Репозиторий Университета

© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the «gold standard» of treatment severe heart failure. Patient survival after heart transplantation has improved dramatically since the availability of calcineurin inhibitor (CNIs). However, nephrotoxicity of CNIs has been largely responsible for the progressive development of renal dysfunction and reduces long-term patient survival. Use mTOR inhibitor in immunosuppressive therapy may improve renal function when everolimus is administered associated with a progressive reduction of CNIs. The purpose of our report is to demonstrate the successful case of conversion of the recipient after heart transplantation to everolimus and to evaluate the effectiveness of this drug during the observation year after heart transplantation.

© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the gold standard of treatment severe heart failure. Immunosuppressive therapy aimed at the prevention of acute allograft rejection is the cornerstone of post-transplant management. In addition to its direct effects, immunosuppressive therapy is also involved in the generation of a number of post-transplant morbidities that limit the long-term outcome of heart transplant recipients. Given these data it appears that the individual tailoring of immunosuppressive therapy is of paramount importance in determining the outcome of heart transplantation. The goal of immunosuppressive therapy is to prevent rejection of the transplanted heart, while minimizing drug-related effects, such as infection, malignancy, diabetes, hypertension, and renal insuffi ciency. This review aimed is to analyze the protocols for the appointment of immunosuppressive therapy in various groups of recipients after heart transplantation.

© 2018 Russian Transplant Society. All rights reserved. Aim. To analyse the status and trends in the development of organ donation and organ transplantation in the Russian Federation according to 2017 data. Materials and methods. The survey of heads of transplantation centers was conducted. A comparative analysis of the data obtained in the dynamics of years, between individual subjects of the Russian Federation, the centers of transplantation is performed. Results. According to the register in 2017 in Russia there were only 41 centers for kidney transplantation, 24 liver and 16 hearts. The waiting list for kidney transplantation in 2017 included 5,531 potential recipients, which is approximately 13.8% of the total number of 40,000 patients receiving dialysis. The level of donor activity in 2017 was 3.8 per million of the population, while the share of multiorgan seizures was 66.5%, the average number of organs received from one effective donor was 2.8. In 2017, the level of kidney transplantation was 8.0 per million of the population, the liver transplantation index was 3.0 per million of the population; the rate of heart transplantation is 1.7 per million of the population. In 2017 the number of transplants in Russia increased by 11.3% compared to 2016. There are 11 transplantation centers on the territory of Moscow and the Moscow Region, and half of all kidney transplants and 70% of all liver and heart transplantations are performed. The number of patients with transplanted organs in the Russian Federation is approaching 13,000. Conclusion. In the Russian Federation there is a strong tendency to increase the number of effective donors and to increase the number of organ transplants, and the number of transplant centers is also increasing. In recent years, the country has created prerequisites for the development of organ donation and transplantation: the regulatory and legal framework, public donation funding, material and technical base, etc. In the coming years, positive experience and organizational patterns of organ donation and transplantation from successful regions in Other subjects of the Russian Federation for building effective programs. The leading role in this process should be played by the Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs.

© 2018 Russian Transplant Society. All rights reserved. Aim: To evaluate clinical efficiency of percutaneous coronary interventions (PCI) at potential recipients of heart with the chronic ischemic heart failure (CHF). Materials and methods. In this retrospective study results of treatment at 76 patients with CHF NYHA III and 36 patients with CHF NYHA IV by scheduled PCI are presented. Duration of observation was from 6 to 160 months. The age of patients at the time of intervention was 61,7 ± 0,62 years (from 33 to 76). 108 male and 4 female. Defined life expectancy and echocardiography parameters of the left ventricle (LV) of heart. Results. 20 patients were died, 16 of them from cardiovascular events. 18 patients during this period undergo orthotopic heart transplantation (HT). The endovascular revascularization leads to LV volumes reduction, increase of ejection fraction and decrease of pulmonary artery pressure. Progress CHF is followed by negative dynamics of these characteristics and need of HT performance. In 74% of cases the effect of myocardial revascularization allows to provide increase in life expectancy of potential recipients of heart with the chronic ischemic heart failure. Conclusion. Performance of PCI at patients with the chronic ischemic heart failure can delay heart transplantation or become its alternative.

