transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2025-17-4-461-478transplantologiya-1056Research ArticleОПЫТ ПРАКТИЧЕСКОЙ ТРАНСПЛАНТОЛОГИИEXPERIENCE IN PRACTICAL TRANSPLANTOLOGYОтдаленный прогноз после ортотопической трансплантации сердцаLong-term prognosis after orthotopic heart transplantationhttps://orcid.org/0000-0002-0746-1884ХубутияМ. Ш.KhubutiyaM. Sh.

Хубутия Могели Шалвович - акад. РАН, проф., д-р мед. наук, президент ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; заведующий кафедрой трансплантологии и искусственных органов Научно-образовательного института «Высшая школа клинической медицины им. Н.А. Семашко» ФГБОУ ВО «РосУниМед» МЗ РФ.

129090, Москва, Большая Сухаревская пл., д. 3; 127006, Москва, Долгоруковская ул., д. 4

Mogeli Sh. Khubutiya - Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), President of N.V. Sklifosovsky Research Institute for Emergency Medicine; Head of the Department of Transplantology and Artificial Organs of the Scientific and Educational Institute "N.A. Semashko Higher School of Clinical Medicine", Russian University of Medicine.

3 Bolshaya Sukharevskaya Sq., Moscow 129090; 4 Dolgorukovskaya St., Moscow 127006

khubutiyams@sklif.mos.ruhttps://orcid.org/0000-0002-6229-8629АлиджановаХ. Г.AlidzhanovaKh. G.

Алиджанова Хафиза Гафуровна - д-р мед. наук, старший преподаватель Учебного центра, старший научный сотрудник отделения неотложной кардиологии с методами неинвазивной диагностики.

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

Khafiza G. Alidzhanova - Dr. Sci. (Med.), Senior Lecturer of the Training Center, Senior Researcher, Department of Emergency Clinical Cardiology with Methods of Non-invasive Functional Diagnosis, N.V. Sklifosovsky Research Institute for Emergency Medicine.

3 Bolshaya Sukharevskaya Sq., Moscow 129090

alidzhanovahg@sklif.mos.ruhttps://orcid.org/0000-0002-8780-716XДятловА. В.DyatlovA. V.

Дятлов Антон Вячеславович - кардиолог, анестезиолог-реаниматоолог отделения реанимации и интенсивной терапии для кардиологических больных.

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

Anton V. Dyatlov - Cardiologist, Anesthesiologist-intensivist, Intensive Care unit for Cardiac Patients N.V. Sklifosovsky Research Institute for Emergency Medicine.

3 Bolshaya Sukharevskaya Sq., Moscow 129090

dyatlovav@sklif.mos.ruhttps://orcid.org/0000-0002-1750-9706ШемакинС. Ю.ShemakinS. Yu.

Шемакин Сергей Юрьевич - канд. мед. наук, ведущий научный сотрудник научного отдела неотложной кардиохирургии.

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

Sergey Yu. Shemakin - Cand. Sci. (Med.), Leading Researcher, Scientific Department of Urgent Cardiac Surgery, N.V. Sklifosovsky Research Institute for Emergency Medicine.

3 Bolshaya Sukharevskaya Sq., Moscow 129090

shemakinsy@sklif.mos.ruhttps://orcid.org/0000-0002-2971-9188СагировМ. А.SagirovM. A.

Сагиров Марат Анварович - канд. мед. наук, заведующий научным отделом неотложной кардиохирургии.

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

Marat A. Sagirov - Cand. Sci. (Med.), Head of the Scientific Department of Urgent Cardiac Surgery, N.V. Sklifosovsky Research Institute for Emergency Medicine.

3 Bolshaya Sukharevskaya Sq., Moscow 129090

sagirovma@sklif.mos.ruhttps://orcid.org/0000-0003-4145-1337МазановМ. Х.MazanovM. Kh.

Мазанов Мурат Хамидбиевич - канд. мед. наук, старший научный сотрудник научного отдела неотложной кардиохирургии.

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

Murat Kh. Mazanov - Cand. Sci. (Med.), Scientific Department of Urgent Cardiac Surgery, N.V. Sklifosovsky Research Institute for Emergency Medicine.

