[Living related liver transplantation in the Republic of Uzbekistan: current status and development prospects]. / Rodstvennaya transplantatsiya pecheni v Respublike Uzbekistan: nyneshnee sostoyanie i perspektivy razvitiya.

OBJECTIVE: To analyze primary results of living related liver transplantation in the Republic of Uzbekistan. MATERIAL AND METHODS: There were 44 living related transplantations of the right liver lobe in patients with decompensated liver failure between February 2018 and February 2023. RESULTS: Uneventful postoperative period was observed in 17 (38.6%) recipients. Other 27 patients (61.4%) developed 47 various postoperative complications (1-3 events per a patient). Of these, 8 (18.2%) patients required early postoperative re-laparotomy. Among 44 patients, 9 (20.5%) ones died in early postoperative period, and one patient died in long-term period (3 years after transplantation) from chronic rejection under refusal to take immunosuppressive drugs. Early satisfactory results were obtained in 79.5% of patients, long-term favorable outcomes - in 77.3% of cases. CONCLUSION: Engraftment rates and survival of recipients to a large extent depend on surgical strategy, baseline disease and clinical severity. The so-called "center effect" is essential at initial stages of implementation of the program.

[Standardization of intensive therapy tactics for acute hepatic insufficiency in patients with liver cirrhosis after portosystem shunting]. / Standartizatsiia taktiki intensivnoi terapii pri ostroi pechenochnoi nedostatochnosti u patsientov s tsirrozom pecheni posle portosistemnogo shuntirovaniia.

AIM: Here we analyze efficiency of the algorithm for intensive therapy of acute hepatic insufficiency in patients with cirrhosis after portosystemic shunting, based on the experience of the Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.V. Vakhidov and considering recommendations of the world's leading hepatology schools. MATERIAL AND METHODS: Algorithm efficiency was analyzed based on the results of portosystemic shunting of 556 patients with cirrhosis and acute liver insufficiency. Treatment effectiveness was assessed by presence and severity of postoperative complications, such as hepatic insufficiency and hepatic encephalopathy. Initial decompensation of liver cirrhosis significantly increases the risk of postoperative complications of portosystemic shunting due to edematous ascites syndrome - liver insufficiency (13.5% vs 6.9% in patients without ascites p≥0.05) and hepatic encephalopathy (64.9% vs. 51,7%, respectively, p≥0.05). In group of patients with preoperative ascites syndrome mortality rate was 3.8% (10 patients) and in the group without ascites - 2.3% (6 patients). The main cause of early postoperative lethality was anastomotic thrombosis development with recurrence of bleeding from esophagus and stomach varicose veins. To reduce the risk of postoperative complications and lethality, a therapeutic-tactical algorithm was developed which was effective in combination with a complex of conservative and biophysical methods of treatment and aimed at eliminating the 'resolving factors' of their developmen. RESULTS: One of the most important components of this algorithm is pharmacotherapy with hepatoprotective drugs use in patients with liver cirrhosis in the postoperative period to maintain liver functional state. Considering the antihypoxic, detoxifying and antioxidant properties of active components of remaxol and revealed positive effect of its use in patients (decrease in bilirubin level, increase in albumin fraction of total blood protein and decrease in activity of ALAT and ASAT in 2 times), this drug can be recommended for inclusion in the postoperative pathogenetic standard therapy in this category of patients.

[Specific development and course of portal hypertension complication in patients with hepatic cirrhosis of HBV and HCV etiology].

During 1976-2007 in the Republican Specialized Center of Surgery named after acad. Vakhidov various types of portosystemic shunting were performed in 669 patients with portal hypertension. The aim was to estimate the influence of HBV- and HCV-cirrhosis on the formation of portal hypertension and the results of portosystenic shunting. An analysis of 115 liver cirrhosis patients with portal hypertension was made to find out which of them had variceal bleeding and high risk of its development. Such operations were performed in all these patients by the period of 2004-2007 years. Various types of portosystemic shunting were performed in all cases. The analysis has shown that unlike HCV-cirrhoses, HBV cirrhoses are characterized by more progressive course with a short period of a compensation pause in relation to progression of hepatocellular insufficiency, but a less pronounced risk of hemorrhagic complications.

[X-ray diagnostic parallels in estimation of the degree of portohepatic circulation reduction in patients with liver cirrhosis].

The data obtained in a retrospective analysis, angiographic and hepatoscintigraphic examinations of 86 patients (aged from 12 to 64 years) with liver cirrhosis (LC) treated during the period from 1998 through 2003 were analyzed. Among them there were 64 men and 22 women. The investigations performed have shown that the angiographic data obtained in LC patients determine not only the topographic interaction of the major and collateral vessels of the porto-lienal pool that is of principal significance in the decision for the method of surgical correction in portal hypertension but also allow an estimation of the picture of the hepatopetal blood flow inversion. The data obtained allowed the authors to define three degrees of reduction of the hepatopetal blood flow. A conclusion was made that the degree of reduction of the hepatopetal blood flow when compared was the findings of angiographic and radionuclide examinations were of great prognostic significance for an estimation of the necessary decompression and possible maximal preservation of the hepatopetal blood flow with respect to the preoperative level.