Laparoscopic LLS is a feasible and efficacious in the setting of a developed program with advanced laparoscopic expertise.

Background: Impairment of hepatic arterial flow including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and splenic artery steal syndrome (SASS) is potentially life-threatening complications. The proposed early diagnosis and urgent treatment strategy of graft arterial flow reduction aim to decrease morbidity and mortality. Methods: Pediatric patients with known hepatic arterial flow impairment were retrospectively reviewed. Patients were grouped by occlusive (HAT) and non-occlusive (HAS/SASS) arterial flow reduction. Patients with HAT were further divided in two groups based on the estimated maximal hepatic artery occlusion time ≤8 and >8 hours. Results: Impairment of hepatic arterial flow developed in 32 of 416 pediatric liver transplant recipients. HAT, HAS, and SASS incidences were 4.1% (n = 17), 2.2%(n = 9), and 1.4% (n = 6), respectively. Neither graft loss nor death occurred in the non-occlusive group. The probabilities of sepsis (OR, 1.7; 95% CI, 1.14-2.53; P=.008) and graft loss or death (OR, 1.42; 95% CI, 1.04-1.92; P=.046) were higher in the occlusive group. Patients with estimated maximal duration of hepatic artery occlusion ≤ 8 hours (n = 7; 41.2%) did not have ischemic-type biliary lesions and sepsis (P=.044 and 0.010, respectively) but had excellent 3-year graft survival compared with > 8 hours group (100% vs 40%; P=.037). Multivariate analysis revealed HAT manifestation by fever was associated with increased chances of graft loss or death. Conclusion:Occlusive arterial complications impose higher risks of graft loss and death. Thorough arterial supply monitoring by Doppler ultrasonography and urgent endovascular arterial flow restoration may salvage both graft and the recipient.

It has been proposed that circulating HSCs play a role in graft survival after liver transplantation. The aim was to analyze the relationship between the number of HSCs before and after LDLT and liver function, immune biomarkers, and clinical outcomes in pediatric patients. We studied 15 pairs of adult healthy liver donors and pediatric recipients with ESLD. The CD34/CD45+ cell number was measured in the blood via flow cytometry, and plasma levels of immune biomarkers - via ELISA. CD34/CD45+ cell number in the recipients decreased within the first week after LDLT. The cell number before LDLT was negatively correlated with the plasma levels of CRP and the development of graft dysfunction in the early post-transplant period. After LDLT, the CD34/CD45+ cell number was positively correlated with the pretransplant plasma level of sCD40L, a T-cell activation marker. In adult liver donors, the cell number did not change within the first week after liver resection and was lower than in pediatric recipients. The results suggest that in pediatric recipients, the HSC number may be associated with graft function and could be regarded as a potential predictor of the clinical outcome after LDLT.

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Summary Respiratory complications can be the cause of graft dysfunction after lung transplantation (LTx). MicroRNAs are small regulatory molecules—potential biomarkers of respiratory diseases and post‐transplant complications. Galectin‐3 is highly expressed in fibrosis of transplanted solid organs. The aim was to evaluate the expression of plasma miR‐339 and galectin‐3 concentrations in lung recipients including with airway obstruction after LTx. The study included 57 lung recipients (34 men and 23 women aged 10 to 74 years) were followed up to 5 years after LTx. The plasma microRNAs were detected by real‐time PCR; galectin‐3 levels were measured by ELISA. During follow‐up in 30 recipients, post‐transplant complications were detected: 12 (40.0%) cases of airway obstruction. The levels of miR‐339 and galectin‐3 were significantly higher in recipients with airway obstruction compare with 27 (47.3%) recipients without any complications (P = 0.036 and P = 0.014, resp.). Increasing miR‐339 (above the 0.02 fold change) and galectin‐3 (above the 11.7 ng/ml) threshold plasma levels in lung recipients is associated with high risk (RR = 7.14 ± 0.97 [95% CI 1.05–48.60], P = 0.045) of airway obstruction after LTx. A measurement of miR‐339 expression in combination with galectin‐3 level might be perspective to identify recipients at risk of airway obstruction after LTx.

76ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XVII № 3-2015Исследование новых лабораторных параметров, отражающих активность процессов, участвующих во взаимоотношении трансплантата и реципиента и значимых при развитии осложнений, является актуальной задачей трансплантологии. Важное клиническое значение имеет поиск и изучение 1 ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 Кафедра трансплантологии и искусственных органов ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова», Москва, Российская Федерация Обзор литературы посвящен анализу роли трансформирующего фактор роста бета 1 (TGF-β1) при трансплантации печени. TGF-β1 играет ключевую роль в развитии фиброза печени, а также в развитии иммунного ответа; его концентрация в ткани и в крови изменяется при заболеваниях печени. Уровень TGF-β1 в крови реципиентов печени связан с развитием фиброза, формированием иммунной толерантности и иммунным ответом на активную инфекцию. Измерение уровня TGF-β1 при трансплантации печени может иметь диагностическое и прогностическое значение при оценке состояния трансплантата. В настоящее время клинических данных о роли цитокина при трансплантации печени накоплено недостаточно, и необходимы дальнейшие исследования связи уровня TGF-β1 с различными клиническими и лабораторными показателями у реципиентов печени. В обзоре проанализированы 54 источника литературы, более половины из которых опубликованы в последние пять лет.Ключевые слова: трансплантация печени, TGF-β, биомаркеры, цитокины.

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