Диагностические и прогностические возможности электрохимических измерений редокс потенциала плазмы крови

Aims: Determination of operating characteristics of the test based on blood plasma redox potential monitoring in patients with different pathological conditions associated with impaired oxygen metabolism during treatment in postoperative period and expanding the range of parameters of the developed method of investigation of blood plasma redox potential.Methods: It were examined healthy volunteers group as following group (n =63), groups of patients with transplanted liver (n =64), kidney (n =59), and lungs (n =7). Redox potential measurements were done by platinum electrode, reference electrode was silver-chlorine one. Potentiostate IPC-ProL was used to registrate and record a dependence redox potential via time. Time of measurement was 15 min.Results: statistically significant differencees of redox potentials ranges was found in healthy volunteers and patients with transplanted kidney and liver. Ratio of measured redox potentials coincident with the values within the confidence interval in healthy volunteers was 12% in patients with transplanted kidney and 10% in patients with transplanted liver. We observed significant differences in the nature of changes of blood plasma's redox potential values in course of monitoring of subgroups of patients with and without complications after liver transplantation. It was found that sensitivity of electrochemical method was 85%, selectivity — 69,8%, precision — 85,2%.Conclusion: we discovered value ranges of blood plasma redox potential typical for different pathological states; we detected an interaction between the effect of treatment and quantitative changes in the values of the blood plasma redox potentials; criterion for early predicition of complications in patients with transplanted liver was proposed basing on redox potential monitoring during postoperative period.Цель исследования: определение операционных характеристик теста на основе мониторинга величин редокс-потенциала плазмы крови пациентов с различными патологическими состояниями, сопровождающимися нарушениями кислородного обмена в процессе лечения; расширение спектра параметров разработанного нами метода исследования редокс-потенциала плазмы крови.Методы: обследованы группы практически здоровых добровольцев (n =63) и пациентов со следующими патологиями: с трансплантацией почки (n =59), печени (n =64) и легкого (n =7). Измерения редокс-потенциала проводили на платиновом микроэлектроде относительно насыщенного хлорсеребряного электрода сравнения. Потенциостат IPC-Pro L (НПФ «Вольта») был использован для записи зависимостей потенциала от времени. Время регистрации составляло 15 мин.Результаты: обнаружены статистически достоверные различия в диапазонах величин редокс-потенциала для практически здоровых людей и пациентов с трансплантированными почкой и печенью. Доля измеренных величин редокс-потенциалов, совпадающих с величинами, находящимися в пределах доверительного интервала редокс-потенциалов практически здоровых людей, составила 12% для пациентов с трансплантированной почкой и 10% для пациентов с трансплантированной печенью. Обнаружено существенное различие в характере изменений величин редокс-потенциала плазмы крови при мониторинге подгрупп пациентов с наличием и отсутствием осложнений после трансплантации печени. Найдено, что чувствительность электрохимического метода определения величин редокс-потенциала плазмы крови составила 85,7%, специфичность — 69,8%, точность — 85,2%.Заключение: обнаружены диапазоны величин редокс-потенциала плазмы крови, характерные для различных патологических состояний; установлена связь эффекта проводимого лечения с количественными изменениями величин редокс-потенциала плазмы крови пациента; предложен критерий для раннего прогнозирования осложнений у пациентов с трансплантированной печенью на основе мониторинга редокс-потенциала в послеоперационном периоде.

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

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