transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2010-0-3-4-10-12transplantologiya-287Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSЭхография в оценке тяжести ишемически-реперфузионных повреждений печеночного трансплантатаEchography in the evaluation of the severity of ischemia-reperfusion injuries of a liver transplantДоноваЛ. В.DonovaL. V.

Любовь Викторовна Донова

donova_lv@rambler.ruНИИ скорой помощи им Н.В. СклифосовскогоРоссияN.V. Sklifosovsky Research Institute of Emergency CareRussian Federation20101708201803-41012Copyright © Донова Л.В., 20182018Донова Л.В.Donova L.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/287

Цель исследования — изучение роли эхографических методик в оценке гемодинамических и структурных изменений печеночного трансплантата (ПТ) при ишемически-реперфузионных повреждениях (ИРП).

Материалы и методы

Материалы и методы. Проанализированы результаты динамического эхографического наблюдения 122 пациентов, которым за период 2005–2010 гг. была выполнена ортотопическая трансплантация печени.

Результаты

Результаты. В первые сутки после выполненной операции в бассейне артериального русла ПТ чаще регистрировался высокорезистентный кровоток. У 35% пациентов к 3-м суткам выявлялась отрицательная динамика в виде увеличения значений индекса резистентности на уровне печеночной артерии или ее ветвей. У 42,3% всех обследованных пациентов были диагностированы преходящие постишемические структурные изменения трансплантированного органа; у 28% выявлено формирование крупноочаговых некрозов. Летальность среди больных с транзиторным отеком печеночной паренхимы составила 4,5%. В группе реципиентов, у которых были диагностированы крупноочаговые некрозы печеночной паренхимы, летальность составила 29,6%. У 10% больных, в связи с дисфункцией трансплантата, была выполнена ретрансплантация печени.

Выводы

Выводы. По данным эхографии, гемодинамические и структурные изменения ПТ, как следствие перенесенного ишемическиреперфузионного синдрома выявляются у подавляющего большинства реципиентов. Динамический ультразвуковой контроль является надежным инструментальным методом определения тяжести повреждений ПТ и факторов риска развития неблагоприятного исхода.

Objective

Objective: to study the role of echographic techniques in the evaluation of hemodynamic and structural changes in a liver transplant (LT) in ischemia-reperfusion injuries (IRI).

Materials and methods

Materials and methods. The results of an echographic follow-up were analyzed in 122 patients who had undergone orthotopic liver transplantation in 2005 to 2010.

Results

Results. A high-resistance flow pattern was more frequently recorded in the arterial bed of LT within the first 24 postoperative hours. On day 3, there were negative changes as an increased resistance index at the level of the hepatic artery or its branches in 35% of the patients. Transient postischemic structural changes in the grafted organ were diagnosed in 42.3% of all the examinees; formation of large focal necroses was found in 28%. Mortality in patients with transient edema of the hepatic parenchyma was 4.5%. In the group of recipients who had been diagnosed as having large focal hepatic parenchymal necroses, mortality was 29.6%. Liver retransplantation was carried out in 10% of the patients because of graft dysfunction.

Conclusion

Conclusion. According to the echographic findings, LT hemodynamic and structural changes as a sequel of prior IRI were revealed in the overwhelming majority of recipients. Ultrasound follow-up monitoring is a reliable tool for assessing the severity of LT injuries and risk factors for poor outcome.

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