Hypersplenism (thrombocytopenia, leukopenia, anemia) syndrome and ascites occur after orthotopic liver transplant. These conditions can be treated by open splenectomy. Splenic artery embolization has been practiced as an alternative surgical method. Between January 2013 and January 2015, twenty-one orthotopic liver transplants were performed at the National Scientific Medical Research Center, Astana, Kazakhstan. Of these patients, 3 subsequently received splenic artery embolization 12, 8, and 6 months after transplant: 2 patients who had been diagnosed with primary biliary cirrhosis and 1 patient with hepatitis B virus -related liver cirrhosis. Two patients received a right-lobe living orthotopic liver transplant, and 1 patient received a deceased donor transplant. Indications for splenic artery embolization (ascites, splenomegaly) were based on clinical and ultrasonographic investigation and laboratory findings (thrombocytopenia, platelet count < 60 × 109/L, leukocytopenia, and white blood cell count < 2 × 109/L). Two recipients had leukothrombocytopenia and refractory ascites, and 1 had only thrombocytopenia. Splenic artery embolization was performed via a percutaneous femoral artery approach under local anesthesia. Transcatheter splenic artery branch occlusion was performed by deploying occlusion material. Preoperative spleen size ranged from 17.5 × 8.0 cm to 22.0 × 12.5 cm; ascites volumes were > 1000 mL. In all patients, ascites and platelet levels decreased after splenic artery embolization. In 1 patient with leukopenia, white blood cell count normalized. After embolization, 1 patient had severe abdominal pain requiring analgesia medication, and 2 patients had fever that lasted 3 days. Patients were discharged 6 to 9 days after embolization. One patient developed a perisplenic abscess without fever 1 month after discharge, and the abscess was drained using an ultrasound-guided percutaneous procedure. Splenic artery embolization is a safe and effective minimally invasive method for treating hypersplenism and ascites in orthotopic liver transplant recipients and an alternative to open splenectomy.

Myltykbay Rysmakhanov, Aibolat Smagulov, Nadiar Mussin, Asset Kaliyev, Bazylbek Zhakiyev, Yerlan Sultangereyev, Gani Kuttymuratov. Korean J Transplant 2022;36:253-8. https://doi.org/10.4285/kjt.22.0053

Objectives: Some of the most common problems after kidney transplant are urologic complications, including ureterocystoanastomosis leakage and stenosis with the development of severe renal graft complications. Isolated plasma contains active substances that cause the activation of various growth factors for the processes of tissue repair or regeneration, has an antiinflammatory effect, activates angiogenesis, and reduces the risk of infectious complications. Platelet-rich plasma is actively used to stimulate bone regeneration, heal wounds and ulcers on the skin, enhance reconstruction of the larynx and trachea, and ameliorate urethral damage, among other uses. This study was developed to evaluate the positive effect of platelet-rich plasma on the healing process of an anastomotic wound in a model of ureterocystoanas-tomosis in rats. Material and Methods: We randomized 14 Wistar albino male rats into 2 groups: group 1 included 7 rats that received platelet-rich plasma after ureterocystostomy; group 2 was the control group and included 7 rats that underwent ureterocystostomy without platelet-rich plasma. On postoperative day 7, all animals were euthanized, and the anastomosis area was resected for determination of the tissue hydroxyproline levels and histopathology examination. Results: Tissue hydroxyproline levels were 767 +/- 62.9 mu g/g in group 1 and 256 +/- 28.0 mu g/g in group 2. Tissue hydroxyproline levels were significantly higher in group 1 compared with group 2 ( P < .05). There were no significant differences in epithelial damage, acute inflammation, or fibrosis between the tissue samples of both groups. Conclusions: The results of this study show that the use of platelet-rich plasma during ureterocystostomy produces a positive effect. Our further research will be devoted to the use of autologous platelet-rich plasma in ureterocystostomy in big models.

The available scientific literature has described the tangible benefits of operations using new 3-dimensional laparoscopic systems. The purpose of this report was to describe the first experience of pure 3-dimensional laparoscopic living-donor nephrectomy for transplant in the Republic of Kazakhstan. A living-donor kidney transplant was performed in a 21-year-old male patient with the father as the donor. The operation was performed with general anesthesia using a 3-dimensional endo-videoscopic stance with flexible camera (Olympus, Tokyo, Japan). The time of warm ischemia was 130 seconds, and the total operation time was 280 minutes. The postoperative period proceeded smoothly, without any complication. The patient was discharged on day 3 after transplant with normal levels of creatinine and urea. The recipient's surgery was typical, and no complications or difficulties in perfor-ming anastomosis were encountered. With further accumulation of experience, 3-dimensional laparoscopic nephrectomy from living donors could become a new criterion standard.

Цель. Анализ результатов первоначального опыта пересадки почек в условиях областной больницы Республики Казахстан. Материалы и методы. Представлены результаты трансплантации почек, проведенных на базе Актюбинского медицинского центра (АМЦ, г. Актобе) 31 пациенту за период с ноября 2014 года по 2017 год. Операции по трансплантации проводились с соблюдением установленных протоколов по общепринятой методике. В 25 случаях проведена трансплантация от живого донора, в 6 случаях – от трупных доноров. Основная часть живых доноров подверглась лапароскопической нефроуретерэктомии с ручной ассистенцией (70,8%). Результаты. После операций по нефроуретерэктомии у доноров осложнений не наблюдалось, все были выписаны в удовлетворительном состоянии на 5–8-е сутки после операции. У реципиентов в послеоперационном периоде наблюдались следующие осложнения: острый канальцевый некроз – 1, послеоперационное кровотечение (забрюшинная гематома) – 2, лимфорея по дренажу – 2, несостоятельность мочевого анастомоза – 2. Умер 1 реципиент в отдаленном послеоперационном периоде на фоне инфекционных осложнений с развитием сепсиса. Выводы. Трансплантация почки, бесспорно, является более эффективным методом лечения больных с терминальной хронической почечной недостаточностью. Результаты первоначального опыта трансплантации почек в условиях областной больницы Актюбинской области Республики Казахстан не отличаются от среднестатистических результатов ведущих отечественных и зарубежных клиник.

A BSTRACT: Extracellular vesicles (EVs) are biological microparticles from lipid layers without a nucleus, ranging from 100 to 1000 nm. The function of extracellular vesicles is to provide cellular communication; transport biologically active molecules (cytokines, inflammatory mediators, and microRNAs); modulate inflammation and immunity; stimulate repair processes, angiogenesis, intracellular interaction, cell survival; and removal cellular waste. The International Society for Extracellular Vesicles (ISEV) constantly updates the “Minimal Information for Studies of Extracellular Vesicle.” The last updated edition was published in February 2024. The purpose of this mini-review is to provide a brief overview of the content and provide information about MISEV-2023 on the allocation, procurement, identification, and functional study of EVs, with the possibility of expanding their study and use in Kazakhstan.