vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2025.6.TX.4vmireaviz-1548Research ArticleДОНОРСТВО И ТРАНСПЛАНТАЦИЯ ОРГАНОВ И ТКАНЕЙORGAN AND TISSUE DONATION AND TRANSPLANTATIONРазработка критериев оценки риска тяжёлого ишемически-реперфузионного повреждения при трансплантации печени в контексте последующей перфузионной реабилитацииDevelopment of Risk Assessment Criteria for Severe Ischemia-Reperfusion Injury in Liver Transplantation in the Context of Subsequent Perfusion Rehabilitationhttps://orcid.org/0000-0002-6362-7914НоврузбековМ. С.NovruzbekovM. S.

Новрузбеков Мурад Сафтарович. Д-р мед. наук, профессор, врач-хирург, руководитель научного отделения; заведующий кафедрой трансплантологии и искусственных органов им. В.П. Демихова; профессор кафедры хирургических болезней

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

ул. Островитянова, д. 1, г. Москва, 117513

Каширское шоссе, д. 23, г. Москва, 115522

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

Murad S. Novruzbekov. Dr. Sci. (Med.), Professor, Surgeon, Head of the Research Department; Head of the Department of Transplantology and Artificial Organs named after V.P. Demikhov; rofessor, Department of Surgical Diseases

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

Ostrovityanova St., 1, Moscow, 117513

Kashirskoe shosse, 23, Moscow, 115522

Krasnobogatyrskaya str., 2, building 2, Moscow, 107564

https://orcid.org/0000-0001-5889-8675ЯреминБ. И.YareminB. I.

Яремин Борис Иванович. Канд. мед. наук, врач-хирург, научный сотрудник; доцент кафедры трансплантологии и искусственных органов им. В.П. Демихова;  заведующий кафедрой хирургических болезней 

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

ул. Островитянова, д. 1, г. Москва, 117513

Каширское шоссе, д. 23, г. Москва, 115522

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

Boris I. Yaremin. Cand. Sci. (Med.), surgeon, researcher; Associate Professor; Head of the Department of Surgical Diseases

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

Ostrovityanova St., 1, Moscow, 117513

Kashirskoe shosse, 23, Moscow, 115522

Krasnobogatyrskaya str., 2, building 2, Moscow, 107564

https://orcid.org/0000-0002-1396-7048БалкаровА. Г.BalkarovA. G.

Балкаров Аслан Галиевич. Канд. мед. наук, руководитель научного отделения; доцент кафедры трансплантологии и искусственных органов им. В.П. Демихова

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

ул. Островитянова, д. 1, г. Москва, 117513

Aslan G. Balkarov. Cand. Sci. (Med.), Head of the Research Department; Associate Professor, V.P. Demikhov Department of Transplantology and Artificial Organs

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

Ostrovityanova St., 1, Moscow, 117513

https://orcid.org/0000-0001-5723-4818КазымовБ. И.KazymovB. I.

Казымов Бахтияр Исмет Оглы. Врач-хирург, научный сотрудник; ассистент кафедры хирургических болезней

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

Каширское шоссе, д. 23, г. Москва, 115522

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

Bakhtiyar I. Kazymov. Surgeon, Researcher; Assistant Professor, Department of Surgical Diseases

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

Kashirskoe shosse, 23, Moscow, 115522

Krasnobogatyrskaya str., 2, building 2, Moscow, 107564

https://orcid.org/0000-0002-3799-7698СвищеваП. О.SvischevaP. O.

Свищева Полина Олеговна. Врач-патологоанатом 

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

Polina O. Svischeva. Pathologist

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

https://orcid.org/0000-0002-8055-1958ПавловаО. Н.PavlovaO. N.

Павлова Ольга Николаевна. Д-р биол. наук, заведующая кафедрой физиологии; профессор кафедры морфологии и патологии

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

ул. Чапаевская, д. 227, г. Самара, 443001

Ol'ga N. Pavlova. Dr. Sci. (Biol.), Head of the Department of Physiology; Professor of the Department of Morphology and Pathology

Chapaevskaya St., 89, Samara, 443099

Chapaevskaya St., 227, Samara, 443001

https://orcid.org/0009-0002-0057-9326ХановаС. М.KhanovaS. M.

Ханова Сафия Магомедовна. Врач-клинический ординатор

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

Safiya M. Khanova. Clinical Resident

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Российский национальный исследовательский медицинский университет им. Н.И. Пирогова; Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Московский медицинский университет «Реавиз»РоссияSklifosovsky Research Institute for Emergency Medicine; Pirogov Russian National Research Medical University; National Medical Research Center of Oncology named after N.N. Blokhin; Moscow Medical University "Reaviz"Russian FederationНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияSklifosovsky Research Institute for Emergency Medicine; Pirogov Russian National Research Medical UniversityRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Московский медицинский университет «Реавиз»РоссияSklifosovsky Research Institute for Emergency Medicine; National Medical Research Center of Oncology named after N.N. Blokhin; Moscow Medical University "Reaviz"Russian FederationНаучно-исследовательский институт скорой помощи им. Н.В. СклифосовскогоРоссияSklifosovsky Research Institute for Emergency MedicineRussian FederationСамарский государственный медицинский университет; Медицинский университет «Реавиз»РоссияSamara State Medical University; Medical University "Reaviz"Russian Federation202510032026156231–244Copyright © Новрузбеков М.С., Яремин Б.И., Балкаров А.Г., Казымов Б.И., Свищева П.О., Павлова О.Н., Ханова С.М., 20262026Новрузбеков М.С., Яремин Б.И., Балкаров А.Г., Казымов Б.И., Свищева П.О., Павлова О.Н., Ханова С.М.Novruzbekov M.S., Yaremin B.I., Balkarov A.G., Kazymov B.I., Svischeva P.O., Pavlova O.N., Khanova S.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/1548Актуальность

Актуальность. Ишемически-реперфузионное повреждение (ИРП) остаётся значимым осложнением после трансплантации печени, ассоциированным с ранней дисфункцией трансплантата и худшими исходами. Прогнозирование риска ИРП могло бы направлять выбор стратегий консервации органов и посттрансплантационного ведения.

