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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">transplantologiya</journal-id><journal-title-group><journal-title xml:lang="ru">Трансплантология</journal-title><trans-title-group xml:lang="en"><trans-title>Transplantologiya. The Russian Journal of Transplantation</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2074-0506</issn><issn pub-type="epub">2542-0909</issn><publisher><publisher-name>IPO Association of Transplantologists</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.23873/2074-0506-2021-13-2-158-164</article-id><article-id custom-type="elpub" pub-id-type="custom">transplantologiya-573</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CASE REPORTS</subject></subj-group></article-categories><title-group><article-title>Случай рабдомиолиза после назначения аторвастатина реципиенту печеночного трансплантата, находящемуся на иммуносупрессивной терапии циклоспорином</article-title><trans-title-group xml:lang="en"><trans-title>A case of rhabdomyolysis after atorvastatin therapy of a liver transplant recipient receiving immunosuppressive therapy with cyclosporine</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0522-0681</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шабунин</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shabunin</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексей Васильевич Шабунин, член-корреспондент РАН, проф., д-р мед. наук, главный врач ГБУЗ ГКБ им. С.П. Боткина ДЗМ, заведующий кафедрой хирургии ФГБОУ ДПО РМАНПО МЗ РФ</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5125993, Москва, Баррикадная ул., д. 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Aleksey V. Shabunin, Corresponding Member of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), Chief Physician of the City Clinical Hospital n.a. S.P. Botkin, Head of the Department of Surgery of The Russian Medical Academy of Continuous Professional Education</p><p>5 2-nd Botkinskiy Dr., Moscow 1252842/1 Bldg. 1 Barrikadnaya St., Moscow 125993</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5379-6749</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Логинов</surname><given-names>С. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Loginov</surname><given-names>S. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сергей Павлович Логинов, заведующий отделением экстракорпоральных методов лечения</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Sergey P. Loginov, Head of the Department of Extracorporeal treatment</p><p>5 2-nd Botkinskiy Dr., Moscow 125284</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8016-1610</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дроздов</surname><given-names>П. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Drozdov</surname><given-names>P. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Павел Алексеевич Дроздов, канд. мед. наук, заведующий отделением трансплантации органов и/или тканей</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Pavel A. Drozdov, Cand. Sci. (Med.), Head of the Department of Organ and/or Tissue Transplantation</p><p>5 2-nd Botkinskiy Dr., Moscow 125284</p></bio><email xlink:type="simple">dc.drozdov@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3995-0324</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Нестеренко</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Nesterenko</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Игорь Викторович Нестеренко, д-р мед. наук, врач-хирург отделения трансплантации органов и/или тканей</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Igor V. Nesterenko, Dr. Sci. (Med.), Surgeon of the Department of Organ and/or Tissue Transplantation</p><p>5 2-nd Botkinskiy Dr., Moscow 125284</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5237-4387</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Макеев</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Makeev</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дмитрий Александрович Макеев, врач-хирург отделения трансплантации органов и/или тканей</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Dmitry A. Makeev, Surgeon of the Department of Organ and/or Tissue Transplantation</p><p>5 2-nd Botkinskiy Dr., Moscow 125284</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8225-0024</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Журавель</surname><given-names>О. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Zhuravel</surname><given-names>O. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Олеся Сергеевна Журавель, врач-хирург ГБУЗ ГКБ им. С.П. Боткина ДЗМ, старший лаборант кафедры хирургии ФГБОУ ДПО РМАНПО МЗ РФ</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5125993, Москва, Баррикадная ул., д. 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Olesya S. Zhuravel, Surgeon of the City Clinical Hospital n.a. S.P. Botkin, Senior Laboratory Technician of the Department of Surgery of The Russian Medical Academy of Continuous Professional Education</p><p>5 2-nd Botkinskiy Dr., Moscow 1252842/1 Bldg. 1 Barrikadnaya St., Moscow 125993</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9180-7824</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Карапетян</surname><given-names>Л. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Karapetyan</surname><given-names>L. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Лаура Рубеновна Карапетян, врач-нефролог отделения трансплантации</p><p>125284, Москва, 2-й Боткинский пр-д, д. 5</p></bio><bio xml:lang="en"><p>Laura R. Karapetyan, Nephrologist of the Department of Organ and/or Tissue Transplantation</p><p>5 2-nd Botkinskiy Dr., Moscow 125284</p></bio><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ГБУЗ ГКБ им. С.П. Боткина ДЗМ; ФГБОУ ДПО РМАНПО МЗ РФ</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Clinical Hospital n.a. S.P. Botkin; The Russian Medical Academy of Continuous Professional Education</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ ГКБ им. С.П. Боткина ДЗМ</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Clinical Hospital n.a. S.P. Botkin</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2021</year></pub-date><pub-date pub-type="epub"><day>19</day><month>06</month><year>2021</year></pub-date><volume>13</volume><issue>2</issue><fpage>158</fpage><lpage>164</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Шабунин А.В., Логинов С.П., Дроздов П.А., Нестеренко И.В., Макеев Д.А., Журавель О.С., Карапетян Л.Р., 2021</copyright-statement><copyright-year>2021</copyright-year><copyright-holder xml:lang="ru">Шабунин А.В., Логинов С.П., Дроздов П.А., Нестеренко И.В., Макеев Д.А., Журавель О.С., Карапетян Л.Р.</copyright-holder><copyright-holder xml:lang="en">Shabunin A.V., Loginov S.P., Drozdov P.A., Nesterenko I.V., Makeev D.A., Zhuravel O.S., Karapetyan L.R.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.jtransplantologiya.ru/jour/article/view/573">https://www.jtransplantologiya.ru/jour/article/view/573</self-uri><abstract><p>Актуальность. На сегодняшний день трансплантация печени – наиболее эффективный метод лечения терминальной печеночной недостаточности, в связи с чем она получила широкое распространение по всему миру. Однако с улучшением качества трансплантологической помощи и увеличением долгосрочной выживаемости больных неизбежно связано развитие сопутствующей патологии, которая нередко нуждается в медикаментозной коррекции. Так, у пациентов, перенесших трансплантацию печени, послеоперационное мониторирование свидетельствует о существенном увеличении частоты дислипидемии. Тем не менее, длительная иммуносупрессивная терапия у пациентов с пересаженными органами может неблагоприятно модифицировать действие назначаемых препаратов, что требует тщательного контроля и учета лекарственных взаимодействий.Цель. На клиническом примере продемонстрировать значимость учета лекарственного взаимодействия в лечении пациентов после трансплантации органов, получающих иммуносупрессивные препараты.Материал и методы. В представленном клиническом наблюдении пациенту после ортотопической трансплантации печени, проведенной в 2005 г. проводилось этапное лечение рубцовой стриктуры холедохеального анастомоза в ГКБ им. С.П. Боткина. В период очередной госпитализации больной предъявлял жалобы на незначительные мышечные боли при ходьбе. При расспросе за 3 недели до госпитализации терапевтом по месту жительства ввиду повышения уровня холестерина плазмы крови назначена терапия аторвастатином в дозе 10 мг в сутки. Пациенту выполнено удаление саморасширяющегося нитинолового стента. При контрольном обследовании данных за нарушение желчеоттока у пациента не было, однако мышечные боли и слабость прогрессивно нарастали, снизился темп диуреза, в биохимическом анализе крови – резкое повышение концентрации креатинина, активности аспартатаминотрансферазы у аланинаминотрансферазы. Отменен аторвастатин, установлен диагноз острого нетравматического рабдомиолиза, начато лечение гемодиализом и плазмообменом от 05.03.2020. Последний сеанс заместительной почечной терапии – 30.03.20.Результаты. На фоне восстановления темпа диуреза – самостоятельное снижение уровня креатинина до 170 мкмоль/л. Пациент выписан с удовлетворительной почечной и печеночной функцией. Болевой синдром полностью купирован.Вывод. Лекарственное взаимодействие аторвастатина и циклоспорина привело к острому рабдомиолизу с угрожающими для жизни последствиями. Это еще раз подтверждает значимость учета лекарственного взаимодействия при ведении пациентов после трансплантации солидных органов.</p></abstract><trans-abstract xml:lang="en"><p>Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>трансплантация печени</kwd><kwd>рабдомиолиз</kwd><kwd>статины</kwd><kwd>аторвастатин</kwd><kwd>циклоспорин</kwd></kwd-group><kwd-group xml:lang="en"><kwd>liver transplantation</kwd><kwd>rhabdomyolysis</kwd><kwd>atorvastatine</kwd><kwd>cyclosporin</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Гоникова З.З., Никольская А.О., Кирсанова Л.А., Шагидулин М.Ю., Онищенко Н.А., Севастьянов В.И. Сравнительный анализ регенераторной активности клеток костного мозга и общей РНК, выделенной из них, при хроническом фиброзирующем повреждении печени. 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