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 Federation10.15825/1995-1191-2025-4-8-23vtio-2066Research ArticleКлиническая трансплантологияClinical TransplantologyКомбинированная машинная перфузия и безышемическая имплантация печени от доноров высокого риска: первый опыт применения в РоссииCombined machine perfusion and ischemia-free implantation of livers from high-risk donors: fi rst experience in Russiahttps://orcid.org/0000-0003-4048-3564БолдыревМ. А.BoldyrevM. A.

Болдырев Михаил Александрович

123182, Москва, ул. Щукинская, д. 1.

Mikhail Boldyrev.

Address: 1, Shchukinskaya str., Moscow, 123182

comex.ksb@gmail.comМонаховА. Р.MonakhovA. R.

Москва

Moscow

ГрудининН. B.GrudininN. V.

Москва

Moscow

БогдановВ. К.BogdanovV. K.

Москва

Moscow

ЗубенкоС. И.ZubenkoS. I.

Москва

Moscow

СалимовВ. Р.SalimovV. R.

Москва

Moscow

БондаренкоД. М.BondarenkoD. M.

Москва

Moscow

МожейкоН. П.MozheikoN. R.

Москва

Moscow

ЮсуфН. В.YusufN. M.

Москва

Moscow

МининаМ. Г.MininaM. G.

Москва

Moscow

ЦирульниковаО. М.TsirulnikovaO. M.

Москва

Moscow

ГотьеC. В.GautierS. V.

Москва

Moscow

ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияShumakov National Medical Research Center of Transplantology and Artificial OrgansRussian FederationФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России; ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Минздрава России (Сеченовский университет)РоссияShumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России; ГБУЗ «Московский многопрофильный научно-клинический центр имени С.П. Боткина Департамента здравоохранения города Москвы»РоссияShumakov National Medical Research Center of Transplantology and Artificial Organs; Botkin HospitalRussian Federation202510012026274823Copyright © Болдырев М.А., Монахов А.Р., Грудинин Н.B., Богданов В.К., Зубенко С.И., Салимов В.Р., Бондаренко Д.М., Можейко Н.П., Юсуф Н.В., Минина М.Г., Цирульникова О.М., Готье C.В., 20262026Болдырев М.А., Монахов А.Р., Грудинин Н.B., Богданов В.К., Зубенко С.И., Салимов В.Р., Бондаренко Д.М., Можейко Н.П., Юсуф Н.В., Минина М.Г., Цирульникова О.М., Готье C.В.Boldyrev M.A., Monakhov A.R., Grudinin N.V., Bogdanov V.K., Zubenko S.I., Salimov V.R., Bondarenko D.M., Mozheiko N.R., Yusuf N.M., Minina M.G., Tsirulnikova O.M., Gautier S.V.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/2066Материалы и методы

Материалы и методы. В работе описаны два случая трансплантации печени с использованием комбинированного протокола D-HOPE-COR-NMP-IFLI, проведенные в мае и июне 2025 года в НМИЦ ТИО. Аллографты были получены от доноров с расширенными критериями (ДРК) со смертью головного мозга. Перфузия проводилась с использованием аппарата ИК после предшествующего периода статической фармакохолодовой консервации (СФХК). Аллографты печени были успешно трансплантированы реципиентам в условиях продолжающейся нормотермической машинной перфузии после достижения ими критериев жизнеспособности. Воспроизводимость и безопасность выполнения IFLI в составе комбинированного протокола оценивалась путем сбора и описательного анализа интра- и послеоперационных показателей реципиентов, характеристик доноров и параметров перфузии.

Результаты

Результаты. В обоих случаях трансплантаты достигли критериев жизнеспособности, несмотря на высокий уровень макровезикулярного стеатоза (95 и 80% соответственно). В случае № 1 аллографт достиг всех критериев жизнеспособности к 4-му часу NMP. В случае № 2 отмечался субоптимальный клиренс лактата (допустимый показатель 4,1 ммоль/л отмечался только через 6 часов перфузии). В обоих случаях не наблюдалось постреперфузионного синдрома и гемодинамической реакции реципиента на реперфузию трансплантата. Оба реципиента достигли критериев ранней дисфункции аллографта печени (уровень цитолиза 6562,9 и 1610,4 ед/л и 3822 и 2662 ед/л соответственно). Реципиенты были выписаны на 17-е и 34-е послеоперационные сутки без серьезных осложнений (Clavien–Dindo ≥3b). Срок наблюдения составил 4 и 5 месяцев; не было отмечено осложнений, причиной которых стал трансплантат либо метод консервации.

Заключение

Заключение. Комбинированная машинная перфузия, дополненная безышемической имплантацией печени, – эффективный и безопасный метод динамической консервации, позволяющий использовать трансплантаты печени от ДРК за счет минимизации ишемически-реперфузионного повреждения.

Objective

Objective: to assess the effi cacy and safety of combining sequential dual hypothermic oxygenated machine perfusion (DHOPE), controlled oxygenated rewarming (COR), and normothermic machine perfusion (NMP) with ischemia-free liver implantation (IFLI) for transplants obtained from high-risk expanded criteria donors (ECDs).

Materials and methods

Materials and methods. The study presents two cases of liver transplantation performed using the combined DHOPE-COR-NMP-IFLI protocol in May and June 2025 at the Shumakov National Medical Research Center of Transplantology and Artifi cial Organs. Liver allografts were procured from brain-dead ECDs. Perfusion was carried out using a cardiopulmonary bypass (CPB) machine following a period of static cold storage (SCS). The allografts were subsequently transplanted into recipients under continuous NMP after meeting viability criteria. The reproducibility and safety of the IFLI approach within the combined protocol were evaluated through descriptive analysis of donor characteristics, perfusion parameters, and intra- and postoperative outcomes in the recipients.

Results

Results. In both cases, the grafts met the established viability criteria despite pronounced macrovesicular steatosis (95% and 80%, respectively). In Case No. 1, all viability parameters were achieved after 4 hours of NMP. In Case No. 2, lactate clearance was suboptimal, reaching the acceptable threshold of 4.1 mmol/L only after 6 hours of perfusion. No post-perfusion syndrome or hemodynamic instability occurred in either recipient during graft reperfusion. Both recipients met the criteria for early allograft dysfunction, with cytolysis levels of 6562.9 and 1610.4 U/L, and 3822 and 2662 U/L, respectively. The recipients were discharged on postoperative days 17 and 34 without serious complications (Clavien–Dindo ≥IIIb). At 4- and 5-month follow-up, no transplant- or preservation-related complications were observed.

Conclusion

Conclusion. The combined application of sequential machine perfusion (DHOPE-COR and NMP) with IFLI is a safe and eff ective dynamic preservation strategy. This approach enables the successful use of liver grafts from ECDs by minimizing ischemia–reperfusion injury.

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