Search

Deficit of donor organs is main critical factor limiting of organ transplantation. In article highlighted the organ donation practice in SaintPetersburg with accent on unsuccessful attempts of the increasing of number deceased organ donors. Given by analyses of neurosurgical and neurological rates of mortality last three years, the authors tried to ground the urgency of the putting in clinical practice the optimization of the transplant algorithms, organ donor’s audit, and the implementation of new approach to define organ donor’s process stages. In article are presented the results worked out of the metrics coefficients for estimating donation potential of emergency hospitals. There was done the study of involvement and education in organ donation practice, legislative issues among critical care professionals, neurologists and critical care nurses. In articles is presented the first attempt of estimate of economical aspects of donation process in donor’s hospitals. There was done the recommendation for national organ donation network creating.

The article discusses the problems of the organization and development of organ donation in the Russian Federation.

Aim of the study was to evaluate patient and graft survival after liver transplantation (LT) and to determine if primary disease diagnosis, early graft dysfunction or other factors affect it. Furthermore, we analyzed the reasonsof short-term and long-term deaths or retransplantations.Materials and methods. 192 LTs from donors with brain death were performed from December 2004 until June 2014. Recipient age varied from 5 to 71 years. Most frequent diagnosis was liver cirrhosis (mainly due to hepatitis C), then hepatocellular carcinoma (HCC), liver graft dysfunction, etc.Results and discussion. 1-year patient survival is 89.5%, graft survival is 87.7%, 3-year –87% and 84.6%, respectively, and 5-year – 83.5% and 83.0%, respectively. Early mortality (in fi rst 30 days after transplantation) was 8%, long-term mortality – 5.9%. Primary non-function graft (PNF) was the reason of 66.7% early deaths. In the long term, infections and oncology were the reasons of death with the same frequency – 36.4%. Early graft dysfunction including primary non-function signifi cantly decreases short term survival (p = 0.0002). Nevertheless, in the majority of cases graft function improves and doesn’t affect survival. Donor factors play role in outcomes: early dysfunction is higher (40.6%) in extended criteria donor group than in standard donor group (р = 0.0431). PNF has the same trend – 8.5% and 0.0%, respectively, but without signifi cance (р =0.0835). 5-year survival is remarkably lower in HCC group 40.8% (p = 0.003) than in other groups.Conclusion: survival after liver transplantation in our Center is comparable with the results of the world’s centers.

Since 2008 up to 2010 eight ABO-incompatible liver transplantations have been performed in our center: one of them was urgent liver transplantation to adult patient from deceased donor, other seven were transplantations of left lateral segment to children from living relative donors. Own experience, as well as world one, proves, that barrier of ABO-incompatibility can be overcome more successfully in liver transplantation, particularly in pediatric population, that in other solid organs transplantation. Good results can be achieved even with less ag- gressive immunosuppressive therapy. Recipient conditioning before operation can significantly improve results of ABO-incompatible liver transplantation, but as own experience has shown, often there’s no need to hold some special preparation of children, because their anti-ABO antibodies are very low or absent before transplantation and do not increase after it. Thereby ABO-incompatible liver transplantation is reasonable in urgent cases and in pediatric population because of the limited pull of living relative donors for children.

Combined liver-pancreas transplantation is considered to be a reasonable treatment of patients with end-stage liver disease and concomitant insulin-dependent diabetes mellitus, so it may become a standard treatment of this category of patients. As known, diabetes mellitus negatively affects the long-term results of isolated liver transplantation and increases a risk of posttransplant complications. Notwithstanding the widening range of indi- cations for simultaneous liver-pancreas transplantation and advances of transplantology, this operation continues to be a rare event in world medical practice. In May 2010 in Academician V.I. Shumakov Federal Research Cen- ter of Transplantology and Artificial Organs there was performed a first in Russia simultaneous liver-pancreas transplantation to 17-years old recipient, suffering with liver cirrhosis (as a result of autoimmune hepatitis) and concomitant insulin-dependent diabetes mellitus. In this article we give an overview of indications for simultaneous liver-pancreas transplantation, different ope- rative techniques, immunological aspects and immunosuppression regimes, as well as we describe the first in Russian experience of such transplantation.