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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">transplantologiya</journal-id><journal-title-group><journal-title xml:lang="ru">Трансплантология</journal-title><trans-title-group xml:lang="en"><trans-title>Transplantologiya. The Russian Journal of Transplantation</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2074-0506</issn><issn pub-type="epub">2542-0909</issn><publisher><publisher-name>IPO Association of Transplantologists</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.23873/2074-0506-2026-18-1-22-31</article-id><article-id custom-type="elpub" pub-id-type="custom">transplantologiya-1075</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>АКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ACTUAL ISSUES OF TRANSPLANTATION</subject></subj-group></article-categories><title-group><article-title>Тромбоцитопения при циррозе печени: эффективность элтромбопага и частичной эмболизации селезеночной артерии в определении оптимальных показаний</article-title><trans-title-group xml:lang="en"><trans-title>Thrombocytopenia in liver cirrhosis: efficacy of eltrombopag and partial splenic artery embolization in determining optimal treatment indications</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4230-8033</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шабунин</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shabunin</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексей Васильевич Шабунин, академик РАН, проф., д-р мед. наук, директор; заведующий кафедрой хирургии, трансплантологии и прикладной онкологии</p><p> </p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p><p>125993, Москва, Баррикадная ул., д. 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Aleksey V. Shabunin, Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), Director; Head of the Department of Surgery, Transplantology and Applied Oncology</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p><p>2/1 Bldg. 1 Barrikadnaya St., Moscow 125993 </p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5699-3695</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Багателия</surname><given-names>З. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Bagateliya</surname><given-names>Z. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Зураб Антонович Багателия, проф., д-р мед. наук, первый заместитель директора</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Zurab A. Bagateliya, Prof., Dr. Sci. (Med.), Prime Deputy Director</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5031-9798</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Павлов</surname><given-names>Ч. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Pavlov</surname><given-names>Ch. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Чавдар Савович Павлов, проф., д-р мед. наук, заведующий кафедрой терапии</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p><p>119048, Москва, Трубецкая ул., д. 8, стр. 2</p></bio><bio xml:lang="en"><p>Chavdar S. Pavlov, Prof., Dr. Sci. (Med.), Head of the Department of Therapy</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p><p>8 Bldg. 2 Trubetskaya St., Moscow 119048 </p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8016-1610</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дроздов</surname><given-names>П. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Drozdov</surname><given-names>P. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Павел Алексеевич Дроздов, д-р мед. наук, заместитель директора по научной работе </p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Pavel A. Drozdov, Dr. Sci. (Med.), Deputy Director for Science</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><email xlink:type="simple">drozdovpa@botkinmoscow.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5814-4504</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Левина</surname><given-names>О. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Levina</surname><given-names>O. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Оксана Николаевна Левина, канд. мед. наук, заведующий отделением гепатопанкреатогастроэнтерологии</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Oksana N. Levina, Cand. Sci. (Med.), Head of the Hepatopancreatogastroenterology Department</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Осипова</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Osipova</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Светлана Владимировна Осипова, врач-гастроэнтеролог отделения гепатопанкреатогастроэнтерологии</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Svetlana V. Osipova, Gastroenterologist, Hepatopancreatogastroenterology Department</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5176-9061</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Цуркан</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Tsurkan</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Владимир Андреевич Цуркан, врач-рентгенолог отделения рентгенхирургических методов диагностики и лечения</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Vladimir A. Tsurkan, Radiologist, Diagnostic and Interventional Radiology Department</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7774-1892</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Астапович</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Astapovich</surname><given-names>S. