Liver transplantation is rightly considered the only radical treatment for terminal chronic liver diseases and patients with acute liver failure. However, despite the accumulated experience in the management of patients in this group, the level of complications development remains at a fairly high level. The success of the correction of emerging pathological conditions largely depends on the timing of their diagnosis. Since complications developing after liver transplantation most often do not have specific clinical and biochemical manifestations, the use of imaging research methods plays a key role in assessing the state of the transplanted organ at all stages of the postoperative period. Among all instrumental methods, ultrasound examination using Doppler techniques, carried out hourly directly in the intensive care unit, with an accuracy of 97 % and a specificity of up to 100 %, makes it possible to detect vascular post-transplant complications as soon as possible. Their timely correction avoids the loss of the graft. The use of dynamic observation contributes to differential diagnosis in identifying non-vascular complications at different stages of the postoperative period. The use of modern techniques greatly expands the possibilities of echography. Thus, the use of contrast enhancement not only shortens the study time, but also increases the sensitivity of Dopplerography in assessing the patency of the vascular bed, especially in patients with decreased central hemodynamics. The use of ARFI-elastography techniques in patients in the late postoperative period makes it possible to objectively assess the severity of hepatic graft fibrosis.

Rationale. Hepatorenal syndrome is a threatening complication in patients with liver cirrhosis and portal hypertension. The occurrence of renal dysfunction associated with hepatorenal syndrome manifestations significantly affects the condition severity, the disease duration, and the survival time during the waiting period for liver transplantation.The study purpose was to investigate the potential of a complex ultrasonography examination in the assessment of intrarenal hemodynamic impairments in patients with various diffuse liver diseases.Material and methods. The ultrasound examination results of 167 patients were analyzed. The 1st group included 28 patients with confirmed diffuse liver diseases of viral etiology who did not have signs of cirrhosis formation, the 2nd group included 139 patients with liver cirrhosis due to diffuse liver diseases of various etiologies, and the 3-rd group included 137 patients who had previously been in the 2nd group in whom orthotopic liver transplantation was performed.Results. The study revealed a statistically significant increase in the incidence of secondary hemodynamic impairments in kidney function in patients with liver cirrhosis and no relationship of their severity and incidence to the disease etiology, and also to such markers of the portal hypertension severity as splenomegaly, ascites, and portal vein thrombosis.Conclusions. The resistive index measured on the renal arterial branches by Doppler ultrasound, has a certain predictive value in relation to hepatorenal syndrome in patients with liver cirrhosis of various origins. This also makes it possible to timely identify a group of patients at a high risk of developing severe renal dysfunction and to assess the efficacy of the treatment that has been given.

Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.

Aim. To evaluate short-term outcomes of ex situ, ex vivo liver resection in patients with lesion of liver veins confluence and inferior vena cava who were undesirable for conventional liver resection. Matherial and methods. There were 4 procedures of ex situ liver resection and autotransplantation without veno-venous bypass. Results. Postoperative complications developed in all cases, complications grade IIIa and over — in 50% of patients. Three patients are alive without signs of disease, follow-up ranged from 8 months to 2 years. One patient died after surgery. Conclusion . Comprehensive planning of such procedures is a key for good early and long-term postoperative outcomes. It is strongly recommended to perform liver autotransplantation in well experienced specialize center due to difficult and traumatic surgery.

Aim. The aim of the study is to determine the effectiveness of liver transplantation (LT) in the treatment of unresectable hepatocellular carcinoma (HCC) occurred in normal liver.Material and methods. 6 patients with unresectable HCC underwent orthotopic liver transplantation (OLT). The long-term OLT results were compared with survival results of liver resection in patients with late stage HCC.Results. Hepatocellular carcinoma is one of the most common types of cancer, which occurs mainly in patients with liver cirrhosis and chronic viral hepatitis. Only about 10 % of HCC develops in non-cirrhotic liver among young and somatically healthy patients. 1-, 3-, 5-year recurrence-free and overall survival in LT group was significantly better than in the control group.Conclusion. LT is indicated for patients with unresectable HCC in non-cirrhotic liver and its extrahepatic localization. A large tumor size and macrovascular invasion should not be a contraindication for LT in such patients.

The paper gives a clinical example of successful therapy for severe sepsis, the cause of which was methicillin-resistant Staphylococcus aureus infection in a patient undergoing liver transplantation and splenectomy.

The paper gives a clinical example of successful therapy for severe sepsis, the cause of which was methicillin-resistant Staphylococcus aureus infection in a patient undergoing liver transplantation and splenectomy.

The study analyzes the reasons for the development of vascular complications, prevention and treatment after liver transplantation. In a retrospective study enrolled 206 patients who had undergone 214 orthotopic liver transplantation (OLT). Vascular complications has diagnosed in 18 (8.4 %) patients in postoperative period. A relatively low incidence of hepatic artery thrombosis (HAT) had seen in our study. Low molecular weight heparin (LMWH) plays an important role in the prevention of thrombosis. Doppler ultrasonography is a convenient and efficient method for detecting posttransplant complications and plays an important role in guiding treatment. Early diagnosis of these complications allows to decide on the tactics of the patients and to determine indications for emergency surgical revascularization and save the graft.

