Репозиторий Университета

© 2019 The Author(s) Intradialytic hypotension is a frequent complication of chronic kidney disease. According to different authors, the incidence of this condition varies in severity and being recorded in 10–70% of cases during chronic intermittent hemodialysis. The development of severe chronic intradialytic hypotension in most cases is considered as a relative contraindication to kidney transplantation due to the risk of the graft dysfunction and loss in the early postoperative period. Meanwhile, there is no consensus on the lower limit of blood pressure, which would be an absolute contraindication for kidney transplantation. In addition, patients with intradialytic hypotension have the dialysis session reduced which leads to inadequate dialysis; also, they often have such complications as thrombosis of an arteriovenous fistula, as a result of which further dialysis sessions become impossible. In such cases, renal transplantation is a risky, but lifesaving operation. We present a clinical case report of kidney allotransplantation in a female patient with a history of bilateral nephrectomy, who had been suffering from severe chronic intradialytic hypotension for three years before the operation. After allograft transplantation, her blood pressure was normalized to reference values, and the graft function fully recovered.

© 2019 The Author(s) Intradialytic hypotension is a frequent complication of chronic kidney disease. According to different authors, the incidence of this condition varies in severity and being recorded in 10–70% of cases during chronic intermittent hemodialysis. The development of severe chronic intradialytic hypotension in most cases is considered as a relative contraindication to kidney transplantation due to the risk of the graft dysfunction and loss in the early postoperative period. Meanwhile, there is no consensus on the lower limit of blood pressure, which would be an absolute contraindication for kidney transplantation. In addition, patients with intradialytic hypotension have the dialysis session reduced which leads to inadequate dialysis; also, they often have such complications as thrombosis of an arteriovenous fistula, as a result of which further dialysis sessions become impossible. In such cases, renal transplantation is a risky, but lifesaving operation. We present a clinical case report of kidney allotransplantation in a female patient with a history of bilateral nephrectomy, who had been suffering from severe chronic intradialytic hypotension for three years before the operation. After allograft transplantation, her blood pressure was normalized to reference values, and the graft function fully recovered.

© 2019, Pediatria Ltd. All rights reserved. Acute kidney damage (AKD) is characterized by rapidly progressing organ dysfunction, which often results in development of chronic kidney disease. There are difficulties in diagnosing initial stages of kidney damage, which are usually reversible. Molecular diagnostics is a sensitive method that can detect early nephron changes that are not detectable by conventional methods (by assessing serum creatinine and urinary albumin in urine, diuresis) before renal filtration function decrease. The review examines markers of AKD development key stages: Ischemia (Kidney Injury Molecule-1 (KIM-1), Clusterin), hypoxia (Vascular Endothelial Growth Factor), Hypoxia Inducible Factor (HIF)), inflammation (Monocyte Chemoattractact Protein-1 (MCP-1), Interleukin 18 (IL18)), kidney tubule damage proximal (Beta-2-Microglobulin (B2M), Cystatin C, Neutrophil gelatinase associated lipocalin (NGAL)), distal (NGAL, Calbindin, Osteopontin). The study of these biomarkers in children's urine can be recommended for non-invasive screening, diagnosis and monitoring of AKD.

© 2018; Pediatria Ltd. All rights reserved. Among the leading forms of socially significant pathology is chronic kidney disease (CKD), which has a variety of causes and often originates in early childhood. Risk factors and causes of CKD in children are associated with congenital anomalies in urinary tract (UT) development, accompanied by a persistent chronic infection, urodynamic disorder, remodeling of renal blood flow. Kidneys homeostatic functions disorder causes morphofunctional changes in various organs and tissues, incl. dentoalveolar system (DAS). The negative effect of CKD on the formation of maxillofacial region in children is studied. The data on disorders of jaw bones structures, temporomandibular joint (TMJ) and its function, oral cavity mucous membrane pathology, periodontal diseases, quantitative and qualitative changes in saliva, the defects of teeth hard tissues, pulp calcification caused by this pathology are systematized. The lack of a holistic view of DAS abnormalities development mechanisms in children with kidney damage makes it difficult for the dentist to conduct a timely diagnosis and combine work with doctors of other specialties, such as a pediatrician and a pediatric nephrologist. An integrated approach to managing children with CKD would allow to personify patient management tactics and improve treatment and rehabilitation results.

