The clinical case of liver revascularization in a recipient using the technique of selective thrombolysis of the hepatic artery and its stenting at the arterial anastomosis site has been reported. The applied technique allowed a quick elimination of thrombosis and stenosis of the arterial anastomosis, providing a long-term effect, preventing more severe consequences for the recipient, and saving the liver graft. The presented case showed that the combined technique of endovascular intervention might be a good alternative to the reconstruction of arterial anastomosis by re-exploration and by liver retransplantation.

Objective: to reflect on a 5-year experience in liver transplant surgery at the Rostov Regional Clinical Hospital. Materials and methods. Liver transplant was performed in Rostov Oblast in July 2015 for the first time. There were 52 liver transplant surgeries performed in the region by the end of February 2020. Cirrhosis due to viral hepatitis is the leading indication for liver transplantation in 33.3% of patients. The average age of recipients was 43.5 ± 15.8 years. Male recipients accounted for 59.6% of cases. Nine recipients got liver transplants from blood relatives, while 43 recipients received an organ from post-mortem donors. For two patients, liver graft was obtained by splitting the liver into two lobes using the in situ split technique. Results. The average duration of surgery was 5.14 ± 1.92 hours. Blood loss during surgery did not exceed 1400 ml. Up to 93% of lost blood was recovered using the reinfusion system. The need for red blood cell transfusion was observed in 48.1% of cases. Fresh frozen plasma was transfused in all cases. Early postoperative complications were observed in 15 patients (29.4%), and some of them had several complications simultaneously. Biliary and vascular complications, which were eliminated by minimally invasive methods and open surgeries, had a significant influence on liver transplant outcome. In-hospital mortality was 5.6%. The causes of death were intra-abdominal bleeding (1), portal vein thrombosis (1) and biliary sepsis (1). Four more people died in the long term after being discharged from hospital: lung cancer (1), graft rejection (1) and fungal sepsis (2). Conclusion. Liver transplant outcome depends on the skills and experience of the specialists implementing this program. Post-transplant in-hospital and long-term mortality depends on the presence and nature of complications, and on the possibility of early treatment.

No abstract

Objective: to determine the threshold MELD scores when prioritizing for liver transplantation. Materials and methods. We conducted a cohort study of 350 patients who were waitlisted for liver transplantation between 2015 and 2020. Results. A logistic regression model was used to identify the independent predictors of liver transplantation waitlist mortality. MELD scores and serum albumin at the time of listing were significant predictors of mortality (p = 0.001 and p = 0.004, respectively). Their predictive values were confirmed using ROC (Receiver Operating Characteristic) analysis. The area under the ROC curve (AUC) was 0.883 [95% confidence interval (CI) 0.828–0.939; p < 0.001] for MELD, and 0.841 [95% CI 0.775–0.907; p < 0.001] for serum albumin. Mortality odds ratio was 3.7778, 95% CI (1.619–7.765) provided that the listing MELD score was ≥25. Mortality odds ratio was 2.979 (95% CI 1.63–5.95) provided that the listing serum albumin concentration was ≤30.1 g/L. With a threshold MELD score of 25, there were significant differences between patient survival when comparing patient cohorts with MELD ≥25 and with MELD ≤25 (Log-rank, p < 0.0001). Conclusion. The MELD model has a high predictive ability in prioritization of waitlisted candidates for liver transplantation. The threshold MELD score and mortality predictors were determined. There were significant differences between patient survival among patient cohorts with MELD ≥25 and with MELD ≤25.

Purpose: analysis of various clinical results in patients registered in the liver transplantation waiting list (LTWL).Materials and methods: the study was carried at the Center of Surgery and Donor Coordination of the Rostov Regional Clinical Hospital using clinical, laboratory and instrumental data of 198 patients from the LTWL. 99 men and 99 women were enrolled into this study. The men age ranged from 21 to 70 years (47.8 ± 10.4 years), women age - from 18 to 66 years (49.2 ± 10.9 years). At the time of analysis of the LTWL, the average follow-up period was 14.8 ± 11.2 months. All patients were examined according to the list required for inclusion in the LTWL.Results: depending on the outcome, 198 patients from TLWL were grouped into 4 groups. The first group (delisting group) — 19 patients (9.6 %) with clinical and laboratory indicators that allowed them to be excluded from WL. The second group — 67 patients (33.8 %) who had positive clinical dynamics following therapy. The third group — 39 patients (19.7 %) who underwent liver transplantation. The fourth group — 73 patients (36.9 %) who had negative dynamics following therapy, including patients with a fatal outcome. While keeping LTWL for 4 years, 61 (30.81 %) of 198 listed patients died. The majority (40 patients) died of bleeding from varicose veins and OPPN, 17 patients died of hepatic coma and SPB. Each group represents the distribution of patients according to the MELD-Na scale, the severity of portal hypertension and hepatic encephalopathy.Conclusion: the following factors are indispensable for successful work of the transplant center: systematic work with the territories in order to expand the donor base; defining the patient priority criteria in the LTWL in order to reduce the death rate in the list; detailed examination of the patient before entering the list; forming the observation base; systematic patient observation during the pre- and postoperative period, at the rehabilitation stage, as well as at long-term periods in order to develop an effective algorithm of management of the recipient of a solid organ.