Трансплантация печени в Московской области: региональный проект и реализация

Rationale: Liver transplantation is the only curative treatment for diffuse end-stage liver disease and some liver neoplasms. The amount of these interventions in the Moscow Region is very low.Aim: To analyze the results of the first series of liver transplantations done in the Moscow Regional Research and Clinical Institute (MONIKI), to compare it with those done currently in Russia and worldwide, and to establish the optimal volume and trend of development for this new regional center.Materials and methods: More than 200 patients with liver cirrhosis, polycystosis and alveococcus invasion have been examined from May 2016 to August 2018; 70 of them were eligible for liver transplantation and were put on the waiting list. From October 2016 to July 2018, 29  liver transplantations from deceased donors (including 2  retransplantations) and one living related transplantation of the right lobe have been performed. Among the indications to the transplantation, the leading one was viral (HCV or HBV-related) cirrhosis. Four patients were diagnosed with hepatocellular carcinoma.Results: The waitlist mortality was 19%. Median waiting time was 5.5 [3; 9] (0 to 27) months. Until now, the results were followed till 22 months, with median follow-up of 7  [2; 13] months. The survival rate of the recipients was 96.4%, of the grafts 93.3%. In-patient mortality was 3.6%. Early allograft dysfunction was seen in 33%  of cases. Median length of the in-hospital stay was 22 [19; 25] days.Conclusion: The successful implementation of the liver transplant program at its initial stage demonstrates the results that meet current efficacy criteria. Achieved level of organ procurement from deceased donors in the Moscow Region could ensure at least 30  liver transplantations annually, with current facilities and a potential for further growth. An increase in the transplantation number would depend on the improvement of transplantation service facilities in MONIKI and on the stable financial support of the program. Finally, it would promote increased availability of this transplantation technology in the region, lower waitlist mortality and shorter waiting times.Актуальность. Трансплантация печени – единственный радикальный метод лечения многочисленных диффузных заболеваний печени в терминальной стадии и некоторых опухолей печени. Жителям Московской области этот вид помощи оказывается в крайне недостаточном объеме.Цель  – провести анализ результатов первой серии операций трансплантации печени, проведенных в  ГБУЗ МО МОНИКИ им.  М.Ф.  Владимирского (МОНИКИ), оценить их в сравнении с современными показателями мировой и отечественной практики, дать обоснование оптимальной мощности и тренда развития нового регионального центра.Материал и методы. В период с мая 2016 по август 2018 г. обследованы более 200  пациентов с  циррозом печени, поликистозом и альвеококкозом, у 70 установлены показания к трансплантации печени, они включены в лист ожидания. С октября 2016 по июль 2018 г. выполнены 29 трансплантаций печени от доноров с  диагнозом смерти мозга 27 реципиентам, включая 2 ретрансплантации, и  1  трансплантация правой доли печени от живого родственного донора. В структуре показаний к трансплантации на первом месте по частоте находился цирроз печени вирусной (HCV, HВV) этиологии. У  4  больных имелся гепатоцеллюлярный рак.Результаты. Смертность в листе ожидания составила 19%. Медиана длительности ожидания трансплантации – 5,5 месяца, 25-й и 75-й процентили – [3; 9], минимальное и  максимальное значения  – (0–27). Отдаленные результаты прослежены до 22  месяцев, медиана сроков наблюдения составила 7 [2; 13] месяцев. Выживаемость реципиентов  – 96,4%, трансплантатов  – 93,3%, госпитальная летальность – 3,6%. Ранняя дисфункция трансплантата отмечена в 33% случаев. Медиана длительности пребывания в стационаре – 22 [19; 25] дня.Заключение. Успешная реализация программы трансплантации печени на начальном этапе демонстрирует результаты, соответствующие современным критериям эффективности. Достигнутый уровень посмертного органного донорства в Московской области уже сегодня может обеспечить выполнение не менее 30 операций в год при сохраняющихся резервах и обладает потенциалом для дальнейшего роста. Увеличение объема операций будет определяться совершенствованием инфраструктуры службы трансплантации МОНИКИ и  устойчивым финансированием программы, способствуя в  конечном итоге повышению доступности этой трансплантационной технологии в  региональном масштабе, снижению смертности в  листе ожидания и  сокращению срока ожидания

Liver transplantation in the Moscow Region: the regional project and its implementation

Rationale: Liver transplantation is the only curative treatment for diffuse end-stage liver disease and some liver neoplasms. The amount of these interventions in the Moscow Region is very low.Aim: To analyze the results of the first series of liver transplantations done in the Moscow Regional Research and Clinical Institute (MONIKI), to compare it with those done currently in Russia and worldwide, and to establish the optimal volume and trend of development for this new regional center.Materials and methods: More than 200 patients with liver cirrhosis, polycystosis and alveococcus invasion have been examined from May 2016 to August 2018; 70 of them were eligible for liver transplantation and were put on the waiting list. From October 2016 to July 2018, 29  liver transplantations from deceased donors (including 2  retransplantations) and one living related transplantation of the right lobe have been performed. Among the indications to the transplantation, the leading one was viral (HCV or HBV-related) cirrhosis. Four patients were diagnosed with hepatocellular carcinoma.Results: The waitlist mortality was 19%. Median waiting time was 5.5 [3; 9] (0 to 27) months. Until now, the results were followed till 22 months, with median follow-up of 7  [2; 13] months. The survival rate of the recipients was 96.4%, of the grafts 93.3%. In-patient mortality was 3.6%. Early allograft dysfunction was seen in 33%  of cases. Median length of the in-hospital stay was 22 [19; 25] days.Conclusion: The successful implementation of the liver transplant program at its initial stage demonstrates the results that meet current efficacy criteria. Achieved level of organ procurement from deceased donors in the Moscow Region could ensure at least 30  liver transplantations annually, with current facilities and a potential for further growth. An increase in the transplantation number would depend on the improvement of transplantation service facilities in MONIKI and on the stable financial support of the program. Finally, it would promote increased availability of this transplantation technology in the region, lower waitlist mortality and shorter waiting times