nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1991Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESМофетила микофенолат в профилактике острого отторжения почечного трансплантата и лечении хронической трансплантационной нефропатииMycophenolate mofetil in prevention of acute renal allograft rejection and treatment of chronic allograft nephropathyЩербаковаЕ. О.ScherbakovaE. O.noemail@neicon.ruПрокопенкоЕ. И.ProkopenkoE. I.noemail@neicon.ruВатазинА. В.VatazinA. V.noemail@neicon.ruКругловЕ. Е.KrouglovE. E.noemail@neicon.ruПасовС. А.PassovS. A.noemail@neicon.ruБудниковаН. Е.BoudnikovaN. E.noemail@neicon.ruГулимоваС. Ю.GoulimovaS. Yu.noemail@neicon.ruОтделение хронического гемодиализа и трансплантации почки МОНИКИ им. М.Ф. Владимирского, г. МоскваRussian Federation200427062025616977Copyright © Щербакова Е.О., Прокопенко Е.И., Ватазин А.В., Круглов Е.Е., Пасов С.А., Будникова Н.Е., Гулимова С.Ю., 20252025Щербакова Е.О., Прокопенко Е.И., Ватазин А.В., Круглов Е.Е., Пасов С.А., Будникова Н.Е., Гулимова С.Ю.Scherbakova E.O., Prokopenko E.I., Vatazin A.V., Krouglov E.E., Passov S.A., Boudnikova N.E., Goulimova S.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1991

Мофетила микофенолат (ММФ) - мощный иммуносупрессивный препарат, способный снижать частоту кризов отторжения при трансплантации почки и замедлять прогрессирование хронической трансплантационной нефропатии (ХТН). Целью исследования было изучение эффективности ММФ для профилактики острого отторжения почечного трансплантата и для лечения ХТН, а также оценка побочных эффектов препарата. Группа из 47 реципиентов ренального трансплантата, принимавших 1,0-2,0 г/сут ММФ в сочетании с циклоспорином А (ЦсА) и стероидами в течение 6 месяцев после трансплантации, сравнивалась с группой из 47 больных, получавших 3-компонентную иммуносупрессию, включавшую азатиоприн (Аза). Девять пациентов, составивших отдельную группу, принимали ММФ с целью лечения ХТН. При использовании ММФ частота кризов отторжения была достоверно меньше, чем при приеме Аза, - 32,6% против 57,45% соответственно, p = 0,022. У больных группы ММФ среднее АД через 12 месяцев после трансплантации было значимо ниже, чем у пациентов группы Аза (АДсист. = 135,00 ± 2,57 мм рт. ст. в сравнении с 145,90 ± 2,00 мм рт. ст. соответственно, p = 0,001; АДдиаст. = 84,81 ± 1,95 мм рт. ст. в сравнении с 91,03 ± 1,63 мм рт. ст. соответственно, p = 0,017). Частота побочных эффектов была сравнимой в обеих группах, при этом общая частота инфекционных осложнений (включая инфекции мочевой системы) была ниже у больных, принимавших ММФ: 72,3% в группе ММФ и 93,6% в группе Аза, p = 0,012. У больных с ХТН ММФ вызвал снижение уровня креатинина плазмы и протеинурии. У 7 из 9 пациентов наблюдалось улучшение или стабилизация функции трансплантата. По нашему мнению, ММФ является эффективным и безопасным препаратом для профилактики острого отторжения почечного трансплантата и лечения ХТН.

Mycophenolate mofetil (MMF) is a potent immunosuppressant which can reduce an incidence of acute rejection in renal allograft recipients and slow progression of chronic allograft nephropathy (CAN). The aim of our study was to evaluate the effectiveness of MMF in acute transplant rejection and in treatment of CAN and to estimate the adverse effects. A group of renal transplant recipients (n = 47) receiving MMF (1,0-2,0 g/day) with cyclosporine A (CsA) and steroids during 6 months after transplantation was compared with a group (n = 47) taking triple immunosuppression protocol including azathioprine (Aza). Separate group of patients (n = 9) received MMF for treatment of CAN. Acute rejection rate was statistically lower in MMF group comparing with Aza group - 32,6% versus 57,45%, respectively, p = 0,022. In patients receiving MMF mean arterial pressure 12 months after transplantation was lower comparing with patients taking Aza - systolic pressure was 135,00 ± 2,57 mm Hg in MMF group versus 145,90 ± 2,00 mm Hg in Aza group, p = 0,001; diastolic pressure - 84,81 ± 1,95 mm Hg versus 91,03 ± 1,63 mm Hg, respectively, p = 0,017. Incidence of adverse effects was similar in both groups. Total rate of infection episodes (including urinary tract infections) was lower in MMF group than in Aza group - 72,3% versus 93,6%, respectively, p = 0,012. Using of MMF in renal transplant recipients with CAN decreased serum creatinine level and proteinuria. In 7 of 9 patients MMF improved or stabilized allograft function. To our mind, MMF is effective and safe drug to prevent of renal allograft acute rejection and to treat CAN.

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