vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2025.2.CASE.3vmireaviz-1265Research ArticleКлинический случайClinical caseУспешное лечение сепсиса после трансплантации печени у ВИЧ-положительного пациента с множественными сопутствующими заболеваниями: клинический случайSuccessful Management of Sepsis Following Liver Transplantation in an HIV-Positive Patient with Multiple Comorbidities: a case reporthttps://orcid.org/0000-0001-5723-4818КазымовБ. И.KazymovB. I.

Казымов Бахтияр Исметович Оглы,  Врач-хирург, научный сотрудник центра трансплантации печени; ассистент кафедры хирургических болезней

Большая Сухаревская пл., д. 3, г. Москва, 129090

ул. Краснобогатырская, д. 2, стр. 2, г. Москва, 107564

Bakhtiyar I. Kazymov, Surgeon, researcher at the Liver Transplantation Center; Assistant of the Department of Surgical Diseases

3, Bolshaya Sukharevskaya Square, Moscow, 129090

2, Krasnobogatyrskaya st., building 2, Moscow, 107564

baha@transpl.moscowhttps://orcid.org/0000-0002-2264-7038АлекберовК. Ф.AlekberovK. F.

Алекберов Кямран Файгович, Врач-хирург, научный сотрудник центра трансплантации печени

Большая Сухаревская пл., д. 3, г. Москва, 129090

Kyamran F. Alekberov, Surgeon, researcher at the Liver Transplantation Center

3, Bolshaya Sukharevskaya Square, Moscow, 129090

https://orcid.org/0000-0002-9649-8522ЯдрихинскаяМ. С.YadrikhinskayaM. S.

Ядрихинская Марина Сергеевна, Врач-инфекционист

8-я ул. Соколиной Горы, д. 15, г. Москва,105275

Marina S. Yadrikhinskaya, Infectious disease specialist

15, 8th Sokolina Gory St., Moscow, 105275

https://orcid.org/0009-0008-4063-5664КузнецоваА. Д.KuznetsovaA. D.

Кузнецова Александра Дмитриевна, Студентка 6 курса лечебного факультета

ул. Высоковольтная, д. 9, г. Рязань, 390026

Aleksandra D. Kuznetsova, 6th year student of the Faculty of Medicine

9, Vysokovoltnaya St., Ryazan, 390026

https://orcid.org/0009-0008-5074-3802ПетроваА. О.PetrovaA. O.

Петрова Алёна Олеговна, Студентка 6 курса лечебного факультета Института клинической медицины

ул. Чапаевская, д. 89, г. Самара, 443099

Alena O. Petrova, 6th year student of the medical faculty of the Institute of Clinical Medicine

89, Chapaevskaya St., Samara, 443099

https://orcid.org/0000-0002-1750-9706ШемакинС. Ю.ShemakinS. Yu.

Шемакин Сергей Юрьевич, Ведущий научный сотрудник, Научный отдел неотложной кардиохирургии

Большая Сухаревская пл., д. 3, г. Москва, 129090

Sergey Yu. Shemakin, Leading researcher, Scientific department of emergency cardiac surgery

3, Bolshaya Sukharevskaya Square, Moscow, 129090

Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Московский медицинского университета «Реавиз»РоссияN.V. Sklifosovsky Research Institute of Emergency Medicine; Moscow Medical University "Reaviz"Russian FederationНаучно-исследовательский институт скорой помощи им. Н.В. СклифосовскогоРоссияN.V. Sklifosovsky Research Institute of Emergency MedicineRussian FederationМосковский городской центр профилактики и борьбы со СПИДомРоссияMoscow City Center for AIDS Prevention and ControlRussian FederationРязанский государственный медицинский университет им. И.П. ПавловаРоссияRyazan State Medical University named after I.P. PavlovRussian FederationСамарский государственный медицинский университет,РоссияSamara State Medical UniversityRussian Federation202502062025152172178Copyright © Казымов Б.И., Алекберов К.Ф., Ядрихинская М.С., Кузнецова А.Д., Петрова А.О., Шемакин С.Ю., 20252025Казымов Б.И., Алекберов К.Ф., Ядрихинская М.С., Кузнецова А.Д., Петрова А.О., Шемакин С.Ю.Kazymov B.I., Alekberov K.F., Yadrikhinskaya M.S., Kuznetsova A.D., Petrova A.O., Shemakin S.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/1265Введение

