Advances in regenerative medicine have generated strong interest in the development of alternative treatments for heart failure and other cardiovascular diseases. Among these, gel-forming materials derived from decellularized extracellular matrices of various tissues have emerged as a promising avenue. However, reported outcomes of their effectiveness remain inconsistent, ranging from high to highly questionable. This may be due to differences in the tissues used to obtain the matrix, decellularization protocols and efficiency. This review summarizes current studies evaluating the potential of acellular injectable products derived from allogeneic biological sources to stimulate endogenous sanogenetic mechanisms in cardiac muscle regeneration.

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease (ESRD), off ering superior survival and quality of life compared with dialysis. Several observational studies have investigated the infl uence of hemodialysis (HD) and peritoneal dialysis (PD) on post-transplant outcomes. Objective: to assess the effect of dialysis modality prior to KT on outcomes during the fi rst two years after transplantation. Materials and methods . The study included 95 KT recipients, divided into two groups: (1) patients previously treated with PD (n = 45) and (2) patients previously treated with HD (n = 50). The groups were comparable in age, dialysis duration, and immunosuppressive therapy regimens. The mean follow-up period was 19.4 ± 6.4 months. Results . Delayed graft function (DGF) occurred less frequently in the PD group (17.8%) compared with the HD group (34%), although the diff erence did not reach statistical signifi cance (p = 0.08). Patients in the HD group required signifi cantly more rehospitalizations, with a median of 2.24 [1–3] compared to 1.9 [0–2.5] in the PD group (p = 0.01). Infectious complications were also more common among HD patients (62% vs 42%, p = 0.005). In particular, bacterial infections occurred signifi cantly more often in the HD group (63% vs 43%, p = 0.0001), whereas viral and fungal infections were detected at similar frequencies in both groups (p > 0.2). The incidence of graft rejection was comparable between groups. Two-year graft survival (91% in PD vs 94% in HD, p = 0.8) and patient survival (94% in PD vs 96% in HD, p = 0.9) did not diff er signifi cantly. Likewise, serum creatinine and daily proteinuria at the end of follow-up showed no statistically signifi cant diff erences (p = 0.7 and p = 0.3, respectively). Conclusion . In this study, patients who received PD prior to transplantation showed more favorable post-transplant outcomes, including a signifi cantly lower frequency of rehospitalizations and infectious complications, as well as a trend toward reduced DGF. However, two-year graft and patient survival were similar between the PD and HD groups.

Dyslipidemia in patients with chronic kidney disease (CKD), particularly those on renal replacement therapy (RRT), is a major risk factor for cardiovascular complications. The pathogenesis of lipid metabolism disorders in this population is multifactorial and infl uenced by the underlying kidney disease, the specific characteristics of RRT, and, in transplant recipients, the effects of immunosuppressive therapy. Despite the high prevalence and clinical significance of dyslipidemia in CKD, therapeutic strategies for its correction remain insuffi ciently studied. This review analyzes current pharmacologic approaches to the management of dyslipidemia and evaluates the potential for their application in patients receiving RRT. Literature search was conducted using electronic databases Medline/PubMed (https://pubmed.ncbi.nlm.nih.gov) and eLIBRARY/Russian Science Citation Index (https://www.elibrary.ru).

Objective: to identify donor and recipient factors associated with the risk of loss of graft function in recipients of kidney grafts from expanded-criteria, brain-dead donors. Materials and methods . A retrospective multicenter cohort study included 254 donors who met the UNOS expanded-criteria defi nition and 444 corresponding recipients. Donor and recipient characteristics, perioperative parameters, and post-transplant outcomes were analyzed using single- and multivariable Cox regression models. Results . Mean donor age was 58.3 ± 4.8 years, and median cold ischemia time was 14.4 [12.3–17.0] hours. Mean recipient age was 51.6 ± 9.6 years. Class I antihuman leukocyte antigen (anti-HLA) antibodies (mean fl uorescence intensity [MFI] >500) were detected in 40 (9.2%) recipients, and class II antibodies in 56 (12.8%). Delayed graft function occurred in 34.3% of recipients. Multivariate analysis revealed that lower donor minimum glomerular filtration rate (GFR) (HR = 0.98; 95% CI 0.965–0.997; p = 0.023) and higher combined donor ALT + AST levels (HR = 1.208; 95% CI 1.063–1.372; p = 0.004) were signifi cantly associated with an increased risk of graft loss. Donor age was not a significant predictor. Among recipient factors, diabetes mellitus with target-organ damage (HR = 3.727; 95% CI 1.380–10.07; p = 0.009), nephropathy of unknown origin (HR = 3.816; 95% CI 1.212–12.02; p = 0.022), and elevated class II antiHLA antibody levels (HR = 1.125 per 1000 MFI; 95% CI 1.039–1.218; p = 0.004) were the strongest predictors of graft loss. When recipient GFR at three months post-transplant was included in the model, the signifi cance of donor-related factors (GFR, ALT, AST) was negated. Conclusion . Recipient-related predictors of graft loss are diabetes mellitus, unknown etiology of initial CKD, high class II anti-HLA antibody levels, and reduced GFR at three months post-transplant. Donor-related predictors of graft loss are minimum GFR during the entire period of donor hospitalization and elevated ALT/AST levels; however, these factors become statistically insignificant when recipient GFR three months after KT is included in the model.

