urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.6.80XHLRAVurmj-1644Research ArticleКлинические случаи | Clinical casesClinical casesСлучай ретрансплантации по поводу гепатоцеллюлярной карциномы у пациента после эффективной противовирусной терапии гепатита CCase Report: Retransplantation Due to Hepatocellular Carcinoma After Direct Antiviral Agents in Cirrhotic Patientshttps://orcid.org/0009-0009-2884-5447АнашкинаМ. А.AnashkinaM. A.

Мария Александровна Анашкина — гастроэнтеролог гастроэнтерологического отделения

Екатеринбург

Maria A. Anashkina — Gastroenterologist of the Gastroenterology Department, Sverdlovsk RegionalHepatological Center

Ekaterinburg

anashkina.gastro.ekb@gmail.comhttps://orcid.org/0000-0002-4223-3473БессоноваЕ. Н.BessonovaE. N.

Елена Николаевна Бессонова — доктор медицинских наук, заведующий гастроэнтерологическим отделением, руководитель Свердловского областного гепатологического центра, Свердловская областная клиническая больница № 1; доцент кафедры поликлинической терапии, Уральский государственный медицинский университет; главный внештатный гастроэнтеролог, Министерство здравоохранения Свердловской области

Екатеринбург

Elena N. Bessonova — Doctor of Sciences (Medicine), Head of the Gastroenterology Department, Head of the Sverdlovsk Regional Hepatological Center, Sverdlovsk Regional Clinical Hospital No. 1; Associate Professor of the Department of Polyclinic Therapy, Ural State Medical University; Chief Freelance Specialist in Gastroenterologist, Ministry of Health of the Sverdlovsk Region

Ekaterinburg

bess.elena@bk.ruhttps://orcid.org/0000-0002-6580-5809КлимушеваН. Ф.KlimushevaN. F.

Наталья Фёдоровна Климушева — доктор медицинских наук, заместитель главного врача по медицинской части, Свердловская областная клиническая больница № 1; доцент кафедры урологии, нефрологии и трансплантологии, Уральский государственный медицинский университет

Екатеринбург

Nataliya F. Klimusheva — Doctor of Sciences (Medicine), Deputy Director for Medical Work, Sverdlovsk Regional Clinical Hospital No. 1; Associate Professor of the Department of Urology, Nephrology and Transplantation, Ural State Medical University

Ekaterinburg

klimusheva@mis66.ruСвердловская областная клиническая больница № 1РоссияSverdlovsk Regional Clinical Hospital No. 1Russian FederationСвердловская областная клиническая больница № 1; Уральский государственный медицинский университет; Министерство здравоохранения Свердловской областиРоссияSverdlovsk Regional Clinical Hospital No. 1; Ural State Medical University; Ministry of Health of the Sverdlovsk RegionRussian FederationСвердловская областная клиническая больница № 1; Уральский государственный медицинский университетРоссияSverdlovsk Regional Clinical Hospital No. 1; Ural State Medical UniversityRussian Federation20241212202423680–90Copyright © Анашкина М.А., Бессонова Е.Н., Климушева Н.Ф., 20242024Анашкина М.А., Бессонова Е.Н., Климушева Н.Ф.Anashkina M.A., Bessonova E.N., Klimusheva N.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1644Введение

Введение. Эра препаратов прямого противовирусного действия открыла широкие возможности для лечения пациентов, хронически инфицированных гепатитом С (HCV), однако пациенты, имеющие декомпенсированный цирроз печени, требуют повышенного внимания и взвешенного индивидуального подхода к назначению противовирусной терапии (ПВТ).

Цель работы — на клиническом примере продемонстрировать возможность развития осложнений цирроза печени после успешной противовирусной терапии.

Материалы и методы

Материалы и методы. Анализ медицинской документации мужчины 52 лет, имеющего цирроз печени в исходе HCV-инфекции, получавшего противовирусную терапию с достижением устойчивого вирусологического ответа. При дальнейшем наблюдении пациента диагностирована гепатоцеллюлярная карцинома, по поводу чего выполнена трансплантация печени, осложнившаяся первично нефункционирующим трансплантатом, что потребовало проведения ретрансплантации печени в раннем послеоперационном периоде, а также применения экстракорпоральных методик и многокомпонентной иммуносупрессивной терапии.

Результаты и обсуждение

Результаты и обсуждение. Проведение противовирусной терапии не всегда приводит к улучшению прогноза для пациента, а достижение элиминации вируса снижает, но не отменяет полностью риски развития гепатоцеллюлярной карциномы.

Заключение

Заключение. Пациенты, имеющие декомпенсированный цирроз печени, на фоне и после проведения ПВТ должны подлежать регулярному наблюдению и онкоскринингу.

Introduction

Introduction. Direct antiviral agents had opened new opportunities of treatment for chronic hepatitis C (HCV) in patients with cirrhosis. However, patients with decompensated liver cirrhosis need special attention and individual approach before antiviral therapy prescription.

The aim of the study — to demonstrate a clinical case probability of developing liver cirrhosis complications aſter effective antiviral therapy.

Materials and methods

Materials and methods. Analysis of medical records of 52 уears old male with HCV-associated liver cirrhosis who was treated with direct antiviral agents with achieving of sustained virologic response (SVR). During follow up hepatocellular carcinoma (HCC) was detected. Patient underwent a liver transplantation complicated by primary non function liver graſt in the early postoperative period. Liver retransplantation with necessity of extracorporeal treatment methods and complex immunosuppressive therapy.

Discussion

Discussion. Antiviral treatment of patients with decompensated liver cirrhosis does not always improve prognosis and sustained SVR does not exclude risk of HCC appearance.

Conclusion

Conclusion. Treated patients should be included in monitoring and HCC surveillance program.

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The authors declare that there are no conflicts of interest present.