[Liver transplantation program at the Burnasyan Federal Biophysical Center: experience in 500 procedures]. / Programma transplantatsii pecheni v Federal'nom meditsinskom biofizicheskom tsentre im. A.I. Burnazyana: opyt 500 operatsii.

OBJECTIVE: To analyze the features and outcomes of 500 liver transplantations in adults over a 12-year period. MATERIALS AND METHODS: The study included data on 500 liver transplantations between May 2010 and April 2023. We analyzed 483 adults who underwent transplantation and 438 candidates for this procedure. All data were obtained from local liver transplantation registry. Clinical outcomes were recorded as of June 1, 2023. Statistical analysis was performed using the Statistica 12 (StatSoft Inc., USA) and Jamovi version 2.3.21.0 software (Jamovi project). RESULTS: Among 438 patients in the waiting list between January 2012 and May 2023, liver transplantation was performed in 198 (45%) cases including 27 (6%) transplantations from living-related donors and 37 (8%) procedures in other centers. There were 109 (25%) deaths. The 1- and 3-year survival rates were 81% (95% CI 76-85%) and 50% (95% CI 42-59%), respectively. Organs from deceased donors (n=134, 27%) and living-related donors (n=366, 73%) were used for transplantations. Redo transplantations were necessary in 21 (4%) cases. The median age of recipients was 45 years (range 18-72), median MELD-Na score - 16 (range 6-43). The most common indications for transplantation were viral cirrhosis (37%), cholestatic liver disease (16%), and hepatocellular carcinoma (14%). Monotherapy with calcineurin inhibitors was performed in 39% of cases, combination of calcineurin inhibitors and glucocorticoids, antimetabolites or mTOR inhibitors - 52%, three-component schemes - 8% of cases. Annual, 5- and 7-year survival rates of recipients after primary transplantation were 87% (95% CI: 84-90%), 79% (95% CI: 75-83%) and 75% (95% CI: 70-80%), respectively. In case of liver transplantation from living-related donors, these values were 89% (95% CI: 86-92%), 84% (95% CI: 80-88%) and 80% (95% CI: 75-85%), after transplantation from deceased donors - 81% (95% CI: 74-88%), 66% (95% CI: 57-76%) and 58% (95% CI: 45-72%), respectively. CONCLUSION: Liver transplantation is highly effective for patients with diffuse and focal liver diseases. Living donors not only significantly improve availability of this technology, but also provide substantial advantages in outcomes compared to liver transplantation from deceased donors, reducing the likelihood of recipient mortality by 10% after one post-transplantation year and by more than 20% after five years.

[Cut-off values of muscle mass indices at the level of ThXII and LIII vertebrae based on the computed tomography for the diagnosis of sarcopenia in the population of the Russia.]

There are original cut-off values of muscle mass indices measured by computed tomography for the diagnostic of sarcopenia in the different countries and regions of the world. In order to get corresponding data for Russia a retrospective analysis of computed tomography data of abdomen of 310 liver donors (151 women, 159 men) presented different country´s regions was performed. The analysis was carried out by two radiologists with more than 10 years of experience and included the determination of the areas of skeletal muscles at the level of the ThXII and LIII vertebrae, followed by the calculation of muscle mass indices with height normalization. A strong correlation was demonstrated between the results of the work of the two radiologists (r=0,98). Cut-off values of muscle mass indices were calculated by two methods: as the difference between the mean and two standard deviations and as the 2,5 percentile. At the ThXII level in women, the cut-off values were EMIThXII 6,4 and 7 cm2/m2, SMIThXII 15,7 and 18,6 cm2/m2, respectively; in men EMIThXII 8,4 and 9,2 cm2/m2, SMIThXII 20,1 and 23,1 cm2/m2, respectively. At the LIII level in women, the cut-off values were PMILIII 2,4 and 2,4 cm2/m2, SMILIII 28,4 and 32,1 cm2/m2, respectively; in men PMILIII 2,9 and 4,9 cm2/m2, SMILIII 38,2 and 41,1 cm2/m2, respectively.

[Bilary anastomotic strictures after right lobe living donor liver transplantation: a single-center experience]. / Biliarnye anastomoticheskie striktury posle transplantatsii pravoi doli pecheni ot zhivogo rodstvennogo donora: opyt odnogo transplantatsionnogo tsentra.

OBJECTIVE: To determine the incidence of AS after right lobe living donor liver transplantation with various biliary reconstructions and to identify the predictors of this complication. MATERIAL AND METHODS: A retrospective and prospective analysis included 245 RLLDLTs for the period 2011-2018 at the Burnazjan Federal Medical Biophysical Center. The results of transplantations in 207 patients aged 19-68 years (median 43 years) were assessed. There were 82 men and 125 women. Follow-up period ranged from 10 to 98 months (median 35 months). We analyzed the relationship between surgical characteristics (preoperative data of recipients and donors, graft parameters, technical features of biliary reconstruction and features of post-transplantation period) and incidence of anastomotic strictures. A total of 58 parameters were analyzed. RESULTS: AS occurred in 20 (9.7%) recipients. Median AS-free period was 5 months (range 1-44). In 17 (85%) patients, AC developed within a year after surgery. Cumulative 1-, 2- and 5-year incidence of AS was 8.3%, 8.9%, and 11%, respectively. Significant predictors of AS were impaired arterial blood supply to the graft (HR 7.8, 95% CI 2.3-26.0, p<0.001), biliary leakage ISGLS class B or C (HR 5.0, 95% CI 2.0-12.8, p<0.001), early allograft dysfunction (HR 4.2, 95% CI 1.5-11.6, p=0.006) and female recipient (HR 3.2, 95% CI 1.1-9.9, p=0.04). In our sample, variant biliary anatomy of the graft and recipient liver, as well as technical features of biliary reconstruction did not affect the risk of AS. CONCLUSION: Variant biliary anatomy of potential donor alone should not be considered as a contraindication for organ donation and right liver lobe transplantation. Precise surgical technique, high transplantation activity, as well as experience of reconstructive interventions on the bile ducts during other operations can significantly reduce the incidence of AS after RLLDLT up to 9.7%.

