transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2024-16-2-230-243transplantologiya-888Research ArticleОПЫТ ПРАКТИЧЕСКОЙ ТРАНСПЛАНТОЛОГИИEXPERIENCE IN PRACTICAL TRANSPLANTOLOGYОпыт одного центра по интраоперационному лигированию селезеночной артерии для профилактики развития синдрома обкрадывания у пациентов после родственной трансплантации печениSingle-center experience of intraoperative ligation of the splenic artery for prevention of splenic artery steal syndrome in patients after living donor liver transplanthttps://orcid.org/0000-0001-5830-5235СёмашК. О.SemashK. O.

Константин Олесьевич Сёмаш, канд. мед. наук, врач хирург трансплантолог отделения общей хирургии, куратор программы трансплантации печени; врач хирург трансплантолог отделения гепатобилиарной хирургии и трансплантации печени № 1; ассистент кафедры госпитальной, факультетской хирургии и трансплантологии 

100016, Ташкент, Яшнабадский р-н, Паркентская ул., д. 294

100096, Ташкент, ул. Кичик халка йули, д. 10

100109, Ташкент, ул. Фаробий, д. 2

Konstantin O. Semash, Cand. Sci. (Med.), Transplant Surgeon, Curator of the Liver Transplantation Program, Department of General Surgery; Transplant Surgeon, Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation № 1; Assistant at the Department of Hospital, Faculty Surgery and Transplantology

294 Parkentskaya St., Tashkent, Yashnabad district, 100016

10 Kichik khalka yuli, Tashkent 100096 

2 Farabi St., Tashkent 100109

mail@doctorsemash.comhttps://orcid.org/0000-0002-8857-947XДжанбековТ. А.DzhanbekovT. A.

Тимур Айдарбекович Джанбеков, канд. мед. наук, врач хирург трансплантолог отделения общей хирургии, куратор программы трансплантации печени; врач хирург трансплантолог отделения гепатобилиарной хирургии и трансплантации печени № 1; ассистент кафедры госпитальной, факультетской хирургии и трансплантологии

100016, Ташкент, Яшнабадский р-н, Паркентская ул., д. 294

100096, Ташкент, ул. Кичик халка йули, д. 10

100109, Ташкент, ул. Фаробий, д. 2

Timur A. Dzhanbekov, Cand. Sci. (Med.), Transplant Surgeon, Curator of the Liver Transplantation Program, Department of General Surgery; Transplant Surgeon, Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation № 1; Assistant at the Department of Hospital, Faculty Surgery and Transplantology

294 Parkentskaya St., Tashkent, Yashnabad district, 100016

10 Kichik khalka yuli, Tashkent 100096 

2 Farabi St., Tashkent 100109

https://orcid.org/0009-0001-9611-7160ГайбуллаевТ. З.GaybullaevT. Z.

Темурбек Зокирович Гайбуллаев, врач хирург отделения гепатобилиарной хирургии и трансплантации печени № 1; магистр кафедры госпитальной, факультетской хирургии и трансплантологии 

100096, Ташкент, ул. Кичик халка йули, д. 10

100109, Ташкент, ул. Фаробий, д. 2

Temurbek Z. Gaybullaev, Surgeon, Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation № 1; Master at the Department of Hospital, Faculty Surgery and Transplantology

10 Kichik khalka yuli, Tashkent 100096 

2 Farabi St., Tashkent 100109

 

Национальный детский медицинский центр; ГУ «Республиканский специализированный научно-практический медицинский центр хирургии им. акад. В. Вахидова»; Ташкентская медицинская академияУзбекистанNational Children’s Medical Center; V. Vakhidov Republican Specialized Scientific and Practical Medical Center of Surgery; Tashkent Medical AcademyUzbekistanГУ «Республиканский специализированный научно-практический медицинский центр хирургии им. акад. В. Вахидова»; Ташкентская медицинская академияУзбекистанV. Vakhidov Republican Specialized Scientific and Practical Medical Center of Surgery; Tashkent Medical AcademyUzbekistan202425062024162230243Copyright © Сёмаш К.О., Джанбеков Т.А., Гайбуллаев Т.З., 20242024Сёмаш К.О., Джанбеков Т.А., Гайбуллаев Т.З.Semash K.O., Dzhanbekov T.A., Gaybullaev T.Z.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/888Актуальность

Актуальность. Трансплантация печени от живого донора является эффективным методом лечения пациентов с различными видами терминальных заболеваний печени. Синдром обкрадывания селезеночной артерией (steal-синдром) может являться причиной ишемии трансплантата у реципиентов, что в свою очередь может приводить к повышению уровня ферментов печени, холестазу, тромбозу печеночной артерии и даже потере трансплантата.

