Разработка критериев оценки риска тяжёлого ишемически-реперфузионного повреждения при трансплантации печени в контексте последующей перфузионной реабилитации

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

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. 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. 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.

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