Введение. Исторически ВИЧ-инфицированным пациентам долгое время отказывали в трансплантации печени из-за опасений худших результатов по сравнению с неинфицированным населением. Благодаря достижениям в области антиретровирусной терапии и улучшенному пониманию иммунологического состояния этих пациентов, трансплантация стала жизнеспособным вариантом лечения.

Описание случая

Описание случая. В данном отчёте описывается 56-летний ВИЧ-положительный мужчина с множественными сопутствующими заболеваниями, перенёсший трансплантацию печени по поводу терминальной стадии заболевания печени вследствие хронического гепатита В. Ранний посттрансплантационный период осложнился тяжёлым сепсисом, полиорганной недостаточностью и дисфункцией трансплантата.

Методы лечения

Методы лечения. Комплексная терапия включала длительную вазопрессорную поддержку, заместительную почечную терапию, многократные переливания крови и целенаправленную антимикробную терапию.

Результаты

Результаты. Пациент был успешно вылечен и выписан в стабильном состоянии с функционирующим трансплантатом.

Заключение

Заключение. Этот случай демонстрирует, что даже тяжёлые инфекционные осложнения после трансплантации печени у полиморбидных ВИЧ-положительных пациентов могут быть успешно излечены при соответствующем мультидисциплинарном интенсивном лечении. 

Introduction

Introduction. Historically, HIV-infected patients were denied liver transplantation due to concerns about poorer outcomes compared to the non-infected population. Due to advances in antiretroviral therapy and improved understanding of the immunological status of these patients, transplantation has become a viable treatment option.

Case Description

Case Description. This report describes a 56-year-old HIV-positive man with multiple comorbidities who underwent liver transplantation for end-stage liver disease due to chronic hepatitis B. The early post-transplantation period was complicated by severe sepsis, multiple organ failure, and graft dysfunction.

Treatment Methods

Treatment Methods. Comprehensive therapy included prolonged vasopressor support, renal replacement therapy, multiple blood transfusions, and targeted antimicrobial therapy.

Results

Results. The patient was successfully treated and discharged in stable condition with a functioning graft.

Conclusion

Conclusion. This case demonstrates that even severe infectious complications after liver transplantation in polymorbid HIV-positive patients can be successfully treated with appropriate multidisciplinary intensive care.

ВИЧ-инфекция [D015658]Трансплантация печени [D016031]Сепсис [D018805]Полиорганная недостаточность [D009102]Иммуносупрессивная терапия [D007166]Антиретровирусная терапия [D044966]Посттрансплантационные осложнения [D011183]Гепатит B [D006509]Интенсивная терапия [D003422]Гемодиафильтрация [D006435]HIV Infection [D015658]Liver Transplantation [D016031]Sepsis [D018805]Multiple Organ Failure [D009102]Immunosuppressive Therapy [D007166]Antiretroviral Therapy [D044966]Postoperative Complications [D011183]Hepatitis B [D006509]Critical Care [D003422]Hemodiafiltration [D006435]ReferencesDi Benedetto F, De Ruvo N, Berretta M, et al. Don’t deny liver transplantation to HIV patients with hepatocellular carcinoma in the highly active antiretroviral therapy era. J Clin Oncol. 2006;24(2).1 Di Benedetto F, De Ruvo N, Berretta M, et al. Don’t deny liver transplantation to HIV patients with hepatocellular carcinoma in the highly active antiretroviral therapy era. 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The authors declare that there are no conflicts of interest present.