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 Federation10.15825/1995-1191-2025-3-110-116vtio-1784Research ArticleТРАНСПЛАНТАЦИЯ СЕРДЦА И ВСПОМОГАТЕЛЬНОЕ КРОВООБРАЩЕНИЕHEART TRANSPLANTATION AND ASSISTED CIRCULATIONОпыт лечения первичной дисфункции трансплантата после трансплантации сердцаExperience in managing primary graft dysfunction after heart transplantationГладкихФ. А.GladkikhF. A.

Гладких Филипп Андреевич.

454076, Челябинск, ул. Воровского, 70 (Медгородок)

Тел. (905) 836-04-02

Filipp A. Gladkikh.

70, Vorovskogo str., Chelyabinsk, 454076

Phone: (905) 836-04-02

filipphome@mail.ruЦарьковА. В.TsarkovA. V.

Царьков Артем Владимирович.

Челябинск

Chelyabinsk

chelokb@mail.ruНуждинМ. Д.NuzhdinM. D.

Нуждин Михаил Дмитриевич.

Челябинск

Chelyabinsk

chelokb@mail.ruМалиновскийЮ. В.MalinovskiyYu. V.

Малиновский Юрий Владимирович.

Челябинск

Chelyabinsk

chelokb@mail.ruМарченкоЮ. М.MarchenkoYu. M.

Марченко Юрий Минахметович.

Челябинск

Chelyabinsk

chelokb@mail.ruГБУЗ «Челябинская областная клиническая больница»РоссияChelyabinsk Regional Clinical HospitalRussian Federation202503092025273110116Copyright © Гладких Ф.А., Царьков А.В., Нуждин М.Д., Малиновский Ю.В., Марченко Ю.М., 20252025Гладких Ф.А., Царьков А.В., Нуждин М.Д., Малиновский Ю.В., Марченко Ю.М.Gladkikh F.A., Tsarkov A.V., Nuzhdin M.D., Malinovskiy Y.V., Marchenko Y.M.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/1784

Трансплантация сердца – кардиохирургическая операция, в результате которой патологически измененное сердце реципиента заменяется на удовлетворительно функционирующее сердце донора. Как и любое хирургическое вмешательство, трансплантация сердца несет в себе риск осложнений, и одним из таких является первичная дисфункция трансплантата. В этом сообщении мы рассказываем о первом опыте диагностики и лечения пациента с первичной дисфункцией трансплантата, потребовавшей механической поддержки кровообращения.

Heart transplantation (HT) is a cardiac surgical procedure involving the replacement of a recipient’s pathologically impaired heart with a functionally adequate donor organ. As with any major surgical intervention, HT comes with possible complications, one of which is primary graft dysfunction (PGD). This report presents our initial experience in the diagnosis and management of a patient who developed PGD, necessitating the use of mechanical circulatory support.