Цель

Цель. Оценка первых результатов опыта нашего центра в рутинном интраоперационном лигировании селезеночной артерии во время процедуры родственной трансплантации правой доли печени взрослым реципиентам для профилактики развития синдрома обкрадывания в послеоперационном периоде.

Материал и методы

Материал и методы. Были ретроспективно оценены реципиенты правой доли печени с доказанными нарушениями печеночного артериального кровотока. Группы пациентов сформированы на основании факта лигирования селезеночной артерии во время проведения трансплантации. Проанализированы артериальные осложнения в обеих группах.

Результаты

Результаты. Ни у одного из 30 пациентов с лигированной селезеночной артерией после родственной трансплантации печени не развился синдром обкрадывания. Steal-синдром возникал у 60% пациентов, у которых не была лигирована селезеночная артерия. Хирургическая техника формирования артериального анастомоза не влияла на развитие синдрома обкрадывания (p>0,5). У пациентов с перевязанной селезеночной артерией локального ишемического некроза в селезенке не отмечалось.

Заключение

Заключение. На основании анализа собственного опыта и анализа литературных данных, лигирование селезеночной артерии представляется эффективным и безопасным методом профилактики синдрома обкрадывания селезеночной артерией у пациентов после родственной трансплантации правой доли печени с минимальным риском ишемических осложнений для селезенки, однако требуются дальнейшие исследования с большей выборкой для получения более достоверных результатов. Основными инструментами раннего выявления нарушений и быстрого восстановления артериального кровотока по артерии трансплантата печени являются соответственно ультразвуковое исследование и эндоваскулярное вмешательство.

Background

Background. Living donor liver transplant is an effective method of treatment in patients with different types of endstage liver diseases. Unfortunately, patients undergoing such a complex treatment sometimes develop various vascular complications. Splenic artery steal syndrome has emerged as a cause of graft ischemia in living donor liver transplant recipients and may lead to high liver enzyme levels, cholestasis, hepatic artery thrombosis, and even a graft loss in some severe cases.

Objective

Objective. Evaluation of the first results in the experience of our center with a routine intraoperative ligation of the splenic artery during the procedure of right lobe living donor liver transplantation in adult recipients for the prevention of the steal syndrome development in the postoperative period.

Material and methods

Material and methods. Living donor liver transplant recipients with known hepatic arterial flow impairment were retrospectively studied. Patients were allocated into groups with regard whether the splenic artery had been ligated or not during the transplant procedure. Arterial complications were reviewed in both groups.

Results

Results. None of 30 patients with ligated splenic artery developed splenic artery steal syndrome after living donor liver transplant. splenic artery steal syndrome occurred in 60% patients with non-ligated splenic artery. Surgical technique of performing arterial anastomosis was not related to the splenic artery steal syndrome development (p<0.01 There was no local ischemic necrosis noted in the spleen in patients with the ligated splenic artery.

Conclusion

Conclusion. Based on the analysis of our own experience and literature data, the splenic artery ligation appears to be an effective and safe method for preventing a splenic artery steal syndrome in patients following right lobe liver transplantation, with a minimal risk of ischemic complications for the spleen. However, further studies with larger sample sizes are needed to obtain more reliable results. Ultrasound examination and endovascular intervention are the primary tools for an early detection of abnormalities and rapid restoration of arterial blood flow in the hepatic artery of the graft.

родственная трансплантация печенисосудистые осложнениясиндром обкрадыванияультразвуковая диагностикаэндоваскулярная интервенцияliving donor liver transplantvascular complicationssplenic artery steal syndromedoppler ultrasoundendovascular managementReferencesBastón Castiñeiras M, Benítez Linero I, Serrano Zarcero V, Fernández Castellano G, Suárez-Artacho G, López Romero JL. Hepatic artery thrombosis after orthotopic liver transplant: experience in the last 10 years. Transplant Proc. 2022;54(1):51–53. PMID: 34953596 https://doi.org/10.1016/j.transproceed.2021.11.006Bastón Castiñeiras M, Benítez Linero I, Serrano Zarcero V, Fernández Castellano G, Suárez-Artacho G, López Romero JL. Hepatic artery thrombosis after orthotopic liver transplant: experience in the last 10 years. Transplant Proc. 2022;54(1):51–53. PMID: 34953596 https://doi.org/10.1016/j.transproceed.2021.11.006Obed M, Othman MI, Siyam M, Hammoudi S, Jarrad A, Bashir A, et al. 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The authors declare that there are no conflicts of interest present.