[Ethicolegal issues of organ donation as the main obstacle to the progress of clinical transplantation].

Ethicolegal issues present the main factor hindering obtaining organs from corpses and living donors, the distribution of cadaveric organs, and the financial providence of donorship in Russia. The actual Russian legislation is contradictory in terms of obtaining relatives' consent for the transplantation of cadaveric organs. There are no precise definitions of the degree of genetic relationship between the donor and recipient sufficient for transplantation. Selling and purchasing human organs is strictly prohibited, while financial compensation of the living donor seems to be a fair measure. Providing the possibility to verify brain death is a necessary condition for expanding the cadaveric organ pool. The organ shortage leads to improper distribution of donor organs. All these problems have to be solved for the progress of organ transplantation in Russia.

Structure of C-reactive protein excreted in urine during acute rejection episodes.

During acute rejection of renal allografts C-reactive protein is excreted in urine in a monomeric form. We developed an immunochemical method for detecting monomeric C-reactive protein in human physiological fluids, which is based on latex agglutination.

[Plasmapheresis in combined treatment of acute rejection crises after kidney transplantation]. / Primenenie plasmafereza v kompleksnoi terapii ostrykh krizov ottorzheniia posle peresadki pochki.

The aim of the study was assessment of effectiveness and safety of extracorporeal procedures (plasmapheresis) in prevention and combined treatment of acute rejection crises (ARC) after kidney transplantation in patients at high risk to develop acute immunological conflicts in early postoperative period. 94 patients aged 21-56 years after allotransplantation of cadaver kidney (ATCK) entered the study. They were divided into two groups: group 1 patients (n = 47) received plasmapheresis procedures in combined preventive and therapeutic treatment of ARC; matched group 2 patients (n = 47, retrospective) received the same therapy but plasmapheresis. In both groups there were many patients with a high titer of pre-existing antibodies and massive hemotransfusions in the past. The analysis covered also recipients with the second ATCK (9 and 4 patients, respectively). After ATCK both groups received three-component immunosuppressive treatment (neoral, prednisolone, azatioprin and/or sell-cept). The analysis of the transplant and recipient 11-month survival has estimated that it was 93.6 and 91.5% for the recipients, respectively, and 91.5 and 76.5% for the transplanted kidney for group 1 and 2, respectively. The conclusion is that plasmapheresis in combined prevention and treatment of ARC by humoral type in sensitized patients (high titer of the pre-existing antibodies, repeat transplantations, hemotransfusions) is pathogenetically grounded and lowers the percentage of irreversible episodes of acute transplant rejection early after surgery.

[Surgical technique and approaches in orthotopic liver transplantation]. / Khirurgicheskaia tekhnika i taktika pri ortotopicheskoi transplantatsii pecheni.

The first clinical experience with orthotopic transplantation of the liver was summarized. Within the period of from February 1990 to May 1991, 8 operations were performed, including one retransplantation of the liver. The peculiarities and variants of surgical technique, general principles of the performance of operation, methods for vascular and biliary reconstruction are presented. After the operation, 3 patients are alive, no surgical complications were observed.

[Kidney and pancreas transplantation in patients with insulin-dependent diabetes mellitus]. / Transplantatsiia pochki i podzheludochnoi zhelezy bol'nym insulinzavisimym sakharnym diabetom.

The article analyses the results of one-stage transplantation of the kidney and pancreas in three patients suffering from insulin-dependent diabetes mellitus with diabetic nephropathy in the stage of terminal renal failure which called for programmed hemodialysis. The specific features of early postoperative management of patients are described, particularly the various routes of drug administration.

[The first clinical experience with orthotopic transplantation of the liver]. / Pervyi opyt ortotopicheskoi transplantatsii pecheni v klinike.

The article deals with material concerning the performance of 4 operations for orthotopic liver transplantation (OLT). The operations were carried out on 2 males and 2 females whose ages ranged from 20 to 52 years. The indications for OLT were as follows: ++hemangioendothelioma of the liver, hepatocellular carcinoma, cirrhosis-carcinoma of the liver, and metastatic affection of the liver. One male patient died immediately after the end of the operation, another patient died 3 days after the operation due to nonfunctioning of the transplant. In 2 female patients the operations were carried out successfully. One of them was discharged from the clinic in 62 days in a satisfactory conditions and a well functioning transplant. The other patient died from a complication which was not connected with the operation--perforation of the small intestine 69 days after OLT. The technical aspects of and the provision for the operation and the postoperative management of patients are discussed. The encountered complications are analysed.

[Comparative evaluation of various methods of initial hypothermic perfusion of donor kidneys]. / Sravnitel'naia otsenka razlichnykh sposobov initsial'noi gipo- termicheskoi perfuzii donorskikh pochek.

The authors discuss three various methods of initial hypothermic perfusion applied in 160 donors. The function of the donor kidneys was evaluated according to the results of clinical transplantation. The advantage of high-current perfusion in situ is shown, it allows the number of donor kidneys which are unfit for transplantation to be reduced to minimum. The method of in situ perfusion of organs in multiorganic collection ensures the most adequate antiischemic protection of all organs removed for transplantation, particularly in donors after circulatory arrest.