Transplantation and artificial organs

Clinical, Diagnostic, and Surgical Aspects of Right Ventricular Fragment Embolism Following Blast Trauma

V. V. Lazoryshynets — 2026-04-13

Abstract. A separate category of such injuries is fragment embolism of the heart and vessels, a rare consequence of ballistic trauma. This condition involves the traumatic penetration of a foreign body (usually a bullet or fragment) into a blood vessel, which then continues to migrate along the vessel to another part of the body. The rarity and high variability of clinical manifestations of such injuries have led to a lack of established treatment or management strategies.

Objective. Based on the experience of treating mine-blast injuries, to present the course, diagnosis, and treatment strategy for fragment embolism of the right heart chambers.

Material and Methods. Our experience includes 90 cases of mine-blast injuries. Direct heart injuries were observed in 40 patients. Localization of fragments in the right ventricular cavity was diagnosed in 14 patients. Fragment embolism of the right ventricular cavity was observed in 2 cases, accounting for 2.5% of the total number of patients with mine-blast injuries. The leading diagnostic method that enabled detection of the fragment was contrast-enhanced CT with synchronization.

Results. As a result of mine-blast fragment injuries, all 4 patients were wounded in the upper or lower limbs. No breaches of the chest cavity or diaphragm were observed. In all cases, fragments were found in the right ventricular cavity. Diagnosis of cardiac fragment presence was made at different times after injury, ranging from 1 day to 5 months. All patients underwent surgery using cardiopulmonary bypass via a trans-tricuspid approach. In all cases, there were no signs damage to the cardiac walls. A neodymium magnet was used during each operation.

Conclusions. The entry of fragments into the venous vessels of the upper and lower limbs may be accompanied by migration to the right heart chambers, with potential fixation to the trabeculae of the right ventricle and risk of entry into the pulmonary artery basin. In our opinion, to prevent fragment migration into the pulmonary artery system, priority should be given to the removal of fragments located in the RV cavity.

Venous Inflow Reconstruction During Liver Transplantation in Patients With Portal Vein Thrombosis

O. Yu. Usenko — 2026-04-13

Background. Liver transplantation is the only treatment for patients with decompensated end-stage liver disease. Recipient portal vein thrombosis is associated with increased mortality risks both pre- and post-transplant, and is associated with higher technical complexity of the surgical procedure.

The aim of this study is to conduct a retrospective analysis of vascular inflow reconstruction during liver transplantation in the setting of portal vein thrombosis.

Materials and methods. From December 2019 to February 2026, 9 liver transplants were performed in recipients with portal thrombosis in the Department of liver transplantation and surgery of State institute "Shalimov's national scientific center of surgery and transplantation to National academy of medical sciences of Ukraine”. The general characteristics of the patients, the indicators of postoperative complications and mortality were studied.

Results. In all cases, physiological reconstruction of the vascular venous inflow was performed, in 6 cases in the form of eversion thrombectomy from the portal vein with subsequent end-to-end anastomosis, in 2 cases – interpositional jump graft between the portal vein and the superior mesenteric vein, in 1 case – reno-portal shunting. Clinically significant postoperative complications were noted in 3 recipients, 1 patient died on the 51 postoperative day from septic complications.

Conclusions. Portal vein thrombosis in a potential liver recipient requires an individual and variable approach to performing venous vascular inflow reconstruction in liver transplantation based on both anatomical and physiological and hemodynamic characteristics.

The Use of Marginal Donor Hearts as an Effective Way to Expand the Donor Pool in Heart Transplantation

S. Chaikovska — 2026-04-13

Introduction. The critical shortage of donor organs is the main problem in the world to provide for a need treatment of patients with terminal heart disease. One of the ways to expand the donor pool may be to expand the criteria for selecting donor hearts using the so-called "marginal donors".

The aim of our study was to analyze the early and long-term results of using hearts from marginal donors in orthotopic heart transplantation in patients with terminal stage chronic heart failure.