© 2018; Pediatria Ltd. All rights reserved. Congenital uropathies (CU) are anomalies associated with impaired patency of the upper and lower urinary tract and include congenital hydronephrosis, megaureter, primary vesicoureteral reflux (VUR), infravesical obstruction with prevalence in the pediatric population up to 1,4-2,8%. The most dangerous complication of CU is the development of kidney fibrosis in 30-60% of children combined with a persistent urinary system infection (USI). The lack of effective methods for early diagnosis and evaluation of renal parenchyma fibrosis treatment efficacy dictates the need for further search for molecular indicators of kidney injury. The article describes the study of inflammation biomarkers (interleukin 6 (IL6), inertleukin 8 (IL8), interleukin 10 (IL10)) and fibrosis (monocyte chemoattractant protein 1 (MCP1), transforming growth factor Β1 (TGFΒ1), vasculoendothelial growth factor (VEGF)) in urine in children with CU for diagnosis, monitoring and predicting the course of pathology. The study included 255 patients with various variants of CU (congenital hydronephrosis - 75, VUR - 169, infravesical obstruction - 11). The mean age of the patients was 4,3±3,2 years. The comparison group included 20 almost healthy children stratified by sex and age without USI. Biomarkers were determined by the method of enzyme immunoassay (ELISA) in the dynamics of pathology. All patients had an increase in urinary levels of proinflammatory cytokines (IL6, 8), even without clinical picture of USI. The increase in the concentration of MCP1 and TGFΒ1 in the urine is proportional to the degree and duration of VUR before its treatment, their content increased after 6 months after the correction of VUR and indicated the persistence of latent pyelonephritis and fibrosis progression. Molecular diagnosis of inflammation and fibrosis markers n the urine is a promising noninvasive method for assessing the pathological process in kidneys, the effectiveness and adequacy of the treatment.

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Neonatal sepsis is one of the major causes of mortality and morbidity in newborns, greatly associated with severe acute kidney injury (AKI) and failure. Handling of newborns with kidney damage can be significantly different compared to adults, and it is necessary to consider the individuality of an organism’s response to systemic inflammation. In this study, we used lipopolysaccharide (LPS)-mediated acute kidney injury model to study mechanisms of kidney cells damage in neonatal and adult rats. We found LPS-associated oxidative stress was more severe in adults compared to neonates, as judged by levels of carbonylated proteins and products of lipids peroxidation. In both models, LPS-mediated septic simulation caused apoptosis of kidney cells, albeit to a different degree. Elevated levels of proliferating cell nuclear antigen (PCNA) in the kidney dropped after LPS administration in neonates but increased in adults. Renal fibrosis, as estimated by smooth muscle actin levels, was significantly higher in adult kidneys, whereas these changes were less profound in LPS-treated neonatal kidneys. We concluded that in LPS-mediated AKI model, renal cells of neonatal rats were more tolerant to oxidative stress and suffered less from long-term pathological consequences, such as fibrosis. In addition, we assume that by some features LPS administration simulates the conditions of accelerated aging.

© 2018 IEEE. The work is focused on the research of urea elimination possibilities out of the waste dialysis solution by its electro-oxidation on the surface of platinum group metals and carbon materials. The work includes findings of experimental tests of various electrode materials for the specific urea elimination rate in a model solution.

