[Simultaneous pancreas-kidney transplantation: patients' perspectives ].

Type 1 diabetes mellitus (DM1) is a chronic disease that may affect survival and quality of life in patients due to the development of acute and chronic complications. This review highlights the publications during the past decade on survival and the degree (stabilization/regression) of complications, such as diabetic retinopathy, nephropathy, neuropathy, and macrovascular events in DM1 patients with end-stage renal disease after simultaneous pancreas-kidney transplantation.

[Apparatus perfusion of the kidneys as a new step in transplantation of organs].

The authors consider actuality of using apparatus perfusion of renal transplants for the distension of the door pool and improvement of quality of transplantation. The article contains the results of the first in Russia clinical application of apparatus perfusion in the work with asystolic donors. The data are presented on possibility of using the apparatus perfusion of renal transplants for their testing, selection and improving results of transplantation.

[Problems of general surgery in clinical transplantology and cardiac surgery].

The authors have analyzed results of operative treatment of 128 patients with terminal chronic renal failure (59) and cardiac pathology (69) associated with general surgical diseases (cholelithiasis, abdominal hernias, ulcer disease, malignant tumors etc). The authors recommend the indications, terms and character of operative measures be defined individually.

[The evolution of surgical techniques for donor liver procurement].

The article is dedicated to the development of donor liver procurement and describes the technique developed by Starzl et al., as well as the method which T. E. Starzl named "a rapid technique" and which eliminates drawbacks of classical liver procurement technique of the former method. The authors describe a standard, simple and fast technique of donor hepatectomy. In addition, a technique of fast liver procurement from an asystolic donor is described. Advantages of the "rapid technique" of combined hepatectomy consist in its atraumaticity and a possibility of its application in utterly instable donors, because this technique makes it possible to begin effective organ cooling in a few minutes after the surgery is commenced.

[First experience of use of a double balloon three-lumen catheter for decreasing the time of heat ischemia in asystolic kidney donors in Russia]. / Pervyi opyt primeneniia v Rossii dvukhballonnogo trekhprosvetnogo katetera dlia sokrashcheniia vremeni teplovoi ishemii u asistolicheskikh donorov pochek.

The authors consider actual problems of transplantation of organs associated with using donors. Special attention is given to current methods of preservation and obtaining donor kidneys from irreversible cardiac arrest donors. The authors propose to use a standard protocol of measures aimed at obtaining high quality transplants in every day practice of surgical teams dealing with taking off donor organs. First positive results of using the proposed method are described.

[The selection and preparation of recipients for orthotopic liver transplantation]. / Otbor i prodgotovka retsipientov dlia ortotopicheskoi transplantatsii pecheni.

Transplantation of the liver, which was performed for the first time in world practice in 1963, employs today the experience in more than 10,000 liver transplantations and solves successfully such scientific-practical problems of this large field as: further improvement in the schemes for selection and preparation of the recipients, improvement of diagnostics and differential diagnostics, and treatment. Since there is neither much experience nor good information on the subject in our country, not all clinics for internal diseases are sufficiently informed. In view of that, there is a growing need in preparation from the psychological standpoint rather than in the selection of patients. The inefficacy of the traditional therapy of chronic hepatic insufficiency created the premises for the search for new methods in the period of complex preparation with the use of modern pathogenetically substantiated technology. This led to wide introduction of auxiliary methods of treatment into the clinic, such as plasmapheresis and hemoperfusion through cryopreserved hepatocytes which, we think, produce good results in preoperative management of the patients. The principal problem of our preoperative management by extracorporeal methods is temporary compensation of the nonfunctioning kidney during the critical period so that its regeneration would attain the minimal volume necessary for maintenance of vital processes. And in this temporary period of "the stage of relative remission" or favorable period transplantation of the liver must be carried out. Extracorporeal methods of blood cleansing in potential recipients with malignant neoplasms in the liver showed quite the reverse, we do not recommend this method for these patients without jaundice.

[The effect of herpesvirus infections on the results of a kidney allograft]. / Vliianie gerpesvirusnykh infektsii na rezul'tat allotransplantatsii pochki.

It was shown to be necessary to control the level of antibody to cytomegalovirus in order to improve the selection of donor-recipient pairs. High antibody titres to cytomegalovirus constitute one of contraindications against allotransplantation.

[Neuroendocrine disorders in brain-dead donors at the time of multiorgan harvesting]. / Neiroéndokrinnye rasstroistva u donorov so smert'iu mozga vo vremia operatsii mul'tiorgannogo zabora.

