vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2021-3-35-49vtio-1340Research ArticleТРАНСПЛАНТАЦИЯ ОРГАНОВORGAN TRANSPLANTATIONПервый в Российской Федерации опыт пересадки печени и почек, полученных от доноров с внегоспитальной остановкой кровообращения: обобщение 3-х летних результатовFirst Russian experience in liver and kidney transplantation from donors with out-of-hospital cardiac arrest: 3 years’ resultsРезникО. Н.ReznikO. N.

Резник Олег Николаевич

192242, Санкт-Петербург, ул. Будапештская, д. 3

Oleg N. Reznik

3, Budapest str., St.-Petersburg, 192242

onreznik@gmail.comСкворцовА. Е.SkvortsovA. E.

Скворцов A. Евгеньевич

Санкт-Петербург

St.-Petersburg

skvortsov.spb@gmail.comДайнекоВ. С.DainekoV. S.

Дайнеко Василий Сергеевич

Санкт-Петербург

St.-Petersburg

dvsis@rambler.ruЛогиновИ. В.LoginovI. V.

Логинов Игорь Валентинович

Санкт-Петербург

St.-Petersburg

loginoviv1966@gmail.comКутенковА. А.KutenkovA. A.

Кутенков Анатольевич Анатольевич

Санкт-Петербург

St.-Petersburg

alexqut@gmail.comКомедевС. С.KomedevS. S.

Комедев Сергей Станиславович

Санкт-Петербург

St.-Petersburg

skomedev@mail.ruТепловВ. М.TeplovV. M.

Теплов Вадим Михайлович

Санкт-Петербург

St.-Petersburg

vadteplov@mail.ruКузьминД. О.KuzminD. O.

Кузьмин Денис Олегович

Санкт-Петербург

St.-Petersburg

saintdeni@gmail.comАнаньевА. Н.AnanievA. N.

Ананьев Алексей Николаевич

Санкт-Петербург

St.-Petersburg

alananyev@yandex.ruУльянкинаИ. В.UliankinaI. V.

Ульянкина Ирина Владимировна

Санкт-Петербург

St.-Petersburg

irina-spb.yl@mail.ruГоголевД. В.GogolevD. V.

Гоголев Денис Вадимович

Санкт-Петербург

St.-Petersburg

simplex5@mail.ruКукушкинА. А.KukushkinA. A.

Кукушкин Андрей Александрович

Санкт-Петербург

St.-Petersburg

kukushkin_a@rambler.ruМалышевМ. Е.MalyshevM. E.

Малышев Михаил Евгеньевич

Санкт-Петербург

St.-Petersburg

malyshev1972@yandex.ruБойковА. А.BoykovA. A.

Бойков Алексей Александрович

Санкт-Петербург

St.-Petersburg

gorsmp@sp.ruСавеллоВ. Е.SavelloV. E.

Савелло Виктор Евгеньевич

Санкт-Петербург

St.-Petersburg

prof_savello@emergency.spb.ruМорозовА. Н.MorozovA. N.

Морозов Алексей Николаевич

Санкт-Петербург

St.-Petersburg

morozovan1983@gmail.comБагненкоС. Ф.BagnenkoS. F.

