transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologiststransplantologiya-138Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONАлгоритм донорского этапа аллотрансплантации сложного комплекса тканей лица. Первый российский опытThe donor management algorithm in transplantation of a composite facial tissue allograft.. First experience in RussiaУйбаВ. В.UybaV. V.fmba@fmbaros.ruГубаревК. К.GubarevK. K.fmba@fmbaros.ruВосканянО. Э.VoskanyanS. E.fmba@fmbaros.ruВолохМ. А.VolokhM. A.fmba@fmbaros.ruВиноградовВ. Л.VinogradovV. L.fmba@fmbaros.ruКалакуцкийН. В.KalakutskiyN. V.fmba@fmbaros.ruХубулаваГ. Г.KhubulavaG. G.fmba@fmbaros.ruЗахлевныйА. И.ZakhlevnyyA. I.fmba@fmbaros.ruМурашовИ. Ю.MurashovI. Yu.fmba@fmbaros.ruЛесняковА. Ф.LesnyakovA. F.fmba@fmbaros.ruРомановаЕ. С.RomanovaE. S.fmba@fmbaros.ruЩербаковВ. А.ShcherbakovV. A.fmba@fmbaros.ruАлександровВ. В.AleksandrovV. V.fmba@fmbaros.ruСамойловА. С.SamoylovA. S.fmba@fmbaros.ruЗабелинМ. В.ZabelinM. V.fmba@fmbaros.ruФМБА РоссииРоссияFederal Medico-Biological Agency of the Russian Federation (FMBA)Russian FederationФГБУ ГНЦ ФМБЦ им. А.И. Бурназяна ФМБА РоссииРоссияA.I. Burnasyan Federal Medical Biophysical Center of FMBARussian FederationФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава РоссииРоссияNorth-Western State Medical University named after I.I. Mechnikov of the Russian Healthcare MinistryRussian FederationФГБВ ОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФРоссияMilitary Medical Academy named after S.M. Kirov of the Russian Federation Ministry of DefenseRussian FederationNorth-Western State Medical University named after I.I. Mechnikov of the Russian Healthcare MinistryRussian Federation20161312201604818Copyright © Уйба В.В., Губарев К.К., Восканян О.Э., Волох М.А., Виноградов В.Л., Калакуцкий Н.В., Хубулава Г.Г., Захлевный А.И., Мурашов И.Ю., Лесняков А.Ф., Романова Е.С., Щербаков В.А., Александров В.В., Самойлов А.С., Забелин М.В., 20162016Уйба В.В., Губарев К.К., Восканян О.Э., Волох М.А., Виноградов В.Л., Калакуцкий Н.В., Хубулава Г.Г., Захлевный А.И., Мурашов И.Ю., Лесняков А.Ф., Романова Е.С., Щербаков В.А., Александров В.В., Самойлов А.С., Забелин М.В.Uyba V.V., Gubarev K.K., Voskanyan S.E., Volokh M.A., Vinogradov V.L., Kalakutskiy N.V., Khubulava G.G., Zakhlevnyy A.I., Murashov I.Y., Lesnyakov A.F., Romanova E.S., Shcherbakov V.A., Aleksandrov V.V., Samoylov A.S., Zabelin M.V.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/138

С 2005 г. по декабрь 2015 г. в мире были выполнены 37 трансплантаций васкуляризированных композитных комплексов тканей (VCA) лица. Признано, что трансплантация VCA в большей степени соответствует пересадке солидного органа, чем просто особый вид трансплантации тканей. Перевод VCA в разряд донорскихорганов породил ряд организационных, этических, правовых, технических и экономических проблем. В мае 2015 г. в РФ была выполнена первая успешная аллотрансплантация сложного комплекса тканей лица. В настоящей статье описан наш опыт взаимодействия между различными бригадами, задействованными надонорском этапе, в идентификации, кондиционировании, эксплантации и транспортировке донорских органов в различные лечебно-профилактические учреждения. Донором стал мужчина 51 года с диагнозом черепно-мозговой травмы (ЧМТ). После диагностики смерти головного мозга и констатации смерти было получено испрошенное согласие родственников. На этапе кондиционирования донора выполнена трахеостомия и сделана посмертная лицевая маска. Для проведения эксплантации донорских органов и VCA лица был выбран алгоритм «face first, concurrent completion» – «сначала лицо, одновременное (параллельное) завершение», – при этом аллотрансплантат лица был сформирован по типу «full face». Общая продолжительность операции от разреза до завершения эксплантации, в том числе и солидных органов, составила 8 часов 20 минут. VCA лица сразу после изъятия был отправлен в Санкт-Петербург ведомственной авиацией, где был пересажен через 9 часов. Донорские почки были доставлены в Москву гражданской авиацией и пересажены через 17 и 20 часов. Авторы считают, что это клиническое наблюдение наглядно демонстрирует возможность и успешность проведения мультиорганной эксплантации солидных органов и васкуляризированного комплекса тканей лица. Тем не менее, подобные операции требуют серьезного мультидисциплинарного подхода. Создание программы трансплантации VCA лица является сложным процессом для трансплантационных центров, и эта задача неможет быть решена без соответствующей организации посмертного органного  онорства на всероссийском уровне. Этим критериям на сегодняшний день удовлетворяет только Координационный центр органного донорства ФМБА России.

In the period from 2005 to December 2015, 37 transplantations of vascularized composite facial tissue allografts (VCAs) were performed in the world. A vascularized composite tissue allotransplantation has been recognized as a solid organ transplantation rather than a special kind of tissue transplantation. The recent classification of composite tissue allografts into the category of donor organs gave rise to a number of organizational, ethical, legal, technical, and economic problems. In May 2015, the first successful transplantation of a composite facial tissue allograft was performed in Russia. The article describes our experience of multiple team interactions at donor management stage when involved in the identification, conditioning, harvesting, and delivering donor organs to various hospitals. A man, aged 51 years old, diagnosed with traumatic brain injury became a donor after the diagnosis of brain deathhad been made, his death had been ascertained, and the requested consent for organ donation had been obtained from relatives. At donor management stage, a tracheostomy was performed and a posthumous facial mask was molded. The "face first, concurrent completion" algorithm was chosen for organ harvesting and facial VCA procurement; meanwhile, the facial allograft was procured as the "full face" category. The total surgery duration from the incision to completing the procurement (including that of solid organs) made 8 hours 20 minutes. Immediately after the procurement, the facial VCA complex was sent to the St. Petersburg clinic by medical aircraft transportation, and was there transplanted 9 hours later. Donor kidneys were transported to Moscow bycivil aviation and transplanted 17 and 20 hours later. The authors believe that this clinical case report demonstrates the feasibility and safety of multiple harvesting of solid organs and a vascularized composite facial tissue allograft. However, this kind of surgery requires an essential multidisciplinary approach. Establishing of facial VCA transplantation Program is a complicated process for transplant centers and can hardly be implemented without a properly organized post-mortem organ donation system at a national level. Today these criteria are met only by the Coordination Center for Organ Donation at FMBA of Russia.

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