Альманах клинической медицины. 2018; 46: 560-571
Трансплантация печени в Новосибирской области: развитие программы и ее результаты
https://doi.org/10.18786/2072-0505-201846-6-560-571Аннотация
Цель – изучить непосредственные и отдаленные результаты программы ортотопической трансплантации печени (ОТП) в Новосибирской области в период с августа 2010 по июнь 2018 г.
Материал и методы. В ретроспективное исследование включены 176 пациентов в возрасте 41,5 ± 16,69 года (от 5 месяцев до 69 лет, медиана – 44 года), которым выполнены 185 ОТП, включая 9 ретрансплантаций.
Результаты. Обсуждены особенности сосудистой и билиарной реконструкции при различных вариантах трансплантации печени. Частота сосудистых и билиарных осложнений была 1,6 и 10,3% соответственно. Продолжительность госпитализации в отделение реанимации и интенсивной терапии составила 7 ± 7,1 дня (от 0 до 69, медиана – 5 дней), общая продолжительность госпитализации после ОТП в среднем была 33 ± 18,1 дня (от 1 до 136, медиана – 30 дней). Ранняя дисфункция трансплантатов зафиксирована у 28 (15,9%) реципиентов. Периоперационная летальность (до 90 суток) составила 4,5% (8 реципиентов, включая 1 случай интраоперационной смерти), у реципиентов фрагментов печени она отсутствовала. Пятилетняя выживаемость реципиентов и трансплантатов была 71 и 65% соответственно.
Заключение. В Новосибирской области создана развитая программа трансплантации печени с результатами, сопоставимыми с данными ведущих российских центров и крупных мировых регистров. Частота ОТП в 2017 г. составила 12,9 на 1 млн жителей. Таким образом, регион стал одним из наиболее обеспеченных этим видом медицинской помощи в Российской Федерации.
Список литературы
1. Starzl TE, Marchioro TL, von Kaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Ginecol Obstet. 1963;117:659–76.
2. Поршенников ИА, Быков АЮ, Юданов АВ. 60 трансплантаций печени в Государственной Новосибирской областной клинической больнице: опыт одного центра. Бюллетень СО РАМН. 2014;34(6): 111–9.
3. Готье СВ, Хомяков СМ. Донорство и трансплантация органов в Российской Федерации в 2017 году. X сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2018;20(2): 6–28. doi: 10.15825/1995-1191-2018-2-6-28.
4. Niemi G, Breivik H. Epidural fentanyl markedly improves thoracic epidural analgesia in a lowdose infusion of bupivacaine, adrenaline and fentanyl. A randomized, double-blind crossover study with and without fentanyl. Acta Anaesthesiol Scand. 2001;45(2): 221–32. doi: 10.1034/j.1399-6576.2001.450214.x.
5. Rogiers X, Bismuth H, Busuttil RW, Broering DC, Azoulay D, editors. Split liver transplantation. Theoretical and practical aspects. Berlin Heidelberg: Springer-Verlag; 2002. 158 p. doi: 10.1007/978-3-642-57523-5.
6. Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, Shaked A, Christie JD. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8): 943–9. doi: 10.1002/lt.22091.
7. Schmitz V, Schoening W, Jelkmann I, Globke B, Pascher A, Bahra M, Neuhaus P, Puhl G. Different cava reconstruction techniques in liver transplantation: piggyback versus cava resection. Hepatobiliary Pancreat Dis Int. 2014;13(3): 242–9. doi: 10.1016/S1499-3872(14)60250-2.
8. Levi DM, Pararas N, Tzakis AG, Nishida S, Tryphonopoulos P, Gonzalez-Pinto I, Tekin A, Selvaggi G, Livingstone AS. Liver transplantation with preservation of the inferior vena cava: lessons learned through 2,000 cases. J Am Coll Surg. 2012;214(4): 691–8. doi: 10.1016/j.jamcollsurg.2011.12.039.
9. Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, Mayer D, McMaster P, Pirenne J. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69(9): 1873–81.
10. Freise CE, Gillespie BW, Koffron AJ, Lok AS, Pruett TL, Emond JC, Fair JH, Fisher RA, Olthoff KM, Trotter JF, Ghobrial RM, Everhart JE; A2ALL Study Group. Recipient morbidity after living and deceased donor liver transplantation: findings from the A2ALL Retrospective Cohort Study. Am J Transplant. 2008;8(12): 2569–79. doi: 10.1111/j.1600-6143.2008.02440.x.
