transporter for hypothermic machine perfusion of donor kidneys. Perfusion time was 285 minutes. The right kidney was transplanted without additional ex-vivo perfusion. Results . Due to the complex use of perfusion techniques both in the donor body and ex-vivo , donor kidneys, after OHCA, with a total warm ischemia time of 110 minutes, were transplanted to recipients with good results. In the postoperative period, there was delayed function of the left and right renal grafts. The patients were discharged in a satisfactory condition under outpatient follow-up. Conclusion. The possibility and efficiency of organ donation after OHCA, facilitated by modern perfusion techniques and devices, open up a new perspective in addressing the organ shortage crisis.

The objective of the study was to investigate the evolution and trends in liver donation in the city of Moscow, with special focus on the expansion of liver donor selection criteria for transplantation. Materials and methods. The study included 1,548 effective donors (EDs) in the period from January 1, 2012 to December 31, 2020. Their basic characteristics - age and cause of death - are presented. The dynamics of changes in the age groups of donors and the dynamics of the number of >= 60-year-old liver donors were studied. The influence of expanded liver donor selection criteria over the dynamics of the number of transplant surgeries and patient flow on the waiting list was assessed. Results. During the study period, the number of effective liver donors (ELDs) in Moscow increased 4.7-fold. The average age of ELDs increased from 37.1 in 2012 to 48.8 in 2020. There was an absolute prevalence of donors who died from cerebrovascular accident compared with donors who died from traumatic causes, 83.4% vs 16.6%, respectively. Since 2016, there has been a progressive increase in >= 60-year-old liver donors; the number of such donors in 2020 reached 39, accounting for 13.6% of the total pool of EDs. The progressive growth in the number of liver transplants has significantly influenced patient movement on the waiting list. In 2012, there was a 25.2% increase in the number of liver transplants per 100 patients on the waiting list; by 2020, it had reached 86.6%. Conclusion. The results reasonably indicate an increase in liver donation and liver transplantation (LTx) in Moscow. Comparison of Russian data with those of leading foreign donor programs shows that the trends in the donor pool in the context of older age, including >= 60-year-old donors, and shifting causes of donor death towards cerebrovascular diseases are similar. An overall increase in donor activity and expansion of liver donor criteria contributed to an increase in the number of transplants performed per 100 patients on the waiting list, which, in turn, reduced the waiting time for a donor organ and increased the intensity of patient flow on the waiting list.

Objective: to present an analysis of the results of 100 cadaveric liver transplants performed at Botkin Hospital from July 2018 to October 2021. Materials and methods. From July 2018 to October 2021, 100 orthotopic liver transplantation (LTx) from a deceased donor were performed at the surgical clinic of Botkin Hospital. The recipients were 58 males (58%) and 42 females (42%). The mean age of the recipients was 48.73 ± 8.56 (24–66) years, while their mean MELD was 19.54 ± 4.35 (15–33). The main indications for LTx were cirrhosis resulting from chronic viral hepatitis (CVH) C (52%), nutritional-toxic cirrhosis (20%), autoimmune liver and bile duct disease (18%), CVH B (7%), and hepatocellular carcinoma (HCC) (3%). During the period under study, 119 potential liver transplant donors were evaluated. The mean age of the donors was 44.2 ± 11.12 (21–63) years. Median levels of sodium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin were 141 (138–146) mmol/L, 27 (20.7–47.4) units/L, 25 (17–41.5) units/L, and 9.65 (6.42–13.7) μmol/L, respectively. The median graft hepatic steatosis was 10% (5–15). LTx was performed using the piggyback technique (99/100 cases) and classic technique with inferior vena cava resection (1/100). End-to-end porto-portal vein anastomosis was performed (99/100 cases). Anastomosis of the donor organ’s portal vein with the recipient’s left gastric vein due to occlusive thrombosis of the recipient’s portal vein was carried out (1/100). In all cases, a continuous end-to-end arterial anastomosis was formed. End-to-end choledochocholedochal anastomotic strictures (95/100) and end-to-side hepaticojejunostomy (5/100) were formed. Results. Median cold ischemia time was 312.5 minutes (280–380). Mean operative time was 488.91 ± 65.34 (95% CI: 475.9–501.9) minutes, median intraoperative blood loss was 1000 (600–1500) mL. Thirty-day mortality was 2% (Clavien–Dindo class V). Early postoperative complications (Clavien–Dindo class IIIa–IVa) developed in 12/100 patients (12%). Graft arterial thrombosis occurred in 3 cases (3%), biliary anastomotic strictures in 6 (6%), and subhepatic hematoma in 2 (2%). The average intensive care unit (ICU) bed day was 2.34 ± 1.67 (1–8). Total postoperative bed-day was 14.63 ± 5.35 (10–39). During case follow-up, a prolonged form of calcineurin inhibitor (CNI) was administered as immunosuppressive therapy in mono regimen (85 patients), in combination with mycophenolic acid derivatives (7), and in combination with everolimus (6). Of the 93 patients, 46 patients (49.46%) had the new coronavirus infection (COVID-19) before or after transplantation; in no case did COVID-19 lead to death. Six patients (13.04%) were hospitalized due to COVID-19. To date, 33/93 (25.48%) patients have been vaccinated, resulting in 75 (75%) liver transplant recipients immune to COVID-19. The overall 1-year survival rate was 95% and the 3-year survival rate was 91%. Conclusion. Introduction of LTx in multidisciplinary hospitals allows to, already at the start of the program, achieve immediate and long-term treatment outcomes (in decompensated diffuse liver disease) that are comparable to those of leading transplantation centers.

