[Living related liver transplantation in the Republic of Uzbekistan: current status and development prospects]

OBJECTIVE

To analyze primary results of living related liver transplantation in the Republic of Uzbekistan.

MATERIAL AND METHODS

There were 44 living related transplantations of the right liver lobe in patients with decompensated liver failure between February 2018 and February 2023.

RESULTS

Uneventful postoperative period was observed in 17 (38.6%) recipients. Other 27 patients (61.4%) developed 47 various postoperative complications (1-3 events per a patient). Of these, 8 (18.2%) patients required early postoperative re-laparotomy. Among 44 patients, 9 (20.5%) ones died in early postoperative period, and one patient died in long-term period (3 years after transplantation) from chronic rejection under refusal to take immunosuppressive drugs. Early satisfactory results were obtained in 79.5% of patients, long-term favorable outcomes - in 77.3% of cases.

CONCLUSION

Engraftment rates and survival of recipients to a large extent depend on surgical strategy, baseline disease and clinical severity. The so-called "center effect" is essential at initial stages of implementation of the program.

Acute respiratory distress-syndrome in the general complications of severe acute pancreatitis

Backgrounds/Aims

Improvement of efficiency of treatment of patients with severe acute pancreatitis (SAP), complicated by acute respiratory distress-syndrome (ARDS).

Methods

The retrospective research of 67 SAP patients treated at the ICU of the NSSPCS has been conducted from 2008 to 2017. The basic criterion of patient inclusion was stable respiration impairment leading to hypoxia with PaO₂/FiO₂<300 mmHg that required mechanical ventilatory support.

Results

Pancreatitis-associated ARDS was diagnosed in 36 cases (53.7%). The most frequent clinical form (15 cases) was ARDS of moderate severity (41.5%). The total mortality due to pancreatitis-associated ARDS made 44.5%. Close relationship between ARDS severity and mortality was evident. All lethal outcomes occurred due to progressing multiple organ dysfunction. No deaths were caused by uncontrollable hypoxemia.

Conclusions

The research has confirmed the leading role of pancreatitis-associated ARDS in development and high mortality rate of multiple organ dysfunction syndrome in SAP. Early recognition of the complication and application of ventilatory support techniques resulted in fast restoration of oxygenation and improvement of treatment efficiency.

[Standardization of intensive therapy tactics for acute hepatic insufficiency in patients with liver cirrhosis after portosystem shunting]

AIM

Here we analyze efficiency of the algorithm for intensive therapy of acute hepatic insufficiency in patients with cirrhosis after portosystemic shunting, based on the experience of the Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.V. Vakhidov and considering recommendations of the world's leading hepatology schools.

MATERIAL AND METHODS

Algorithm efficiency was analyzed based on the results of portosystemic shunting of 556 patients with cirrhosis and acute liver insufficiency. Treatment effectiveness was assessed by presence and severity of postoperative complications, such as hepatic insufficiency and hepatic encephalopathy. Initial decompensation of liver cirrhosis significantly increases the risk of postoperative complications of portosystemic shunting due to edematous ascites syndrome - liver insufficiency (13.5% vs 6.9% in patients without ascites p≥0.05) and hepatic encephalopathy (64.9% vs. 51,7%, respectively, p≥0.05). In group of patients with preoperative ascites syndrome mortality rate was 3.8% (10 patients) and in the group without ascites - 2.3% (6 patients). The main cause of early postoperative lethality was anastomotic thrombosis development with recurrence of bleeding from esophagus and stomach varicose veins. To reduce the risk of postoperative complications and lethality, a therapeutic-tactical algorithm was developed which was effective in combination with a complex of conservative and biophysical methods of treatment and aimed at eliminating the 'resolving factors' of their developmen.