Materials and methods. From December 2019 to October 2024, the heart transplantation team of the State Institution "Heart Institute of the Ministry of Health of Ukraine" performed 106 heart transplantations. In 39 (36.7%) cases, we used hearts from "marginal" donors for orthotopic heart transplantation, in 67 cases, orthotopic heart transplantation from classical donors was performed.

Results. The criteria for donor marginality were the need for regional normothermic perfusion, the ratio between the mass of the donor and the recipient <0.8, the presence of concomitant cardiosurgical pathology of the donor organ (the need for revascularization, correction of valvular defect), prolonged ischemia time of the donor organ more than
240 min., ABO incompatibility, the presence of congenital heart disease. Orthotopic heart transplantation from marginal donors provided results comparable in both the early and long-term to those of standard donor hearts.

Conclusions. The use of marginal donor hearts does not significantly affect the long-term outcomes of heart transplantation, which allows for a significant expansion of the donor pool, especially for patients with high status on the waiting list.

Analysis of X-Ray Anthropometric Parameters of the Proximal Femur from the Position of Planning Hip Joint Arthroplasty

D. A. Syniehubov — 2026-04-13

Abstract: In the structure of morbidity of modern society, diseases of bones and joints occupy one of the leading positions. In the surgical treatment of severe forms of hip joint diseases, hip arthro-plasty is a radical method of treatment. At the same time, the number of total hip arthroplasties in the world is increasing annually. Preoperative planning of the implantation of the femoral component of the endoprosthesis is performed by analyzing the radiographic anthropometric parameters of the proximal femur.

Objective. Based on a comparative assessment of radiographic anthropometric characteristics of the proximal femur, to develop an algorithm for planning implantation of the femoral component of a hip joint endoprosthesis.

Materials and methods. An assessment of radiographic anthropometric parameters was performed in 232 patients (258 joints) with various nosological forms of hip joint diseases who underwent total hip arthroplasty; 26 patients underwent bilateral staged hip arthroplasty. Idiopathic coxarthrosis of the III degree (IC) was diagnosed in 42 patients, dysplastic coxarthrosis of the III degree (DC) – in 46 patients, aseptic necrosis of the femoral head of the IV degree (ANFH) – in 62, medial femoral neck fracture (MF) – in 48 patients, rheumatoid arthritis (RA) – in 32 patients, traumatic coxarthro-sis (TC) – in 2 patients. Cementless fixation of endoprostheses was used in 187 cases (72.5%), in the remaining cases – in 71 (27.5%), cement fixation of the stem was used, while a total cement endo-prosthesis was installed in 33 cases (12.8%), and in 38 cases (14.7%) an endoprosthesis with hybrid fixation was implanted. The following methods were used for qualitative and quantitative assess-ment of the structure of the proximal femur: cortical index (CI), morpho-cortical index (MCI), No-ble medullary canal narrowing index, Spotorno–Romagnoli index, assessment of the proximal femur according to Dorr L. et al.

Results. Based on the analysis of descriptive and calculated radiographic anthropometric indicators in various nosological forms of hip joint involvement, analysis of the dependence of radiographic anthropometric indicators and the designs of the installed stems of endoprostheses, an algorithm was developed for selecting the design of the femoral component of the endoprosthesis and the type of its fixation.

Discussion. Radiographic anthropometric indicators in IC revealed a decrease in bone mass in the area of implantation of the endoprosthesis stem and a tendency to a straight shape of the proximal femoral canal. In DC, the structure of the proximal femoral canal tends to a conical shape, while the loss of bone mass in the area of implantation of the endoprosthesis stem is less pronounced than in IC. In ANFN, the “normal” type of canal prevailed, which indicated the possibility of cementless fixation of the endoprosthesis stem, and in RA, the structure of the canal indicated the likelihood of cement fixation of the stem. In MF, the greatest loss of bone mass was established according to ra-diographic anthropometric indicators, which indicated a tendency to a “pipe” type of canal and ce-ment fixation of the endoprosthesis stem.

