Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Aim. To assess the possibilities of the use of laparoscopic transabdominal nephrectomy (LNE) for surgical treatment and preparation of the patients with autosomal dominant polycystic kidney disease (ADPKD) for kidney transplantation. Materials and тethods. In the course of the study 28 patients who underwent nephrectomy of

Aim. To investigate the structure and frequency of occurrence of the infection in the cysts of the kidneys in patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD).Materials and methods.For the first time the microbiological study of the biological materials obtained from the patients with PKD were performed. That  were the polycystic-altered kidneys removed in preparation of potential  recipients for kidney transplantation, which were made as a routine step. All  patients underwent surgical treatment in order to prepare for kidney  transplantation or according to clinical indications. Two groups of patients have  been distinguished: the 1st group – 7 (33.3%) patients with asymptomatic  course of disease, the 2nd group – 14 (76.7%) patients who had symptoms of infection of kidneys and urinary tract.Results. As a result of this work, the presence of latent and active infection in  18 (85.7%) patients, including 6 (85.7%) patients with asymptomatic polycystic course, was proved. At microbiological research the causative agent of infection was not revealed only at the 1st patient in the first group and in 2  patients in the second group. Infection of cysts of kidneys of 6 patients with asymptomatic course of PKD was proved only after research of their  contents taken intraoperatively. There is no correlation between the presence of  infection, symptoms and the size of polycystic kidneys. Multidrug resistant infection only sensitive to modern antibiotics ultrawide spectrum of  action was detected in 6 patients, including 2 patients with asymptomatic.Conclusion.Critically high actual infection of more than 80% of polycystic-altered kidneys has been established, which allows to consider them as a source  of chronic infection in the context of future transplantation. The presence of  latent, including multiresistant infection in cysts, worsens the prognosis of kidney transplantation in this category of patients without nephrectomy.

Aim. To investigate the renal transplantation results for patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD). Materials and methods. The study included a prospective and retrospective analysis of the kidney transplantation results in 46 patients with ESRD caused by PKD, performed in the period from 2003 to 2018. Two groups of patients were formed. The comparison group consisted of 23 (50%) cases of kidney transplantation in patients whose polycystic-changed kidneys were preserved at the time of transplantation. The study group included 23 (50%) patients who underwent pretransplantation nephrectomy of native kidneys for clinical indications or to prepare for the waiting list. During the study, an algorithm of examination and surgical preparation for inclusion patients with PKD in the waiting list for kidney transplantation was developed and actively used. Results. The mean follow up period of patients who underwent pretransplantation nephrectomy was 3.6 ± 2.5 years, patients with preserved native kidneys-5.3 ± 3.08 years (p > 0.05). Periodic pain in the lumbar region disturbed 12 (52.2%) patients with preserved polycystic-changed kidneys. The frequency of episodes of leukocyturia, bacteriuria and(or) hematuria significantly differed and amounted to 0.27 ± 0.35 cases per year in the study group, 1.49 ± 0.54 (p < 0.05) in the comparison group. Posttransplant nephrectomy of polycystic-changed kidneys at different times after transplantation was required in 5 (21.7%) patients. Five-year graft survival in the study group was 87.5%, in the comparison group-76.1%. Among the patients of the comparison group, 76.4% of transplants lost their function after 10 years. The 5 and 10-year survival rates of patients with preserved native kidneys were 90.5% and 80%, respectively. In particular, there was one fatal outcome due to sepsis on the background of infection with cysts of preserved polycystic kidney. There were no deaths in the study group. Conclusion. Among patients whom polycystic-changed kidneys removed, there is a more favorable course of the post-transplant period due to the low frequency of infectious complications. More than 60% of patients with PKD need to perform nephrectomy of native kidneys during life for various reasons, including more than 21,7% need it after kidney transplantation due to complications during immunosuppressive therapy. Reasonable assessment of the polycystic kidneys and timely pretransplantation nephrectomy are an integral part of the preparation and management of the waiting list for transplantation of a patient with PKD.

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