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Том 1 №1 1999 год - Нефрология и диализ

Отдаленные результаты трансплантации почки и факторы риска хронической нефропатии отторжения


Ким И. Г. Стенина И. И. Ильинский И. М. Томилина Н. А.

Аннотация: Изучены отдаленные результаты первичной аллотрансплантации трупной почки (АТП) и факторы риска хронического отторжения (ХОТ) на материале наблюдений 232 реципиентов аллогенной почки, оперированных в НИИТ и ИО в период с января 1989 г. по январь 1993 г. и прослеженных не менее 12 мес. после операции. Отдаленные результаты АТП оценивались по выживаемости трансплантатов и периоду полужизни, а факторы риска ХОТ - по актуариальной функциональной выживаемости (АФВ), под которой понимали долю трансплантатов, обеспечивавших нормальный уровень креатинина плазмы крови. Выживаемость трансплантатов через 5 лет после операции составила 57%, период полужизни - 8,1 г. Наиболее частой (в 59% случаев) причиной прекращения функции ренального аллотрансплантата (PAT) было ХОТ. В многофакторной регрессионной модели Кокса выявилась значимая связь ХОТ с антиген-зависимыми (кризы отторжения, адекватность иммуносупрессии) и неспецифическими факторами (уменьшение массы действующих нефронов PAT к 6 мес. после операции, артериальная гипертензия и протеинурия). 5-летняя АФВ PAT при течении без кризов была равна 54%, после 1 криза отторжения - 40%, после повторных кризов - 18%. Отрицательное прогностическое значение имело неполное восстановление функции после криза. Последнее тесно коррелировало с дисфункцией PAT через 6 мес. после АТП. Неадекватность иммуносупрессии констатирована в случаях недостаточной дозировки циклоспорина А и/или отмены азатиоприна. 5-летняя АФВ PAT снижалась при этом на 43% и 27% соответственно. Повышение АД и степень артериальной гипертензии (АГ) значимо коррелировали с АФВ PAT, которая снижалась на 21% при умеренной и на 35% - при выраженной АГ. Последняя была тесно связана с протеинурией, но выступала при этом как независимый фактор. Полученные данные позволяют также считать, что оба указанных синдрома являются ранними предикторами ХОТ.

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Ключевые слова: трансплантированная почка, отдаленные результаты, хроническое отторжение, антиген-зависимые и неспецифические факторы риска, артериальная гипертензия, протеинурия

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