© 2018, Silicea-Poligraf. All rights reserved. The current population is characterized by a high prevalence of risk factors for the development of chronic kidney disease: hypertension, diabetes, obesity, metabolic syndrome, physical inactivity, smoking. The development of severe complications and a close connection with potentially fatal cardiovascular disorders make this disease a socially and economically significant problem. Treatment of chronic kidney disease in advanced stages belong to nephrologist duties. However, the success of preventive interventions depends on the time of their onset, which makes it relevant to identify the disease. The use of nephroprotective approaches by physicians of different specialties (general practitioners, cardiologists, gerontologists, nephrologists, endocrinologists) can significantly improve the prognosis of both those at risk of developing renal dysfunction and the existing disease. The review presents data on the clinical and laboratory efficacy of angiotensin-renin blocker use, as well as the combination of angiotensin II receptor blockers with calcium antagonists. Using the combination of the angiotensin II receptor blocker irbesartan and amlodipine as an example, we demonstrated the possibilities of nephroprotective therapy in patients with renal dysfunction.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Mathematical modeling of pharmacokinetic (PK) and pharmacodynamic (PD) parameters essential for establishing correct dosing regimens is an alternative to pharmacokinetic studies (PKS) adopted in the clinical setting. The aim of this work was to compare the values of PK parameters for vancomycin obtained in an actual PKS and through MM in postoperative patients with kidney injury. Our prospective study included 61 patients (47 males and 14 females aged 60.59 ± 12.23 years). During PKS, drug concentrations at steady state Сtrough and Cpeak were measured by high-performance liquid chromatography followed by the calculation of the area under the plasma concentration-time curve AUC24. For mathematical modeling, a single-compartment model was employed; PK parameters were estimated using R 3.4.0. The values of Ctrough measured 48 h after the onset of antibiotic therapy during PKS were significantly lower than those predicted by MM (р = 0.004). In a group of patients with acute kidney injury (AKI), AUC24 measured at the end of treatment was significantly higher than its value predicted by MM (р = 0.011). The probability of achieving the target AUC24 to MIC ratio of over 400 µg•h /ml is higher in the group of patients with Ctrough = 10–15 µg /ml. Our findings confirm that the use of MM in postoperative patients with renal dysfunction is limited and therapeutic drug monitoring should be used instead.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The review discusses the issue of reflux nephropathy for specialists of the system of higher medical education: the article provides the definition, characterizes the epidemiology, risk factors for disease development in children with vesicoureteral reflux, causes and molecular mechanisms of renal fibrosis formation and progression in reflux nephropathy, markers for diagnosing and predicting the disease course.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The lecture discusses the issue of reflux nephropathy for specialists of the system of higher medical education: the article provides the definition, characterizes the epidemiology, risk factors for disease development in children with vesicoureteral reflux, causes and molecular mechanisms of renal fibrosis formation and progression in reflux nephropathy, and markers for diagnosing and predicting the disease course. In order to control the retention of the lecture material, the text includes case problems and multiple-choice tests.

© 2018 Media Sphera Publishing Group. All rights reserved. The study demonstrated the results of the comparative analysis of various types of renal replacement therapy effects on the quality of life patients with terminal stage of chronic kidney disease on the basis of standardized questionnaires. It has been shown that the quality of life is significantly improved after a kidney transplantation. At the same time, it has also been found that the introduction of home dialysis, epoetins, active metabolites of Vitamin D, calcimimetics in the clinic care expanded the opportunities for the labor rehabilitation of the dialysis patients and made their quality of life comparable with the same of the kidney transplant recipients.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Purpose of the study. To examine the frequency and risk factors for the development of diastolic dysfunction (DD) of the left ventricle (LV) of the heart in patients with chronic kidney disease (CKD). Materials and methods. The study included 225 patients with stage I-CKD of non-diabetic etiology (median age 47.0 years, 50.2% of women). Depending on the degree of decrease in the glomerular filtration rate (GFR), all patients were divided into 3 groups. Group 1 (n=70) consisted of patients with GFR 89-45 ml / min / 1.73 m2, group 2 (n=120) - patients with GFR 44-15 ml / min / 1.73 m2, group 3 (n=35) - patients with GFR <15 mL / min / 1.73 m2. The control group includes persons without CKD. All patients underwent general clinical examination and transthoracic echocardiography; in 86 patients the level of cystatin C in the blood serum was determined. Results. Hypertrophy of the left ventricle (LVH) of the heart was detected in 87 (38.7%) of 225 patients with CKD. Hypertrophic type (type I) of myocardial DD is diagnosed in 90 (41.4%) of 225 patients with CKD. The incidence of myocardial left ventricular dysfunction of the 1st type increased with a decrease in GFR, amounting to 30, 40 and 60% in groups 1, 2 and 3, respectively. The systolic function of the left ventricular myocardium was preserved. Patients with DD were older, they had a higher body mass index (BMI), a more pronounced decrease in GFR, a higher level of fibrinogen. They were more likely to have LVH. The level of cystatin C as the kidney function worsened, but when comparing the mean levels of cystatin C in patients with the presence / absence of DD in the groups isolated depending on the stage of CKD, no statistically significant differences were found. According to the multivariate analysis, the independent predictor of DD was the age (odds ratio 1.106, 95% confidence interval 1.051-1.157, p=0.00001). The conclusion. DD of the myocardium of the LV is detected on average in 40% of patients with CKD, the frequency of its development increases with the progression of renal dysfunction. The development of DD is influenced by traditional factors of cardiovascular risk (age, BMI), as well as the decline in GFR and closely related structural remodeling of LV myocardium.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To present the possibility of the computed tomography (CT) in determination of a kidney injury for improving the quality of diagnostics and treatment of this group of patients. Materials and methods. Analyzed data comes from 72 T-researches with 50 patients with kidney injury at the closed injury of a stomach who were on treatment in Sklifosovsky Research and Clinical Institute for Emergency Medicine. Data of T was verified with the results of operations and autopsies. For determination of injury severity of a kidney the scale of Organ Injury Scale (OIS) was used. Results and discussion. Kidney injuries of the 1 degree (a contusion of a kidney and a subcapsular hematoma) were found in 12 patients, including the one with pre-existing pathology. Injuries of a kidney of the II degree were revealed in 14 patients: a cortical gap-in 9 cases, a subcapsular hematoma of a kidney with gap signs-in 3 cases; a subcapsular cyst with symptoms of hemorrhage and a gap-in two patients. Kidney injuries of the III degree were diagnosed in 7 patients in the form of a rupture of cortical substance from 12 mm to 18 mm deep. Damages of the IV degree were revealed in cases of 11 patients, including thrombosis of a segmentary branch of a renal artery in 6 patients. Injuries of a kidney of the V degree were revealed in 6 patients mainly in the form of fragmentation of a kidney. For an assessment of efficiency of treatment of 22 patients CT research in dynamics was executed, identification of complications served as the indication for repeated surgical intervention. Conclusions. T is an informative method which is possible to define not only an injury of a kidney, but also the degree of its severity. It allows to choose rational tactics for the treatment and to avoid an unreasonable nephrectomy. Performance of T in dynamics allows to estimate efficiency of treatment and in due time to diagnose complications.