[Pediatric kidney transplantation: early and long-term outcomes following 1187 procedures]. / Transplantatsiia pochki detiam: neposredstvennye i otdalennye rezul'taty 1187 operatsii.

AIM: To estimate short- and long-term outcomes of pediatric kidney transplants in Russia considering the maximum available number of cases. MATERIAL AND METHODS: Retrospective, observational, multi-center study included data about 1187 kidney transplantation procedures (866 - deceased donor, 281 - living donor and 40 - AB0-incompatible living donor) performed in 1065 patients (age 0-17 years) since 1990 till 2017. Patient and graft survival, causes of recipient deaths and graft losses, as well as, the influence of donor type, blood group incompatibility and recipient age on outcomes were analyzed. Results of redo transplantations (n=131) were also investigated. RESULTS: Annual, 5- , 10- , and 15-year survival of patient was 94, 86, 79 and 69%, respectively; graft survival - 85, 67, 53 and 33%, respectively. Transplantation from related donors including AB0-incompatible cases was associated with 15-30% increase of graft survival (p<0.0001). Up to 23% of children required redo transplantation within 4-5 years after primary procedure and 2/3 of patients - after 10-15 years. There were no significant differences in outcomes after primary and redo procedures: annual, 5-, 10- and 15-year graft survival was 85, 68, 55, 42 and 85, 62, 45, 19%, respectively (p=0.1164). CONCLUSION: It is reasonable to consider the outcomes of transplantations as satisfactory in Russia. However, there is a great potential for improvement. The main problems are high incidence of infectious complications followed by fatal outcomes (41% of all fatal outcomes) and loss of allograft due to primary dysfunction and death of recipients with functioning allografts (19 and 23%, respectively). Primary use of living-related donors for pediatric kidney transplantation seems to be the most effective way to improve both short- and long-term outcomes.

[Salvage liver transplantation for hepatocellular carcinoma]. / Salvage-transplantatsiia pecheni pri lechenii gepatotselliuliarnoi kartsinomy.

OBJECTIVE: To analyze clinical course and the results of salvage liver transplantation in patients with recurrent hepatocellular carcinoma (HCC) after liver resection. MATERIAL AND METHODS: A 54-year-old man with HCV-infection and HCC and 22-year-old woman with fibrolamellar variant of HCC underwent resection of the right and left liver lobe, respectively. The first patient experienced recurrent HCC four times with an interval of 3-6 months within 2 years after surgery. Repeated liver resection was made in first three cases, right liver lobe transplantation - after the fourth recurrence. In the second patient, HCC recurred in 4 months after resection and was accompanied by subtotal portal vein thrombosis. Therefore, repeated liver resection was excluded and patient underwent right liver lobe transplantation. RESULTS: Patients are alive in 5 and 3.5 years after liver resection and in 2.5 and 3 years after transplantation, respectively. There are currently no signs of recurrent HCC in the graft.

Interstitial Glucose Metabolism Monitoring as an Additional Method for Objective Assessment of Donor Liver, Prediction and Immediate Diagnosis of Early Graft Dysfunction.

The current clinical practice of assessing the quality and suitability of a donor liver for human transplantation does not exclude cases of primary graft dysfunction of the transplanted organ and, at the same time, leads to an unreasonable refusal to transplant a significant number of functionally suitable organs. In this regard, searching for new methods for additional objective assessment and monitoring of the state of donor organs in the peritransplant period is relevant. The aim of the study was to determine the clinical utility of monitoring interstitial concentrations of glucose and its metabolites to assess the viability and functional state of a donor liver before and after human transplantation. Materials and Methods: A retrospective observational single-center study included 32 cases of liver transplantation. Along with standard methods for assessing the initial function of grafts during the first week after surgery, interstitial (in the transplanted liver) concentrations of glucose and its metabolites were monitored. In 18 cases, the interstitial glucose metabolism was also studied during static cold storage (SCS). Results: With the development of early allograft dysfunction (EAD), compared with the uneventful post-transplant period, statistically significantly higher interstitial lactate concentrations were observed as early as 3 h after reperfusion: 12.3 [10.1; 15.6] mmol/L versus 7.2 [3.9; 9.9] mmol/L (p=0.003). A value above 8.8 mmol/L may be considered as a criterion for the immediate diagnosis of EAD (sensitivity - 89%, specificity - 65%).Interstitial lactate concentration at the end of SCS and the area under the "lactate concentration-SCS duration" curve were associated with the initial graft function. Values of these parameters greater than 15.4 mmol/L and 76.1 mmol/L·h, respectively, with a sensitivity of 100% in both cases and a specificity of 77 and 85%, may be used to assess the risk of primary EAD. Conclusion: Monitoring of interstitial concentrations of glucose and its metabolites, primarily, lactate, is an objective additional method for the assessment of the donor liver viability both during SCS and in the early postoperative period.