Fatty liver disease (steatosis) is considered a risk factor in donor liver transplantation (LT). Macrosteatosis (>50%) is associated with primary graft dysfunction and may reduce long-term recipient survival.Objective: to identify predictors of macrovesicular steatosis (>50%) by analyzing donor characteristics.Materials and methods. The retrospective study included 525 potential liver donors between January 1, 2019 and December 31, 2020. Clinical and morphological characteristics of donors were studied using logistic regression and receiver operating characteristic (ROC) analysis. Threshold values of parameters demonstrating statistical significance in multivariate analysis as predictors of >50% hepatic steatosis were obtained by ROC analysis based on calculation of the optimal cutoff point.Results. Diabetes mellitus (DM), cause of donor’s death (traumatic brain injury), alanine transaminase (ALT) >90 units/L and aspartate transaminase (AST) >110 units/L were predictors of >50% steatosis, revealed by time-zero biopsy in the donor. Almost identical sensitivity and specificity indicators were determined in ROC analysis for liver enzymes – ALT and AST – which were 69.1 and 80.6; 72.2 and 81.1, respectively. Given the obtained values, we can say that with elevated levels of liver enzymes in the donor’s blood, there is a high degree of probability of liver parenchymal damage, but low sensitivity indicates possible multifactoriality of liver damage, and fatty liver disease may be one of the factors, but there may also be no damage to the liver parenchyma. At the same time, the rather high specificity revealed in ROC analysis for liver enzymes is a reliable sign of the absence of fatty liver disease at enzyme values less than the threshold.Conclusion. The thresholds established for ALT and AST and their corresponding levels of sensitivity and specificity indicate that these parameters have a relatively low predictive level in the context of the presence of severe fatty liver disease in a donor. This allows, nevertheless, to use models built on their basis as screening models in the primary evaluation of liver donors.

Objective: to demonstrate, using a clinical case, the first successful experience in a combined use of an automated chest compression device (ACCD) and hypothermic oxygenated machine perfusion (HOPE) for kidney transplantation from a donor with irreversible cardiopulmonary arrest. Materials and methods. In the presented clinical case, ACCD was successfully used in a donor who was pronounced dead following an irreversible cardiopulmonary arrest. This allowed to minimize the primary warm ischemia time. Kidney graft HOPE for 585 minutes reduced the static cold storage time to 165 minutes. Results. In the uneventful postoperative period, there was immediate kidney graft function. This allowed for rapid rehabilitation and discharge from hospital. Conclusion. Introduction of ACCD and HOPE will increase the number of donor organs, mainly kidneys intended for transplantation.

