transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2018-10-4-308-326transplantologiya-406Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESУвеличит ли аппаратная перфузия печени количество донорских органов, пригодных для трансплантации?Will the machine perfusion of the liver increase the number of donor organs suitable for transplantation?https://orcid.org/0000-0001-8650-0855ГуляевВ. А.GulyaevV. A.

Владимир Алексеевич Гуляев – доктор медицинских наук, ведущий научный сотрудник отделения трансплантации почки и поджелудочной железы 

129090, Москва, Большая Сухаревская площадь, д. 3

Vladimir A. Gulyaev – Dr. Med. Sci., Leading Researcher of the Kidney and Pancreas Transplantation Department 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

vgulyaev-8@yandex.ruhttps://orcid.org/0000-0002-9992-9260ЖуравельС. В.Zhuravel’S. V.

Сергей Владимирович Журавель– доктор медицинских наук, заведующий научным отделением анестезиологии и реанимации для трансплантации органов 

129090, Москва, Большая Сухаревская площадь, д. 3

Sergey V. Zhuravel – Dr. Med. Sci., Head of the Scientific Department of Anesthesiology and Intensive Care for Organ Transplantation 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-6362-7914НоврузбековМ. С.NovruzbekovM. S.

Мурад Сафтарович Новрузбеков – кандидат медицинских наук, заведующий научным отделением трансплантации печени 

129090, Москва, Большая Сухаревская площадь, д. 3

Murad S. Novruzbekov – Dr. Med. Sci., Head of the Scientific Department of Anesthesiology and Intensive Care for Organ Transplantation 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-0691-5581ОлисовО. Д.OlisovO. D.

Олег Даниелович Олисов – кандидат медицинских наук, старший научный сотрудник отделения трансплантации печени 

129090, Москва, Большая Сухаревская площадь, д. 3

Oleg D. Olisov – Cand. Med. Sci., Senior Researcher of the Liver Transplantation Department 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0003-2305-4055ЛуцыкК. Н.LutsykK. N

Константин Николаевич Луцык – кандидат медицинских наук, заведующий операционным блоком Городского центра трансплантации печени 

129090, Москва, Большая Сухаревская площадь, д. 3

Konstantin N. Lutsyk – Cand. Med. Sci., Head of the Operating Theatre of the Liver Transplantation City Center 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0001-5473-2272МининаМ. Г.MininaM. G.

Марина Геннадьевна Минина – доктор медицинских наук, заведующая Московским координационным центром органного донорства 

125284, Москва, 2-й Боткинский пр-д, д. 5

Marina G. Minina – Dr. Med. Sci., Head of the Moscow Coordination Center of Organ Donation 

5 2-nd Botkinskiy Dr., Moscow 125284 

https://orcid.org/0000-0001-9592-7682МироновА. С.MironovA. S.

Александр Сергеевич Миронов –кандидат медицинских наук, старший научный сотрудник отделения анестезиологии и реанимации для трансплантации органов 

129090, Москва, Большая Сухаревская площадь, д. 3

Aleksandr S. Mironov – Cand. Med. Sci., Head of the Department of Tissue Conservation and Transplant Production 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-2824-1020КузнецоваН. К.KuznetsovaN. K.

Наталья Константиновна Кузнецова – врач-хирург операционного блока Городского центра трансплантации печени

129090, Москва, Большая Сухаревская площадь, д. 3

Natal’ya K. Kuznetsova – Cand. Med. Sci., Senior Researcher of the Department of Anaesthesiology and Intensive Care for Organ Transplantation 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-5057-6628МагомедовК. М.MagomedovK. M.

