Кафедра трансплантологии и искусственных органов (зав.-академик РАМН, проф. С.В. Готье), ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова» (ректор-член-корр. РАМН, проф. П.В. Глыбочко), Москва, Российская Федерация 2 Лаборатория стратегии и мониторинга развития трансплантологической помощи (зав.-С.М. Хомяков) ФГБУ «ФНЦТИО им. ак. В.И. Шумакова» Минздрава России (директоракадемик РАМН, проф. С.В. Готье), Москва, Российская Федерация 3 Регистр по донорству и трансплантации органов ОООТ «Российское трансплантологическое общество» (председатель-академик РАМН, проф. С.В. Готье), Москва, Российская Федерация Мониторинг состояния и перспектив развития донорства и трансплантации органов в России в форме регистра проводится под эгидой Профильной комиссии по трансплантологии Минздрава России и Российского трансплантологического общества. По данным регистра, в 2012 г. показатель донорской активности снизился, но показатель трансплантационной активности сохранился на уровне последних лет. Снижение числа посмертных доноров удалось компенсировать благодаря повышению эффективности донорских программ, а именно увеличения числа доноров с диагнозом смерти мозга и мультиорганных изъятий, увеличения среднего числа органов, полученных от одного донора. В 2012 г. увеличилось число трансплантаций печени и сердца. Основным механизмом финансирования трансплантаций органов в России является государственное задание центрам трансплантации (федеральное финансирование), его роль возрастает. Для повышения стабильности донорского обеспечения центров трансплантации необходимо продолжить развивать правовую базу в сфере донорства и трансплантации органов.
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.
Recent statistics have shown increased rates of morbidity and mortality from Clostridium difficile infection worldwide. This problem is mainly typical for surgical patients and is associated with an antibiotic therapy and a prolonged hospital stay. Recipients of solid organs are at a high risk of developing severe forms of C. difficile infection due to immunosupression. Existing recommendations for the treatment of C. difficile infection are based on the severity of the disease and do not consider patients after liver transplantation. The aim of this work is to determine an actual tactics for the diagnosis and treatment of C. difficile in organ recipients in clinical practice.
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