In this article we presented the new approach to the liver transplantation based on the prognosis paradigm of the tumor recurrence before the operation using largest experience of the liver transplantation in Russia. The effect independent clinicopathologic factors on outcome were tested using univariate and multivariate analyses by the Cox regression. The value molecular biomarker for choice of the patients to the transplantation liver was presented.

Objective: to study the role of echographic techniques in the evaluation of hemodynamic and structural changes in a liver transplant (LT) in ischemia-reperfusion injuries (IRI).Materials and methods. The results of an echographic follow-up were analyzed in 122 patients who had undergone orthotopic liver transplantation in 2005 to 2010.Results. A high-resistance flow pattern was more frequently recorded in the arterial bed of LT within the first 24 postoperative hours. On day 3, there were negative changes as an increased resistance index at the level of the hepatic artery or its branches in 35% of the patients. Transient postischemic structural changes in the grafted organ were diagnosed in 42.3% of all the examinees; formation of large focal necroses was found in 28%. Mortality in patients with transient edema of the hepatic parenchyma was 4.5%. In the group of recipients who had been diagnosed as having large focal hepatic parenchymal necroses, mortality was 29.6%. Liver retransplantation was carried out in 10% of the patients because of graft dysfunction.Conclusion. According to the echographic findings, LT hemodynamic and structural changes as a sequel of prior IRI were revealed in the overwhelming majority of recipients. Ultrasound follow-up monitoring is a reliable tool for assessing the severity of LT injuries and risk factors for poor outcome.

Objective: to analyze the causes of acute renal failure (ARF) and to study the efficiency of renal replacement therapy (RRT) in the treatment of this condition after liver transplantation.Materials and methods. Eighty liver transplantations made at the N.V. Sklifosovsky Research Institute of Emergency Care from 2000 to 2008 were analyzed. The patients were divided into 2 groups: 1) 29 patients with evolving ARF who received RRT in the postoperative period; 2) 51 patients who had no indications for RRT.Results. Postoperative RRT was performed in 29 (36.3%) patients. Of them, 23 patients had been identified to have the hepatorenal syndrome in the preoperative period. Renal function recovered in 20 (72.4%) of the 29 patients who needed RRT during the performed treatment and they were discharged from the clinic. Due to the conducted treatment, these patients showed stabilization and their ARF resolution occurred within 12.7±6.2 days. The mean number of performed sessions required to restore renal function was 8.8 (range 1 to 56).Conclusion. Preoperative hepatorenal syndrome is a predictor of ARF in the postoperative period. At the same time ARD has a good prognosis after liver transplantation. With a primary non-functioning graft, extracorporeal techniques are ineffective and maintenance therapy used prior to liver retransplantation.

The paper describes a case of posttransplantation fibrosing cholestatic hepatitis C (PFCHC) in a female patient whose transplant was preserved due to timely antiviral therapy (AVT). Its differential diagnosis primarily required that chronic graft rejection and biliary anastomotic stricture be excluded as a cause of dysfunction. PFCHC was proposed to be a possible cause of graft dysfunction on the basis of the clinical course of the disease, the presence of a very high viral load, intervals after orthotopic liver transplantation, the results of histological studies, and no signs of biliary hypertension. Antiviral monotherapy was initiated using pegylated interferon α-2a (Pegasys), which resulted in a considerable improvement and yielded complete early virological and biochemical responses to AVT. This allows one to hope to obtain a sustained virological response and to eliminate hepatitis C infection in the patient after termination of a 48-week course of therapy.

The results of multiple complex ultrasound examinations performed in 180 patients after the OLT in early and late postoperative period are analyzed. The presence of biliary anastomotic failure (BAF) after OLT was diagnosed in 6.1 % of recipients. Sensitivity, specificity and diagnostic accuracy of BAF by dynamic ultrasound observation in our study were 100, 98 and 99 % respectively. The emergence of biliary hypertension (BH) due to strictures of anastomotic and nonanastomotic localization was diagnosed by ultrasound in 12.2 % of operated patients. According to the study of dynamic ultrasound investigation previous ischemic damage to liver transplant or vascular complications were detected in 82.3 % of patients with the BAF and in 30.4 % patients with evidence of the presence of strictures of the biliary tree.

The widespread use of heparin as an anticoagulant has led to the formation of the problem of heparin-induced thrombocytopenia (HIT). At the present time, the number of different areas of surgical practice, in which we have to face this threat complication, is increasing. We present the clinical case of HIT in a young patient after liver transplantation. Diagnostics of HIT allowed in time to establish the cause of massive thrombus formation, perform liver transplantation, exclude the use of heparin and save the life of the patient.

