transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2026-18-1-50-66transplantologiya-1077Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONРанние и отдаленные исходы пересадки первично инфицированного почечного трансплантатаEarly and long-term outcomes of primary infected kidney transplantationhttps://orcid.org/0000-0002-0746-1884ХубутияМ. Ш.KhubutiyaM. Sh.

Могели Шалвович Хубутия, акад. РАН, проф., д-р мед. наук, президент; заведующий

129090, Москва, Большая Сухаревская пл., д. 3

127006, Россия, Москва, Долгоруковская ул., д. 4

Mogeli Sh. Khubutiya, Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), President; Head 

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

4 Dolgorukovskaya St., Moscow 127006 

khubutiyams@sklif.mos.ruhttps://orcid.org/0000-0002-2232-7296ЛоньшаковД. В.LonshakovD. V.

Денис Владимирович Лоньшаков, врач хирург отделения трансплантации почки и поджелудочной железы

129090, Москва, Большая Сухаревская пл., д. 3

Denis V. Lonshakov, Surgeon, Kidney and Pancreas Transplantation Department

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

lonshakovdv@sklif.mos.ruhttps://orcid.org/0000-0002-1396-7048БалкаровА. Г.BalkarovA. G.

Аслан Галиевич Балкаров, канд. мед. наук, заведующий научным отделением трансплантации почки и поджелудочной железы; доцент

129090, Москва, Большая Сухаревская пл., д. 3

117997, Москва, ул. Островитянова, д. 1

Aslan G. Balkarov, Cand. Sci. (Med.), Head of the Scientific Department of Kidney and Pancreas Transplantation; Associate Professor 

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

1 Ostrovityanov St., Moscow 117997 

balkarovag@sklif.mos.ruhttps://orcid.org/0000-0002-8199-905XШмаринаН. В.ShmarinaN. V.

Нонна Валерьевна Шмарина, канд. мед. наук, старший научный сотрудник отделения трансплантации почки и поджелудочной железы; доцент

129090, Москва, Большая Сухаревская пл., д. 3

117997, Москва, ул. Островитянова, д. 1

Nonna V. Shmarina, Cand. Sci. (Med.), Senior Researcher, Department of Kidney and Pancreas Transplantation; Associate Professor 

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

1 Ostrovityanov St., Moscow 117997 

shmarinanv@sklif.mos.ruhttps://orcid.org/0000-0002-6167-7117ЧерненькаяТ. В.ChernenkayaT. V.

Татьяна Витальевна Черненькая, канд. мед. наук, заведующая научным отделением лаборатории клинической микробиологии

129090, Москва, Большая Сухаревская пл., д. 3

Tatyana V. Chernenkaya, Cand. Sci. (Med.), Head of the Scientific Department, Clinical Microbiology Laboratory

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

chernenkayatv@sklif.mos.ruhttps://orcid.org/0000-0003-1769-7038КулабуховВ. В.KulabukhovV. V.

Владимир Витальевич Кулабухов, канд. мед. наук, ведущий научный сотрудник отдела неотложной хирургии, эндоскопии и интенсивной терапии

129090, Москва, Большая Сухаревская пл., д. 3

Vladimir V. Kulabukhov, Cand. Sci. (Med.), Leading Researcher, Department of Emergency Surgery, Endoscopy, and Intensive Care

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

kulabukhovvv@sklif.mos.ruhttps://orcid.org/0000-0002-5731-3310ДмитриевИ. В.DmitrievI. V.

Илья Викторович Дмитриев, д-р мед. наук, заведующий отделением трансплантации почки и поджелудочной железы; доцент 

129090, Москва, Большая Сухаревская пл., д. 3

117997, Москва, ул. Островитянова, д. 1

 

Ilya V. Dmitriev, Dr. Sci. (Med.), Head of the Kidney and Pancreas Transplantation Department; Associate Professor 

3 Bolshaya Sukharevskaya Sq., Moscow 129090 

1 Ostrovityanov St., Moscow 117997 

dmitrieviv@sklif.mos.ruГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов Научно-образовательного института «Высшая школа клинической медицины им. Н.А. Семашко» ФГБОУ ВО «Российский университет медицины» МЗ РФРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Department of Transplantology and Artificial Organs of the Scientific and Educational Institute "N.A. Semashko Higher School of Clinical Medicine", Russian University of MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов им. В.П. Демихова МБФ ФГАОУ ВО РНИМУ им. Н.И. Пирогова МЗ РФ (Пироговский Университет)РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; V.P. Demikhov Department of Transplantology and Artificial Organs, N.I. Pirogov Russian National Research Medical University (Pirogov University)Russian Federation2026160320261815066Copyright © Хубутия М.Ш., Лоньшаков Д.В., Балкаров А.Г., Шмарина Н.В., Черненькая Т.В., Кулабухов В.В., Дмитриев И.В., 20262026Хубутия М.Ш., Лоньшаков Д.В., Балкаров А.Г., Шмарина Н.В., Черненькая Т.В., Кулабухов В.В., Дмитриев И.В.Khubutiya M.S., Lonshakov D.V., Balkarov A.G., Shmarina N.V., Chernenkaya T.V., Kulabukhov V.V., Dmitriev I.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/1077Введение