11. Duailibi DF, Ribeiro MA Jr. Biliary complications following deceased and living donor liver transplantation: a review. Transplant Proc. 2010;42(2): 517–20. doi: 10.1016/j.transproceed.2010.01.017.
12. Miyagi S, Kakizaki Y, Shimizu K, Miyazawa K, Nakanishi W, Hara Y, Tokodai K, Nakanishi C, Kamei T, Ohuchi N, Satomi S. Arterial and biliary complications after living donor liver transplantation: a single-center retrospective study and literature review. Surg Today. 2018;48(2): 131–9. doi: 10.1007/s00595-017-1515-9.
13. Riediger C, Müller MW, Michalski CW, Hüser N, Schuster T, Kleeff J, Friess H. T-Tube or no T-tube in the reconstruction of the biliary tract during orthotopic liver transplantation: systematic review and meta-analysis. Liver Transpl. 2010;16(6): 705–17. doi: 10.1002/lt.22070.
14. Sun N, Zhang J, Li X, Zhang C, Zhou X, Zhang C. Biliary tract reconstruction with or without T-tube in orthotopic liver transplantation: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2015;9(4): 529–38. doi: 10.1586/17474124.2015.1002084.
15. Готье СВ, Мойсюк ЯГ, Попцов ВН, Корнилов МН, Ярошенко ЕБ, Погребниченко ИВ, Мойсюк ЛЯ, Сушков АИ, Малиновская ЮО, Цой ДЛ. Отдаленные результаты трансплантации трупной печени. Вестник трансплантологии и искусственных органов. 2014;16(3): 45–53. doi: 10.15825/1995-11912014-3-45-53.
16. Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, Wainright JL, Snyder JJ, Israni AK, Kasiske BL. OPTN/ SRTR 2016 Annual Data Report: Liver. Am J Transplant. 2018;18 Suppl 1:172–253. doi: 10.1111/ajt.14559.
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Almanac of Clinical Medicine. 2018; 46: 560-571
Liver transplantation in the Novosibirsk Region: evolution of the program and its outcomes
https://doi.org/10.18786/2072-0505-201846-6-560-571Abstract
Objective: To assess early and late outcomes of the orthotopic liver transplantation (LTx) program in the Novosibirsk Region from August 2010 to June 2018.
Materials and methods: This retrospective study included 176 patients aged 41.5 ± 16.69 years (from 5 months to 69 years; median 44 years), who underwent 185 LTx procedures including nine retransplantations.
Results: Some particulars of vascular and biliary reconstruction in various LTx types are discussed. The incidence of vascular and biliary complications was 1.6% and 10.3%, respectively. The duration of stay in the intensive care unit was 7 ± 7.1 days (from 0 to 69 days, median 5) and mean total duration of hospital stay was 33 ± 18.1 days (from 1 to 136 days, median 30). Early graft dysfunction was observed in 28 (15.9%) of the recipients. Perioperative (up to 90 days) mortality was 4.5% (8 recipients, including one intra-operative death). There was zero mortality in the liver fragment recipients. The overall 5-year patient and graft survival rates were 71% and 65%, respectively.
Conclusion: The Novosibirsk Region has a well-established LTx program, with its outcomes being comparable to those of the leading Russian centers and large worldwide registries. In 2017, LTx prevalence was 12.9 per million of the population. Thus, the region has become one of the most provided with this type of medical care in the Russian Federation.
References
1. Starzl TE, Marchioro TL, von Kaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Ginecol Obstet. 1963;117:659–76.
2. Porshennikov IA, Bykov AYu, Yudanov AV. 60 transplantatsii pecheni v Gosudarstvennoi Novosibirskoi oblastnoi klinicheskoi bol'nitse: opyt odnogo tsentra. Byulleten' SO RAMN. 2014;34(6): 111–9.
3. Got'e SV, Khomyakov SM. Donorstvo i transplantatsiya organov v Rossiiskoi Federatsii v 2017 godu. X soobshchenie registra Rossiiskogo transplantologicheskogo obshchestva. Vestnik transplantologii i iskusstvennykh organov. 2018;20(2): 6–28. doi: 10.15825/1995-1191-2018-2-6-28.
