Частота возникновения и факторы риска развития хронического отторжения при остром отторжении трансплантированной печени у детей

Актуальность. Хроническое отторжение (ХО) трансплантата становится все более серьезной проблемой при трансплантации печени (ТП) у детей. Факторы риска ХО в этой популяции остаются неопределенными. В настоящем исследовании мы стремились выяснить, можно ли спрогнозировать возникновение ХО у детей с ТП по клиническим параметрам.

Методы. Мы провели ретроспективный анализ 47 случаев острого отторжения трансплантата печени у детей, прооперированных в больнице Намази (г. Шираз, Иран) в период с 2007-го по 2017 год.

Результаты. В исследование включили 47 детей: 22 (46,8%) мальчика и 25 (53,2%) девочек. Асцит, желудочно-кишечное кровотечение и спонтанный бактериальный перитонит наблюдались в 20 (44,4%), 14 (31,1%) и 4 (9,1%) случаях соответственно. Посттрансплантационные сосудистые и билиарные осложнения отмечались в 3 (7%) и 4 (9,3%) случаях соответственно. Показатели печеночных ферментов нормализовались в среднем через 14,2 ± 7,5 дня после ТП. Среднее количество эпизодов острого отторжения составило 1,4 ± 0,6 (медиана = 1 (22; 46,8%), диапазон 1–3). У 6 (12,7%) пациентов наблюдалось ХО. Среднее время от ТП до ХО составило 75 ± 28,4 дня. Мы выявили статистически значимую корреляцию между ХО и предоперационным периодом (нахождение в стационаре или амбулаторная подготовка, р = 0,03). ХО статистически значимо коррелировало с наличием билиарных осложнений (р = 0,01), другие послеоперационные факторы статистически значимо на него не влияли. Билиарные осложнения (ОР = 33,7, 95% ДИ 2,2–511, р = 0,01) и предоперационный статус пациента (ОР = 10,9, 95% ДИ 1,1–102,5, р = 0,03) значительно повышали риск ХО.

Заключение. Госпитализация при подготовке к трансплантации и раннее выявление билиарных осложнений могут предотвратить развитие ХО трансплантата у детей после ТП.

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