Email this article Liver transplantation in the Moscow Region: the regional project and its implementation
- Authors: Moysyuk Y.G.1, Malinovskaya Y.O.1, Bel'skikh L.V.1, Bogomolov P.O.1, Lobakov A.I.1, Ammosov А.A.1, Sidorenko A.B.1, Grigor'ev N.S.1, Kosov A.A.1
-
Affiliations:
- Moscow Regional Research and Clinical Institute (MONIKI)
- Issue: Vol 46, No 6 (2018)
- Pages: 572-583
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/896
- DOI: https://doi.org/10.18786/2072-0505-2018-46-6-572-583
- ID: 896
Cite item
Full Text
Abstract
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.
About the authors
Ya. G. Moysyuk
Moscow Regional Research and Clinical Institute (MONIKI)
Author for correspondence.
Email: moysyuktrans@list.ru
Yan G. Moysyuk – MD, PhD, Professor, Chief Research Fellow, Division of Abdominal Surgery, Department of Hepatology.
61/2–15 Shchepkina ul., Moscow, 129110, tel.: +7 (964) 640 86 16 Russian FederationYu. O. Malinovskaya
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Yulia O. Malinovskaya – MD, Research Fellow, Division of Abdominal Surgery, Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationL. V. Bel'skikh
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Leonid V. Bel'skikh – MD, PhD, Head of the Moscow Region Organ Procurement Center.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationP. O. Bogomolov
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Pavel O. Bogomolov – MD, PhD, Head of Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationA. I. Lobakov
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Aleksandr I. Lobakov – MD, PhD, Professor, Head of the Division of Abdominal Surgery, Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationА. A. Ammosov
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Aleksandr A. Ammosov – MD, PhD, Surgeon, Division of Abdominal Surgery, Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationA. B. Sidorenko
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Aleksey B. Sidorenko – Junior Research Fellow, Division of Abdominal Surgery, Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationN. S. Grigor'ev
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Nikita S. Grigor'ev – Junior Research Fellow, Division of Abdominal Surgery, Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationA. A. Kosov
Moscow Regional Research and Clinical Institute (MONIKI)
Email: fake@neicon.ru
Artem A. Kosov – Junior Research Fellow, Division of Abdominal Surgery, Department of Hepatology.
61/2 Shchepkina ul., Moscow, 129110
Russian FederationReferences
- Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963;117:659–76.
- Busuttil R, Klintman G. Transplantation of the liver. 3rd edition. Elsevier Saunders; 2015. 1568 p.
- The Global Observatory on Donation and Transplantation (GODT) 2016 data [Internet]. Available from: http://www.transplant-observatory.org/data-charts-and-tables/.
- Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, Wainright JL, Snyder JJ, Israni AK, Kasiske BL. OPTN/ SRTR 2016 Annual Data Report: Liver. Am J Transplant. 2018;18 Suppl 1:172–253. doi: 10.1111/ajt.14559.
- Adam R, Karam V, Delvart V, O'Grady J, Mirza D, Klempnauer J, Castaing D, Neuhaus P, Jamieson N, Salizzoni M, Pollard S, Lerut J, Paul A, Garcia-Valdecasas JC, Rodríguez FS, Burroughs A; All contributing centers (www.eltr.org); European Liver and Intestine Transplant Association (ELITA). Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012;57(3): 675–88. doi: 10.1016/j.jhep.2012.04.015.
- Blok JJ, de Boer JD, Putter H, Rogiers X, Guba MO, Strassburg CP, Samuel U, van Hoek B, Hamming JF, Braat AE; Eurotransplant Liver Intestine Advisory Committee. The center effect in liver transplantation in the Eurotransplant region: a retrospective database analysis. Transpl Int. 2018;31(6): 610–9. doi: 10.1111/tri.13129.
- Johnson SR, Karp SJ, Curry MP, Barugel M, Rodrigue JR, Mandelbrot DA, Rogers CP, Hanto DW. Liver transplant center risk tolerance. Clin Transplant. 2012;26(3):E269–76. doi: 10.1111/j.1399-0012.2012.01658.x.
- Asrani SK, Kim WR, Edwards EB, Larson JJ, Thabut G, Kremers WK, Therneau TM, Heimbach J. Impact of the center on graft failure after liver transplantation. Liver Transpl. 2013;19(9): 957–64. doi: 10.1002/lt.23685.
