nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2017-21-6-20-28nefr-309Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSПОСТТРАНСПЛАНТАЦИОННЫЙ САХАРНЫЙ ДИАБЕТ У РЕЦИПИЕНТОВ РЕНАЛЬНОГО ТРАНСПЛАНТАТА: ОПЫТ ОДНОГО ЦЕНТРАNEW-ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION: SINGLE CENTER EXPERIENCEПрокопенкоЕ. И.ProkopenkoE. I.

Прокопенко Елена Ивановна - доктор медицинских наук, факультет усовершенствования  врачей,  кафедра  трансплантологии,  нефрологии и искусственных органов.

129110, Москва,  ул.  Щепкина,  д.  61/2, тел.: (495) 684-57-91

Elena I. Prokopenko - MD PhD, Post-graduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, 495)684-57-91

renalnephron@gmail.comВатазинА. В.VatazinA. V.

Ватазин Андрей Владимирович - доктор медицинских наук, проф., факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва,  ул.  Щепкина,  д.  61/2, тел.: (495) 684-54-53

Prof. Andrey V. Vatazin - MD PhD, Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, (495)684-54-53

vatazin@yandex.ruЩербаковаЕ. О.ShcherbakovaE. O.

Щербакова Евгения Оттовна - кандидат медицинских наук, факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва, ул. Щепкина, д. 61/2, тел.: (495) 684-57-91

Evgenia O. Shcherbakova - MD PhD, Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, (495) 684-57-91

eottovna@yandex.ruКантарияР. О.KantariyaR. O.

Кантария Русудана Отаровна - кандидат медицинских наук, факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва, ул. Щепкина, д. 61/2, тел.: (495) 684-57-91

Rusudana O. Kantariya - MD PhD, Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, (495) 684-57-91

rusiko_k@mail.ruМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияM.F. Vladimirsky Moscow Regional Research Clinical InstituteRussian Federation2017281120172162028Copyright © Прокопенко Е.И., Ватазин А.В., Щербакова Е.О., Кантария Р.О., 20172017Прокопенко Е.И., Ватазин А.В., Щербакова Е.О., Кантария Р.О.Prokopenko E.I., Vatazin A.V., Shcherbakova E.O., Kantariya R.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/309

Посттрансплантационный сахарный диабет (ПТСД),  развивающийся у реципиентов ренального трансплантата, может не только способствовать развитию различных осложнений, но и оказывать существенное негативное влияние на результаты трансплантации почки (ТП).

Цель

Цель. Сравнение клинико-демографических показателей и результатов ТП у реципиентов ренального трансплантата с ПТСД и без данного осложнения.

Пациенты и методы

Пациенты и методы.  В исследование включены 439 пациентов 18 лет и старше без претрансплантационного диабета, которым была выполнена ТП от умершего  донора в нашем центре с 01.01.2007 г. по 31.12.2016 г. Все пациенты после ТП получали ингибиторы кальцинейрина и микофенолаты, 322 больных принимали такролимус (ТАК), 117 – циклоспорин А (ЦсА). Иммуносупрессию без стероидов получали 17 реципиентов.

Результаты

Результаты.  ПТСД развился у 41 (9,3%) из 439 пациентов: у 33 (10,2%) из 322 на ТАК и 8 из 117  (6,8%) на ЦсА, p=0,368. Группы с ПТСД и без ПТСД не различались по полу,  доле больных с поликистозом почек, модальности и продолжительности диализной терапии, характеру иммуносупрессии, хотя имелась тенденция к более старшему возрасту и более высокому индексу массы тела у больных с ПТСД. В группе ПТСД было достоверно больше больных с исходным метаболическим синдромом (31,7% против 12,3%, p=0,002), посттрансплантационными хирургическими осложнениями (21,9% против 8,5%, p=0,012), грибковыми инфекциями (14,6% против 5,0%, p=0,026), сердечно-сосудистыми осложнениями (26,8% против 9,8%, p=0,003), пациентов, погибших с функционирующим трансплантатом (17,1% против 5,5%, p=0,0012). Выживаемость реципиентов и трансплантатов была достоверно ниже  в группе ПТСД (p=0,008 и p=0,022 соответственно).

Заключение

Заключение. ПТСД негативно влияет на результаты ТП. Профилактика, раннее выявление и адекватное лечение ПТСД могут способствовать снижению частоты осложнений после ТП и улучшению выживаемости реципиентов и трансплантатов.

New-onset diabetes mellitus  after  transplantation (NODAT) in kidney  transplant recipients promote the development of complications and  have  a negative impact on kidney  transplantation (KT) results.

Aim

Aim. Comparison of clinico-demographic characteristics and  KT results in recipients with and  without  NODAT.

Patients and methods

Patients and methods.  Study included 439  patients 18+ years without  pre-transplantation diabetes who  underwent KT from  the  deceased donor in our  center from  01.01.2007 to 31.12.2016. All patients after  KT received calcineurin inhibitors and  mycophenolate, 322 received tacrolimus (TAK), 117cyclosporin A (CsA). Seventeen recipients received immunosuppression without  steroids.

Results

Results. NODAT developed in 41 (9.3%) of 439 patients: 33 (10.2%) of 322 on TAK, and  8 of 117 (6.8%) on CsA, p=0.368. The groups with NODAT and  without NODAT did not differ in gender, proportion of patients with polycystic kidney disease, modality and duration of dialysis, features of immunosuppression, although there was  a tendency for older  age and  higher body  mass index  in patients with NODAT. In NODAT group there were significantly more patients with preexisting metabolic syndrome (31.7% versus 12.3%, p = 0.002), post-transplant surgical complications (21.9% vs. 8.5%, p= 0.012), fungal  infections (14.6% vs 5.0%, p=0.026), cardiovascular  complications (26.8% vs. 9.8%, p=0.003), patients who  died  with functioning graft  (17.1% % vs. 5.5%, p = 0.0012). Recipients and  transplants survival was significantly lower in NODAT group (p=0.008, p=0.022, resp.).

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