Objective : to evaluate the safety and efficacy of hypothermic oxygenated machine perfusion (HOPE) for kidney grafts obtained from expanded criteria donors (ECD). Materials and methods . From June 2018 to June 2021, 200 surgeries involving kidney transplants from deceased donors were performed at Botkin City Clinical Hospital. Of these, 123 were men (61.5%) and 77 were women (38.5%). The mean age was 47.62 ± 11.69 (20–73) years. In 102 cases, kidney grafts were procured from ECD. In 92 recipients (90.2%) of kidney transplants from an expanded criteria donor, static cold storage done according to the standard technique was used to preserve the organ; these patients constituted observation group 1. In 10 recipients (9.8%), hypothermic oxygenated perfusion was used in addition to static cold preservation; these patients formed observation group 2. Results . No 30-day mortality was recorded in both observation groups. The mean static cold storage time in group 1 patients was 612.33 ± 178.88 (133–1180) minutes. Overall incidence of delayed graft function was 26.5% (53/200). Incidence of delayed graft function was 19.3% (19/98) for organs from standard donors using static cold storage and 35.8% (33/92) for ECD organs. Twenty-five patients (12.5%) had postoperative complications. Postoperative complications with delayed graft function were diagnosed in 12 patients, which was 22.6% (12/53), with immediate function in 13 patients, which was 8.8% (13/147). Mean cold storage time in group 2 patients was 319.11 ± 110.24 (311–525) minutes. Mean HOPE time was 202.34 ± 21.48 (150–210) minutes. Delayed graft function was recorded in 1 group 2 patient (10%). No complications, including perfusion-related one, were recorded in this group. Conclusion . The unique technique used at Botkin City Clinical Hospital for HOPE in kidney transplant is safe. It provides a low risk of delayed graft function for ECD kidneys.

Aim . To study the frequency of fatty hepatosis in liver biopsies of consecutive brain death donors before cold preservation. Materials and methods . Liver biopsies (before cold preservation) of 300 consecutive donors with brain death were studied. Histological preparations were stained with hematoxylin and eosin, and tricolor Masson staining was performed. Results . The frequency of different degrees of fat hepatosis in men and women did not differ significantly (>0.05). Fat dystrophy of hepatocytes was absent in more than half of the cases (n = 182; 60.7%). A slight degree of fatty degeneration was diagnosed in 57 (19,0%) donors. In total, 239 (79.7%) donor livers were absolutely suitable for transplantation. Moderate degree of steatosis, which is associated with early biliary complications, was detected in 18 (6.0%) cases, and severe degree, which is a contraindication to the use of the organ for transplantation, was detected in 43 (14.3%) cases. Conclusion . Before cold preservation, liver from brain death donors is relatively rarely unsuitable for transplantation.

Organ donation and transplantation in Moscow have witnessed changes in the last decade. These changes have led not only to quantitative growth in the number of effective donors but also to fundamentally new (for Russian medical practice) characteristics of the donor pool. As a result, the selection criteria for organ donors have undergone some radical revisions. Objective: to analyze the medical and epidemiological characteristics of the pool of effective heart donors and assess their impact on selection of heart transplants. Materials and methods. In our study, we used the medical and epidemiological data of 650 brain-dead donors whose organs were procured from January 1, 2012 to December 31, 2017. Results. During the study period, the number of effective heart donors in Moscow increased from 4.4 (2012) to 11.2 (2017) per million population per year. The medical and epidemiological characteristics of the total pool of donors and the pool of heart donors underwent major changes. Among effective heart donors, there was a dynamic increase in the average age from 38.4 to 47 years, predominance of a proportion of donors with stroke 38.2 (2012) vs 83.2 (2017) and, accordingly, an increase in the frequency of such comorbid conditions, as hypertension and diabetes. Conclusion. The results presented in the study indicate a growing practice of working with expanded criteria donors. This practice is most effectively developed in the field of heart transplantation than in transplantation of other extrarenal organs. Undoubtedly, the experience under study is unique and relevant not only for the Russian Federation, but also for the world of transplantology, as it allows to provide vital assistance to patients with end-stage heart failure within a reasonable timeframe.

