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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">10.23873/2074-0506-2020-12-4-319-331</article-id><article-id custom-type="elpub" pub-id-type="custom">transplantologiya-537</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>КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CASE REPORTS</subject></subj-group></article-categories><title-group><article-title>Серонегативный фиброзирующий холестатический гепатит С после ретрансплантации печени, проведенной по поводу нерезектабельных метастазов нейроэндокринного рака тонкой кишки</article-title><trans-title-group xml:lang="en"><trans-title>Seronegative fibrosing cholestatic hepatitis С after liver retransplantation for unresectable neuroendocrine tumor liver metastases</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5691-5398</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Восканян</surname><given-names>С. Э.</given-names></name><name name-style="western" xml:lang="en"><surname>Voskanyan</surname><given-names>S. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сергей Эдуардович Восканян - чл.-корр. РАН, проф., д-р мед. наук, заведующий кафедрой хирургии с курсами онкохирургии, эндоскопии, хирургической патологии, клинической трансплантологии и органного донорства ИППО, заместитель главного врача по хирургической помощи, руководитель центра хирургии и трансплантологии  </p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Sergey E. Voskanyan - Corresponding Member of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), Head of the Surgery Department with the Courses of Oncology, Anesthesiology and Resuscitation, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation, the Institute of Postgraduate Professional Education; Deputy Chief Doctor for Surgical Care, Head of the Center for Surgery and Transplantation </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0001-8391-5211</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сюткин</surname><given-names>В. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Syutkin</surname><given-names>V. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Владимир Евгеньевич Сюткин - д-р мед. наук, профессор кафедры хирургии с курсами онкохирургии, эндоскопии, хирургической патологии, клинической трансплантологии и органного донорства ИППО; ведущий научный сотрудник отделения трансплантации печени  </p><p>123098, Москва, ул. Маршала Новикова, д. 23</p><p>129090, Москва, Большая Сухаревская пл., д. 3</p></bio><bio xml:lang="en"><p>Vladimir E. Syutkin - Dr. Sci. (Med.), Professor of the Surgery Department with the Courses of Oncology, Anesthesiology and Resuscitation, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation, the Institute of Postgraduate Professional Education; Leading Research Associate, Department for Liver Transplantation </p><p>23 Marshal Novikov St., Moscow 123098</p><p>3 Bolshaya Sukharevskaya Sq., Moscow 129090</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/0000-0002-4527-0448</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шабалин</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shabalin</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Максим Вячеславович Шабалин, канд. мед. наук, врач-хирург Центра хирургии и трансплантологии  </p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Maksim V. Shabalin - Cand. Sci. (Med.), Surgeon </p><p>23 Marshal Novikov St., Moscow 123098</p></bio><email xlink:type="simple">shabalin.max.v@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1784-5945</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Артемьев</surname><given-names>А. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Artemyev</surname><given-names>A. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексей Игоревич Артемьев - канд. мед. наук, заведующий хирургическим отделением Центра хирургии и трансплантологии</p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Aleksey I. Artemyev - Cand. Sci. (Med.), Head of the Surgical Department at the Surgery and Transplantation Centre </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0002-6254-130X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Колышев</surname><given-names>И. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Kolyshev</surname><given-names>I. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Илья Юрьевич Колышев - канд. мед. наук, заведующий хирургическим отделением № 1 Центра новых хирургических технологий </p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Ilya Yu. Kolyshev - Cand. Sci. (Med.), Head of Surgical Department № 1, Center for New Surgical Technologies </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0002-4560-6415</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Башков</surname><given-names>А. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Bashkov</surname><given-names>A. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Андрей Николаевич Башков - заведующий отделением лучевой и радиоизотопной диагностики </p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Andrey N. Bashkov - Head of the Diagnostic Radiology and Radionuclide Imaging Department </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0002-9699-8375</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Борбат</surname><given-names>А. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Borbat</surname><given-names>A. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Артем Михайлович Борбат - врач-патологоанатом патологоанатомического отделения</p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Artem M. Borbat - Pathologist of the Anatomic Pathology Department </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0001-9006-163X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Губарев</surname><given-names>К. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Gubarev</surname><given-names>K. