nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2013-17-3-9-13nefr-490Research ArticleПЕРЕДОВАЯ СТАТЬЯLEADING ARTICLEРЕКУРРЕНТНЫЕ ЗАБОЛЕВАНИЯ В ПЕДИАТРИЧЕСКОЙ ПОЧЕЧНОЙ ТРАНСПЛАНТАЦИИRECURRENT DISEASES IN PEDIATRIC RENAL TRANSPLANTATIONКошаП.CochatP.

Pierre Cochat, MD Service de pédiatrie

59 boulevard Pinel. 69677 Bron cedex; Tel: +33 4 27856125

Pierre Cochat, MD Service de pédiatrie

59 boulevard Pinel. 69677 Bron cedex; Tel: +33 4 27856125

pierre.cochat@chu-lyon.frХарамбаЖ.HarambatJ.

Jérôme Harambat

ЛеклеркА-Л.LeclercA.-L.

Anne-Laure Leclerc

Centre de référence des maladies rénales rares, Service de Pédiatrie & 2.Epicime, Hôpital Femme Mère Enfant & Université de LyonФранцияCentre de référence des maladies rénales rares, Service de Pédiatrie & 2.Epicime, Hôpital Femme Mère Enfant & Université de LyonFranceNéphrologie pédiatrique, Hôpital des Enfants, CHUФранцияNéphrologie pédiatrique, Hôpital des Enfants, CHUFrance201310032013173916Copyright © Коша П., Харамба Ж., Леклерк А., 20132013Коша П., Харамба Ж., Леклерк А.Cochat P., Harambat J., Leclerc A.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/490

Риск развития рекуррентного заболевания после трансплантации почки у детей относительно высокий и может привести к потере трансплантата в 7–8% случаев. Рецидив основного заболевания почек может быть связан с высоким риском потери трансплантата (фокальный и сегментарный гломерулосклероз, мембранопролиферативный гломерулонефрит, оксалоз, атипичный гемолитико-уремический синдром) или с низким риском потери трансплантата (IgA-нефропатия, СКВ, ANCA-ассоциировынный гломерулонефрит). Рецидив также может повышать отсроченный риск потери трансплантата при таких заболеваниях, как инсулин-зависимый сахарный диабет и серповидно-клеточная анемия. В связи с этим необходимо применять соответствующую стратегию, например, проводить претрансплантационное генотипирование, адекватный отбор доноров, использовать специфическую иммуносупрессию и/или биотерапию, сочетанную трансплантацию почки и печени, а также другие. Это позволит значительно расширить лист ожидания за счет существенного снижения исключения пациентов из-за высокого развития рецидива. В будущем проблема рекуррентных заболеваний после трансплантации почки может решиться благодаря альтернативным методам лечения.

The risk of disease recurrence (DR) after renal transplantation (Tx) is relatively high in children and may lead to graft loss (GL) representing 7 to 8% of all graft failures. Recurrence of the prior disease may be associated with either a high risk of GL (focal and segmental glomerulosclerosis, membranoproliferative glomerulonephritis, oxalosis, atypical hemolytic uremic syndrome) or with a low risk of GL (IgA nephropathy, SLE, ANCA-associated glomerulonephritis). Recurrence may also increase delayed risk of GL at such diseases as insulin-dependent diabetes mellitus and sickle cell disease. Adequate strategies should therefore be added to kidney Tx, such as pre-Tx genotyping, adequate donor selection, specific immunosuppression and/or biotherapy, combined liver and kidney Tx, etc. This will allow significantly enlarge waiting list because very few patients would be excluded from kidney Tx because of a major risk of DR. In the future, the issue of DR after kidney Tx may be resolved due to alternative treatment methods.

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