Медицинская литература. Новинки

 

 

 

 

 

 

Первый опыт одномоментной трансплантации печени и поджелудочной железы в России

Вы можете загрузить полный текст статьи в формате pdf

Одномоментная трансплантация печени и поджелудочной железы является рациональной лечебной тактикой и в перспективе может стать стандартом лечения у пациентов с необратимыми заболеваниями печени и сопутствующим сахарным диабетом 1-го типа. Известно, что сахарный диабет 1-го типа ухудшает отдаленные результаты изолированной трансплантации печени и является дополнительным фактором риска послеоперационных осложнений. В мае 2010 г. впервые в России выполнена одномоментная трансплантация печени и поджелудочной железы от трупного донора 17-летнему реципиенту с циррозом печени в исходе аутоиммунного гепатита и сопутствующим сахарным диабетом 1-го типа. В статье рассмотрены показания к сочетанной трансплантации печени и поджелудочной железы, описаны клиническое наблюдение, различные способы операции и особенности посттрансплантационной терапии.

Ключевые слова:
трансплантация печени, трансплантация поджелудочной железы, аутоиммунный гепатит, сахарный диабет 1-го типа.

Литература:
1. Shetty A., Wilson S., Kuo P. et al. Liver transplantation improves
cirrhosis-associated impaired oral glucose tolerance //
Transplantat. 2000. V. 69. P. 2451–2454.
2. Konrad T., Steinmüller T., Vicini P. et al. Regulation of glucose
tolerance in patients after liver transplantation. Impact of
cyclosporine versus tacrolimus therapy // Transplantat. 2000.
V. 69. P. 2072–2078.
3. Miles A.M., Sumrani N., Horowitz R. et al. Diabetes mellitus after
renal transplantation: as deleterious as non-transplant-associated diabetes? // Transplantat. 1998. V. 65. P. 380–384.
4. Boudreaux J.P., McHugh L., Canafax D.M. et al. The impact of
cyclosporine and combination immunosuppression on the incience of posttransplant diabetes in renal allograft recipients //
Transplantat. 1987. V. 44. P. 376–381.
5. Haydon G., Neuberger J. Liver transplantation in cirrhotic patients
with diabetes mellitus // Liv. Transplant. 2001. V. 7. P. 234–237.
6. Trail K.C., McCashland T.M., Larsen J.L. et al. Morbidity in
patients with posttransplant diabetes mellitus following orthotopic liver transplantation // Liv. Transplant. Surg. 1996. V. 2.
P. 276–283.
7. Shields P.L., Tang H., Neuberger J.M., Gunson B.K. et al. Poor
outcome in patients with diabetes mellitus undergoing liver
transplantation // Transplantat. 1999. V. 68. P. 530–535.
8. Yoo H.Y., Thuluvath P.J. The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation //
Transplantat. 2002. V. 74. P. 1007–1012.
9. Fioretto P., Steffes M.W., Sutherland D.E. et al. Reversal of
lesions of diabetic nephropathy after pancreas transplantation //
N. Engl. J. Med. 1998. V. 339. P. 115–117.
10. James O., Day C. Nonalcoholic steatohepatitis: Another disease
of affluence // Lanc. 1999. V. 353. P. 1634–1636.
11. Day C.P. Nonalcoholic steatohepatitis (NASH): Where are we
now and where are we going? // Gut. 2002. V. 50. P. 585–588.
12. Garcia R.F., Morales E., Garcia C.E. et al. Recurrent and de
novo-alcoholic steatohepatitis following orthotopic liver transplantation // Arq. Gastroenterol. 2001.V. 38. P. 247–253.
13. Molloy R.M., Komorowski R., Varma R.R. Recurrent nonalcoholic steatohepatitis and cirrhosis after liver transplantation //
Liv. Transpl ant. Surg. 1997. V. 3. P. 177–178.
14. Alessiani M., Tzakis A., Todo S. et al. Assessment of five-year
experience with abdominal organ cluster transplantation //
J. Am. Coll. Surg. 1995. V. 180. P. 1–9.
15. Starzl T.E., Todo S., Tzakis A. et al. Abdominal organ cluster
transplantation for the treatment of upper abdominal malignancies // Ann. Surg. 1989. V. 210. P. 374–386.
16. Abu/Elmagd K., Bond G., Reyes J., Fung J. Intestinal transplantation: A coming of age // Adv. Surg. 2002. V. 36. P. 65–101.
17. Fridell J.A., Vianna R., Mangus R.S. et al. Addition of a total pancreatectomy and pancreas transplantation in a liver transplant
recipient with intraductal papillary mucinous neoplasm of the
pancreas // Clin. Transplant. 2008. V. 22. N 5. P. 681–684.
18. Mayes J.T., Boyle J.T., Schulak JA. Simultaneous orthotopic
liver and heterotopic pancreas transplantation // Transplantat.
1991. V. 52. P. 146–147.
19. Trail K.C., Stratta R.J., Larsen J.L.et al. Orthotopic hepatic
transplantation in patients with type 1 diabetes mellitus // J. Am.
Coll. Surg. 1994. V. 178. P. 337–342.
20. Thompson H.H., Pitt H.A., Tompkins R.K., Longmire W.P.Jr.
Primary sclerosing cholangitis: A heterogenous disease // Ann.
Surg. 1982. V. 196. P. 127–136.
21. Alberti/Flor J.J., Jeffers L., Schiff E.R. Primary sclerosing cholangitis occurring in a patient with systemic lupus erythematosus and
diabetes mellitus // Am. J. Gastroenterol. 1984. V. 79. P. 889–891.
22. Gluch J., Glaser J. Primar sklerosierende cholangitis, colitis
ulcerosa und diabetes mellitus Typ 1 // Z. Gastroenterol. 1999.
V. 37. P.735–738.
