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ПРОФИЛАКТИКА И ЛЕЧЕНИЕ СИНДРОМА ИШЕМИИ-РЕПЕРФУЗИИ

https://doi.org/10.24884/1561-6274-2019-23-2-41-48

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Аннотация

Основные негативные последствия ишемии-реперфузии почек – рано развивающаяся тяжелая хроническая дисфункция трансплантата, а в наиболее тяжелых случаях – функция трансплантированной почки не восстанавливается (первично нефункционирующий трансплантат). В результате утраты функции трансплантата пациент, как правило, возвращается на диализ. Эти осложнения чаще встречаются при трансплантации почек от «доноров с расширенным критериями», так как эти органы наиболее чувствительны повреждениям, развивающимся в результате синдрома ишемии-реперфузии (ИР-синдром). При этом, доля таких (субоптимальных) доноров постепенно растет в России. Золотым стандартом при трансплантации почки остается холодовая консервация органа в специальных растворах, однако, это не в состоянии полностью защитить орган. В статье представлены основные перспективные методы, которые позволяют снизить тяжесть ишемического и реперфузионного повреждения: кондиционирование донора, ишемическое прекондиционирование, различные варианты консервации почки, воздействие на медиаторы воспаления, применение биологических таргетных препаратов. Тем не менее, патогенез ИР-синдрома изучен значительно лучше, чем методы его коррекции. На данный момент имеются лишь косвенные или экспериментальные свидетельства того, что тяжесть ИР-синдрома может быть уменьшена за счет фармакопротекции органа до изъятия, при консервации, а также в раннем послеоперационном периоде. Необходимы дальнейшие исследования, направленные на поиск возможностей снижения тяжести ишемического и реперфузионного повреждения трансплантата.

 

Об авторах

А. В. Ватазин
Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского
Россия
Проф., д-р мед. наук, Государственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», хирургическое отделение трансплантологии и диализа


Д. В. Артемов
Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского
Россия
Государственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», хирургическое отделение трансплантологии и диализа


А. Б. Зулькарнаев
Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского
Россия
д-р мед. наук, Государственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», хирургическое отделение трансплантологии и диализа


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Для цитирования:


Ватазин А.В., Артемов Д.В., Зулькарнаев А.Б. ПРОФИЛАКТИКА И ЛЕЧЕНИЕ СИНДРОМА ИШЕМИИ-РЕПЕРФУЗИИ. Нефрология. 2019;23(2):41-48. https://doi.org/10.24884/1561-6274-2019-23-2-41-48

For citation:


Vatazin A.V., Artemov D.V., Zulkarnaev A.B. PREVENTION AND TREATMENT OF ISCHEMIA-REPERFUSION SYNDROME. Nephrology (Saint-Petersburg). 2019;23(2):41-48. (In Russ.) https://doi.org/10.24884/1561-6274-2019-23-2-41-48

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ISSN 1561-6274 (Print)
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