Conclusions. Descriptive and calculated methods for assessing of radiographic anthropometric pa-rameters of the proximal femur should be effectively used in combination. To obtain a full-fledged characteristic, it is necessary to assess at least one descriptive and at least two calculated radiographic anthropometric parameters of the proximal femur, which, together with the determination of the Spotorno-Romagnoli integral index, will allow to optimize plan the choice of the stem design and the type of its fixation. The developed algorithm allows to standardize the determination of radio-graphic anthropometric parameters of the proximal femur and optimize approaches to the selection of the endoprosthesis stem design and the type of its fixation, and to ensure both high-quality primary stability of the femoral component and subsequent operational longevity of the hip joint endo-prosthesis.

Case Report: LVAD as a Bridge to Heart Transplantation. Technical and Infectious Challenges

O. Samchuk — 2026-04-13

Abstract: Mechanical circulatory support devices, particularly left ventricular assist devices (LVADs), are widely used as a bridge to transplantation in patients with end-stage heart failure. Despite their significant clinical benefits, LVAD use is associated with the risk of infectious complications that can complicate the post-transplant period and affect the outcome of heart transplantation.

In recent decades, the development of mechanical circulatory support devices, particularly left ventricular assist devices (LVADs), has significantly improved the interim management of patients awaiting heart transplantation. LVADs serve as a bridge to transplantation by stabilizing hemodynamics, improving end-organ perfusion, reducing the symptoms of heart failure, and, ideally, enhancing post-transplant outcomes.

However, the use of LVADs as a pre-transplant bridge is associated with specific risks and challenges. According to recent reviews and clinical studies, these include infectious complications, bleeding events, and immunological sensitization, which may adversely affect the post-transplant course.

In this clinical case, we present a patient in whom an LVAD was implanted as a bridge to transplantation, followed by successful heart transplantation. We describe the clinical course as well as the challenges encountered in the management of this patient.

Post-Transplant Sleep and Circadian Disruption: Links to Rejection and Quality of Life

А. I. Pavlov — 2026-04-13

Background: Sleep and circadian disruption are highly prevalent after transplantation but seldom managed as primary targets. At the level of analysis it is possible to show that they constitute a coherent, modifiable risk domain with consequences for functioning and, in specific contexts, survival.

Methods: We conducted a structured narrative synthesis restricted to the studies spanning kidney, liver, lung and heart transplantation and allogeneic HSCT. Eligible reports used validated sleep/circadian measures and outcomes (fatigue, social participation, health-related quality of life [HRQoL], rejection, relapse, or mortality), with longitudinal and within-person effects prioritised.

Results: Across organs, disturbed sleep affected roughly one third to one half of recipients, consistently exceeding healthy peers. In kidney pathways, poor sleep related independently to lower “individual strength”, curtailed participation and poorer physical and mental HRQoL, with sex- and age-contingent patterns and treatment correlates (notably calcineurin inhibitors). Liver and lung studies highlighted depression, symptom burden and anxiety as dominant associates; family support was protective in liver cohorts. In HSCT, pre-transplant sleep disruption predicted higher risks of relapse and mortality over six years, while actigraphy and daily diaries showed a post-treatment nadir in sleep (Days +7–14) and same-day coupling between poorer prior-night sleep, sedentary time and evening fatigue. In heart transplantation, donor procurement during “activation” hours (day–evening) was associated with inferior long-term survival compared with “repression” hours (night–morning), aligning clinical signals with chrono-immunological plausibility.

Conclusions: Sleep and circadian alignment are systems-level mediators, not epiphenomena. Immediate priorities are routine screening; brief, behaviourally anchored interventions (exercise, CBT-I, morning light); ward-level nocturnal hygiene; and timing-aware audit in cardiac pathways, while organ-specific randomised trials and multicentre replications proceed.