Комбинированная последовательная гипотермическая оксигенированная и нормотермическая машинная перфузия трансплантата печени от донора с расширенными критериями: первый в РФ опыт применения в клинической практике

Цель: проанализировать серию случаев и оценить безопасность и эффективность применения в клинической практике протокола комбинированной последовательной двойной гипотермической оксигенированной (D-НОРЕ) и нормотермической (NMP) машинной перфузии с целью кондиционирования и оценки жизнеспособности трансплантатов печени от доноров с расширенными критериями (ДРК).

Материалы и методы: с ноября по декабрь 2024 года в НМИЦ ТИО было проведено два сеанса комбинированной D-HOPE и NMP аллографтов печени, полученных от ДРК со смертью головного мозга. Перфузия проводилась с использованием аппарата ИК после предшествующего периода статической фармакохолодовой консервации (СФХК). Использовался перфузат на основе раствора HTK и эритроцитарной взвеси для этапов D-HOPE и NMP соответственно. Перфузия проводилась с поддержанием параметров температуры и гемодинамики и оценки лабораторных показателей согласно разработанному в НМИЦ ТИО протоколу.

Результаты: в результате перфузии аллографт №1 был признан нежизнеспособным из-за роста уровня лактата после 3 часов перфузии и отсутствия метаболизма глюкозы. Срок СФХК составил 424 мин, D-HOPE - 120 мин, NMP - 300 минут, общее время консервации - 844 минуты. Аллографт №2 достиг критериев жизнеспособности и был успешно трансплантирован. Срок СФХК составил 260 минут, D-HOPE и NMP - 124 и 480 минут соответственно. Общее время консервации составило 884 минуты. Пиковые значения АСТ, АЛТ и общего билирубина  у реципиента составили 922,5 ед/л, 613 ед/л и 63,3 мкмоль/л соответственно. Единственным осложнением у реципиента было острое почечное повреждение, потребовавшее проведения 2 сеансов гемодиализа. Срок госпитализации составил 14 дней без необходимости повторных госпитализаций. На момент написания работы пациент жив без осложнений, срок наблюдения составил 3 месяца.

Заключение: Комбинированная машинная перфузия трансплантатов печени - безопасная и эффективная методика, позволяющая уменьшить ишемически-реперфузионно-консервационное повреждение и оценить жизнеспособность маргинальных трансплантатов печени, а также уменьшить количество потенциальных осложнений у реципиента и расширить донорский пул за счет использования аллографтов от ДРК.

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