Введение. Пересадка первично инфицированных трансплантатов представляет серьезную проблему клинической трансплантации почки (ТП). Она недостаточно освещена в доступной медицинской литературе. В нашей стране систематических исследований результатов таких трансплантаций не проводили.

Цель

Цель. Оценить частоту пересадки первично инфицированных почечных трансплантатов, структуру микроорганизмов, выделенных при положительных бактериальных посевах перфузатов. Изучить частоту клинически значимых инфекционных осложнений (ИО) у этой категории пациентов и их исходы. Выявить факторы, статистически значимо влиявшие на исходы лечения.

Материал и методы

Материал и методы. В период с 01.01.2015 года по 31.12.2024 года выполнили 1923 ТП от посмертных доноров. Исследуемую группу составили 87 пациентов, у которых выявили положительный бактериальный посев перфузата. Среди них было 42 мужчины (48,3%) и 45 женщин (51,7%). Средний возраст пациентов составил 47±11,9 года. Для оценки влияния клинически значимых ИО на исходы лечения пациенты были разделены на две группы: группу I составили 15 пациентов с клинически значимыми ИО, группу II – 72 пациента без таковых. Пациенты обеих групп были сопоставимы по основным характеристикам.

Результаты

Результаты. Частота пересадки первично инфицированных почечных трансплантатов составила 4,5%. Структура микроорганизмов, вызвавших контаминацию перфузатов: 88 бактериальных штаммов и один грибковый. Из бактерий 51 относилась к грамположительным, 36 – к грамотрицательным, 1 – к анаэробной флоре. Частота клинически значимых ИО составила 17,2%, медиана сроков развития составила 9 (4;12) суток. Развитие ИО значимо снижало выживаемость трансплантата почки. К факторам, значимо влиявшим на исходы, отнесли клинически значимые ИО, выявление в перфузате Klebsiella pneumonia и сахарный диабет 2-го типа у реципиентов.

Заключение

Заключение. Частота пересадки первично инфицированных почечных трансплантатов, как и частота клинически значимых инфекционных осложнений, соответствует данным других трансплантационных центров. Алгоритмы диагностики и лечения инфекционных осложнений позволили избежать смертельных исходов у данной категории пациентов.

Introduction

Introduction. The transplantation of primary infected grafts poses a significant challenge in the field of kidney transplantation. This issue is not adequately addressed in the existing medical literature. In our country, no systematic studies of the results of such transplants have been conducted.

Objective

Objective. To evaluate the frequency of primary infected kidney transplants and the types of microorganisms isolated from positive bacterial cultures of perfusates; to study the frequency of clinically significant infectious complications in this category of patients and their outcomes; to identify factors that had a statistically significant impact on the outcomes.

Material and methods

Material and methods. Between 1 January 2015 and 31 December 2024, 1,923 kidney transplants from deceased donors were performed. The study group consisted of 87 patients who tested positive for bacterial perfusion culture. Of these, 42 (48.3%) were men and 45 (51.7%) were women. The average age of the patients was 47±11.9 years. Patients were divided into two groups to assess the impact of clinically significant infectious complications on treatment outcomes: group I consisted of 15 patients with such complications and group II consisted of 72 patients without. Patients in both groups were comparable in terms of key characteristics.

Results

Results. The frequency of initially infected kidney transplants was 4.5%. The microorganisms causing perfusion contamination were as follows: 88 bacterial strains and one fungal strain. Of these bacteria, 51 were Gram-positive, 36 were Gram-negative and one was anaerobic. Clinically significant infectious complications occurred in 17.2% of cases, with a median time to development of 9 (4;12) days. The development of infectious complications significantly reduced kidney transplant survival. Significant factors included clinically significant infectious complications, the detection of Klebsiella pneumoniae in the perfusate and type 2 diabetes mellitus in patients.

Conclusion

Conclusion. The frequency of primary infected kidney transplants, as well as the frequency of clinically significant infectious complications, is consistent with data from other transplant centers. Algorithms for diagnosing and treating infectious complications enabled fatal outcomes to be avoided in this patient group.

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