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 Federation10.15825/1995-1191-2021-2-158-166vtio-1376Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSОстрые симптоматические судорожные приступы в раннем послеоперационном периоде трансплантации печени, почкиEarly postoperative seizures in liver and kidney recipientsЦирульниковаО. М.TsirulnikovaO. M.

Москва

Moscow

СыркинаА. В.SyrkinaA. V.

Сыркина Алла Владиславовна

123182, Москва, ул. Щукинская, д. 1

Alla  V. Syrkina

1, Shchukinskaya str., Moscow, 123182

AllaSyrk@gmail.comМилосердовИ. А.MiloserdovI. A.

Москва

Moscow

ПашковаИ. Е.PashkovaI. E.

Москва

Moscow

ОлешкевичС. Ю.OleshkevichS. Yu.

Москва

Moscow

КомароваИ. Б.KomarovaI. B.

Москва

Moscow

ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Минздрава России (Сеченовский университет); ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияSechenov University; Shumakov National Medical Research Center of Transplantology and Artificial OrgansRussian FederationФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияShumakov National Medical Research Center of Transplantology and Artificial OrgansRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202112072021232158166Copyright © Цирульникова О.М., Сыркина А.В., Милосердов И.А., Пашкова И.Е., Олешкевич С.Ю., Комарова И.Б., 20212021Цирульникова О.М., Сыркина А.В., Милосердов И.А., Пашкова И.Е., Олешкевич С.Ю., Комарова И.Б.Tsirulnikova O.M., Syrkina A.V., Miloserdov I.A., Pashkova I.E., Oleshkevich S.Y., Komarova I.B.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/1376Актуальность

Актуальность. В настоящее время единственным способом лечения терминальной печеночной и почечной недостаточности является трансплантация. До 42% реципиентов печени и до 30% реципиентов почки имеют неврологические осложнения трансплантации. Острые симптоматические судорожные приступы (ОССП) занимают важное место в структуре неврологических осложнений раннего послеоперационного периода. Верификация причин приступов и управление рисками развития рецидива представляет собой актуальную задачу на современном этапе.

Цель

Цель. Обзор последних достижений в оценке, распространенности и подходах к лечению ОССП у реципиентов печени и почек.

Материалы и методы

Материалы и методы. Причины ОССП после трансплантации печени, почки разнообразны. Неспецифические причины приступов, такие как дисметаболические и волемические изменения, связанные с операцией трансплантации, известны широко. Также существуют специфические синдромы, связанные с судорогами, у реципиентов печени, почки – синдром задней обратимой лейкоэнцефалопатии, нейротоксичность ингибиторов кальциневрина, гипонатриемия в терминальной стадии печеночной недостаточности, гипокальциемия у реципиентов почки и др. Диагностика проводится по общим правилам, а лечение зависит от выявленной причины судорог. Управление острыми симптоматическими судорожными приступами предполагает назначение противосудорожных препаратов в соответствии с риском рецидива приступов, а также используется конверсия иммуносупрессии при выявленной нейротоксичности.

Результаты

Результаты. Диагностический алгоритм, а зачастую и лечебные стратегии, в случаях ОССП у реципипентов печени, почки четко не определены.

Заключение

Заключение. Множество причин ОССП диктует различия в лечебной тактике. Дальнейшее накопление и обобщение данных исходов ОССП позволит создать удобный алгоритм для быстрого определения причины и максимально эффективной лечебной тактики.

Background

Background. Transplantation is presently the only treatment for end-stage liver and kidney failure. Up to 42% of liver transplant recipients and up to 30% of kidney transplant recipients have neurological complications from the transplantation. Acute symptomatic seizures (ACS) occupy an important place in the structure of early postoperative neurological complications. Verification of the causes of seizures and management of the risk of relapse is presently a critical task.

Objective

Objective: to review recent advances in ACS assessment, prevalence, and treatment approaches in liver and kidney transplant recipients.

Materials and methods

Materials and methods. The causes of ACS after liver and kidney transplant are diverse. Nonspecific causes of seizures such as dysmetabolic and volemic changes associated with transplantation are widely known. There are also specific syndromes associated with seizures in liver and kidney recipients, such as posterior reversible leukoencephalopathy syndrome, neurotoxicity of calcineurin inhibitors, hyponatremia in the final stage of liver failure, hypocalcemia in kidney recipients, etc. Diagnosis is made based on general rules, and treatment depends on the identified causes of seizures. Management of acute symptomatic seizures involves prescribing anticonvulsants according to the risk of seizure recurrence; immunosuppression is converted when neurotoxicity is identified. Results. The diagnostic algorithm, and often the treatment strategies, in ACS cases in liver and kidney recipients, are not clearly defined.

Conclusion

Conclusion. Due to the multiple causes of ACS, there are differences in treatment tactics. Further accumulation and generalization of ACS outcome data will help in creating a convenient algorithm for rapid identification of the cause and the most effective treatment tactics.

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