The paper describes a case of posttransplantation fibrosing cholestatic hepatitis C (PFCHC) in a female patient whose transplant was preserved due to timely antiviral therapy (AVT). Its differential diagnosis primarily required that chronic graft rejection and biliary anastomotic stricture be excluded as a cause of dysfunction. PFCHC was proposed to be a possible cause of graft dysfunction on the basis of the clinical course of the disease, the presence of a very high viral load, intervals after orthotopic liver transplantation, the results of histological studies, and no signs of biliary hypertension. Antiviral monotherapy was initiated using pegylated interferon α-2a (Pegasys), which resulted in a considerable improvement and yielded complete early virological and biochemical responses to AVT. This allows one to hope to obtain a sustained virological response and to eliminate hepatitis C infection in the patient after termination of a 48-week course of therapy.

The study analyzes the reasons for the development of vascular complications, prevention and treatment after liver transplantation. In a retrospective study enrolled 206 patients who had undergone 214 orthotopic liver transplantation (OLT). Vascular complications has diagnosed in 18 (8.4 %) patients in postoperative period. A relatively low incidence of hepatic artery thrombosis (HAT) had seen in our study. Low molecular weight heparin (LMWH) plays an important role in the prevention of thrombosis. Doppler ultrasonography is a convenient and efficient method for detecting posttransplant complications and plays an important role in guiding treatment. Early diagnosis of these complications allows to decide on the tactics of the patients and to determine indications for emergency surgical revascularization and save the graft.

The results of multiple complex ultrasound examinations performed in 180 patients after the OLT in early and late postoperative period are analyzed. The presence of biliary anastomotic failure (BAF) after OLT was diagnosed in 6.1 % of recipients. Sensitivity, specificity and diagnostic accuracy of BAF by dynamic ultrasound observation in our study were 100, 98 and 99 % respectively. The emergence of biliary hypertension (BH) due to strictures of anastomotic and nonanastomotic localization was diagnosed by ultrasound in 12.2 % of operated patients. According to the study of dynamic ultrasound investigation previous ischemic damage to liver transplant or vascular complications were detected in 82.3 % of patients with the BAF and in 30.4 % patients with evidence of the presence of strictures of the biliary tree.

Objective: to study the role of echographic techniques in the evaluation of hemodynamic and structural changes in a liver transplant (LT) in ischemia-reperfusion injuries (IRI). Materials and methods. The results of an echographic follow-up were analyzed in 122 patients who had undergone orthotopic liver transplantation in 2005 to 2010. Results. A high-resistance flow pattern was more frequently recorded in the arterial bed of LT within the first 24 postoperative hours. On day 3, there were negative changes as an increased resistance index at the level of the hepatic artery or its branches in 35% of the patients. Transient postischemic structural changes in the grafted organ were diagnosed in 42.3% of all the examinees; formation of large focal necroses was found in 28%. Mortality in patients with transient edema of the hepatic parenchyma was 4.5%. In the group of recipients who had been diagnosed as having large focal hepatic parenchymal necroses, mortality was 29.6%. Liver retransplantation was carried out in 10% of the patients because of graft dysfunction. Conclusion. According to the echographic findings, LT hemodynamic and structural changes as a sequel of prior IRI were revealed in the overwhelming majority of recipients. Ultrasound follow-up monitoring is a reliable tool for assessing the severity of LT injuries and risk factors for poor outcome.

: The results of treatment of 66 patients with non-gunshot abdominal injuries, involving retroperitoneal organs, are described. Preoperative clinical and ultrasound investigations are not accurate enough to diagnose retroperitoneal lesions, which were diagnosed intraoperatively in 57,6% of patients. In 97% retroperitoneal haematoma was located 2-10 sm from the posterior parietal peritoneum. In case of aorta injury, postcava or renal injury grade IV, retroperitoneal haematoma is large and bulging, though absence of these signgns does not exclude serious injuries of retroperitoneal organs and structures. Retroperitoneal cavity revision by the dissection of the wound canal can provoke further bleeding, so it should be performed only after visualization and cross-clamping the afferent vessel.

Authors describe experience of diagnosis and treatment of hemobilia at 10 of 743 patients with trauma of liver. At 7 patients hemobilia was due to closed trauma, and at 3--due to injuries. For diagnosis of hemobilia the USE, Doppler examination of hepatic vessels, esophagogastroduodenoscopy, selective angiography of liver were used. Selective embolization was effective at 7 of 8 patients. Hemobilia has been cured conservatively at 2 patients. Two patients died. It is concluded that complex examination including dopplerography of hepatic liver, esophagogastroduodenoscopy, selective angiography is necessary for diagnosis of traumatic hemobilia. Traumatic hemobilia must be suspected at patients with symptoms of gastrointestinal bleeding in postoperative (posttraumatic) period, and diagnosis of other sources of bleeding does not exclude hemobilia. Selective angiography and embolization of afferent arterial branch is the most effective and safe method of traumatic hemobilia treatment.