Objective : to perform a comparative analysis of donor lung preconditioning protocols in donors after circulatory arrest, followed by normothermic ex vivo lung perfusion (EVLP), using two approaches: topical lung cooling and continued artificial ventilation after circulatory arrest. Materials and methods . The study was conducted on male Grey Giant rabbits weighing 4.5–5.0 kg (n = 20). Group 1: Donor lung preconditioning after circulatory arrest using topical cooling (n = 10). Group 2: Donor lung preconditioning after circulatory arrest with continued artificial ventilation in protective modes (n = 10). To evaluate the viability and functional state of donor lungs following preconditioning and cold preservation, both groups underwent normothermic EVLP. Assessments included lactate concentration, perfusate gas composition, endoscopic evaluation of the tracheobronchial tree, and subsequent morphological examination. Results . After 60 minutes of cold preservation, all grafts demonstrated satisfactory gas exchange function during normothermic EVLP. In Group 1 (topical cooling), the oxygenation index (OI) at 60 minutes was 552 (461–599) and increased to 558 (462–603) at 120 minutes. In Group 2 (continuous artifi cial ventilation), OI was 358 (343–368) at 60 minutes, with a tendency to increase to 374 (349–395) at 120 minutes. The difference between the groups was statistically signifi cant (p = 0.000). Lactate levels in both groups showed an upward trend, with a mean value of 6.99 ± 0.81, and no statistically significant intergroup differences were observed (p > 0.05). Conclusion . The study demonstrates the potential advantages of using topical cooling as part of the donor lung preconditioning protocol after cessation of eff ective circulation, employing a dextran40-based preservation solution at all stages. This approach may increase the number of donor lungs suitable for transplantation.

Objective : to evaluate the association between carriage of the rs1800469 polymorphism of the TGFB1 gene and the risk of post-transplant complications, rejection episodes, and infectious diseases in pediatric liver recipients. Materials and methods. The study included 219 pediatric liver recipients (92 boys, 127 girls), aged 2.4 to 204 months (median 8 months). Indications for liver transplantation (LT) were end-stage liver failure resulting from congenital or acquired liver diseases. Genotyping of the TGFB1 rs1800469 polymorphism was performed using real-time polymerase chain reaction (PCR) with TaqMan probes. Results . A comparative analysis of the allele frequency of rs1800469 of the TGFB1 gene was performed in three groups of pediatric liver recipients: (1) with versus without post-transplant complications, (2) with versus without rejection episodes, and (3) with versus without infectious complications. In all groups, allele frequencies conformed to Hardy–Weinberg equilibrium (p > 0.05). No significant differences in rs1800469 variant distribution were observed between recipients with and without overall complications or between those with and without rejection episodes. However, marked differences emerged between recipients with and without infectious complications: the C/C genotype was 1.9 times less frequent (p = 0.0102), the C allele was 1.3 times less frequent (p = 0.0175), and the T allele was 1.4 times more frequent (p = 0.0175) in the infection group. Under a dominant inheritance model, carriers of the T allele (C/T + T/T) had 2.53-fold higher odds of infection compared with those with the homozygous C/C genotype in the group of recipients with infections than in those without (p = 0.0077). Conclusion . In pediatric liver transplant recipients, the TGFB1 polymorphic variant rs1800469 is not associated with either a complicated post-transplant course or the occurrence of graft rejection episodes. However, carriers of the T allele appear to have an increased risk of infectious complications compared with those with the homozygous C/C genotype. These fi ndings suggest that the rs1800469 T allele may serve as a genetic marker for increased susceptibility to infections and could be considered in strategies for prevention of complications and individualized adjustment of immunosuppressive therapy.

