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The data summarized in this review suggest that radionuclide studies are highly effective in the clinical situations that the structure and function of the liver should be simultaneously evaluated, which is in full measure appropriate for liver transplantation.

Experience of Institute of Emergency Medicine n.a. Sklifosovski in management of liver transplantation waiting list is analyzed. International protocols are described and applied to the treatment of 324 pts. with end stage liver diseases. Authors stressed the importance of dynamic evaluation of severity of liver disease as well as treatment of different complications such as resistant ascites, esophageal varicose, encephalopathy and gastrointestinal bleeding. Prophylactics and treatment of viral hepatitis takes important place in the management of liver transplant recipient pts.

We analyzed natural history of recurrent HCV-infection after cadaveric liver transplantation (LTx) in 38 cases. The mean follow-up time was 23.8 (95% CI, 18.4; 29.2) mo after LTx. There were latent course in 19 pts, and active hepatitis in another 19 pts in the 1st post-LTx year. Active hepatitis has been associated with CMV-infection, acute cellular rejection and methylprednisolon pulse-therapy. Liver biopsy had shown advanced fibrosis or cirrhosis in 19% cases independently on latent or active course. In 5 out 8 pts with latent course of HCV-infection in the 1st y., the active hepatitis developed up to the end of the 2nd y. FU. Two cases of fibrosing cholestatic hepatitis resulted in the death or retransplantation. Two cases of unusual course of recurrent HCV-infection described (i.e. fulminant liver failure without cholestasis).

The review discusses whether antiviral therapy for recurrent hepatitis C virus (HCV) infection may be used following liver transplantation. It analyzes the concepts of pre-emptive therapy initiated within the first weeks after the transplantation, as well as therapy for histologically verified active hepatitis and/or liver fibrosis. Capabilities and limits in the use of pegylated interferons and ribavirin as monotherapy or combination therapy are considered. Particular emphasis is placed on the role of viral kinetics in the determination of the duration of further therapy, including the possibility of its prolongation up to > 12 months. There are arguments in favor of a better course of recurrent HCV infection in patients receiving cyclosporine versus those taking tacrolimus.

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 authors provide the results of colloid hepatic scintigraphy and whole body studies, by determining the hepatic and splenic uptake of the radiotracer in 105 patients with hepatic cirrhosis (HC) of different etiology. The results obtained in the groups of patients with varying HC according to the Child-Pugh classification and in the group of 11 healthy volunteers were compared. The results were analyzed in 17 patients prior to and following liver transplantation. In the Child-Pugh B-C groups, the liver showed a tendency to be reduced along with progressive splenic enlargement and radiocolloid redistribution towards the spleen and bone marrow with the most significant differences in the relative splenic and bone marrow uptake of the radiotracer (p < 0.005) and its hepatic capture in percentage of the whole body (p < 0.001). One-six months after surgery, there was a significant improvement of all parameters with obvious regression of the signs of portal hypertension in the patients who had undergone liver transplantation. Colloid hepatic scintigraphy has been shown to be a highly informative technique in assessing liver function in patients with HC; it also permits evaluation of the regression of symptoms of portal hypertension and the functional state of a liver graft in the postoperative period.

A method for identifying mixed infections, dysbioses, and inflammatory processes from specific markers (fatty acids, aldehydes, and sterols) by chromatographic mass spectrometry was used to study the microecological status of patients eligible for liver transplantation. Heterogeneous microorganisms (aerobes, anaerobes, actinobacteria, fungi, and viruses) were quantified from molecular markers in an experiment within 3 hours after the samples were sent to the laboratory. The examinees were found to have excessive growth of gram-positive anaerobes (Clostridia, eubacteria), actinobacteria of the genera Streptomyces, Nocardia, and Candida yeasts. Next were staphylococci, streptococci, and gram-negative microorganisms of the group Moraxella/Acinetobacter, Pseudomonas aeruginosa, Helicobacter pylory, and Fusobacterium/Haemophylus. Antibiotics and probiotics were chosen to correct dysbiosis and infection, by taking into account the data available in the literature. The speed and accuracy of the procedure ensure real-time monitoring of a treatment process under control of mass spectrometry.

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.

Clinical laboratory results were analyzed in patients on one- and two-component suppression in the late period after liver transplantation.Objective: to study the impact of one-component immunosuppression with calcineurin inhibitors on clinical laboratory parameters in the late period after liver transplantation.Subjects and methods. Examinations were made in 3 groups of patients receiving various immunosuppressive therapy regimens: 1) 15 took cyclosporine; 2) 10 had tacrolimus; 3) 8 received a calcineurin inhibitor and a mycophenolic acid preparation. Their peripheral blood samples were biochemically and immunologically studied.Results. Hyperglycemia was detected in 5 (38.5%) patients receiving tacrolimus and 3 (15%) patients taking cyclosporine. Hypertension was observed in 11 (55%) patients on cyclosporine and in 3 (23%) on tacrolimus. The above complications were seen in 50% of the patients on two-component immunosuppression. Two cases of acute rejection were noted in Groups 1 (6.7%) and 3 (12.5%). The most pronounced biochemical and immunological changes were observed in the two-component immunosuppression group.Conclusion. The use of one-component immunosuppression with calcineurin inhibitors in patients after liver transplantation is effective and adequate; however, the etiology of liver cirrhosis should be taken into account on switching to one-component suppression.

The paper describes a case of successful cadaveric orthotopic liver transplantation (OLT) in a patient with hepatic B virus (HBV)-induced liver cirrhosis. It considers preoperative antiviral therapy with nucleoside analogues, including the occurrence of limivudine-resistant mutation in HBV (YMDD mutations) during long-term Zeffix therapy, the necessity of converting to entecavir (Baraclude). A combined immunoprophylaxis scheme using specific immunoglobulin (HB Ig, Neohepatex) and entecavir (Baraclude) is given for liver graft infection with HBV. The result of treating the patient was that the liver graft was not infected with HBV within 420 days after OLT.