© 2018 Media Sphera Publishing Group. All rights reserved. Obstetric atypical hemolytic uremic syndrome (aHUS) is one of the reasons for the development of acute kidney injury (AKI) and can determine the prognosis of both mother and child. Aim. Analysis of clinical manifestations, course and outcomes of obstetric aHUS. Materials and methods. 45 patients with aHUS development during pregnancy or immediately after childbirth were observed between 2011 and 2017, age from 16 to 42 years. Results and discussion. All patients had AKI (serum creatinine 521,5±388,0 μmol/l, oliguria or anuria that required initiation of hemodialysis). 93.3% pts had extrarenal manifestations of TMA with the development of multiple organ failure (MOF). The mean number of damage organs was 3,7±1,2. In all patients, the development of aHUS was preceded by obstetric complications, surgery, infection, etc. In the outcome: 53.4% women showed complete recovery of renal function, 11.1% developed CKD 4-5 stages, 35.5% had dialysis-dependent end-stage renal failure (ESDR). Maternal mortality was 23.9%. Perinatal mortality was 32.6%. The early start of eculizumab treatment (within 1-2 weeks from the onset of aHUS), compared with therapy start after 3 weeks, increased the chances of favorable outcome for mother in 5.33 times, and the chances for normalization of renal function in 48.7 times. Conclusion. Obstetric aHUS is characterized by the development of AKI in 100% of cases. In most patients, the obstetric aHUS occurs with the development of MOF. Timely diagnosis of aHUS and immediate treatment by eculizumab allows not only to save the life of patients, but also completely restore their health.

© 2018 Media Sphera Publishing Group. All rights reserved. Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (ÑKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow- up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

© 2018 Media Sphera Publishing Group. All rights reserved. A review deals with the problem of chronic kidney disease (CKD) from the position of a physician and cardiologist. The epidemiology of the disease was discussed both abroad and in Russia, including the most up-to-date data. In Russia CKD markers were detected in 49.4% of hypertensives. Authors describe risk factors and mechanisms of CKD at the most important pathogenetic conditions: hypertension, diabetes and obesity. The current classification and methods for calculating the glomerular filtration rate are given. The review disclose a paradigm of the renal continuum and its relation to cardiovascular diseases. It is well known fact that the final causes of the death of patients with CKD, as a rule, are cardiovascular complications. Based on the literature data, the necessity and expediency of screening for renal dysfunction is justified. In the example of use of an angiotensin receptor blocker II - irbesartan nephroprotective demonstrated possibilities of intervention in patients with renal dysfunction of varying severity.