Objective: to propose and justify approaches for improving the classical hemodynamic test bench, widely used to model the integration of mechanical circulatory support (MCS) systems. Materials and methods . The hemodynamic test bench consisted of multiple containers and resistors simulating systemic and pulmonary circulation, enabling the study of physiological conditions in heart failure (HF). The setup also included an auxiliary circulatory support pump and a pulsatile flow generator. Results. A mathematical model of the cardiovascular system was developed, capable of reproducing physiological states under conditions of pump-assisted circulation and pulsatile flow. Comparative evaluation of experimental and modeling results highlighted the advantages and limitations of different modeling methods. Conclusion. Based on these findings, strategies for further development of the hemodynamic test bench, aimed at enhancing its ability to simulate the impact of mechanical circulatory support on key hemodynamic parameters, were formulated and justified.

The aim of this study was to conduct a comparative analysis of the bioregulatory role of mesenchymal stem cells (MSCs) in the liver under physiological conditions, in acute and chronic injury with fibrotic remodeling, and during therapeutic correction by implanting exogenous MSCs from healthy tissues into the body. The analysis showed that hepatic MSCs maintain structural homeostasis by interacting with tissue myofibroblasts and migrating immune cells. In acute liver injury that does not deplete adaptive reserves, hepatic (resident) MSCs regulate tissue homeostasis.. Chronic injury that depletes adaptive reserves activates both immune cells and hepatic MSCs, leading to liver inflammation and the transdifferentiation of MSCs into myofibroblasts. These activated fibroblasts overproduce extracellular matrix components, thereby driving liver fibrosis progression. Exogenous apoptotic MSCs from healthy auto- or allogeneic tissues, when administered in cases of chronic liver injury, can compensate for deficient regulatory factors and restore metabolic regulation and structural homeostasis through their paracrine and trophic activity. Their therapeutic potential is maximized when their regulatory properties are enhanced prior to administration and when applied in recipients without irreversible liver injury.

Swyer–James–MacLeod syndrome is a rare disease characterized by emphysematous transformation of an entire lung or lobe. Traditionally, the main treatment method has been surgical resection of the aff ected lung or lobe to reduce compression of adjacent healthy lung tissue and improve vital lung capacity. This article presents a clinical case of successful endoscopic treatment in a patient with emphysematous transformation of the entire lung, who was referred to the transplant center as a potential candidate for lung transplantation.

Background. Heart transplantation (HT) remains the primary surgical treatment for children with end-stage chronic heart failure (CHF). More than 30% of pediatric HT candidates require shortor long-term mechanical circulatory support (MCS) due to refractoriness to medical therapy. In recent years, the use of left ventricular assist device (LVAD) systems has expanded not only in teenagers and middle-aged children but also in younger and smaller patients. Objective: to investigate the perioperative course of emergency LVAD implantation in children with critical hemodynamic compromise (INTERMACS profile I) requiring short-term MCS via peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Materials and methods. We studied 25 patients under 18 years of age (12 girls, 48.0%; 13 boys, 52.0%) who had a HeartMate III LVAD LVAD implanted between January 1, 2021, and June 30, 2024. The severity of pre-implantation CHF was classified according to INTERMACS profiles: I (n = 4, 16.0%), II (n = 9, 36.0%), and III (n = 12, 48.0%). Patients were divided into two groups based on the need for VA-ECMO prior to LVAD implantation: the VA-ECMO–LVAD group (n = 4, 16.0%) and the LVAD group (n = 21, 84.0%). Results. The VA-ECMO–LVAD group (n = 4) did not differ significantly from the LVAD group (n = 21) in age, sex, or underlying disease. Intraoperatively, there were no significant differences between groups in the duration of cardiopulmonary bypass, doses of sympathomimetic cardiotonics, or the use of inhaled nitric oxide. The VA-ECMO–LVAD group showed a trend toward greater intraoperative blood loss and transfusion requirements (p > 0.05). In the postoperative period, blood loss volumes were similar between groups. However, patients in the VA-ECMO–LVAD group more frequently required re-sternotomy (25% vs 9.5%, p < 0.05), had a longer duration of postoperative mechanical ventilation (1.79-fold, p < 0.05), more often required renal replacement therapy (2.5-fold, p = 0.166), and had significantly longer ICU stays (2.75-fold, p = 0.041). In the VA-ECMO–LVAD group, the incidence of severe acute right ventricular dysfunction was significantly higher (25.0% vs 9.5%, p = 0.016). No significant difference in postoperative hospital mortality was observed between the two groups. Conclusion. Emergency implantation of an LVAD system in children with critical hemodynamic instability requiring preoperative short-term MCS using peripheral VA-ECMO has demonstrated high effectiveness. However, careful consideration should be given to the presence and severity of multiple organ dysfunction before and after LVAD implantation, as well as perioperative blood loss. These factors largely determine the anesthetic and resuscitative management strategies, as well as the immediate outcomes of long-term MCS.