3 Bolshaya Sukharevskaya Sq., Moscow 129090

mazanovmh@sklif.mos.ruГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; ФГБОУ ВО «Российский университет медицины» МЗ РФРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Russian University of MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202511122025174461478Copyright © Хубутия М.Ш., Алиджанова Х.Г., Дятлов А.В., Шемакин С.Ю., Сагиров М.А., Мазанов М.Х., 20252025Хубутия М.Ш., Алиджанова Х.Г., Дятлов А.В., Шемакин С.Ю., Сагиров М.А., Мазанов М.Х.Khubutiya M.S., Alidzhanova K.G., Dyatlov A.V., Shemakin S.Y., Sagirov M.A., Mazanov M.K.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/1056Введение

Введение. Проблема лечения хронической сердечной недостаточности (ХСН) по-прежнему остается одной из наиболее важных задач кардиологии. Несмотря на достижения в области фармакотерапии сердечно-сосудистых заболеваний и использование всего арсенала существующих методов, радикальным методом лечения больных с терминальной стадией сердечной недостаточности, способным существенно улучшить прогноз и качество их жизни, остается трансплантация сердца.

Цель

Цель. Изучить заболеваемость, структурно-функциональное состояние миокарда и смертность в отдаленном периоде у реципиентов после ортотопической трансплантации сердца (ОТТС).

Материал и методы

Материал и методы. В исследование включены 50 реципиентов (44 муж. и 6 жен.), которым выполнена ОТТС в НИИ скорой помощи им. Н.В. Склифосовского. Средний возраст пациентов – 51,2±10,5 года. Средний период наблюдения после ОТТС составил 6,5±1,5 года.

Результаты

Результаты. В отдаленном периоде после ОТТС 16% реципиентов признаны здоровыми лицами; у остальных – диагностированы ХСН с сохранной фракцией выброса левого желудочка (ЛЖ) I и II функционального класса (86%); артериальная гипертония (50%) и ишемическая болезнь сердца без гемодинамического стеноза коронарных артерий (98%). Нормальные показатели общей продольной и циркумференциальной деформируемости миокарда ЛЖ позволяют утверждать, что через 6 лет у реципиентов адаптивные функции сердца восстановлены и имеет место благоприятный исход, что подтверждается отсутствием ремоделирования правых отделов сердца и восстановлением трудоспособности (77%). В отдаленном периоде наблюдали побочные эффекты иммуносупрессивной терапии (онкопатология, посттрансплантационная артериальная гипертония, нефропатия и инфекции), которые по частоте встречаемости не отличались от результатов других исследований. Смертность составила 42%. Через 1 год умерли 11,3%, далее уровень смертности составил 4–6% в год. Наиболее высокий уровень смертности наблюдался в первые 3 года ОТТС. Основными причинами смерти в отдаленном периоде были онкологические болезни, реакция хронического отторжения трансплантата и внезапная сердечная смерть.

Заключение

Заключение. В отдаленном периоде после ОТТС здоровыми признаны 16% реципиентов; трудоспособными были 77%; уровень смертности составил 4–6% в год. Через 6 лет наблюдения адаптивные функции сердца реципиентов восстановлены.

Introduction

Introduction. The problem of treating chronic heart failure (CHF) remains one of the most important challenges in cardiology. Despite advances in pharmacotherapy of cardiovascular diseases and the use of the entire arsenal of existing treatment methods, heart transplantation remains the only radical treatment for patients with end-stage heart failure that can significantly improve their prognosis and quality of life.

Objective

Objective. To investigate the morbidity, the structural-functional state of the myocardium, and mortality of recipients after orthotopic heart transplantation (OHT) in the long term.

Material and methods

Material and methods. The study included 50 recipients (44 males and 6 females) who underwent OHT at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The mean age of the patients was 51.2±10.5 years. The mean follow-up period after OHT was 6.5±1.5 years.

Results

Results. In the long term after OHT, 16% of recipients were considered healthy; the others were diagnosed with chronic heart failure (CHF) with preserved left ventricular (LV) ejection fraction of functional classes I and II (86%); arterial hypertension (50%); and ischemic heart disease (IHD) without hemodynamic stenosis of the coronary arteries (98%). Normal values of LV global longitudinal and circumferential myocardial strain suggested that after 6 years, the adaptive functions of the heart in transplant recipients was restored, indicating a favorable outcome, confirmed by the absence of remodeling of the right heart chambers and restoration of work capacity (77%). In the long term, side effects of immunosuppressive therapy (oncopathology, post-transplant hypertension, nephropathy, and infections) were observed, which did not differ in frequency from the results of other studies. The mortality rate was 42%. After 1 year, 11.3% had died, and thereafter the mortality rate was 4–6% per year. The highest mortality rate was observed in the first 3 years post-OHT. The main causes of death in the long term were oncological diseases, chronic graft rejection and sudden cardiac death.

Conclusion

Conclusion. In the long term after OHT, 16% of recipients were considered healthy; 77% were capable of work. After 6 years of follow-up, the adaptive functions of the heart in recipients were restored. The long-term mortality rate was 4–6% per year.

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