Vol 48, No 3 (2020)

Rationale: The imbalance between the need for donor organs and their current availability is a growing problem for all countries. An assessment of potential donor numbers is considered to be an important step towards better understanding of the problem as a whole at the national scale. This would help to build up a concept of a successful strategy to resolve this inequity.

Aim: To analyze the use of external audit of the efficacy of identification of potential organ donors with confirmed brain death.

Materials and methods: As a part of a pilot project aimed to increase the efficacy of donor bases of the Russian Federal Medical Biological Agency (FMBA), we retrospectively analyzed 5932 medical files of patients who died from 2014 to 2018 in the departments of resuscitation and intensive care units of 26 medical establishments serving as a donor bases in Moscow, Orenburg, Saratov, Abakan, Stavropol and FMBA of Russia. The probability of brain death was assessed with a special QAPDD (Quality Assurance Program in the Deceased Donation Process) technique focused on organ donation after brain death which is used for external audit in Spanish hospitals.

Results: Clinical manifestation of brain death were identified in 20.3% (95% confidence interval (CI) 18.4–22.4) of the patients aged 18 to 65 years with severe primary and secondary brain injury who died in the departments of resuscitation and had been maintained on mechanical ventilation at least 12 hours until their death was confirmed. The rate of potential donor identification with clinical manifestations of brain death in the donating in-patient departments was 12% (95% CI 10.5–13.7) of those who died with severe primary and secondary brain injury. The external audit performed in 26 donating in-patient departments, has shown that 41% (95% CI 35.8–46.4) of potential donors with brain death were not identified.

Conclusion: With the use of the QAPDD technique in our study, we found that 41% of potential donors were not identified in the Russian in-patient clinics participating in organ donation. Based on the information obtained during the audit of medical files in intensive care units, we can make realistic conclusions on the current system of organ donation, identify potential pitfalls in the identification procedures of potential donors, increase the efficacy of donation process, and to improve the system as a whole. The process could become effective only through the activities of specially trained donor hospital transplant coordinators.

Background: Biliary anastomosis strictures after orthotopic liver transplantation (OLT) develop in 5–12% of patients. This complication significantly impairs the patients’ quality of life and can lead to graft loss.

Aim: To analyze the first experience in the use of coated self-expanding nitinol stents in patients with biliary anastomosis strictures after OLT.

Materials and methods: From December 2018 to January 2019, there were 5 patients with anastomotic strictures after OLT in the Department of Organ and/or Tissue Transplantation of the S.P. Botkin Municipal Clinical Hospital. All patients underwent endoscopic stenting of strictures with a self-expanding nitinol-coated stent. In all patients, the stent was removed at 3 months after its placement.

Results: No complications and deaths were recorded in this patient group. The median duration of the follow-up after stent removal was 14.15 ± 2.35 (3–17) months, with no cases of restenosis identified.

Conclusion: The use of coated nitinol stents in the management of patients with anastomotic strictures after liver transplantation is effective and safe. The possibility of their use in routine clinical practice requires confirmation in further studies.

Background: Infectious complications are a major problem in transplantology of today. Soluble urokinase-type plasminogen activator receptor (suPAR) could be one of the markers of infection in kidney transplant recipients. Aim: To determine the potential of suPAR implementation into clinical practice to choose the management strategy in kidney graft recipients with infectious complications.

Materials and methods: We conducted a single center, open-label pilot trial in 30 kidney graft recipients aged above 18 years, with clinical signs of infection (body temperature above 37.5 °С, dysuria or respiratory manifestations). Patients with diabetes mellitus, focal segmental glomerulosclerosis, chronic heart failure and cancer, as well as those with glomerular filtration rate below 15 mL/min/1.73 m² were excluded. The patients were divided into 2 groups: those who were hospitalized to the nephrology department and those who were treated as outpatients.

Results: There was no difference in suPAR levels between the inand out-patients with kidney transplant and infectious complications (12.8 [10.4; 15] and 10.8 [7.6; 14.5] ng/mL, respectively, р = 0.194). The mean duration of hospitalization for infectious complications was 17.9 ± 10 days. SuPAR levels in the patients with a short in-hospital stay was 12.35 [9.6; 15] ng/mL, being not significantly different from that in the patients who required prolonged hospitalization (15 [10.4; 15] ng/mL, р = 0.347).

Conclusion: We have made the first attempt to use the permeability factor suPAR in kidney transplant patients with clinical signs of infections at an out-patient visit to decide if they should be hospitalized to the nephrology department for in-patient treatment. The results obtained indicate that the stratification of the risk of death and unfavorable disease course, as well as the recommendations for patient managements developed for the general population, are not applicable to kidney transplant recipients. The results of this pilot trial have shown that high suPAR levels are not always indicative of severe status in the patients with kidney transplant and infectious complications. The predictive value of the marker for unfavorable disease course and death in this patient category remains vague.

At present, it is widely recognized that machine perfusion allows for a decreased rate of delayed function of the renal graft and of the risk of liver graft early dysfunction. The aim of the review is to present the actual changes of the donor pool related to prevailing numbers of donors by expanded criteria, to determine the prospects of expanding of the available donor pool based on their selection, as well as development of functional rehabilitation and modification at tissue, cell and molecular levels with the help of perfusion technologies. The article presents the state-of-the art view on the mechanisms of ischemic-reperfusion injury of donor organs, delineates the trends in the maintenance of their viability, and gives the literature data on the role and outlook of perfusion methods in organ transplantation. The authors provide the rationale for a comprehensive systemic approach to the assessment of the functional status of a donor organ with any baseline parameters and discuss a number of theoretical provisions on the implementation of a personalized perfusion approach to ensure the availability of transplantation care.

Surgical wound infection is the most common complication after kidney transplantation. It is associated with a prolonged hospital stay, repeated surgical procedures, significant costs, which explains the constant search for optimized treatment for wound infections. We describe a clinical case of a patient with an infected lymphocele of the upper pole of the renal graft at Day 29 after kidney transplantation from a donor after brain death. The infected lymphocele was opened and VAC system was installed without the removal of the graft. With antibiotic therapy and modification of the immunosuppressive therapy, the graft function remained stable and no generalization of the infection occurred. The wound was completely clean at Day 28 of VAC therapy, with subsequent tight closure of the wound. The patient was discharged with a functioning graft.