nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-831Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЛегочные инфекции у реципиентов ренального аллотрансплантата (Результаты одноцентрового исследования)Lung infections in renal transplant recipients Data of single-center studyПрокопенкоЕ. И.ProkopenkoE. I.renalnephron@gmail.comЩербаковаЕ. О.ScherbakovaE. O.noemail@neicon.ruВатазинА. В.VatazinA. V.noemail@neicon.ruРусановаЕ. В.RusanovaE. V.noemail@neicon.ruГулимоваС. Ю.GulimovaS. U.noemail@neicon.ruЯнковойА. Г.YankovoyA. G.noemail@neicon.ruФоминыхН. М.FominiyhN. M.noemail@neicon.ruГУ «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияVladimirsky Moscow Region Research Clinical Institute, MoscowRussian Federation201117062025132101111Copyright © Прокопенко Е.И., Щербакова Е.О., Ватазин А.В., Русанова Е.В., Гулимова С.Ю., Янковой А.Г., Фоминых Н.М., 20252025Прокопенко Е.И., Щербакова Е.О., Ватазин А.В., Русанова Е.В., Гулимова С.Ю., Янковой А.Г., Фоминых Н.М.Prokopenko E.I., Scherbakova E.O., Vatazin A.V., Rusanova E.V., Gulimova S.U., Yankovoy A.G., Fominiyh N.M.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/831

У 204 реципиентов ренального трансплантата (РТ), оперированных в Центре трансплантации и диализа МОНИКИ в январе 2005 г. – июне 2010 г., были изучены частота развития, этиология, клинические и рентгенологические особенности, факторы риска и исходы легочных инфекций (ЛИ). Пневмонии развились у 31 больного (14,2%). Бактериальные пневмонии составили 19,3% всех ЛИ, вирусно-бактериальные – 19,3%, туберкулез – 16,2%, пневмонии смешанной этиологии (3–4 возбудителя) – 45,2%. Наиболее частыми клиническими признаками ЛИ были повышение температуры тела (100%), одышка (61,3%) и общая слабость (54,8%). При рентгеновской компьютерной томографии чаще всего выявлялись очаги и фокусы уплотнения легочной ткани (74,4%), симптом «матового стекла» (72,7%), участки пневмофиброза (45,5%) и лимфаденопатия средостения (45,5%). Общая летальность составила 35,5%. Наиболее высокая летальность наблюдалась в группе больных с ЛИ смешанной этиологии. Пневмонии оказывали значимое негативное влияние на выживаемость реципиентов и РТ. Достоверными факторами риска развития ЛИ после трансплантации почки были отсроченная функция РТ (OR 3,31; p = 0,014), хроническая дисфункция трансплантата (OR 3,48; p = 0,002), острое отторжение (OR 3,72; p = 0,004), применение антилимфоцитарных антител (OR 2,96; p = 0,011), хирургические осложнения (OR 3,04; p = 0,013), ЦМВ-инфекция (OR 4,39; p = 0,0002), ЭБВ-инфекция (OR 3,49; p = 0,009) и лейкопения (OR 5,76; p = 0,0002). Для уменьшения частоты тяжелых ЛИ и снижения летальности реципиентов РТ необходимы выявление больных повышенного риска развития легочных инфекционных осложнений, тщательный клинический мониторинг этой группы пациентов, посттрансплантационная профилактика инфекций валганцикловиром и триметопримом/сульфаметоксазолом, своевременная диагностика и раннее начало лечения пневмоний.

We evaluated the incidence, aetiology, clinical and radiological features, the risk factors and outcome of pulmonary infections (PI) in 204 patients who received renal transplant (RT) from January 2005 to June 2010 in our centre. Pneumonia developed in 31 RT recipients (14,2%). Among all patients with PI, 19,3% had bacterial infection, 19,3% had viral and bacterial infection, 45,2% had polyaetiological infection (3–4 microorganisms) and 16,2% had pulmonary tuberculosis. The most common clinical signs of PI were fever (100%), dyspnoea (61,3%), and general fatigue (54,8%). Chest CT scan most often revealed consolidation (74,4%), ground-glass opacity (72,7%), local pneumofibrosis (45,4%) and mediastinal lymphadenopathy (45,5%). Overall mortality rate was 35,5%. The highest mortality was observed in patients with severe polyaetiological pneumonia. PI had a great negative impact on recipients and RT survival. Significant risk factors for PI were delayed graft function (OR 3,31, p = 0,014), chronic graft dysfunction (OR 3,48, p = 0,002), acute rejection of RT (OR 3,72, p = 0,004), treatment with antilymphocytic antibodies (OR 2,96, p = 0,011), CMV infection (OR 4,39, p = 0,0002), EBV infection (OR 3,49, p = 0,009) and leukopenia (OR 5,76, p = 0,0002). Identifying patients with risk factors and careful clinical monitoring, posttransplant chemoprophylaxis with valganciclovir and trimethoprim-sulphamethoxazole, early diagnosis and early treatment are necessary to decrease the incidence of severe pneumonia and mortality from PI in RT recipients.

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