Трансплантация тонкой кишки: современные достижения и проблемы

Введение. Трансплантация тонкой кишки (ТТК) за последние пять лет претерпела значительные изменения, превратившись из экспериментальной процедуры в жизненно важный стандарт лечения пациентов с необратимой хронической кишечной недостаточностью. Анализ данных Международного регистра трансплантации кишечника подтверждает постепенное сокращение числа операций в связи с улучшением альтернативных методов лечения, однако ТТК остается единственным шансом на выживание для пациентов с опасными для жизни осложнениями парентерального питания.

Цель. Обобщение знаний и описание текущего статуса развития направления трансплантации тонкой кишки. В обзоре представлены ключевые аспекты современной ТТК: эпидемиология, диагностические критерии, показания к трансплантации, схемы иммуносупрессии и возможные осложнения. Особое внимание уделяется улучшению выживаемости, сохраняющимся проблемам хронического отторжения, а также новым подходам и направлениям.

Материал и методы. Обзор основан на анализе научной литературы за период с 2010 по 2025 год, включая клинические руководства, метаанализы, рандомизированные контролируемые исследования и крупные регистровые данные. Учтены как зарубежные, так и российские публикации.

Заключение. Клиническая ТТК остается сложной и развивающейся областью медицины. Продолжающиеся исследования и технологические достижения будут формировать ее будущее. Значительные успехи уже были достигнуты в консервативном и хирургическом лечении пациентов, получающих кишечный трансплантат. Показатели выживаемости теперь аналогичны показателям при использовании домашнего парентерального питания, поэтому трансплантация кишечника должна быть рассмотрена, по крайней мере, для всех пациентов с необратимой кишечной недостаточностью.

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