ПРАКТИЧЕСКОЕ ИСПОЛЬЗОВАНИЕ ЭКСТРАКОРПОРАЛЬНОЙ МЕМБРАННОЙ ОКСИГЕНАЦИИ В ДОНОРСТВЕ ОРГАНОВ ДЛЯ ТРАНСПЛАНТАЦИИ

In Russia more than 50% of effective donors are non – heartbeating donors. As we all know, they appear mainly as the source of kidney transplants. The perfusion in situ through DBTL catheter is the most frequent technique usable. The rate of delayed graft function (DGF) following the DBTL perfusion may vary from 48 to 78,4%. ECMO technology use in organ donation may lead to dramatic decrease in DGF and create premises for multiorgan explantation. In the following paper we present the first Moscow experience of ECMO use in our practice of organ donation. В России пул эффективных доноров с небьющимся сердцем (ДНС) составляет более 50% от общего пула эффективных доноров. Как известно, такие доноры являются преимущественно донорами почек. Наиболее часто для эксплантации почек у ДНС используется перфузия in situ через двухбаллонный трехпросветный катетер. Частота отсроченной функции почечных трансплантатов составляет при таком методе, по разным данным, от 48 до 78,4%. Использование технологии экстракорпоральной мембранной оксигенации (ЭКМО) у ДНС позволяет значимо снизить частоту отсроченной функции почечных трансплантатов, а также при соблюдении ряда условий выполнять у ДНС мультиорганную эксплантацию. В статье представлен первый опыт Москвы в использовании технологии ЭКМО в донорстве органов.

Features of the Restoration of Arterial Circulation in Liver Transplantation

Objectives. Violations of tissue blood supply remain one of the most serious complications after liver transplantation. Design. To improve the surgical technique of performing reconstructive interventions on the arteries of the donor and the recipient in order to reduce the frequency of its thrombosis after liver transplantation. We studied 25 donors, 20 men and 5 women, the mean age was 56± 4 years, eighteen of them had left aberrant supplementary artery, which in fifteen departed from the left gastric artery and in three from the aorta above the ventricular stem. Seventeen had the right aberrant artery moving away from the upper mesenteric artery. Twenty recipients with liver cirrhosis (eleven with primary biliary cirrhosis, five with primary sclerosing cholangitis, five with viral etiology C cirrhosis, and three of the lower cirrhosis-cirrhosis disseminated within the Milan criteria. All recipients had standard anatomical branching of the arteries of the liver. The average age was 50±6. All recipients had standard anatomical branching of the liver arteries. Patients underwent liver transplantation with new methods of reconstructive interventions on the donor and recipient arteries. The developed technique provides the shortest pathway of the recipient's arterial blood to the liver transplant, through the superior mesenteric artery provides an alternative source of arterial blood supply from the aorta in which this transplant additionally needs. Presented method of blood circulation restoration at liver transplantation at abnormal structure of arterial channel of the liver transplant is performed inside the recipient's abdominal cavity. At first, blood flow is restored along the reconstructed common hepatic artery, after the right or left aberrant arteries liver transplant. Such technique provides the shortest route of the recipient's arterial blood to the liver transplant, through the upper mesenteric artery provides an alternative source of arterial blood supply from the aorta for which the transplant is additionally needed. This new method of blood circulation restoration provides an opportunity to avoid the formation of "kinking" syndrome, in the occurrence of which the blood vessels are lengthened, the angulation and location of the blood vessel in relation to the grafts and other abdominal organs. This reduces the risk of thrombosis of the arteries of the transplanted liver

PRACTICAL USE OF EXTRACORPOREAL MEMBRANE OXYGENATION IN ORGAN DONATION FOR TRANSPLANTATION

In Russia more than 50% of effective donors are non – heartbeating donors. As we all know, they appear mainly as the source of kidney transplants. The perfusion in situ through DBTL catheter is the most frequent technique usable. The rate of delayed graft function (DGF) following the DBTL perfusion may vary from 48 to 78,4%. ECMO technology use in organ donation may lead to dramatic decrease in DGF and create premises for multiorgan explantation. In the following paper we present the first Moscow experience of ECMO use in our practice of organ donation

SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: EARLY POSTOPERATIVE COMPLICATIONS

Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation.Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported.Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%.Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community

Possibilities for Recovery of Blood Outflow During Thrombosis of the Liver's Own Hepatic Veins in the Early Periods after Transplantation

Orthotopic liver transplantation with preservation of the retrohepatic inferior vena cava (IVC) using the so-called piggyback technique (MBT) has a number of priorities over the classical technique. Since 2006, our Belghiti modified piggyback technique (MPBT) has been used in our center as a normal procedure for a liver transplantation program and has been performed 490 times by December 2018. Among them, in 6 recipients in the immediate postoperative period (12- 48 hours), occlusion of the own veins of the liver graft was noted. In all 6 observations, whole liver was used, obtained from the donor after ascertaining brain death. The age of these recipients was 32 ± 12 years, the age of donors was 48 ± 10 years. Percutaneous stenting was not used to correct the venous outflow. Re-transplantation due to the absence of a donor organ was not performed. The best way to treat occlusion of blood outflow from the veins of a liver transplant is to prevent the very cause of its occurrence. The length of the upper vena cava of the graft must be short enough to prevent its fracture and redundancy, and the length of the anastomosis must provide a good venous outflow and be at least 6 cm. segments of the transplanted liver. The results of our study led to the conclusion that early diagnosis of occlusion of the own veins of a liver transplant, based on clinical signs and ultrasound diagnostics, allows detecting pathology in time, reducing ischemic damage to the transplanted organ increases the possibilities of its recovery