Objective: to evaluate the first results of the Botkin Hospital transplant program. Materials and methods. From June 2018 to October 2019, 100 solid organ transplants were performed at the Botkin City Clinical Hospital. Out of the 100 transplantations, 72 were kidney transplants (average age of recipients was 45.65 ± 11.35 years, HLA match averaged 2.09 ± 1.03) and 28 were liver transplants (average age of recipients was 50.14 ± 7.62 years, average MELD was 17.78 ± 3.28 (14–34). Results. After transplantation, there was no 30-day mortality. Postoperative complications following kidney transplantation were established in 11 patients (15.2%). In 3 patients (4.3%) – suppuration of postoperative wound, in 2 patients (2.8%) – hematomas in the area of the postoperative suture during hemodialysis, in 5 patients (6.9%) – retroperitoneal lymphocele, in 1 patient (1.4%) – urosepsis. There were 4 cases (5.5%) of acute rejection, 3 cases (4.2%) of humoral rejection, and 1 case (1.3%) of cellular rejection. Early postoperative complications following liver transplantation were detected in 2 patients (7.2%). In one patient – hematoma under the right lobe of the liver on the 1st day after surgery, the diaphragm was the source of bleeding, in one patient – ascites leakage through postoperative sutures, which required relaparotomy. In 2 patients (7.2%), postoperative complications were found in the separated postoperative period. In one case, of choledochocholedochal anastomotic stricture – stricture stenting was performed with coated nitinol stent. In another case, acute adhesive intestinal obstruction, which required laparotomy, adhesiolysis. Conclusion. Implementation of the transplantation program in multidisciplinary hospitals can boost transplant care in a district and improve the treatment results of patients with terminal organ damage.

Selection of heart donors is the most important stage on which the success of heart transplantation depends. Objective: to create a donor heart scoring model based on a number of donor characteristics. Materials and methods. The study used data from 650 brain-dead donors who underwent organ explantations between January 1, 2012 and December 31, 2017. In binomial logistic regression, non-selection of heart donor was used as a dependent variable, while donor characteristics were used as factor features. In regression model, the odds ratio was determined for each donor factor, which was transformed into points. The sum of the points of each of the donor factors included in the model was taken as the score of the donor heart. The proposed model was validated on a sample of donors for the period from January 1, 2019 to December 31, 2019; n = 218. Results. The model includes donor characteristics, such as age, cause of death (traumatic brain injury (TBI)/stroke), history of hypertension and diabetes, cardiac arrest with subsequent recovery, own pathology and traumatic heart disease, as well as heart rate, systolic blood pressure, arterial lactate, and need for norepinephrine immediately before organ harvesting. Based on the average value of the sum of points, low-risk donors (LRD ≤17 points) and high-risk donors (HRD ≥18 points) were identified. In the validation pool of donors, the proportion of heart failure among LRD and HRD was 4.1% and 78.6%, respectively, p < 0.0001, Pearson’s χ2 – 130.9. Conclusion. The presented donor heart scoring model accurately reflects the probability of using a donor’s heart for transplantation and creates conditions for optimal distribution of heart transplants, especially from high-risk donors.

With the limited capacity of the available donor pool and the simultaneously growing demand for heart transplantation, expanding the heart donor selection criteria as one of the ways of increasing the availability of organ transplantation, and particularly donor heart, has become a challenge. On one hand, the use of expanded criteria donors increases the number of transplants and reduces the time spent on the waiting list. On the other hand, however, it increases the risk of adverse transplant outcomes. Accordingly, high-risk donors require a more thorough objective assessment using predictive models, while organs obtained from expanded criteria donors, require optimal selection of a donor-recipient pair. Analysis of global and national studies presented in this review reveals the depth of the current problem of heart donor selection.

Objective: to study the differences in the frequency of pathological processes in liver biopsy samples of donors older than 60 years (group 1) and donors currently recognized as “standard” by age – 60 years and younger (group 2). Material and methods. Of the total pool of 300 consecutive donors with brain death, there were 28 (9.3%) donors over 60 years old (61 to 73 years old; 19 men and 9 women). Results. The frequency of pathology is independent of gender in both groups (p > 0.05). In elderly donors, compared with “standard” donors, mild (p < 0.05) and significantly more often severe (p < 0.05) albuminous degeneration are significantly less frequent, and there is only a tendency (p > 0.05) to more frequent mild hepatic steatosis. Dystrophic processes are the result of more severe ischemic injury to the liver of elderly donors. Ischemic liver injury determines the risk of more frequent biliary complications, which require careful monitoring and maintenance at an optimal level of hemodynamics for donors in the intensive care unit. Based on other morphological parameters, the liver of donors above 60 years of age does not significantly differ (p > 0.05) from the liver of donors 60 years and younger. Conclusion. To expand the donor pool, age restrictions should be removed when selecting a liver for transplantation, thereby maximizing the use of donor potential.