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 Federation10.15825/1995-1191-2023-3-113-121vtio-1668Research ArticleДонорство органовOrgan DonationКомплексное использование перфузионных технологий при трансплантации почек от донора с внегоспитальной остановкой кровообращения (клинический случай)Complex use of perfusion techniques in kidney transplantation from a donor with out-of-hospital cardiac arrest (clinical case)ШабунинА. В.ShabuninA. V.

Moscow

minmar50@yahoo.comМининаМ. Г.MininaM. G.

Moscow

minmar50@yahoo.comДроздовП. А.DrozdovP. A.

Moscow

minmar50@yahoo.comМилосердовИ. А.MiloserdovI. A.

Moscow

igor-miloserdov@mail.ruСайдулаевД. А.SaydulaevD. A.

Moscow

sdzhabrail@yandex.ruСевостьяновВ. М.SevostyanovV. M.

Moscow

minmar50@yahoo.comТенчуринаЭ. А.TenchurinaE. A.

Тенчурина Эльмира Анвяровна,

125284, Москва, 2-й Боткинский пр-д, 5

Elmira Tenchurina,

5, Vtoroy Botkinsky Proezd, Moscow, 125284

arimle@inbox.ruГБУЗ «Городская клиническая больница имени С.П. Боткина» Департамента здравоохранения города Москвы; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияBotkin Hospital; Russian Medical Academy of Continuous Professional EducationRussian FederationГБУЗ «Городская клиническая больница имени С.П. Боткина» Департамента здравоохранения города Москвы; ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияBotkin Hospital; 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 FederationГБУЗ «Городская клиническая больница имени С.П. Боткина» Департамента здравоохранения города МосквыРоссияBotkin HospitalRussian Federation202310072023253113121Copyright © Шабунин А.В., Минина М.Г., Дроздов П.А., Милосердов И.А., Сайдулаев Д.А., Севостьянов В.М., Тенчурина Э.А., 20232023Шабунин А.В., Минина М.Г., Дроздов П.А., Милосердов И.А., Сайдулаев Д.А., Севостьянов В.М., Тенчурина Э.А.Shabunin A.V., Minina M.G., Drozdov P.A., Miloserdov I.A., Saydulaev D.A., Sevostyanov V.M., Tenchurina E.A.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/1668Цель

Цель: представить успешный опыт работы с донором с внегоспитальной остановкой кровообращения, у которого использовался комплекс современных перфузионных технологий, направленных на получение почек, пригодных для трансплантации.

Материалы и методы

Материалы и методы. У донора с внегоспитальной остановкой кровообращения после констатации биологической смерти в стационаре возобновлена автоматическая компрессия грудной клетки для поддержания минимальной перфузии в условиях искусственной вентиляции легких c FiO2 100%. Путем канюляции бедренных сосудов подключен экстракорпоральный контур с центрифужным насосом и оксигенатором и начата нормотермическая перфузия абдоминальных органов. По истечении 215 минут в условиях нормотермической перфузии выполнена эксплантация почек. Далее левая почка помещена в устройство для гипотермической перфузии донорских почек LifePort, время перфузии составило 285 минут. Правая почка пересажена без дополнительной перфузии ex vivo.

Результаты

Результаты. Благодаря комплексному использованию перфузионных технологий как в организме донора, так и ex vivo почки донора после внегоспитальной остановки кровообращения с общим временем тепловой ишемии 110 минут были пересажены реципиентам с хорошими результатами. В послеоперационном периоде отмечалась отсроченная функция левого и правого почечного трансплантатов. Пациенты выписаны в удовлетворительном состоянии под амбулаторное наблюдение.

Заключение

Заключение. Возможность и эффективность донорства органов после внегоспитальной остановки кровообращения, обеспечиваемого современными перфузионными технологиями и устройствами, открывает новую перспективу в решении дефицита донорских органов для трансплантации. 

Objective

Objective: to present the successful experience with a donor with out-of-hospital cardiac arrest (OHCA) in whom a set of modern perfusion techniques was used to obtain kidneys suitable for transplantation.

Materials and methods

Materials and methods. Automatic chest compression was resumed in an OHCA donor (after biological death has been confirmed in the hospital) to maintain minimal perfusion under mechanical ventilation with 100% FiO2. With femoral vein cannulation, an extracorporeal circuit with a centrifuge pump and oxygenator was connected and abdominal normothermic regional perfusion was initiated. After 215 minutes, kidney was explanted under normothermic machine perfusion. Next, the left kidney was placed in the LifePort Kidney Transporter for hypothermic machine perfusion of donor kidneys. Perfusion time was 285 minutes. The right kidney was transplanted without additional ex-vivo perfusion.

Results

Results. Due to the complex use of perfusion techniques both in the donor body and ex-vivo, donor kidneys, after OHCA, with a total warm ischemia time of 110 minutes, were transplanted to recipients with good results. In the postoperative period, there was delayed function of the left and right renal grafts. The patients were discharged in a satisfactory condition under outpatient follow-up.

Conclusion

Conclusion. The possibility and efficiency of organ donation after OHCA, facilitated by modern perfusion techniques and devices, open up a new perspective in addressing the organ shortage crisis.

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