трансплантация сердцапервичная дисфункция трансплантатамеханическая поддержка кровообращенияЭКМОострое почечное повреждениезаместительная почечная терапияheart transplantationprimary graft dysfunctionmechanical circulatory supportECMOacute kidney injuryrenal replacement therapyReferencesКлинические рекомендации. Трансплантация сердца, наличие трансплантированного сердца, отмирание и отторжение трансплантата сердца. Министерство здравоохранения РФ. 2023.Klinicheskie rekomendatsii. Transplantatsiya serdtsa, nalichie transplantirovannogo serdtsa, otmiranie i ottorzhenie transplantata serdtsa. Ministerstvo zdravookhraneniya RF. 2023.Russo MJ, Iribarne A, Hong KN, Ramlawi B, Chen JM, Takayama H et al. Factors associated with primary graft failure after heart transplantation. Transplantation. 2010; 90 (4): 444–450. https://doi.org/10.1097/TP.0b013e3181e6f1eb.Russo MJ, Iribarne A, Hong KN, Ramlawi B, Chen JM, Takayama H et al. Factors associated with primary graft failure after heart transplantation. Transplantation. 2010; 90 (4): 444–450. https://doi.org/10.1097/TP.0b013e3181e6f1eb.Dronavalli VB, Rogers CA, Banner NR. Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition. Transplantation. 2015; 99 (9): 1919–1925. https://doi.org/10.1097/TP.0000000000000620.Dronavalli VB, Rogers CA, Banner NR. Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition. Transplantation. 2015; 99 (9): 1919–1925. https://doi.org/10.1097/TP.0000000000000620.D’Alessandro C, Aubert S, Golmard JL, Praschker BL, Luyt CE, Pavie A et al. Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2010; 37 (2): 343–349. https://doi.org/10.1016/j.ejcts.2009.05.034.D’Alessandro C, Aubert S, Golmard JL, Praschker BL, Luyt CE, Pavie A et al. Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2010; 37 (2): 343–349. https://doi.org/10.1016/j.ejcts.2009.05.034.Oto T, Excell L, Griffiths AP, Levvey BJ, Bailey M, Marasco S et al. Association between primary graft dysfunction among lung, kidney and heart recipients from the same multiorgan donor. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2008; 8 (10); 2132–2139. https://doi.org/10.1111/j.1600-6143.2008.02357.x.Oto T, Excell L, Griffiths AP, Levvey BJ, Bailey M, Marasco S et al. Association between primary graft dysfunction among lung, kidney and heart recipients from the same multiorgan donor. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2008; 8 (10); 2132–2139. https://doi.org/10.1111/j.1600-6143.2008.02357.x.Ibrahim M, Hendry P, Masters R, Rubens F, Lam BK, Ruel M et al. Management of acute severe perioperative failure of cardiac allografts: a single-centre experience with a review of the literature. The Canadian journal of cardiology. 2007; 23 (5): 363–367. https://doi.org/10.1016/s0828-282x(07)70769-9.Ibrahim M, Hendry P, Masters R, Rubens F, Lam BK, Ruel M et al. Management of acute severe perioperative failure of cardiac allografts: a single-centre experience with a review of the literature. The Canadian journal of cardiology. 2007; 23 (5): 363–367. https://doi.org/10.1016/s0828-282x(07)70769-9.Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M et al. Consensus Conference participants. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation. 2014; 33 (4): 327–340. https://doi.org/10.1016/j.healun.2014.02.027.Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M et al. Consensus Conference participants. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation. 2014; 33 (4): 327–340. https://doi.org/10.1016/j.healun.2014.02.027.Subramani S, Aldrich A, Dwarakanath S, Sugawara A, Hanada S. Early Graft Dysfunction Following Heart Transplant: Prevention and Management. Seminars in Cardiothoracic and Vascular Anesthesia. 