Цель

Цель: разработать и валидировать клиническую систему оценки риска для прогнозирования тяжёлого ИРП при трансплантации печени.

Материалы и методы

Материалы и методы. Ретроспективный анализ 1238 трансплантаций печени, выполненных в НИИ скорой помощи им. Н.В. Склифосовского с 2000 по 2025 год. Тяжёлое ИРП определялось как пиковые значения трансаминаз >1000 МЕ/л в первые 7 суток. Оценивались донорские, процедурные и реципиентные факторы с использованием многофакторной логистической регрессии для создания упрощенной системы оценки риска.

Результаты

Результаты. Полные данные были доступны для 827 пациентов, среди которых зарегистрировано 312 случаев тяжёлого ИРП, что составило 37,7% когорты. Независимыми предикторами явились возраст донора с отношением шансов 1,04 на каждый год, время холодовой ишемии с отношением шансов 1,17 на каждый час и тромбоз воротной вены с отношением шансов 1,52. Разработанный Индекс Риска ИРП (IRI Score) в диапазоне от 0 до 9 баллов стратифицировал пациентов на группы низкого риска при 0–2 баллах с частотой ИРП 35,6%, промежуточного риска при 3–5 баллах с частотой 42,1% и высокого риска при 6 и более баллах с частотой 52,2%. Площадь под ROC-кривой составила 0,555 при p<0,001. Пациенты высокого риска составили 2,8% когорты.

Заключение

Заключение. IRI Score обеспечивает раннюю идентификацию пациентов с повышенным риском тяжёлого ИРП и предоставляет конкретный алгоритм для принятия решений о применении машинной перфузии. Простота индекса и использование предтрансплантационных переменных делают его практичным для клинического применения.

Background

Background. Ischemia-reperfusion injury (IRI) remains a significant complication following liver transplantation, associated with early allograft dysfunction and worse outcomes. Predicting the risk of IRI could guide the selection of organ preservation strategies and posttransplant management.

Objective

Objective. To develop and validate a clinical risk scoring system for predicting severe IRI in liver transplantation.

Materials and Methods

Materials and Methods. A retrospective analysis of 1,238 liver transplantations performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2000 to 2025 was conducted. Severe IRI was defined as peak transaminase levels >1,000 IU/L within the first 7 postoperative days. Donor, procedural, and recipient factors were evaluated using multivariable logistic regression to construct a simplified risk scoring system.

Results

Results. Complete data were available for 827 patients, among whom 312 cases of severe IRI were recorded, accounting for 37.7% of the cohort. Independent predictors included donor age with an odds ratio of 1.04 per year, cold ischemia time with an odds ratio of 1.17 per hour, and portal vein thrombosis with an odds ratio of 1.52. The developed IRI Risk Index (IRI Score), ranging from 0 to 9 points, stratified patients into low-risk (0–2 points) with an IRI rate of 35.6%, intermediate-risk (3–5 points) with a rate of 42.1%, and high-risk (≥6 points) with a rate of 52.2%. The area under the ROC curve was 0.555 (p<0.001). High-risk patients comprised 2.8% of the cohort.

Conclusion

Conclusion. The IRI Score enables early identification of patients at elevated risk for severe IRI and provides a specific algorithm for decision-making regarding the use of machine perfusion. The simplicity of the index and its reliance on pre-transplant variables make it practical for clinical application.

трансплантация печени [D016031]ишемически-реперфузионное повреждение [D015427]стратификация риска [D018570]предиктивное моделирование [D011237]консервация органов [D009926]машинная перфузия [D010477]холодовая ишемия [D060749]ранняя дисфункция трансплантата [D055031]возраст донора [D014019]тромбоз воротной вены [D011169 / D020246]трансаминазы [D014176]логистическая регрессия [D016015]ROC-анализ [D012372]шкала оценки риска [D012720]выживаемость трансплантата [D006085]liver transplantation [D016031]reperfusion injury [D015427]risk assessment [D018570]predictive value of tests [D011237]organ preservation [D009926]perfusion [D010477]cold ischemia [D060749]primary graft dysfunction [D055031]tissue donors [D014019]portal vein / venous thrombosis [D011169 / D020246]transaminases [D014176]logistic models [D016015]ROC curve [D012372]severity of illness index [D012720]graft survival [D006085Исследование поддержано грантом Московского центра инновационных технологий в здравоохранении №2312-15/22.This study was supported by a grant from the Moscow Center for Innovative Technologies in Healthcare No. 2312-15/22.ReferencesZhai Y, Petrowsky H, Hong JC, Busuttil RW, Kupiec-Weglinski JW. 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The authors declare that there are no conflicts of interest present.