RESULTS

One of the most important components of this algorithm is pharmacotherapy with hepatoprotective drugs use in patients with liver cirrhosis in the postoperative period to maintain liver functional state. Considering the antihypoxic, detoxifying and antioxidant properties of active components of remaxol and revealed positive effect of its use in patients (decrease in bilirubin level, increase in albumin fraction of total blood protein and decrease in activity of ALAT and ASAT in 2 times), this drug can be recommended for inclusion in the postoperative pathogenetic standard therapy in this category of patients.

[Characteristics of early postoperative complications after esophageal surgery]

The data of a retrospective analysis of the studies conducted over a decade in 171 patients with benign and malignant esophageal diseases operated on at the Acad. V. Vakhidov Republican Specialized Center of Surgery were examined. The incidence and nature of early postoperative complications were studied in patients with surgical benign malignant esophageal diseases. The pattern of early postoperative complications mainly involved bronchopulmonary complications. The incidence of postoperative respiratory disorders was greater in patients with benign esophageal diseases than that in those with malignant ones. Overall mortality after reconstructive operations on the esophagus depended on neither respiratory nor specific causes and it was virtually equal in both benign and malignant esophageal lesions.

[The results of porto-systemic shunting in patients with liver cirrhosis]

The research is based on the analysis of 500 patients with liver cirrhosis and complicated portal hypertension, treated during 1976--2005. Survival analysis was performed using the Kaplan-Mayer method. Immediate and long-term results of various modifications of porto-systemic shunting procedure are analyzed for stratificated groups. Thus, the highest mortality (12.5-19.5%) is noted during the first 3 years after operation in all groups. The best survival results showed patients with functional class Ch "A" and no varices bleeding anamnestically, with no regard of method of the shunting procedure, ages of patients and cirrhosis morphological type. The 5-year survival-rate after distal spleno-renal anastomosis and central variants of porto-systemic shunting are 89 and 85%, respectively.

[X-ray diagnostic parallels in estimation of the degree of portohepatic circulation reduction in patients with liver cirrhosis]

The data obtained in a retrospective analysis, angiographic and hepatoscintigraphic examinations of 86 patients (aged from 12 to 64 years) with liver cirrhosis (LC) treated during the period from 1998 through 2003 were analyzed. Among them there were 64 men and 22 women. The investigations performed have shown that the angiographic data obtained in LC patients determine not only the topographic interaction of the major and collateral vessels of the porto-lienal pool that is of principal significance in the decision for the method of surgical correction in portal hypertension but also allow an estimation of the picture of the hepatopetal blood flow inversion. The data obtained allowed the authors to define three degrees of reduction of the hepatopetal blood flow. A conclusion was made that the degree of reduction of the hepatopetal blood flow when compared was the findings of angiographic and radionuclide examinations were of great prognostic significance for an estimation of the necessary decompression and possible maximal preservation of the hepatopetal blood flow with respect to the preoperative level.

[Some pathogenetic aspects of developing liver failure and preventing it in patients with liver cirrhosis after portosystemic shunting]

Patients with cirrhosis of the liver were found to have a considerable suppression of the system of biotransformation of the liver before operation which correlated with the data of the direct indices of monooxigenase system of hepatocytes--cytochrome P-450 and activity of N-demethylase of amidopyrine. Operative interventions on such patients independent of the type of portosystemic shunting result in considerably decreased content of metabolites of amidopyrine--4AAP and N-ac-4-APP in urine as compared with the preoperative level (p < 0.05). Hyperbaric oxygenation is the optimal stimulator of activity of the liver biotransformation system. Better indicators characterizing the increased metabolic activity of the liver were noted in patients with selective portosystemic anastomoses and hyperbaric oxygenation in the postoperative period.

[Use of the glue composition TachoComb in forming the portosystemic anastomosis]

The Tachocomb plates were used by the authors in 15 patients for forming the proximal splenorenal anastomosis and selective decompression of the portal system. The data of sonography have shown the valuable functioning of the shunt in all the patients within the period from 6 months to 3 years. The proposed method provides reliable hemostasis during operation and prevents thrombosis of portosystemic anastomoses.