2020; 24 (1): 24–33. doi: 10.1177/1089253219867694.Subramani S, Aldrich A, Dwarakanath S, Sugawara A, Hanada S. Early Graft Dysfunction Following Heart Transplant: Prevention and Management. Seminars in Cardiothoracic and Vascular Anesthesia. 2020; 24 (1): 24–33. doi: 10.1177/1089253219867694.Hull TD, Crowley JC, Villavicencio MA, D’Alessandro DA. Primary graft dysfunction in heart transplantation: How to recognize it, when to institute extracorporeal membrane oxygenation, and outcomes. JTCVS Open. 2021 May 27; 8: 128–133. doi: 10.1016/j.xjon.2021.05.010. PMID: 36004187; PMCID: PMC9390270.Hull TD, Crowley JC, Villavicencio MA, D’Alessandro DA. Primary graft dysfunction in heart transplantation: How to recognize it, when to institute extracorporeal membrane oxygenation, and outcomes. JTCVS Open. 2021 May 27; 8: 128–133. doi: 10.1016/j.xjon.2021.05.010. PMID: 36004187; PMCID: PMC9390270.Sabatino M, Vitale G, Manfredini V, Masetti M, Borgese L, Maria Raffa G et al. Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: Epidemiology, risk factors, and outcomes. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation. 2017; 36 (11): 1217–1225. https://doi.org/10.1016/j.healun.2017.02.014.Sabatino M, Vitale G, Manfredini V, Masetti M, Borgese L, Maria Raffa G et al. Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: Epidemiology, risk factors, and outcomes. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation. 2017; 36 (11): 1217–1225. https://doi.org/10.1016/j.healun.2017.02.014.Jacob S, Lima B, Gonzalez-Stawinski GV, El-Sayed Ahmed MM, Patel PC, Belli EV et al. Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant. Clinical transplantation. 2019; 33 (5): e13538. https://doi.org/10.1111/ctr.13538.Jacob S, Lima B, Gonzalez-Stawinski GV, El-Sayed Ahmed MM, Patel PC, Belli EV et al. Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant. Clinical transplantation. 2019; 33 (5): e13538. https://doi.org/10.1111/ctr.13538.Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995; 92 (8): 2226–2235. https://doi.org/10.1161/01.cir.92.8.2226.Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995; 92 (8): 2226–2235. https://doi.org/10.1161/01.cir.92.8.2226.Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2010; 11 (2): 234–238. https://doi.org/10.1097/PCC.0b013e3181b806fc.Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2010; 11 (2): 234–238. https://doi.org/10.1097/PCC.0b013e3181b806fc.Favia I, Vitale V, Ricci Z. The vasoactive-inotropic score and levosimendan: Time for LVIS? J Cardiothorac Vasc Anesth. 2013; 27: e15–e16. doi: 10.1053/j.jvca.2012.11.009.Favia I, Vitale V, Ricci Z. The vasoactive-inotropic score and levosimendan: Time for LVIS? J Cardiothorac Vasc Anesth. 2013; 27: e15–e16. doi: 10.1053/j.jvca.2012.11.009.Caruso V, Berthoud V, Bouchot O, Nguyen M, Bouhemad B, Guinot PG. ECMOVIS Study Group. Should the Vasoactive Inotropic Score be a Determinant for Early Initiation of VA ECMO in Postcardiotomy Cardiogenic Shock? J Cardiothorac Vasc Anesth. 2024 Mar; 38 (3): 724–730. doi: 10.1053/j.jvca.2023.11.040. Epub 2023 Dec 1. PMID: 38182434.Caruso V, Berthoud V, Bouchot O, Nguyen M, Bouhemad B, Guinot PG. ECMOVIS Study Group. Should the Vasoactive Inotropic Score be a Determinant for Early Initiation of VA ECMO in Postcardiotomy Cardiogenic Shock? J Cardiothorac Vasc Anesth. 2024 Mar; 38 (3): 724–730. doi: 10.1053/j.jvca.2023.11.040. Epub 2023 Dec 1. PMID: 38182434.Hyun J, Kim AR, Lee SE, Hong JA, Kang PJ, Jung SH, Kim MS. Vasoactive-Inotropic Score as a Determinant of Timely Initiation of Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock. Circ J. 2022 Mar 25; 86 (4): 687–694. doi: 10.1253/circj.CJ-21-0614. Epub 2021 Nov 9. PMID: 34759121.Hyun J, Kim AR, Lee SE, Hong JA, Kang PJ, Jung SH, Kim MS. Vasoactive-Inotropic Score as a Determinant of Timely Initiation of Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock. Circ J. 2022 Mar 25; 86 (4): 687–694. doi: 10.1253/circj.CJ-21-0614. Epub 2021 Nov 9. PMID: 34759121.Leprince P, Aubert S, Bonnet N, Rama A, Léger P, Bors V et al. Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure. Transplantation proceedings. 2005; 37 (6): 2879–2880. https://doi.org/10.1016/j.transproceed.2005.05.018.Leprince P, Aubert S, Bonnet N, Rama A, Léger P, Bors V et al. Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure. Transplantation proceedings. 2005; 37 (6): 2879–2880. https://doi.org/10.1016/j.transproceed.2005.05.018.Taghavi S, Zuckermann A, Ankersmit J, Wieselthaler G, Rajek A, Laufer G et al. Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation. The Annals of thoracic surgery. 2004; 78 (5): 1644–1649. https://doi.org/10.1016/j.athoracsur.2004.04.059.Taghavi S, Zuckermann A, Ankersmit J, Wieselthaler G, Rajek A, Laufer G et al. Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation. The Annals of thoracic surgery. 2004; 78 (5): 1644–1649. https://doi.org/10.1016/j.athoracsur.2004.04.059.Thongprayoon C, Lertjitbanjong P, Hansrivijit P, Crisafio A, Mao MA, Watthanasuntorn K et al. Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis. Medicines (Basel). 2019 Nov 1; 6 (4): 108. doi: 10.3390/medicines6040108. PMID: 31683875; PMCID: PMC6963309.Thongprayoon C, Lertjitbanjong P, Hansrivijit P, Crisafio A, Mao MA, Watthanasuntorn K et al. Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis. Medicines (Basel). 2019 Nov 1; 6 (4): 108. doi: 10.3390/medicines6040108. PMID: 31683875; PMCID: PMC6963309.Поз ЯЛ, Строков АГ, Попцов ВН, Шевченко АО, Готье СВ. Патогенетические механизмы, эпидемиология и классификация острого повреждения почек у реципиентов сердечного трансплантата. Вестник трансплантологии и искусственных органов. 2021; 23 (2): 147–157. https://doi.org/10.15825/1995-1191-2021-2-147-157.Poz IL, Strokov AG, Poptsov VN, Shevchenko AO, Gautier SV. Pathogenetic mechanisms, epidemiology and classification of acute kidney injury in heart transplant recipients. Russian Journal of Transplantology and Artificial Organs. 2021; 23 (2): 147–157. https://doi.org/10.15825/1995-1191-2021-2-147-157.Kidney disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl. 2012; 2: 1–138. doi: 10.1038/kisup.2012.1.Kidney disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl. 2012; 2: 1–138. doi: 10.1038/kisup.2012.1.Ostermann M, Connor M Jr, Kashani K. Continuous renal replacement therapy during extracorporeal membrane oxygenation: why, when and how? Current opinion in critical care. 2018; 24 (6): 493–503. https://doi.org/10.1097/MCC.0000000000000559.Ostermann M, Connor M Jr, Kashani K. Continuous renal replacement therapy during extracorporeal membrane oxygenation: why, when and how? Current opinion in critical care. 2018; 24 (6): 493–503. https://doi.org/10.1097/MCC.0000000000000559.Поз ЯЛ, Строков АГ, Копылова ЮВ, Попцов ВН, Готье СВ. Заместительная почечная терапия у реципиентов сердечного трансплантата. Вестник трансплантологии и искусственных органов. 2021; 23 (4): 62–72. https://doi.org/10.15825/1995-1191-2021-4-62-72.Poz IL, Strokov AG, Kopylova YuV, Poptsov VN, Gautier SV. Renal replacement therapy in heart transplant recipients. Russian Journal of Transplantology and Artificial Organs. 2021;23 (4): 62–72. https://doi.org/10.15825/1995-1191-2021-4-62-72.Ajibowo AO, Okobi OE, Emore E, Soladoye E, Sike CG, Odoma VA et al. Cardiorenal Syndrome: A Literature Review. Cureus. 2023 Jul 1; 15 (7): e41252. doi: 10.7759/cureus.41252. PMID: 37529809; PMCID: PMC10389294.Ajibowo AO, Okobi OE, Emore E, Soladoye E, Sike CG, Odoma VA et al. Cardiorenal Syndrome: A Literature Review. Cureus. 2023 Jul 1; 15 (7): e41252. doi: 10.7759/cureus.41252. PMID: 37529809; PMCID: PMC10389294.

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