transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2011-0-2-3-75-79transplantologiya-340Research ArticleПРОФИЛАКТИКА И ЛЕЧЕНИЕPREVENTION AND TREATMENTПрименение гипербарической оксигенации в комплексной терапии больных после трансплантации почки в раннем послеоперационном периодеUse of hyperbaric oxygenation in the combination therapy of posttransplant kidney patients in the early postoperative periodРомасенкоМ. В.RomasenkoM. V.ЛевинаО. А.LevinaO. A.

Ольга Аркадьевна Левина

levina_olga@bk.ruПинчукА. В.PinchukA. V.СторожевР. В.StorozhevR. V.РжевскаяО. Н.RzhevskayaO. N.НИИ скорой помощи им. Н.В. СклифосовскогоРоссияResearch Institute for Emergency named after N.V. SklifosovskyRussian Federation20112108201802-37579Copyright © Ромасенко М.В., Левина О.А., Пинчук А.В., Сторожев Р.В., Ржевская О.Н., 20182018Ромасенко М.В., Левина О.А., Пинчук А.В., Сторожев Р.В., Ржевская О.Н.Romasenko M.V., Levina O.A., Pinchuk A.V., Storozhev R.V., Rzhevskaya O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/340Введение

Введение. Посттрансплантационный острый канальцевый некроз (ОКН) является преимущественно ишемической травмой, обусловленной в основном развитием реперфузионного синдрома, нарушением микроциркуляции и усугублением гипоксии пересаженного органа. Одним из методов борьбы с общей и регионарной гипоксией, лежащей в основе развития ишемического повреждения трансплантата, служит гипербарическая оксигенация (ГБО), позволяющая осуществлять доставку кислорода к органам и тканям за счет растворения его в жидких средах организма. Цель исследования – оценка эффективности ГБО в комплексной терапии пациентов с тяжелым ишемическим повреждением трансплантата почки в раннем послеоперационном периоде.

Материалы и методы

Материалы и методы. Проведен сравнительный анализ течения раннего послеоперационного периода после трансплантации почки в 2 группах больных: основной (29 пациентов, получавших сеансы ГБО в комплексной терапии) и контрольной (24 пациента, получавших традиционную терапию). Сеансы ГБО проводили в одноместных лечебных барокамерах при режиме 1,2–1,6 АТА в течение 40 мин. Проводили корреляционный анализ связи времени холодовой ишемии трансплантата и таких показателей, как восстановление водовыделительной функции, нормализация уровня азотемии, уровень креатинина и мочевины, количество процедур гемодиализа в указанных сравниваемых группах.

Результаты

Результаты. Проведенный анализ показал, что имеется прямая корреляционная связь между изучаемыми параметрами. Функция почечного трансплантата в основной группе восстанавливалась в более ранние сроки по сравнению с контрольной группой.

Выводы

Выводы. Раннее включение ГБО в комплексное лечение после трансплантации почки способствует более быстрому восстановлению функции трансплантата. Проведенное исследование позволяет считать необходимым максимально раннее включение ГБО в комплексное лечение, проводимое в ранние сроки после трансплантации почки.

Background

Background. Posttransplantation acute tubular necrosis (CTN) is mainly an ischemic injury caused predominantly by reperfusion syndrome, impaired microcirculation, and worsening hypoxia of a transplanted organ. Hyperbaric oxygenation (HBO) making possible the delivery of oxygen to organs and tissues, by dissolving it in the body’s fluids, is one of the methods for combating systemic and regional hypoxia underlying the development of ischemic graft injury.

Objective

Objective: to evaluate the efficiency of HBO in the combination therapy of patients with severe ischemic kidney graft injury in the early postoperative period.

Subjects and methods

Subjects and methods. The early postoperative period after kidney transplantation was comparatively analyzed in 2 patient groups: study (29 patients were given HBO sessions in the combination therapy) and control (24 patients receiving traditional therapy) ones. HBO sessions were carried out in single-person medical altitude chambers at 1.2-1.6 ATA for 40 min. A correlation analysis was made between cold graft ischemia time and indicators, such as recovered water excretory function, normalized azotemia level, the level of creatinine and urea, and the number of hemodialysis sessions in the above comparison groups.

Results

Results. The performed analysis has shown that there is a direct correlation between the parameters under study. In the study group, renal graft function recovered in the earlier periods than that in the control group.

Conclusion

Conclusion. The early incorporation of HBO into combination treatment after kidney transplantation contributes to prompter recovery of graft function. The conducted study permits one to consider that HBO should be incorporated as soon as possible into the combination treatment performed in the early period after kidney transplantation.

