Проблемные вопросы оптимизации перевода реципиентов почечного трансплантата из детской во взрослую службу здравоохранения (обзор литературы)

Перевод реципиентов почечного трансплантата из детской во взрослую службу здравоохранения должен представлять спланированный процесс, поскольку сопряжен с различными рисками, вплоть до потери пересаженного органа и смерти пациента. Наиболее критичным возрастом развития неблагоприятных событий является период 17–24 года. Это обусловлено особенностями созревания головного мозга подростков, наличием тяжелого почечного заболевания и необходимостью постоянного приема лекарственных средств. В этом возрасте пациенты испытывают давление со стороны сверстников, озабочены своим внешним видом, развитием личности, стремлениями и мечтами о будущем, что может не осуществиться на фоне длительного хронического заболевания и привести к низкой самооценке, депрессии и гневу. Результатом этих психоэмоциональных переживаний может быть несоблюдение режима приема иммуносупрессивных препаратов с развитием отторжения и даже потери почечного трансплантата. Процесс перехода в идеале должен занимать несколько лет и начинаться рано, обычно в возрасте от 12 до 14 лет. Перевод должен осуществляться не только после наступления определенного возраста, но и на основании имеющихся навыков и готовности пациента. Пациент должен оставаться в педиатрической службе при развитии тяжелых осложнений (отторжение, инфекции) до их излечения и не менее 1 года после трансплантации, даже если на этот период приходится возраст перехода во взрослую службу. После оценки готовности к переходу должен быть составлен структурированный план, требующий объединения медицинских, образовательных, поведенческих и социальных стратегий как во время, так и после него. Создание переходных клиник или выделение должности координатора позволяют контролировать процесс перехода и минимизировать возможные риски и негативные последствия. Разработка и внедрение программ по переходу реципиентов почечного трансплантата во взрослую службу направлены на увеличение выживаемости почечного трансплантата и пациентов, улучшение качества их жизни.

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