Changes in the level of antidiuretic hormone (ADH), adrenocorticotropic hormone (ACTH), somatotropic hormone (STH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), prolactin (PL), thyroxin (T4), triiodothyronine (T3) and thyroxine-binding globulin (TBG) have been assessed before and during multiorgan excision in 22 donors with brain death. A progressing decrease in ADH blood supply and changes in ACTH, STH, FSH and PL content have been recorded. No regularities have been observed in LH level changes. TSH and thyroid hormone changes were in most cases characterized by a gradual decrease in their plasma levels. A drop in T3 concentration observed at the initial stage of the study was most pronounced with practically normal T4 and TBG values, that also decreased by the moment of heart excision. It has been concluded that brain death is accompanied by a considerable neuroendocrine disfunction and a marked syndrome of low T3 content.

[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.

[Anesthesiologic management of clinical orthotopic liver transplantation]. / Anesteziologicheskoe obespechenie ortotopicheskoi transplantatsii pecheni v klinike.

The first clinical experience of anesthesiological management during 6 orthotopic liver transplantations (5 primary operations and 1 retransplantation) in 2 males and 3 females, aged 20 to 52 years, is presented. The method of general anesthesia is described--the use of veno-venous bypass without systemic heparinization and rapid infusion system. Hemodynamic, temperature, metabolic and coagulologic homeostasis disturbances are analysed at different stages of orthotopic liver transplantation, especially upon reperfusion of the donor organ. The tactics of infusion-transfusion therapy, as well as correction of electrolyte disturbances and blood coagulation disorders are being discussed. Different intraoperative complications are characterized. It is concluded that anesthesiological management of liver transplantations is one of the most complex problems of modern anesthesiology which takes joint effort of a large team of specialists: surgeons, anesthesiologists, perfusiologists, transfusiologists, and laboratory assistants specializing in different areas.

[The role of electrocardiographic examination in the complex evaluation of potential heart donors]. / Rol' élektrokardiograficheskogo issledovaniia v kompleksnoi otsenke potentsial'nykh donorov serdtsa.

From October, 1986 to February, 1990 eighty-five potential donors with death of the brain were examined at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Public Health. Thirty of them were used as heart donors in orthotopic transplantation of the heart; 24 (80%) were males and 6 (20%) females. The cause of death of the brain was craniocerebral trauma in 13, brain tumor in 9, hemorrhage into the brain tissue in 7 cases, and gunshot injury to the skull with damage to the brain in one case. In appraisal of the donors; in 8 (26.7%) cases the ECG did not differ from the initial one, in another 8 cases (26.7%) the ECG demonstrated electrolyte disorders in the form of hypokalemia , still in another 8 cases right bundle-branch block was encountered, in 2 (6.65%) the ECG showed transient form of cardiac fibrillation, in still another 2 cases I-II degree atrioventricular block was found, in one (3.3%) right and left bundle-branch block was demonstrated, and in one case the ECG showed diminished nutrition in the region of the posterior left-ventricular wall. All donors had disorders of homeostasis characteristic of patients with death of the brain, while the condition of hemodynamics conformed to these disorders. It is concluded on the basis of the obtained data that electrocardiographic monitoring is expedient and that it plays a role in complex appraisal of a potential heart donor.

[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.

[Selection of donors for heart transplantation]. / Selektsiia donora dlia transplantatsii serdtsa.

The article discusses the first clinical experience of the donor maintenance of the program of heart transplantation. Under analysis are etiology and terms of the process of death of the brain in 65 potential donors. The authors propose a scheme of the three-stages assessment of fitness of his heart for transplantation. Specific features of intensive therapy of the donors are considered. Twenty donors were used for clinical transplantations of the heart, in 18 cases (90%) satisfactory recovery of functions of the transplanted heart was noted.

[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.

[Use of an autovenous transplant, polytetrafluoroethylene prosthesis and human umbilical vein bioprosthesis for creating an arteriovenous fistula for programmed hemodialysis]. / Primenenie autovenoznykh transplantatov, protezov iz politetraftorétilena i bioprotezov iz veny pupoviny cheloveka pri sozdanii arterio-venoznykh fistul dlia programmnogo gemodializa.

The work presents an experience with 84 operations of making nonstandard arteriovenous fistulas in 75 patients using autovenous transplants, polytetrafluorethylene prosthesis and home bioprostheses from human umbilical veins made at plant "Sever". Results of the operations were followed-up during 3 years. It was shown that arteriovenous fistulas made of plastic materials generally have a higher level of complications and shorter terms of functioning as compared with ordinary fistulas. Nevertheless, using nonstandard fistulas is justified in a certain category of patients.