Кубай Магомедович Магомедов – врач-хирург операционного блока Городского центра трансплантации печени 

 129090, Москва, Большая Сухаревская площадь, д. 3

Kubay M. Magomedov – Doctor-surgeon of the Operating Theatre of the Liver Transplantation City Center

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-0746-1884ХубутияМ. Ш.KhubutiyaM. Sh

Могели Шалвович Хубутия – академик РАН, профессор, доктор медицинских наук, президент НИИ скорой помощи им. Н.В. Склифосовского ДЗМ 

129090, Россия, Москва, Большая Сухаревская площадь, д. 3

Mogeli Sh. Khubutiya – Acad. of RAS, Prof., Dr. Med. Sci., President of N.V. Sklifosovsky Research Institute for Emergency Medicine 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationМКЦОД ГБУЗ «ГКБ им. С.П. Боткина ДЗМ»,РоссияCity Clinical Hospital n.a. S.P. BotkinRussian Federation201821122018104308326Copyright © Гуляев В.А., Журавель С.В., Новрузбеков М.С., Олисов О.Д., Луцык К.Н., Минина М.Г., Миронов А.С., Кузнецова Н.К., Магомедов К.М., Хубутия М.Ш., 20182018Гуляев В.А., Журавель С.В., Новрузбеков М.С., Олисов О.Д., Луцык К.Н., Минина М.Г., Миронов А.С., Кузнецова Н.К., Магомедов К.М., Хубутия М.Ш.Gulyaev V.A., Zhuravel’ S.V., Novruzbekov M.S., Olisov O.D., Lutsyk K.n., Minina M.G., Mironov A.S., Kuznetsova N.K., Magomedov K.M., Khubutiya M.S.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/406

Во всем мире наблюдается тенденция к росту числа пациентов, ожидающих трансплантацию печени, несмотря на увеличение общего количества операций по трансплантации печени. Решение проблемы дефицита донорских органов возможно за счет использования органов от маргинальных доноров, а именно органов, изъятых после остановки сердца, органов с большим процентом жирового гепатоза, а также органов от доноров в возрасте старше 60 лет. Основная причина отказа от их применения – риск развития тяжелых осложнений и неблагоприятного исхода операции. Статическая холодовая консервация на сегодняшний день – основной метод защиты донорских органов от тепловых повреждений, обладающий достаточно эффективными протективными свойствами. В то же время продолжительность холодовой консервации имеет ограниченный временной интервал. Всегда существует неопределенность относительно жизнеспособности органа. Современные методы оценки донорских органов – анамнез донора, лабораторные данные, визуальный осмотр и морфология – не позволяют достоверно прогнозировать функцию печени после трансплантации. В связи с этим разработка методов консервации органа после изъятия, которые не ухудшают качество органа или даже способны восстановить утраченные функции, является актуальной. Аппаратная перфузия печени представляет собой одну из новых концепций, направленных на решение данной проблемы. В статье освещен международный опыт применения аппаратной перфузии донорской печени за последние 15 лет. Аппаратная перфузия представляет собой перспективное направление развития трансплантологии, позволяющее сократить дефицит донорских органов и улучшить их качество.

Worldwide, there is a trend towards an increase in the number of patients waiting for liver transplantation, despite an increase in the total number of liver transplantation operations. Solving the problem of donor organ shortage is possible through the use of organs from marginal donors: organs removed after cardiac arrest, organs with a high percentage of steatosis, organs from donors over the age of 60 years. The main reason for refusing to use them is the risk of severe complications and an unfavorable outcome of the operation. Static cold preservation today is the main method of protecting donor organs from thermal damage, which possesses rather effective protective properties. At the same time, the duration of cold preservation has a limited time interval. There is always uncertainty about the viability of the organ. Modern methods for assessing donor organs such as donor history, laboratory data, visual examination and morphology, do not reliably predict liver function after transplantation. In this regard, the development of methods for preserving the organ after removing, which do not degrade the quality of the organ or even are capable of restoring the lost functions, is relevant. The machine perfusion of the liver is one of the new concepts aimed at solving this problem. The article highlights the international experience of using the machine perfusion of the donor liver over the past 15 years. Machine perfusion is a promising trend of transplantation development, which allows reducing the shortage of donor organs and improving their quality.

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