23. Kay M., Wyllie R., Michener W. et al. Associated ulcerative colitis, sclerosing cholangitis and insulindependent diabetes mellitus // Cleve. Clin. J. Med. 1993. V. 60. P. 473–478.
24. Xu J., Yu L.X., Deng W.F. et al. Simultaneous liver-pancreas-duodenum transplantation: one case report and review of the literature // Zhonghua Wai Ke Za Zhi. 2006. V. 1. N 3. P. 157–160.
25. Stern R.C., Mayes J.T., Weber F.L.Jr. et al. Restoration of exocrine
pancreatic function following pancreasliver-kidney transplantation
in a cystic fibrosis patient // Clin .Transplant. 1994. V. 8. P. 1–4.
26. Fridell J.A., Vianna R., Kwo P.Y. et al. Simultaneous liver and
pancreas transplantation in patients with cystic fibrosis //
Transplant Proc. 2005. V. 37. N 8. P. 3567–3569.
27. Suárez F., Otero A., Quintela J. et al. Steroid-free immunosuppression for pancreas-after-liver transplantation // Transplant
Proc. 2005. V. 37. N 9. P. 3975–3976.
28. Wang H., Dou K.F., Yang X.J. A case report of simultaneous liver,
pancreas-duodenum, and kidney transplantation in a patient
with post-hepatitic cirrhosis combined with uremia and insulindependent diabetes related to chronic pancreatitis // Zhonghua
Yi Xue Za Zhi. 2006. V. 12 N86 (34). P. 2421–2424.
29. Trotter J.F., Bak T.E., Wachs M.E. et al. Combined liver-pancreas transplantation in a patient with primary sclerosing cholangitis and insulindependent diabetes mellitus // Transplantat.
2000. V. 70. P. 1469–1471.
30. Sollinger H.W., Odorico J.S., Knechtle S.J. et al. Experience with
500 simultaneous pancreas-kidney transplants // Ann. Surg.
1998. V. 228. P. 284–296.
31. Gaber A.O., Shokouh/Amiri H., Hathaway D.K. et al. Pancreas
transplantation with portal venous and enteric drainage eliminates hyperinsulinemia and reduces pos-operative complications // Transplant. Proc. 1993. V. 35. P. 1176–1178.
32. Calne R.Y., Brons J.G.M. Paratopic pancreas transplantation.
In:Groth CG, ed. Pancreatic Transplantation. Philadelphia:
Saunders, 1988. P.169.
33. Pirenne J., Deloosea K., Coosemans W. et al. Combined ‘En
Bloc’ Liver and Pancreas Transplantation in Patients with Liver
Disease and Type 1 Diabetes Mellitus // Am. J. Tansplantat.
2004. V. 4. P. 1921–1927
34. Humar A., Khwaja K., Ramcharan T. et al. Chronic rejection:
The next major challenge for pancreas transplant recipients //
Transplantat. 2003. V. 76. P. 918–923.
35. Calne R.Y., Sells R.A., Pena J.R. et al. Induction of immunological tolerance by porcine liver allografts // Nat. 1969. V. 223.
P. 472–476.
36. Johnston T.D., Ranjan D. Transplantation of the liver combined
with other organs // Hepatogastroenterol. 1998. V. 45.
P. 1387–1390.
37. Benedetti E., Pirenne J., Troppmann C. et al. Combined liver and
kidney transplantation // Transplant, Int. 1996. V. 9. P. 486–491.
38. Wang C., Sun J., Wang L. et al. Combined liver and pancreas
transplantation induces pancreas allograft tolerance //
Transplant, Proc. 1997. V. 29. P. 1145–1146.
39. Wang C., Sun J., Li L. et al. Conversion of pancreas allograft
rejection to acceptance by liver transplantation // Transplantat.
1998. V. 65. P. 188–192.
40. Abu/Elmagd K., Reyes J., Bond G. et al. Clinical intestinal transplantation: A decade of experience at a single center // Ann,
Surg. 2001. V. 234. P. 404–416.
41. Abu/Elmagd K., Reyes J., Todo S. et al. Clinical intestinal transplantation: New perspectives and immunological considerations
// J. Am. Coll. Surg. 1998. V. 186. P. 512–525.
42. Pirenne J., Benedetti E., Dunn D.L. Graft-versus-host responses. Clinical and biological relevance after transplantation of
solid lymphoid organs // Transplant. Rev. 1996. V. 10. P. 46–68.
43. Pirenne J., Nakhleh R., Dunn D.L. Graft-versus-host disease
after multiorgan transplantation in the rat // J. Surg. Res. 1991
V. 50. P. 622–628.
44. Calne R.Y., Rolles K., White D.J. et al. Cyclosporine A initially as
the only immunosuppressant in 34 recipients of cadaveric
organs: 32 kidneys, 2 pancreases and 2 livers // Lanc. 1979. V. 2.
P. 1033–1036.

Simultaneous Liver-Pancreas Transplantation: the First Russian Experience

Combined liver-pancreas transplantation is considered to be a reasonable treatment of end-stage liver disease and concomitant insulin-dependent diabetes mellitus patents, so it may become a standard treatment of this category of patients. As known, diabetes mellitus negatively affects the long-term results of isolated liver transplantation and increases a risk of posttransplant complications. In May 2010 there was performed a first in Russia simultaneous liver-pancreas transplantation to 17-years old recipient, suffering with liver cirrhosis (as a result of autoimmune hepatitis) and concomitant insulin-dependent diabetes mellitus. In the article an overview of indications for simultaneous liver-pancreas transplantation, different operative techniques, immunological aspects and immunosuppression regimes are given.

Keywords:
liver transplantation, pancreatic transplantation, autoimmune hepatitis, insulin-dependent diabetes mellitus.