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сергей Андреевич Астапович, канд. мед. наук, врач отделения трансплантации органов и тканей человека</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Sergey A. Astapovich, Cand. Sci. (Med.), Physician, Department of Human Organ and Tissue Transplantation</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1120-5450</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лиджиева</surname><given-names>Э. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Lidzhieva</surname><given-names>E. А.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Эльза Анатольевна Лиджиева, врач-хирург отделения трансплантации органов и тканей человека</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Elza A. Lidzhieva, Surgeon, Department of Human Organ and Tissue Transplantation</p><p>5 2nd Botkinskiy Dr., Moscow 125284 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8726-824X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Михайлянц</surname><given-names>Г. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Mikhaylyant</surname><given-names>G. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Георгий Сергеевич Михайлянц, д-р мед. наук, профессор кафедры хирургии, трансплантологии и прикладной онкологии</p><p>125993, Москва, Баррикадная ул., д. 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Georgiy S. Mikhaylyants, Dr. Sci. (Med.), Professor of the Department of Surgery, Transplantology and Applied Oncology</p><p>2/1 Bldg. 1 Barrikadnaya St., Moscow 125993 </p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2990-2035</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Матвеев</surname><given-names>Д. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Matveev</surname><given-names>D. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дмитрий Валентинович Матвеев, д-р мед. наук, профессор кафедры хирургии, трансплантологии и прикладной онкологии</p><p>125993, Москва, Баррикадная ул., д. 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Dmitriy V. Matveev, Dr. Sci. (Med.), Professor of the Department of Surgery, Transplantology and Applied Oncology</p><p>2/1 Bldg. 1 Barrikadnaya St., Moscow 125993 </p></bio><xref ref-type="aff" rid="aff-4"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru">ГБУЗ ММНКЦ им. С.П. Боткина ДЗМ; Кафедра хирургии, трансплантологии и прикладной онкологии ФГБОУ ДПО РМАНПО МЗ РФ<country>Россия</country></aff><aff xml:lang="en">Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin; Russian Medical Academy of Continuous Professional Education<country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru">ГБУЗ ММНКЦ им. С.П. Боткина ДЗМ<country>Россия</country></aff><aff xml:lang="en">Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin<country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru">ГБУЗ ММНКЦ им. С.П. Боткина ДЗМ; Кафедра терапии ФГАОУ ВО Первый МГМУ им. И.М. Сеченова МЗ РФ (Сеченовский Университет)<country>Россия</country></aff><aff xml:lang="en">Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin; First Moscow State Medical University named after Sechenov (Sechenov University)<country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru">Кафедра хирургии, трансплантологии и прикладной онкологии ФГБОУ ДПО РМАНПО МЗ РФ<country>Россия</country></aff><aff xml:lang="en">Russian Medical Academy of Continuous Professional Education<country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>16</day><month>03</month><year>2026</year></pub-date><volume>18</volume><issue>1</issue><fpage>22</fpage><lpage>31</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Шабунин А.В., Багателия З.А., Павлов Ч.С., Дроздов П.А., Левина О.Н., Осипова С.В., Цуркан В.А., Астапович С.А., Лиджиева Э.А., Михайлянц Г.С., Матвеев Д.В., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Шабунин А.В., Багателия З.А., Павлов Ч.С., Дроздов П.А., Левина О.Н., Осипова С.В., Цуркан В.А., Астапович С.А., Лиджиева Э.А., Михайлянц Г.С., Матвеев Д.В.</copyright-holder><copyright-holder xml:lang="en">Shabunin A.V., Bagateliya Z.A., Pavlov C.S., Drozdov P.A., Levina O.N., Osipova S.V., Tsurkan V.A., Astapovich S.A., Lidzhieva E.А., Mikhaylyant G.S., Matveev D.V.</copyright-holder><license license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.jtransplantologiya.ru/jour/article/view/1075">https://www.jtransplantologiya.ru/jour/article/view/1075</self-uri><abstract><sec><title>Актуальность</title><p>Актуальность. Тромбоцитопения – частое осложнение цирроза печени, повышающее риск геморрагических осложнений и ограничивающее возможности проведения инвазивных процедур. В настоящее время для коррекции этого состояния применяются два принципиально разных подхода: терапия агонистами рецепторов тромбопоэтина и инвазивные методы, такие как частичная эмболизация артерий селезенки (ЧЭАС). В данной работе мы провели сравнительный анализ эффективности и безопасности этих подходов у пациентов с циррозом печени и выраженной тромбоцитопенией.</p></sec><sec><title>Цель</title><p>Цель. Сравнить эффективность и безопасность, а также определить оптимальные показания для применения элтромбопага или частичной эмболизации артерий селезенки с целью коррекции тромбоцитопении у больных с циррозом печени и печеночной недостаточностью.