cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2023-3872WZKBXFcardiovascular-3872Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEW ARTICLESОсобенности гиполипидемической терапии у реципиентов печеночного трансплантатаFeatures of lipid-lowering therapy in liver transplant recipientshttps://orcid.org/0000-0001-9256-6674КучеровА. А.KucherovA. A.

Алексей Алексеевич Кучеров — исследователь-лаборант лаборатории клиномики.

Москва

Moscow

kucherovalexey@yandex.ruhttps://orcid.org/0000-0001-7989-0760ЕршоваА. И.ErshovaA. I.

Александра Игоревна Ершова — д.м.н., зам. директора по фундаментальной науке, руководитель лаборатории клиномики.

Москва

Moscow

alersh@mail.ruhttps://orcid.org/0000-0001-8391-5211СюткинВ. Е.SyutkinV. E.

Владимир Евгеньевич Сюткин — д.м.н., профессор кафедры хирургии с курсами онкохирургии, эндоскопии, хирургической патологии, клинической трансплантологии и органного донорства Медико-биологического университета инноваций и непрерывного образования; в.н.с. отделения трансплантации печени.

Москва

Moscow

vladsyutkin@gmail.comhttps://orcid.org/0000-0003-0323-2635ДрапкинаО. М.DrapkinaO. M.

Оксана Михайловна Драпкина — д.м.н., профессор, академик РАН, директор.

Москва

Moscow

drapkina@bk.ruФГБУ "Национальный медицинский исследовательский центр терапии и профилактической медицины" Минздрава РоссииNational Medical Research Center for Therapy and Preventive MedicineФГБУ "ГНЦ ФМБА им. А.И. Бурназяна" ФМБА России; ГБУЗ "НИИ скорой помощи им. Н.В. Склифосовского ДЗМ"Burnasyan Federal Medical Biophysical Center; Sklifosovsky Research Institute for Emergency Medicine202308022024221238723872Copyright © Кучеров А.А., Ершова А.И., Сюткин В.Е., Драпкина О.М., 20232023Кучеров А.А., Ершова А.И., Сюткин В.Е., Драпкина О.М.Kucherov A.A., Ershova A.I., Syutkin V.E., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/3872

Трансплантация печени (ТП) требует не только тщательно организованной системы мониторирования состояния пациентов в раннем послеоперационном периоде, но и надежной координации действий врачей разных специальностей в отдаленном периоде, в частности врачей терапевтического профиля, что обусловлено улучшением выживаемости реципиентов печеночного транплантата, смещением в структуре смертности в сторону сердечно-сосудистых заболеваний и необходимостью коррекции часто возникающих у реципиентов донорской печени метаболических осложнений, в частности гиперлипидемии. Лечение нарушений липидного обмена после ТП включает изменение образа жизни, коррекцию иммуносупрессивной терапии и применение медикаментозной гиполипидемической терапии (ГЛТ), снижающей сердечно-сосудистый риск. Применение ГЛТ у пациентов после ТП ограничивают потенциальные побочные эффекты, обусловленные  лекарственными  взаимодействиями, в частности миопатия вплоть до рабдомиолиза. Согласно текущим клиническим рекомендациям, у пациентов после ТП наиболее безопасным представляется назначение правастатина и флувастатина, применение которых ограничено низкой доступностью и невысокой эффективностью. Перспективным представляется расширение возможностей ГЛТ у пациентов после ТП за счет применения эзетимиба, имеющего потенциально благоприятный профиль переносимости при сочетании с иммуносупрессантами, питавастатина, метаболизирующегося через изоферменты цитохрома P-450, не вовлеченные в метаболизм иммуносупрессантов, и метаболически нейтральных ингибиторов PCSK9.

Liver transplantation (LT) requires not only a carefully organized system for monitoring the condition of patients in the early postoperative period, but also reliable coordination of the actions of doctors of different specialties in the long-term period. This is due to improved survival of liver transplant recipients and a shift in the mortality structure towards cardiovascular diseases and the need to correct metabolic complications that often occur in recipients, in particular hyperlipidemia. Treatment of lipid metabolism disorders after LT includes lifestyle changes, immunosuppressive and lipid-lowering therapy (LLT), which reduces cardiovascular risk. The use of LLT in patients after LT is limited by potential side effects caused by drug interactions, in particular myopathy up to rhabdomyolysis. According to current clinical guidelines, the safest treatment for patients after LT is pravastatin and fluvastatin, the use of which is limited by low availability and low efficacy. It seems promisingto improve LLT in patients after LT through the use of ezetimibe, which has a potentially favorable tolerability profile when combined with immunosuppressants, as well as pitavastatin, which is metabolized through cytochrome P-450 isoenzymes not involved in the metabolism of immunosuppressants, and metabolically neutral PCSK9 inhibitors.

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