НЕИНВАЗИВНЫЕ МЕТОДЫ ОЦЕНКИ СТЕАТОЗА ПЕЧЁНОЧНОГО ГРАФТА У ДОНОРА С УСТАНОВЛЕННОЙ СМЕРТЬЮ ГОЛОВНОГО МОЗГА
Аннотация
Рост числа пациентов, нуждающихся в трансплантации печени, ставит вопрос о расширении и уточнении критериев пригодности печёночного графта для трансплантации, а также показывает необходимость разработки новых, быстрых и неинвазивных методов оценки функционального состояния печени на этапе обследования донора и его кондиционирования. Печёночные графты с выраженным стеатозом, которые ранее считались непригодными для трансплантации, из-за высокого риска развития ранней дисфункции теперь рассматриваются для пересадки как потенциальные. Существует несколько способов диагностики и определения стадии стеатоза, но, к сожалению, на сегодняшний день ни один из них не может дать точную и быструю оценку его степени развития в печёночном графте. В настоящее время «золотой стандарт» определения стеатоза печени – биопсия с последующим исследованием гепатобиоптата патоморфологом. Существуют также прогностические модели, неинвазивные тесты и инструментальные методы, эффективность которых доказана – это ультразвуковое исследование печени с эластографией, рентген-контрастная компьютерная томография и рентген-контрастная компьютерная томография печени с определением плотности печёночной ткани. Принятие решения о пригодности печёночного графта для трансплантации зависит от многих факторов как со стороны донора, так и со стороны реципиента, и правильным будет полагать, что эти данные надо учитывать в совокупности. В настоящем обзоре нами рассматриваются все подходы, которые в настоящее время используются для количественной и качественной оценки стеатоза в трансплантатах печени у донора со смертью головного мозга.
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