应用多学科方法治疗慢性病毒性肝炎肝硬化患者的结果

A. Shabunin, S. Smetanina, P. Drozdov, O. N. Levina, E. Nurmukhametova, D. A. Makeev, O. S. Zhuravel, D. A. Solomatin
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Satisfactory graft function against the background of constant antiviral therapy was observed in all patients. No deaths were recorded. The average follow-up time for patients with cirrhosis of the liver in the outcome of chronic hepatitis C after OTTP was 21.67 ± 4.85 (1–38) months. Antiviral therapy was prescribed to 24 patients 2.7 ± 0.34 (2–4) months after surgery. Three patients did not receive AVT after surgery due to their low adherence to treatment. Satisfactory graft function was observed in all patients, confident virological response against the background of AVT – in 17 patients (70.8%). 7 patients (29.2%) are currently undergoing antiviral therapy. Of the three patients who did not receive AVT in the postoperative period of their own free will, 1 patient (33.3%) developed graft cirrhosis and death from decompensation of liver failure at 23 months after transplantation. Conclusion. 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引用次数: 0

摘要

目的:评价应用多学科方法治疗慢性病毒性肝炎肝硬化患者的结果。材料和方法。从2018年7月到2021年9月,在Botkin医院的外科诊所进行了94例来自死后供体的原位肝移植(OTLT)。在94名受者中,48名(51.1%)因慢性丙型肝炎(CVHC)导致肝硬化需要手术,8名(8.5%)因慢性乙型肝炎(CVHB)导致肝硬化需要手术。在cveb导致肝硬化的情况下,病毒复制的存在是移植的禁忌症;在将其列入等候名单阶段的患者被送到传染病专家那里接受抗病毒治疗。预防移植物中ccv乙肝复发包括术中,以及术后早期和晚期给予400-800 IU抗乙肝免疫球蛋白。在肝硬化的肝移植受者中,不到一半(43.75%)的患者在手术时没有HCV RNA,背景是通过或接受了OEM。其余患者有AVT禁忌症,移植后进行HCV根除。结果。cveb肝硬化肝移植患者的平均随访时间为12.28±4.11(7-23)个月。在持续抗病毒治疗的背景下,所有患者的移植物功能都令人满意。没有死亡记录。慢性丙型肝炎OTTP术后肝硬化患者的平均随访时间为21.67±4.85(1-38)个月。24例患者术后2.7±0.34(2-4)个月给予抗病毒治疗。3例患者术后因治疗依从性低而未接受AVT治疗。在所有患者中观察到令人满意的移植物功能,17例患者(70.8%)对AVT -背景的病毒学反应有信心。7例患者(29.2%)目前正在接受抗病毒治疗。在3例术后自愿未接受AVT的患者中,1例(33.3%)在移植后23个月发生移植物肝硬化并因肝功能失代偿而死亡。结论。在治疗由慢性病毒性肝炎引起的肝硬化患者时,采用多学科方法可以获得可靠的病毒学反应,从根本上治愈肝硬化,从而预防相关并发症,提高患者的生活质量并恢复其工作能力。
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Results of the Application of a Multidisciplinary Approach in the Treatment of Patients with Liver Cirrhosis as a Result of Chronic Viral Hepatitis
Aim – to evaluate the results of applying a multidisciplinary approach to the treatment of patients with liver cirrhosis in the outcome of chronic viral hepatitis. Material and methods. From July 2018 to September 2021, 94 orthotopic liver transplants (OTLT) from a posthumous donor were performed at the surgical clinic of the Botkin Hospital. Of 94 recipients, 48 (51.1%) indicated for surgery as liver cirrhosis as a result of chronic viral hepatitis C (CVHC), in 8 (8.5%) cirrhosis as a result of chronic viral hepatitis B (CVHB). In the case of cirrhosis as a result of CVHB, the presence of viral replication was a contraindication for transplantation; patients with its presence at the stage of placing on the waiting list were sent to an infectious disease specialist to receive antiviral therapy (AVT). Prevention of recurrence of CVHB in the graft consisted of intraoperative, as well as early and late postoperative administration of 400–800 IU of immunoglobulin against hepatitis B. Among liver transplant recipients with liver cirrhosis in the outcome of CVHC, less than half (43.75%) did not have HCV RNA against the background of passed or the OEM received by the time of the operation. The rest of the patients had contraindications to AVT, and HCV eradication was performed after transplantation. Results. The average follow-up period for hepatic transplant recipients with liver cirrhosis as a result of CVHB was 12.28 ± 4.11 (7–23) months. Satisfactory graft function against the background of constant antiviral therapy was observed in all patients. No deaths were recorded. The average follow-up time for patients with cirrhosis of the liver in the outcome of chronic hepatitis C after OTTP was 21.67 ± 4.85 (1–38) months. Antiviral therapy was prescribed to 24 patients 2.7 ± 0.34 (2–4) months after surgery. Three patients did not receive AVT after surgery due to their low adherence to treatment. Satisfactory graft function was observed in all patients, confident virological response against the background of AVT – in 17 patients (70.8%). 7 patients (29.2%) are currently undergoing antiviral therapy. Of the three patients who did not receive AVT in the postoperative period of their own free will, 1 patient (33.3%) developed graft cirrhosis and death from decompensation of liver failure at 23 months after transplantation. Conclusion. The use of a multidisciplinary approach in the treatment of patients with liver cirrhosis as a result of chronic viral hepatitis allows achieving a confident virological response, radically curing liver cirrhosis, thereby preventing associated complications, improving the quality of life of patients and restoring their ability to work.
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