- International Registry in Organ Donation and Transplantation June 2018 [Internet]. Available from: http://www.irodat.org/img/database.
- Готье СВ, Хомяков СМ. Донорство и трансплантация органов в Российской Федерации в 2017 году. X сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2018;20(2): 6–28. doi: 10.15825/1995-1191-2018-2-6-28.
- Готье СВ, Хомяков СМ. Донорство и трансплантация органов в Российской Федерации в 2016 году. IX сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2017;19(2): 6–26. doi: 10.15825/1995-1191-2017-2-6-26.
- Готье СВ, Мойсюк ЯГ, Попцов ВН, Корнилов МН, Ярошенко ЕБ, Погребниченко ИВ, Мойсюк ЛЯ, Сушков АИ, Малиновская ЮО, Цой ДЛ. Отдаленные результаты трансплантации трупной печени. Вестник трансплантологии и искусственных органов. 2014;16(3): 45–53. doi: 10.15825/1995-11912014-3-45-53.
- Мойсюк ЯГ, Попцов ВН, Сушков АИ, Мойсюк ЛЯ, Малиновская ЮО, Бельских ЛВ. Ранняя дисфункция трансплантата печени: факторы риска, клиническое течение и исходы. Трансплантология. 2016;(2): 16–28.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2): 433–85. doi: 10.1016/j.jhep.2015.10.006.
- Martin P, DiMartini A, Feng S, Brown R Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59(3): 1144–65. doi: 10.1002/hep.26972.
- Lai Q, Avolio AW, Graziadei I, Otto G, Rossi M, Tisone G, Goffette P, Vogel W, Pitton MB, Lerut J; European Hepatocellular Cancer Liver Transplant Study Group. Alpha-fetoprotein and modified response evaluation criteria in solid tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation. Liver Transpl. 2013;19(10): 1108–18. doi: 10.1002/lt.23706.
- Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, Greenstein SM, Merion RM. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4): 783–90. doi: 10.1111/j.1600-6143.2006.01242.x.
- Готье СВ, Мойсюк ЯГ, Корнилов МН. Выбор хирургической техники при ортотопической трансплантации печени. Анналы хирургической гепатологии. 2011;16(1): 10–6.
- Национальные клинические рекомендации: трансплантация печени [Интернет]. Доступно на: http://transpl.ru/files/rto/transpl_pecheni.pdf.
- Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, Shaked A, Christie JD. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8): 943–9. doi: 10.1002/lt.22091.
- Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2): 187–96. doi: 10.1097/SLA.0b013e3181b13ca2.
- Burroughs AK, Sabin CA, Rolles K, Delvart V, Karam V, Buckels J, O'Grady JG, Castaing D, Klempnauer J, Jamieson N, Neuhaus P, Lerut J, de Ville de Goyet J, Pollard S, Salizzoni M, Rogiers X, Muhlbacher F, Garcia Valdecasas JC, Broelsch C, Jaeck D, Berenguer J, Gonzalez EM, Adam R; European Liver Transplant Association. 3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome. Lancet. 2006;367(9506): 225–32. doi: 10.1016/S01406736(06)68033-1.
- Macomber CW, Shaw JJ, Santry H, Saidi RF, Jabbour N, Tseng JF, Bozorgzadeh A, Shah SA. Centre volume and resource consumption in liver transplantation. HPB (Oxford). 2012;14(8): 554–9. doi: 10.1111/j.14772574.2012.00503.x.
- Axelrod DA, Guidinger MK, McCullough KP, Leichtman AB, Punch JD, Merion RM. Association of center volume with outcome after liver and kidney transplantation. Am J Transplant. 2004;4(6): 920–7. doi: 10.1111/j.1600-6143.2004.00462.x.
- Asrani SK, Kim WR, Edwards EB, Larson JJ, Thabut G, Kremers WK, Therneau TM, Heimbach J. Impact of the center on graft failure after liver transplantation. Liver Transpl. 2013;19(9): 957–64. doi: 10.1002/lt.23685.
- Готье СВ, Мойсюк ЯГ, Хомяков СМ. Донорство и трансплантация органов в Российской Федерации в 2014 году: VII сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2015;17(2): 7–22. doi: 10.15825/1995-1191-2015-2-7-22.
Supplementary files