4. Niemi G, Breivik H. Epidural fentanyl markedly improves thoracic epidural analgesia in a lowdose infusion of bupivacaine, adrenaline and fentanyl. A randomized, double-blind crossover study with and without fentanyl. Acta Anaesthesiol Scand. 2001;45(2): 221–32. doi: 10.1034/j.1399-6576.2001.450214.x.
5. Rogiers X, Bismuth H, Busuttil RW, Broering DC, Azoulay D, editors. Split liver transplantation. Theoretical and practical aspects. Berlin Heidelberg: Springer-Verlag; 2002. 158 p. doi: 10.1007/978-3-642-57523-5.
6. Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, Shaked A, Christie JD. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8): 943–9. doi: 10.1002/lt.22091.
7. Schmitz V, Schoening W, Jelkmann I, Globke B, Pascher A, Bahra M, Neuhaus P, Puhl G. Different cava reconstruction techniques in liver transplantation: piggyback versus cava resection. Hepatobiliary Pancreat Dis Int. 2014;13(3): 242–9. doi: 10.1016/S1499-3872(14)60250-2.
8. Levi DM, Pararas N, Tzakis AG, Nishida S, Tryphonopoulos P, Gonzalez-Pinto I, Tekin A, Selvaggi G, Livingstone AS. Liver transplantation with preservation of the inferior vena cava: lessons learned through 2,000 cases. J Am Coll Surg. 2012;214(4): 691–8. doi: 10.1016/j.jamcollsurg.2011.12.039.
9. Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, Mayer D, McMaster P, Pirenne J. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69(9): 1873–81.
10. Freise CE, Gillespie BW, Koffron AJ, Lok AS, Pruett TL, Emond JC, Fair JH, Fisher RA, Olthoff KM, Trotter JF, Ghobrial RM, Everhart JE; A2ALL Study Group. Recipient morbidity after living and deceased donor liver transplantation: findings from the A2ALL Retrospective Cohort Study. Am J Transplant. 2008;8(12): 2569–79. doi: 10.1111/j.1600-6143.2008.02440.x.
11. Duailibi DF, Ribeiro MA Jr. Biliary complications following deceased and living donor liver transplantation: a review. Transplant Proc. 2010;42(2): 517–20. doi: 10.1016/j.transproceed.2010.01.017.
12. Miyagi S, Kakizaki Y, Shimizu K, Miyazawa K, Nakanishi W, Hara Y, Tokodai K, Nakanishi C, Kamei T, Ohuchi N, Satomi S. Arterial and biliary complications after living donor liver transplantation: a single-center retrospective study and literature review. Surg Today. 2018;48(2): 131–9. doi: 10.1007/s00595-017-1515-9.
13. Riediger C, Müller MW, Michalski CW, Hüser N, Schuster T, Kleeff J, Friess H. T-Tube or no T-tube in the reconstruction of the biliary tract during orthotopic liver transplantation: systematic review and meta-analysis. Liver Transpl. 2010;16(6): 705–17. doi: 10.1002/lt.22070.
14. Sun N, Zhang J, Li X, Zhang C, Zhou X, Zhang C. Biliary tract reconstruction with or without T-tube in orthotopic liver transplantation: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2015;9(4): 529–38. doi: 10.1586/17474124.2015.1002084.
15. Got'e SV, Moisyuk YaG, Poptsov VN, Kornilov MN, Yaroshenko EB, Pogrebnichenko IV, Moisyuk LYa, Sushkov AI, Malinovskaya YuO, Tsoi DL. Otdalennye rezul'taty transplantatsii trupnoi pecheni. Vestnik transplantologii i iskusstvennykh organov. 2014;16(3): 45–53. doi: 10.15825/1995-11912014-3-45-53.
16. Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, Wainright JL, Snyder JJ, Israni AK, Kasiske BL. OPTN/ SRTR 2016 Annual Data Report: Liver. Am J Transplant. 2018;18 Suppl 1:172–253. doi: 10.1111/ajt.14559.
17. Evolution of LTs in Europe. European Liver Transplant Registry data [Internet]. Available from: http://www.eltr.org/Evolution-of-LTs-inEurope.html.
