transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2025-17-2-200-214transplantologiya-1008Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESПроблема гипераммониемии после ортотопической трансплантации печениThe problem of hyperammoniemia after orthotopic liver transplantationhttps://orcid.org/0000-0002-9992-9260ЖуравельС. В.ZhuravelS. V.

Сергей Владимирович Журавель - доц., д-р мед. наук, заведующий научным отделением анестезиологии

129090, Москва, Большая Сухаревская пл., д. 3

Sergey V. Zhuravel - Assoc. Prof., Dr. Sci. (Med.), Head of the Scientific Department of Anesthesiology and Critical Care Medicine

3 Bolshaya Sukharevskaya Sq., Moscow 129090

zhuravelsv@sklif.mos.ruhttps://orcid.org/0009-0000-7655-8244ФалевкоП. Ю.FalevkoP. Yu.

Полина Юрьевна Фалевко - врач анестезиолог-реаниматолог, младший научный сотрудник отделения анестезиологии и реанимации № 9

192242, Санкт-Петербург, Будапештская ул., д. 3, лит. А

Polina Yu. Falevko - Anesthesiologist-Intensivist, Junior Research Fellow, Anesthesiology and Intensive Care Department No. 9

3 lit. A Budapeshtskaya St., St. Petersburg 192242

falevkopolina@yandex.ruhttps://orcid.org/0000-0003-0319-814XМануковскийВ. А.ManukovskiyV. A.

Вадим Анатольевич Мануковский - проф., д-р мед. наук, директор ГБУ «СПб НИИ скорой помощи им. И.И.Джанелидзе»

192242, Санкт-Петербург, Будапештская ул., д. 3, лит. А

Vadim A. Manukovsky - Prof., Dr. Sci. (Med.), Director of the St. Petersburg I.I. Dzhanelidze Research Institute for Emergency Medicine

3 lit. A Budapeshtskaya St., St. Petersburg 192242

sekr@emergency.spb.ruhttps://orcid.org/0000-0001-7549-682XМалышевМ. Е.MalyshevM. E.

Михаил Евгеньевич Малышев - д-р биол. наук, заведующий Городской лабораторией иммуногенетики и серодиагностики ГБУ «СПб НИИ скорой помощи им. И.И. Джанелидзе»; профессор кафедры челюстно-лицевой хирургии и хирургической стоматологии ФГБОУ ВО «Санкт-Петербургский государственный университет»

192242, Санкт-Петербург, Будапештская ул., д. 3, лит. А

99034, Санкт-Петербург, Университетская наб., д. 7–9

Mikhail E. Malyshev - Dr. Sci. (Biol.), Head of the City Laboratory of Immunogenetics and Serodiagnosis, St. Petersburg I.I. Dzhanelidze Research Institute for Emergency Medicine; Professor of the Department of Oral and Maxillofacial Surgery and Surgical Dentistry, St. Petersburg State University

3 lit. A Budapeshtskaya St., St. Petersburg 192242

7–9 Universitetskaya Emb., St. Petersburg 199034

malyshev1972@yandex.ruГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationГБУ «СПб НИИ скорой помощи им. И.И. Джанелидзе»РоссияSt. Petersburg I.I. Dzhanelidze Research Institute for Emergency MedicineRussian FederationГБУ «СПб НИИ скорой помощи им. И.И. Джанелидзе»; Кафедра челюстно-лицевой хирургии и хирургической стоматологии ФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияSt. Petersburg I.I. Dzhanelidze Research Institute for Emergency Medicine; Department of Maxillofacial Surgery and Surgical Dentistry, St. Petersburg State UniversityRussian Federation202504062025172200214Copyright © Журавель С.В., Фалевко П.Ю., Мануковский В.А., Малышев М.Е., 20252025Журавель С.В., Фалевко П.Ю., Мануковский В.А., Малышев М.Е.Zhuravel S.V., Falevko P.Y., Manukovskiy V.A., Malyshev M.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/1008Актуальность

Актуальность. В настоящее время не вызывает сомнений, что ортотопическая трансплантация печени (ОТП) увеличивает продолжительность жизни по сравнению со стандартными методами лечения при ее декомпенсированном циррозе. В последние годы диагностике и лечению гипераммониемии уделяют все больше внимания при различных заболеваниях печени, а также после ее трансплантации. При этом исследований с высоким уровнем доказательной базы, устанавливающих связь между уровнем аммиака и тяжестью состояния пациента в раннем периоде после трансплантации печени, недостаточно.

Цель

Цель. Обобщить современные данные о проблеме гипераммониемии после трансплантации печени, проанализировать механизмы развития и патогенетическую роль высоких концентраций аммиака в сыворотке крови в развитии осложнений после ОТП, а также способы контроля уровня аммиака.

Материал и методы

Материал и методы. Проведен анализ данных зарубежных и отечественных экспериментальных и клинических исследований, посвященных вопросам патогенеза, диагностики, методов лечения гипераммониемии после ОТП. Поиск литературных данных проводили в международных базах данных (PubMed/MedLine, ResearchGate), а также в научной электронной библиотеке России (eLIBRARY.RU) за период 2019–2024 гг.

Заключение

Заключение. В проанализированных публикациях заслуживают внимание вопросы, посвященные проблеме гипераммониемии после трансплантации печени. Несмотря на большие успехи в понимании патогенеза гипераммониемии и ее влияния на развитие печеночной энцефалопатии и других нарушений со стороны прочих органов и систем организма, остается много нерешенных вопросов как в диагностике, так и выборе наиболее эффективных методов лечения.

Background

Background. Currently, there is no doubt that orthotopic liver transplantation increases life expectancy compared to standard treatment methods in patients with decompensated liver cirrhosis. In recent years, diagnostics and treatment of hyperammonemia have attracted increasing attention in various liver diseases, and also after liver transplantation. At the same time, there are few studies with a high level of evidence establishing a relationship between the blood level of ammonia and the severity of patient condition in the early period after liver transplantation.

Objective

Objective. To summarize current data on the problem of hyperammonemia after liver transplantation, to analyze the mechanisms of appearing high ammonia concentrations in blood serum and their pathogenetic role in the development of complications after orthotopic liver transplantation, and also to investigate the methods for monitoring the blood ammonia levels.

Material and methods

Material and methods. The analysis of data from world experimental and clinical studies on the pathogenesis, diagnostics, and treatment methods of hyperammonemia after orthotopic liver transplantation has been made. The literature search was conducted in international databases (PubMed/MedLine, ResearchGate), as well as in the scientific electronic library of Russia (eLIBRARY.RU) for the period from 2019–2024.

Conclusion

Conclusion. In the analyzed publications, the issues on the problem of hyperammonemia after liver transplantation are worthwhile to be addressed to. Despite advances in understanding the pathogenesis of hyperammonemia and its impact on the development of hepatic encephalopathy and disorders on the part of other body organs and systems, many unresolved issues remain both in diagnosis and in choosing the most effective treatment methods.

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The authors declare that there are no conflicts of interest present.