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 Federation10.15825/1995-1191-2026-2-19-30vtio-2083Research ArticleКЛИНИЧЕСКАЯ ТРАНСПЛАНТОЛОГИЯCLINICAL TRANSPLANTOLOGYТечение HCV-ассоциированного цирроза печени после элиминации вируса у пациентов, ожидающих трансплантациюClinical course of HCV-associated liver cirrhosis after viral eradication in transplant candidateshttps://orcid.org/0000-0003-3205-4647КоробкаВ. Л.KorobkaV. L.

Коробка Вячеслав Леонидович - д.м.н, профессор, главный врач Ростовской ОКБ; заведующий кафедрой реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии РостГМУ.

Ростов-на-Дону

Rostov-on-Don

vyacheslavkorobka@gmail.comhttps://orcid.org/0000-0003-3965-5277ЦирульниковаО. М.TsirulnikovaO. M.

Цирульникова Ольга Мартеновна - д.м.н., профессор, ФГБУ «НМИЦ трансплантологии и искусственных органов им. акад. В.И. Шумакова» Минздрава России; ФГАОУ ВО ПМГМУ им. И.М. Сеченова Минздрава России (Сеченовский университет).

Москва

Moscow

tsiroulnikova@mail.ruhttps://orcid.org/0000-0002-9552-2666ПакЕ. С.PakE. S.

Пак Екатерина Сергеевна - к.м.н, ассистент кафедры реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии РостГМУ; заведующая Гастроэнтерологическим отделением Центра хирургии и координации донорства (областного) Ростовской ОКБ.

Ростов-на-Дону

Rostov-on-Don

katya_pack-k@mail.ruhttps://orcid.org/0000-0003-2280-3931ПасечниковВ. Д.PasechnikovV. D.

Пасечников Виктор Дмитриевич - д.м.н, профессор, Центр хирургии и координации донорства (областного).

355017, Ставрополь, ул. Авиационная, 21

Тел. (962) 447-75-13

Victor D. Pasechnikov.

21, Aviatsionnaya str., Stavropol, 355017

Phone: (962) 447-75-13

passetchnikov@mail.ruhttps://orcid.org/0000-0002-4489-4232КоробкаР. В.KorobkaR. V.

Коробка Роман Вячеславович - д.м.н, доцент кафедры реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии РостГМУ; Директор Центра хирургии и координации донорства (областного) Ростовской ОКБ.

Ростов-на-Дону

Rostov-on-Don

roman_korobka@icloud.comhttps://orcid.org/0000-0002-0737-7455МалеванныйМ. В.MalevannyM. V.

Малеванный Михаил Владимирович - ассистент кафедры реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии РостГМУ; заведующий отделением рентгенхирургических методов диагностики и лечения №2 Ростовской ОКБ.

Ростов-на-Дону

Rostov-on-Don

doctorm.m@mail.ruhttps://orcid.org/0000-0001-7302-3690ПасечниковД. В.PasechnikovD. V.

Пасечников Дмитрий Викторович - к.м.н., доцент кафедры терапии с курсом диетологии.

Ставрополь

Stavropol

spicher@mail.ruhttps://orcid.org/0009-0007-5945-7610ОпряП. С.OpryaP. S.

Опря Павел Сергеевич - врач-гастроэнтеролог Гастроэнтерологического отделения Центра хирургии и координации донорства (областного).

Ростов-на-Дону

Rostov-on-Don

paveo-oprya@yandex.ruГБУ Ростовской области «Ростовская областная клиническая больница»; ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov Regional Clinical Hospital; Rostov State Medical UniversityRussian 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 FederationГБУ Ростовской области «Ростовская областная клиническая больница»РоссияRostov Regional Clinical HospitalRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава РоссииРоссияStavropol State Medical UniversityRussian Federation2026280620262821930Copyright © Коробка В.Л., Цирульникова О.М., Пак Е.С., Пасечников В.Д., Коробка Р.В., Малеванный М.В., Пасечников Д.В., Опря П.С., 20262026Коробка В.Л., Цирульникова О.М., Пак Е.С., Пасечников В.Д., Коробка Р.В., Малеванный М.В., Пасечников Д.В., Опря П.С.Korobka V.L., Tsirulnikova O.M., Pak E.S., Pasechnikov V.D., Korobka R.V., Malevanny M.V., Pasechnikov D.V., Oprya P.S.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/2083

Цель: исследовать показатели повреждения печени (MELD и CTP) до и после проведения терапии препаратами прямого противовирусного действия; после элиминации вируса охарактеризовать клинические исходы HCV-ассоциированного декомпенсированного цирроза печени у больных, ожидающих трансплантацию. Материалы и методы. Проведено сравнительное проспективное исследование у 320 пациентов с декомпенсированным циррозом, находившихся в листе ожидания трансплантации печени. Проведен анализ демографических, клинических и лабораторных показателей, индексов MELD-Na, Child–Turcotte–Pugh (CTP), выраженности печеночной энцефалопатии, выраженности асцита, количества кровотечений и развившихся осложнений в группах пациентов до проведения терапии HCV и через 12 месяцев после достижения устойчивого вирусологического ответа (n = 320), а также в группах пациентов с развившейся рекомпенсацией (n = 113) и дальнейшей декомпенсацией цирроза печени (n = 207). Оценку накопленных рисков в сравниваемых группах проводили с помощью математической модели пропорциональных рисков (регрессии Кокса) в однофакторном и многофакторном анализе. Результаты. Через 12 месяцев последовательного наблюдения после достижения устойчивого вирусологического ответа отмечено достоверное увеличение количества лейкоцитов и тромбоцитов, альбумина, снижение креатинина, международного стандартизованного отношения, билирубина, снижение активности АЛТ и АСТ, снижение выраженности асцита, печеночной энцефалопатии, количества кровотечений, показателей CTP и MELD-Na. Установлены предикторы развития дальней декомпенсации цирроза (снижение концентрации Na в сыворотке крови, увеличение выраженности поражения печени по СТР, выраженности асцита и печеночной энцефалопатии, увеличение количества развившихся осложнений).

Objective: to investigate markers of liver injury ( MELD-Na and Child–Turcotte–Pugh [CTP] scores) before and after treatment with direct-acting antiviral (DAA) therapy, and to characterize clinical outcomes of HCV-associated decompensated liver cirrhosis following viral eradication in liver transplant (LT) candidates. Materials and methods. A prospective comparative study was conducted in 320 patients with decompensated cirrhosis listed for LT. Demographic, clinical, and laboratory parameters were analyzed, including MELD-Na and CTP scores, severity of hepatic encephalopathy, ascites, number of bleeding episodes, and occurrence of complications. Assessments were performed prior to HCV therapy and 12 months after achieving sustained virologic response (SVR). Subgroup analyses included patients who transitioned to compensated cirrhosis (n = 113) and those who remained or progressed to decompensated cirrhosis (n = 207). Cumulative risks were evaluated using Cox proportional hazards regression in univariate and multivariate models. Results. After 12 months of follow-up following the achievement of SVR, significant increases were observed in white blood cell and platelet counts, as well as serum albumin levels. In parallel, creatinine, international normalized ratio (INR), and bilirubin levels decreased. There was also a reduction in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, along with improvements in the severity of ascites and hepatic encephalopathy, a decrease in the number of bleeding episodes, and lower CTP and MELD-Na scores. Predictors of further decompensation of cirrhosis included decreased serum sodium level, increased severity of liver injury on CT imaging, greater severity of ascites and hepatic encephalopathy, and a higher number of complications during follow-up.

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