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Константин Константинович Губарев - канд. мед. наук, заведующий хирургическим отделением координации донорства органов и (или) тканей человека</p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Konstantin K. Gubarev - Cand. Sci. (Med.), Head of the Surgical Department for the Coordination of Human Organ and(or) Tissue Donation </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0002-6558-7143</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Попов</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Popov</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Максим Васильевич Попов - врач-хирург отделения рентгенохирургических методов диагностики и лечения</p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Maksim V. Popov - Surgeon, the Department of Diagnostic and Treatment Techniques in Interventional Radiology </p><p>23 Marshal Novikov St., Moscow 123098</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/0000-0003-1192-9598</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мальцева</surname><given-names>А. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Maltseva</surname><given-names>A. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Анна Погосовна Мальцева - врач-хирург Центра хирургии и трансплантологии</p><p>123098, Москва, ул. Маршала Новикова, д. 23</p></bio><bio xml:lang="en"><p>Anna P. Maltseva - Surgeon, the Surgery and Transplantation Centre </p><p>23 Marshal Novikov St., Moscow 123098</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ ГНЦ ФМБЦ им. А.И. Бурназяна ФМБА России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State Research Center – Burnasyan Federal Medical Biophysical Center of Medico-Biological Agency of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБУ ГНЦ ФМБЦ им. А.И. Бурназяна ФМБА России; ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State Research Center – Burnasyan Federal Medical Biophysical Center of Medico-Biological Agency of the Russian Federation; N.V. Sklifosovsky Research Institute for Emergency Medicine</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2020</year></pub-date><pub-date pub-type="epub"><day>11</day><month>12</month><year>2020</year></pub-date><volume>12</volume><issue>4</issue><fpage>319</fpage><lpage>331</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Восканян С.Э., Сюткин В.Е., Шабалин М.В., Артемьев А.И., Колышев И.Ю., Башков А.Н., Борбат А.М., Губарев К.К., Попов М.В., Мальцева А.П., 2020</copyright-statement><copyright-year>2020</copyright-year><copyright-holder xml:lang="ru">Восканян С.Э., Сюткин В.Е., Шабалин М.В., Артемьев А.И., Колышев И.Ю., Башков А.Н., Борбат А.М., Губарев К.К., Попов М.В., Мальцева А.П.</copyright-holder><copyright-holder xml:lang="en">Voskanyan S.E., Syutkin V.E., Shabalin M.V., Artemyev A.I., Kolyshev I.Y., Bashkov A.N., Borbat A.M., Gubarev K.K., Popov M.V., Maltseva A.P.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" 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/537">https://www.jtransplantologiya.ru/jour/article/view/537</self-uri><abstract><p>Приводим наблюдение необычной причины дисфункции трансплантата печени – серонегативного фиброзирующего холестатического гепатита С у больной, перенесшей аллотрансплантацию печени от посмертного донора по поводу нерезектабельных метастазов нейроэндокринного рака тонкой кишки и ретрансплантацию фрагмента правой доли печени от родственного донора по поводу первично нефункционирующего трансплантата. Послеоперационный период осложнился тромбозом печеночной артерии, кровоизлиянием в головной мозг, острым клеточным отторжением, двухсторонней полисегментарной пневмонией, кровотечением в мягкие ткани шеи, тяжелой гнойной раневой инфекцией и сепсисом. Необходимость проведения антикоагулянтной терапии и отсутствие антител к вирусу гепатита С в крови затруднили раннюю диагностику фиброзирующего холестатического гепатита. Противовирусная терапия современными препаратами привела к полному клиническому и вирусологическому излечению. По данным контрольного обследования через, 240 суток после операции признаков прогрессирования рака и дисфункции трансплантата не выявлено. Трансплантация печени у данной больной явилась радикальным и эффективным методом лечения нерезектабельных метастазов нейроэндокринного рака тонкой кишки, а распознавание и адекватное лечение фиброзирующего холестатического гепатита С позволило сохранить трансплантат и жизнь пациентки.</p></abstract><trans-abstract xml:lang="en"><p>We present an uncommon case of liver graft dysfunction caused by seronegative hepatitis C-related fibrosing cholestatic hepatitis after cadaver liver transplantation for unresectable liver metastases of neuroendocrine small intestine cancer followed by living relation donor liver fragment retransplantation for primary graft nonfunction. Early postoperative period was complicated by hepatic artery thrombosis, cerebral hemorrhage, acute cellular rejection, bilateral polysegmental pneumonia, bleeding into neck soft tissues, severe surgical site infection, and sepsis. Anticoagulant therapy, as well as the absence of Hepatitis C Virus antibodies made difficult early diagnostics of fibrosing cholestatic hepatitis. A present-day antiviral therapy produced a complete clinical and virological response. At control examination performed at 240 days after surgery, there were neither signs of cancer progression no graft dysfunction. Liver transplantation in that case was an example of radical and effective treatment method for unresectable liver metastases of neuroendocrine small intestine cancer. Timely diagnosis and proper treatment of fibrosing cholestatic hepatitis made it possible to save the liver graft and patient's life.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>нейроэндокринный рак тонкой кишки</kwd><kwd>метастазы</kwd><kwd>фиброзирующий холестатический гепатит С</kwd><kwd>серонегативный гепатит С</kwd><kwd>возвратный гепатит С</kwd><kwd>аллотрансплантат печени</kwd><kwd>дисфункция</kwd><kwd>трансплантация печени</kwd><kwd>осложнения</kwd></kwd-group><kwd-group xml:lang="en"><kwd>neuroendocrine small intestine cancer</kwd><kwd>metastases</kwd><kwd>seronegative hepatitis C-related fibrosing cholestatic&#13;
hepatitis</kwd><kwd>seronegative hepatitis C</kwd><kwd>recurrent hepatitis C</kwd><kwd>liver allograft</kwd><kwd>dysfunction</kwd><kwd>liver transplantation</kwd><kwd>complications</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">Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem R, et al. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol. 2014;15(1):e8– 21. PMID: 24384494 https://doi.org/10.1016/S1470-2045(13)70362-0</mixed-citation><mixed-citation xml:lang="en">Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem R, et al. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol. 2014;15(1):e8– 21. 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