</p></sec><sec><title>Материал и методы</title><p>Материал и методы. В одноцентровое проспективное исследование на базе ММНКЦ им. С.Р. Боткина были включены 59 пациентов с циррозом печени и тромбоцитопенией (&lt;50×109/мкл). Критериями не включения стали онкологические заболевания, тяжелая почечная недостаточность (скорость клубочковой фильтрации &lt;45 мл/ мин) и активные инфекционные процессы. Пациенты были разделены на две группы: 1-я группа (n=28) получала элтромбопаг в дозе 50 мг/сут в течение 14 дней; 2-я группа (n=31) подверглась ЧЭАС. Оценку эффективности проводили по динамике уровня тромбоцитов, длительности компенсации и частоте осложнений. Поиск литературных данных осуществляли в базах данных (PubMed/MedLine, ResearchGate), а также в научной электронной библиотеке России (eLIBRARY.RU) за период 2010–2024 годов.</p></sec><sec><title>Результаты</title><p>Результаты. Терапия элтромбопагом позволила достичь целевого уровня тромбоцитов (&gt;50×109/л) у 78,6% пациентов, однако эффект сохранялся в среднем 6 недель. В группе ЧЭАС через 1 месяц после вмешательства нормализация уровня тромбоцитов наблюдалась у 100% пациентов, с последующим ростом до 110±17,37×109/л к 12-й неделе. Медиана длительности компенсации в этой группе составила 50,35±9,12 недель. Осложнения после ЧЭАС зафиксированы у 41,9% пациентов, однако летальность оставалась низкой (3,2%).</p></sec><sec><title>Выводы</title><p>Выводы. Результаты исследования демонстрируют, что ЧЭАС обеспечивает более стойкую коррекцию тромбоцитопении по сравнению с медикаментозной терапией и может рассматриваться как метод выбора у пациентов с гиперспленизмом. Элтромбопаг остается предпочтительным вариантом для краткосрочной подготовки к плановым инвазивным вмешательствам. Риск осложнений при ЧЭАС требует тщательного отбора пациентов, но не превышает преимуществ метода в долгосрочной перспективе.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Background</title><p>Background. Thrombocytopenia is a frequent complication of liver cirrhosis that significantly increases the risk of hemorrhagic complications and limits the possibilities of invasive diagnostic and therapeutic procedures. Currently, two fundamentally different approaches are used to correct this condition: pharmacological therapy with thrombopoietin receptor agonists and invasive methods such as partial splenic artery embolization (PSAE). This study presents a comparative analysis of the efficacy and safety of these methods in patients with liver cirrhosis and severe thrombocytopenia.</p></sec><sec><title>Objective</title><p>Objective. A comparison of the efficacy and safety, and optimal indications for eltrombopag versus partial splenic artery embolization in the management of thrombocytopenia in patients with liver cirrhosis and hepatic failure.</p></sec><sec><title>Material and methods</title><p>Material and methods. A single-center prospective study was conducted at Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin involving 59 patients with liver cirrhosis and thrombocytopenia (&lt;50×109/L). Noniclusion criteria included oncological diseases, severe renal failure (GFR &lt;45 mL/min), and active infectious processes. Patients were divided into two groups: Group 1 (n=28) received eltrombopag therapy at a dose of 50 mg/day for 14 days; Group 2 (n=31) underwent PSAE. Efficacy was assessed by platelet count dynamics, compensation duration, and complication rates. The literature search was conducted in the following databases: PubMed/MedLine, ResearchGate, and the Russian Scientific Electronic Library (eLIBRARY.RU), covering publications from 2010 to 2024.</p></sec><sec><title>Results</title><p>Results. Eltrombopag therapy achieved target platelet levels (&gt;50×109/L) in 78.6% of patients, but the effect lasted only 6 weeks on average. In the PSAE group, platelet count normalization was observed in 100% of patients 1 month after the procedure, with subsequent increase to 110±17.37×109/L by week 12. The median compensation duration in this group was 50.35±9.12 weeks. Complications after PSAE were recorded in 41.9%, though mortality remained low (3.2%).</p></sec><sec><title>Conclusions</title><p>Conclusions. The study results demonstrate that PSAE provides a more sustained thrombocytopenia correction compared to the drug therapy and may be considered the method of choice for patients with hypersplenism. Eltrombopag remains preferable for short-term preparation for planned invasive procedures. While PSAE complications require careful patient selection, they do not outweigh the method's long-term benefits.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>тромбоцитопения</kwd><kwd>цирроз печени</kwd><kwd>элтромбопаг</kwd><kwd>эмболизация селезеночной артерии</kwd><kwd>гиперспленизм</kwd></kwd-group><kwd-group xml:lang="en"><kwd>thrombocytopenia</kwd><kwd>liver cirrhosis</kwd><kwd>eltrombopag</kwd><kwd>splenic artery embolization</kwd><kwd>hypersplenism</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">. Cai M, Huang W, Lin C, Li Z, Qian J, Huang M, et al. Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications. Eur Radiol. 2016;26(2):370– 380. PMID: 26002134 https://doi.org/10.1007/s00330-015-3839-4</mixed-citation><mixed-citation xml:lang="en">. 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