© 2018 National Research University Higher School of Economics. All Rights Reserved. The aim: to analyze the waiting list for heart transplantation from 2010 to 2017 and to characterize recipients with chronic heart failure III–IV NYHA Class. Methods. The study comprised 997 patients (139 [14%] females and 858 [86%] males) included in the waiting list for heart transplantation the period from January 2010 to December 2017. The average age of patients on the waiting list was 49.0 ± 12.0 (from 10 to 78 years). Before making a decision on inclusion in the waiting list, all patients underwent clinical and instrumental examination, including general clinical studies, echocardiography, measurement of central hemodynamic parameters using a Swan–Gans catheter, computer and/or magnetic resonance imaging of the chest, abdominal and brain. Results. Heart transplantation was performed on 728 patients (99 females – 13.6% and 629 males – 86.4%) including 18 children aged 12 to 17 years (14.18 ± 2.07 years). Mortality in the waiting list in 2010 was 16.1%, compared with 3.2% in 2017.

© 2018 Russian Transplant Society. All Rights Reserved. Aim. To study the effect of ACE inhibitors (ACEI) in heart recipients on the prognosis and myocardial remodeling. Materials and methods. Three hundred and eighty-six patients who received orthotopic heart transplantation (HT) were consequently enrolled to the study from February 2009 to November 2016. Results. Thirty days after the HT, ACEIs were assigned to 141 recipients. Arterial hypertension was diagnosed in all cardiac recipients who received ACEI and among 48 patients (19.5%) from non-ACEI group. Patients receiving ACEI had significantly better event-free survival than control group (p = 0.045) during the follow-up for 1361,6 ± 36,9 days. Left ventricle (LV) end-diastolic dimension did not change over the time in both groups, whereas LV posterior wall thickness in non-ACEI group significantly increased from 1.35 ± 0.03 cm to 1,23 ± 0.05 cm (p < 0.05). Conclusion. Cardiac recipients who received ACE inhibitors had better survival and less transplant left ventricle progression, that could reflect beneficial effects of renin-aldosterone-angiotensin system inhibition after heart transplantation.

© 2018 Russian Transplant Society. All rights reserved. Tricuspid valve insufficiency is one of the most common variants of valve pathology of transplanted heart. The review is sanctified to the analysis of modern looks to on causes, potentially influencing on development of tricuspid valve insufficiency of transplanted heart, and also methods sent to declines risk his development.

© 2018 Russian Transplant Society. All rights reserved. Aim: To develop an optimal surgical tactic for implantation of "AVK-N" system as a "bridge" to heart transplantation. Materials and methods. 17 patients were included. They were operated in the period from 2012 to October 2017 in Federal State Budgetary Institution V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs. A tiny implantable system Portable device for assisting cardiac circulation (AVK-N; Russia) was used for replacing the pumping function of the left ventricle. All patients were examined according to the program of potential recipients for heart transplantation, before the applying of prolonged mechanical circulatory support. Among the operated patients there were 16 (94.1%) men and 1 (5.9%) woman, the average age was 52.64 ± 10.56 (from 33 to 67 years). All patients had congestive heart failure III-IV functional class according to NYHA, refractory to optimal drug therapy. Heart failure was triggered by dilated cardiomyopathy in 12 (70,58%) cases, and by postinfarction systolic dysfunction of the left ventricle in 5 (29,42%). Implantation of AVK-N system was performed to potential recipients of the donor heart with terminal stage of CHF with a decrease in LV ejection fraction up to 10%. Results. As a result of this study there were developed several technological aspects facilitating the subsequent heart transplantation. Conclusion. Our experience in optimizing the surgical tactics of the "AVK-N" system implantation as a bridge to heart transplantation, demonstrated the possibility and safety of its active use in both patients with terminal heart failure on the waiting list of heart transplantation and patients having temporary contraindications to HTX.