© 2018 ABC-press Publishing House. All rights reserved. Objective: to compare the predictive value of RENAL, PADUA, C-index nephrometry score systems according to projection of complexity of operative measure in terms of warm ischaemic time, extent of blood loss and rate of postoperative complications. Materials and methods. Information for the research was collected from 314 patients with localized kidney cancer, who had laparoscopic partial nephrectomy from January 2012 to May 2017. In 210 (66.8 %) cases, in addition to the routine examinations, 3D modelling and operative measure planning were carried out. The average tumor volume of the patients was equal to 62.5 ± 33.5 mm3. All patients before the operation were estimated the complexity of operative measure on the nephrometry score systems: PADUA, RENAL, C-index. The average sum of balls according to scale RENAL - 7.56 ± 1.12, on scale PADUA - 7.98 ± 1.55, on scale C-index - 2.76 ± 1.14. Then in retrospect by the method of logistic regression analysis was determined predictive value of RENAL, PADUA, C-index nephrometry score systems for prediction of warm ischaemic time, duration of operative measure, extent of intraoperative blood loss and possibility of rate of postoperative complications. Results. In 265 (84.4) cases transperitoneal approach was perfomed and in 49 (15.6 %) cases it was retroperitoneal approach. The average time of laparoscopic partial nephrectomy is 140.15 ± 55.8 min, the average time of ischaemic warm is 13.35 ± 7,65 min. The average extent of blood loss during the laparoscopic partial nephrectomy is 291.95 ± 196.5 ml. Intraoperative complications were found in 8 (2.54 %) cases. Postoperative complications were estimated according to the Clavien-Dindo classification of surgical complications and were found in 31 (9.9 %) cases, among them 12 (3.8 %) patients had surgical complications. The index of the RENAL nephrometry scoring system had the highest predictive value in the multivariant analysis for warm ischaemic time, extent of intraoperative blood loss and possibility of development after complications (p = 0.049; 0.028; 0.046). None of indices were significant for multivariant analysis of prognosis the duration of laparoscopic partial nephrectomy. The indices of the RENAL (p = 0.032) and C-index (p = 0.040) nephrometry score systems were significant for univariate analysis of prognosis the duration of the laparoscopic partial nephrectomy. Conclusion. The usage of RENAL, PADUA, C-index nephrometry score systems is useful for the prediction of warm ischaemic time, extent of blood loss, duration of operative measure and possibility of rate of postoperative complications at laparoscopic partial nephrectomy. According to our data the index of RENAL nephrometry scoring system has the highest predictive value. Applications of 3D modelling for counting nephrometry indices in preoperative period makes the process of counting balls easier on all three nephrometry score systems.

© 2018 S. Karger AG.All right reserved. Objective: to estimate the state and the rate of bone metabolism in women with chronic kidney disease (CKD) 1-3 stages during pregnancy. Materialsandmethods:observational cross-sectional and prospective study included 137 pregnant women. CKD 1-3 stage had 85 of them: 64 with CKD 1-2 stage, 21 with CKD 3 stage. Median age 29 years, second and third trimester (42 and 37, respectively). The comparison group consisted of 52 pregnant women with of the same age and gestational age without CKD. Dynamic examination was carried out in 18 cases with CKD 1-3 stage. Ionized, total calcium and inorganic phosphorus, 25-OH vitamin D, parathyroid hormone (PTH), the activity of total alkaline phosphatase (ALP), osteocalcin (OC), N-terminal propeptid of type 1 procollagen (P1NP) and β-isomer of C-terminal telopeptide of type I collagen (β-CTX) were determined. Results: serum calcium, phosphorus and PTH levels in all the examined pregnant women were within their normal range. In pregnant with CKD 3 stage, a deficiency of vitamin D was more significant (р0.02) compared to pregnant women without CKD and pregnant with CKD 1-2 stage. The levels OC and P1NP and β-CTX in pregnant with CKD 3 stage were higher than in the control group and pregnant women with CKD 1-2 stage. It was also higher in pregnant women with CKD 1-3 stages in the third trimester in comparison with the second one, although remained within the limits of reference values. Significant direct correlations were found between serum concentrations of P1NP and OC (r=0.575, р0.001), P1NP and ALP (r=0.415, р=0.001), OC and ALP (r=0.276, р=0, 02) and vitamin D and PTH (r=0.235, р=0.04). A significant inverse correlation was found between the blood levels of vitamin D and P1NP (r=-0.344, р=0.002). Conclusions: the peculiarities of bone metabolism in pregnant with CKD of 3 stage are manifested by the vitamin D deficiency and the acceleration of bone formation and resorption to a greater extent in the third trimester.

© 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.