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This paper reviews modern literature and presents a brief analysis of our own data on one of the most pressing issues in modern transplantology and, in particular, transplant hepatology – the role and place of gut-liver axis (GLA) in the early post-transplant period. Objective: to compare the correlation between gut microbiome palette and incidence of certain early postoperative complications in liver transplantation. Materials and methods. The study design is presented as a pilot, prospective, observational, double-blind study based on investigation of the composition of the microbiome residing in the large intestinal in patients that underwent orthotopic liver transplantation (OLTx). The primary cohort of patients consisted of 12 patients who underwent OLTx from a postmortem donor. To assess the gut microbiome palette, biomaterial was collected from all patients in the preand post-transplant period followed by next-generation sequencing. The study was conducted as primary study results registered under number NCT04281797. Results. In the preoperative period, differences close to statistically reliable in relation to Actinobacteria were observed in patients included in the liver transplant waiting list for cirrhosis (LC) and hepatocellular carcinoma (HCC) in cirrhosis. However, due to the pilot nature of the study, this study cohort was limited to an extremely small sample. In turn, in the post-transplant period, there was a statistically significant difference in the taxonomic range of Actinobacteria (p < 0.05) between the above groups, indicating a possible effect of liver transplantation on the gut microbiome. In addition, in the early post-transplant period, there was a marked difference in the microbiome palette between patients with and without acute cellular rejection. Conclusion. GLA and the gut microbiome play a critical role in many liver diseases, and may also have a significant impact on the post-transplant period. In this regard, further research in this direction will not only characterize the predictors and risk factors of bacterial infection and rejection episodes, but will also allow us to form a completely new approach to the treatment tactics for certain complications, including through formation of a microbiota-oriented pharmacotherapy.

The paper shows the main stages of introduction and organization of liver transplantation in the Republic of Belarus, the procedure of examination of patients on the waiting list for liver transplantation, and the experience of the first 37 orthotopic liver transplantations made in the Republic of Belarus in April 3, 2008, to February 1, 2010.

Objective: to compare the degree of sympathetic blockade caused by thoracic epidural or bilateral paravertebral anesthesia. Superior mesenteric artery blood flow was measured calculating the coefficient of flow resistance (resistance index) as an indicator of the degree of sympathetic block in patients undergoing high-traumaticity operations on the upper abdominal organs under thoracic epidural or bilateral paravertebral anesthesia. The patients of both groups were noted to develop sympathetic blockade with a statistically significant reduction in vascular resistance (resistance index) of the superior mesenteric artery and with an increase in blood flow in the visceral bed. The degree of sympathetic blockade was statistically significantly higher in patients under epidural anesthesia. Conclusion. Bilateral thoracic paravertebral blockade decreases sympathetic nervous system activation and may be used during high-traumaticity surgery if there are existing or predictable contraindications to epidural anesthesia.

Ligation of the inferior vena cava (IVC) during classical orthotopic liver transplantation (OLT) may be followed by pronounced hemodynamic changes and may provoke renal dysfunction. The authors have examined the impact of IVC ligation during OLT without venovenous bypass grafting on early postoperative renal function in 6 patients. The Cockcroft-Gault formula was used to evaluate renal function from the creatinine clearance on postoperative days 1, 3, 7, and 10. The endogenous creatinine clearance was diminished within the first 24 hours after surgery; this was 68.2±18.1 (24.3—146) ml/min and significantly correlated with that before OLT, with the mean blood pressure (BPmean) in the icteric period, and with age. At the same time, icteric BPmean was in the normal range — 77.2±1.59 (71.6—81.6) mm Hg and clinical renal failure developed in a female patient with significant preoperative renal dysfunction. Thus, IVC ligation at OLT with IVC interposition in the study contributed to a lower endogenous creatinine clearance within the first 24 postoperative hours, but results in no clinical renal function aggravation.