Багненко Сергей Федорович

Санкт-Петербург

St.-Petersburg

bagnenko_spb@mail.ruГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе»; ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени И.П. Павлова» Минздрава России; ФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Минздрава РоссииРоссияDzhanelidze St. Petersburg Research Institute of Emergency Medicine; Pavlov First St. Petersburg State Medical University; Mechnikov North-Western State Medical UniversityRussian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» МЗ РФРоссияMechnikov North-Western State Medical UniversityRussian FederationГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе»; ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени И.П. Павлова» Минздрава РоссииРоссияDzhanelidze St. Petersburg Research Institute of Emergency Medicine; Pavlov First St. Petersburg State Medical UniversityRussian FederationГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе»РоссияDzhanelidze St. Petersburg Research Institute of Emergency MedicineRussian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени И.П. Павлова» Минздрава РоссииРоссияPavlov First St. Petersburg State Medical UniversityRussian FederationСПб ГБУЗ «Городская станция скорой медицинской помощи»РоссияCity Ambulance StationRussian Federation2021170920212333549Copyright © Резник О.Н., Скворцов А.Е., Дайнеко В.С., Логинов И.В., Кутенков А.А., Комедев С.С., Теплов В.М., Кузьмин Д.О., Ананьев А.Н., Ульянкина И.В., Гоголев Д.В., Кукушкин А.А., Малышев М.Е., Бойков А.А., Савелло В.Е., Морозов А.Н., Багненко С.Ф., 20212021Резник О.Н., Скворцов А.Е., Дайнеко В.С., Логинов И.В., Кутенков А.А., Комедев С.С., Теплов В.М., Кузьмин Д.О., Ананьев А.Н., Ульянкина И.В., Гоголев Д.В., Кукушкин А.А., Малышев М.Е., Бойков А.А., Савелло В.Е., Морозов А.Н., Багненко С.Ф.Reznik O.N., Skvortsov A.E., Daineko V.S., Loginov I.V., Kutenkov A.A., Komedev S.S., Teplov V.M., Kuzmin D.O., Ananiev A.N., Uliankina I.V., Gogolev D.V., Kukushkin A.A., Malyshev M.E., Boykov A.A., Savello V.E., Morozov A.N., Bagnenko S.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1340Введение

Введение. В мегаполисах использование для пересадки органов, полученных от умерших в результате внезапной внегоспитальной остановки кровообращения, является одним из перспективных путей решения проблемы дефицита донорских органов. В Санкт-Петербурге впервые была апробирована модель перехода от ЭКМО-поддержки жизни пациентов после внегоспитальной остановки кровообращения к ЭКМО-жизнеобеспечению органов потенциальных доноров.

Материалы и методы

Материалы и методы. С целью реализации программы на базе стационарного отделения неотложной помощи Первого Санкт-Петербургского государственного медицинского университета имени И.П. Павлова были организованы круглосуточные команды ЭКМО и трансплантации, налажено взаимодействие с Санкт-Петербургской Городской станцией скорой медицинской помощи. Разработан, одобрен этическим комитетом и внедрен в клиническую практику первый в России, и в международной практике, протокол работы с потенциальными донорами, доставленными из дома после внезапной остановки кровообращения. В период с 2017 по 2020 год в стационарное отделение скорой медицинской помощи доставлено 67 пациентов с внезапной внегоспитальной остановкой кровообращения. В 4 (5,97%) случаях мероприятия расширенной сердечно-легочной реанимации с целью спасения жизни были успешны, а 11 (16,42%) пациентов стали эффективными донорами. Летальность среди этой группы больных без последующего факта посмертного донорства составила 77,61% (52 пациента).

Результаты

Результаты. Трансплантация печени от асистолических доноров (АСД), восстановление кровообращения у которых проводилось с помощью ЭКМО (ЭКМО-АСД) выполнена 5-ти реципиентам, находившимся в тяжелом состоянии на фоне печеночной недостаточности. В 1 (20%) случае имела место тяжелая дисфункция трансплантата печени в течение 33 суток с последующим полным восстановлением функции. Пересадка почки была выполнена 22-м пациентам. Немедленная функция трансплантата имела место у 10(45,45%), отсроченная - у 12 (54,55%) пациентов. Выживаемость почечных трансплантатов составила 86,4%, реципиентов почечного трансплантата – 95,5%, реципиентов печеночного трансплантата – 80%, период наблюдения составил -  24,1±7,15 месяцев.

Вывод

Вывод. Применение ЭКМО для спасения жизни пациентов с внезапной внегоспитальной остановкой кровообращения может быть реализовано в условиях высокой степени организации и синхронизации работы городской станции скорой медицинской помощи и отделения экстренной медицинской помощи многопрофильного стационара. При неудачном исходе сердечно-легочной реанимации с помощью ЭКМО (ЭКМО-СЛР) возможен запуск донорской программы - ЭКМО-АСД. Результаты трансплантации печени и почек от ЭКМО-АСД в долгосрочной перспективе соответствуют таковым при использовании органов от доноров со смертью мозга. Широкое внедрение новой модели донорства органов позволит увеличить доступность трансплантационной помощи.

Introduction

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.

Materials and methods

Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).

Results

Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.

Conclusion

Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

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