трансплантация почкиреперфузионный синдромгипоксияострый канальцевый некрозгипербарическая оксигенацияkidney transplantationreperfusion syndromehypoxiaacute tubular necrosishyperbaric oxygenationReferencesSawai T., Niimi A., Takahashi H., Ueda M. Histologic study of the effect of hyperbaric oxygen therapy on autogenous free bone grafts. J Oral Maxillofac Surg 1996; 54(8):975–81.Sawai T., Niimi A., Takahashi H., Ueda M. Histologic study of the effect of hyperbaric oxygen therapy on autogenous free bone grafts. J Oral Maxillofac Surg 1996; 54(8):975–81.Kutlay M., Colak A., Demircan N. et al. Effect of hyperbaric oxygen therapy on fetal spinal grafts: an experimental study. Undersea Hyperb Med 2000;27:205–13.Kutlay M., Colak A., Demircan N. et al. Effect of hyperbaric oxygen therapy on fetal spinal grafts: an experimental study. Undersea Hyperb Med 2000;27:205–13.Juang J.-H., Hsu B.R.S., Kuo C.H. et al. Beneficial effects of hyperbaric oxygen therapy on islet transplantation. Cell Transplant 2002;11(2):95–101.Juang J.-H., Hsu B.R.S., Kuo C.H. et al. Beneficial effects of hyperbaric oxygen therapy on islet transplantation. Cell Transplant 2002;11(2):95–101.Muradlidharan V., Cristophi C. Hyperbaric oxygen therapy and liver transplantation. HPB (Oxford) 2007; 9(3):174–82.Muradlidharan V., Cristophi C. Hyperbaric oxygen therapy and liver transplantation. HPB (Oxford) 2007; 9(3):174–82.Трансплантология. Руководство. Под ред. В.И. Шумакова. Гл. 1. Трансплантация почки. М.: Медицина,1995; с.183–210.Трансплантология. Руководство. Под ред. В.И. Шумакова. Гл. 1. Трансплантация почки. М.: Медицина,1995; с.183–210.Хубутия М.Ш., Пинчук А.В. Трансплантация почки. В кн.: Трансплантация органов и тканей в многопрофильном научном центре. Под ред. М.Ш. Хубутия. М., 2011; с. 144–72.Хубутия М.Ш., Пинчук А.В. Трансплантация почки. В кн.: Трансплантация органов и тканей в многопрофильном научном центре. Под ред. М.Ш. Хубутия. М., 2011; с. 144–72.Piper H.M., Garcia-Dorado D., Ovize M. A fresh look at reperfusion injury. Cardiovasc Res 1998;38:291–300.Piper H.M., Garcia-Dorado D., Ovize M. A fresh look at reperfusion injury. Cardiovasc Res 1998;38:291–300.Mashiach E., Sela S., Winaver J. et al. Renal ischemia-reperfusion injury: contribution of nitric oxide and renal blood flow. Nephron 1998;80:458–67.Mashiach E., Sela S., Winaver J. et al. Renal ischemia-reperfusion injury: contribution of nitric oxide and renal blood flow. Nephron 1998;80:458–67.Kihara K., Ueno S., Sakoda M., Aikou T. Effects of hyperbaric oxygen exposure on experimental hepatic ischemia reperfusion injury: relationship between its time and neutrophil sequestration . Liver Transpl 2005;11(12):1574–80.Kihara K., Ueno S., Sakoda M., Aikou T. Effects of hyperbaric oxygen exposure on experimental hepatic ischemia reperfusion injury: relationship between its time and neutrophil sequestration . Liver Transpl 2005;11(12):1574–80.Wang W., Jittikanont S., Falk S.A. et al. Interaction among nitric oxide, reactive oxygen species and antioxydants during endotoxemia-related acute renal failure. Am J Physiol Renal Physiol 2003;284(3):532–7.Wang W., Jittikanont S., Falk S.A. et al. Interaction among nitric oxide, reactive oxygen species and antioxydants during endotoxemia-related acute renal failure. Am J Physiol Renal Physiol 2003;284(3):532–7.Thom S. Oxidative stress is fundamental to hyperbaric oxygen therapy. J Appl Physiol 2008;106(3):988–95.Thom S. Oxidative stress is fundamental to hyperbaric oxygen therapy. J Appl Physiol 2008;106(3):988–95.Rubinstein I., Abassi Z., Milman F. et al. Hyperbaric oxygen treatment improves GFR in rat with ischemia/reperfusion renal injury: a possible role for the antioxidant/oxidant balance in the ischemic kidney. Nephrol Dial Transplant 2009;24(2):428–36.Rubinstein I., Abassi Z., Milman F. et al. Hyperbaric oxygen treatment improves GFR in rat with ischemia/reperfusion renal injury: a possible role for the antioxidant/oxidant balance in the ischemic kidney. Nephrol Dial Transplant 2009;24(2):428–36.Kolski J., Mazolewski P.J., Stephenson L.L. et al. Effect of hyperbaric oxygen therapy on testicular ischemia-reperfusion injury. J Urol 1998;160(2):601–4.Kolski J., Mazolewski P.J., Stephenson L.L. et al. Effect of hyperbaric oxygen therapy on testicular ischemia-reperfusion injury. J Urol 1998;160(2):601–4.Buras J. Basic mechanism of hyperbaric oxygen in the treatment of ischemiareperfusion injury. Int Anesthesiol Clin 2000; 38(1):91–109.Buras J. Basic mechanism of hyperbaric oxygen in the treatment of ischemiareperfusion injury. Int Anesthesiol Clin 2000; 38(1):91–109.Ozden T., Uzun H., Bohloli M. et al. The effect of hyperbaric oxygen treatment on oxidant and antioxidant levels during liver regeneration in rats. Tohoku J Exp Med 2004;203 (4):253–65.Ozden T., Uzun H., Bohloli M. et al. The effect of hyperbaric oxygen treatment on oxidant and antioxidant levels during liver regeneration in rats. Tohoku J Exp Med 2004;203 (4):253–65.Gurer A., Ozdogan M., Gomceli I. et al. Hyperbaric oxygenation attenuates renal ischemia-reperfusion injury in rats. Transplant Proc 2006; 38(10):3337– 40.Gurer A., Ozdogan M., Gomceli I. et al. Hyperbaric oxygenation attenuates renal ischemia-reperfusion injury in rats. Transplant Proc 2006; 38(10):3337– 40.Solmazgul E., Uzun G., Cermik H. et al. Hyperbaric oxygenation attenuates renal ischemia-reperfusion injury in rats. Urol Int 2007;78(1):82–5.Solmazgul E., Uzun G., Cermik H. et al. Hyperbaric oxygenation attenuates renal ischemia-reperfusion injury in rats. Urol Int 2007;78(1):82–5.Benson R., Minter L.M., Osborne B.A. et al. Hyperbaric oxygen inhibits stimulus induced proinflammatory cytocine synthesis by human blood derived monocyte macrophages Clin Exp Immunol 2003;134:57–62.Benson R., Minter L.M., Osborne B.A. et al. Hyperbaric oxygen inhibits stimulus induced proinflammatory cytocine synthesis by human blood derived monocyte macrophages Clin Exp Immunol 2003;134:57–62.Mizuguchi T. Hyperbaric oxygen stimulated cell proliferation and normalizes multidrug resistance protein-2 protein localization in primary rat hepatocyres. Wound Repair Regen 2005;6(13):551–7.Mizuguchi T. Hyperbaric oxygen stimulated cell proliferation and normalizes multidrug resistance protein-2 protein localization in primary rat hepatocyres. Wound Repair Regen 2005;6(13):551–7.Labrouche S., Javorschi S., Leroy D. et al. Influence of hyperbaric oxygen on leukocyte functions and haemostasis in normal volunteer dives. Thromb Res1999; 96:309–15.Labrouche S., Javorschi S., Leroy D. et al. Influence of hyperbaric oxygen on leukocyte functions and haemostasis in normal volunteer dives. Thromb Res1999; 96:309–15.Larson J.L., Stephenson L.L., Zamboni W.A. Effect of hyperbaric oxygen on neutrophil CD 18 expression. Plast Peconstr Surg 2000;4(105):1375–81.Larson J.L., Stephenson L.L., Zamboni W.A. Effect of hyperbaric oxygen on neutrophil CD 18 expression. Plast Peconstr Surg 2000;4(105):1375–81.MacKenzie D.A., Sollinger H.W., Hullett D.A. et al. Decreased immunogenicity of human fetal pancreas allografts following hyperbaric oxygen culture. Transplant Proc 2003;35(4): 1449–502.MacKenzie D.A., Sollinger H.W., Hullett D.A. et al. Decreased immunogenicity of human fetal pancreas allografts following hyperbaric oxygen culture. Transplant Proc 2003;35(4): 1449–502.Miao G., Ostrowski R. P., Mace J. et al. Dynamic production of hypoxia- Induction factor -1 (alfa) in early transplanted islets. Am J Transplantation 2006;6(11):2636–43.Miao G., Ostrowski R. P., Mace J. et al. Dynamic production of hypoxia- Induction factor -1 (alfa) in early transplanted islets. Am J Transplantation 2006;6(11):2636–43.Mazariegos G.V., O'Toole K., Mieles L.A. et al. Hyperbaric oxygen therapy for hepatic artery thrombosis after liver transplantation in children. Liver Transpl Surg 1999;5(5):429–36.Mazariegos G.V., O'Toole K., Mieles L.A. et al. Hyperbaric oxygen therapy for hepatic artery thrombosis after liver transplantation in children. Liver Transpl Surg 1999;5(5):429–36.Dubost T., Goubaux B., Duhalde M. et al. Use of hyperbaric oxygen for hepatic artery thrombosis following adult orthotopic liver transplantation. Eur J Anesthesiol 2002;19(3):223–4.Dubost T., Goubaux B., Duhalde M. et al. Use of hyperbaric oxygen for hepatic artery thrombosis following adult orthotopic liver transplantation. Eur J Anesthesiol 2002;19(3):223–4.Suehiro T., Shimura T., Okamura K. et al. The effect of hyperbaric oxygen treatment on postoperative morbidity of left lobe donor in living donor adult liver transplantation. Hepatogastroenterology 2008;55(84):1014–9.Suehiro T., Shimura T., Okamura K. et al. The effect of hyperbaric oxygen treatment on postoperative morbidity of left lobe donor in living donor adult liver transplantation. Hepatogastroenterology 2008;55(84):1014–9.

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