transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2021-13-2-165-178transplantologiya-574Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESСовременные возможности улучшения результатов трансплантации почки пациентам старшей возрастной группы, в том числе с отягощенным урологическим анамнезомCurrent possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological historyhttps://orcid.org/0000-0001-8988-8525ХубутияБ. З.KhubutiyaB. Z.

Бидзина Зурабович Хубутия, врач-уролог, научный сотрудник отдела трансплантации почки и поджелудочной железы

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

Bidzina Z. Khubutiya, Urologist, Research Associate of the Department of Kidney and Pancreas Transplantation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

hybytiya@gmail.comhttps://orcid.org/0000-0001-6849-1457РжевскаяО. Н.RzhevskayaO. N.

Ольга Николаевна Ржевская, д-р мед. наук, врач-нефролог, ведущий научный сотрудник отдела трансплантации почки и поджелудочной железы

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

Olga N. Rzhevskaya, Dr. Sci. (Med.), Nephrologist, Leading Researcher of the Department of Kidney and Pancreas Transplantation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0003-2715-6112ЛисенокА. А.LisenokA. A.

Александр Андреевич Лисенок, канд. мед. наук, врач-нефролог, младший научный сотрудник отдела трансплантации почки и поджелудочной железы

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

Aleksandr A. Lisenok, Cand. Sci. (Med.), Nephrologist, Junior Researcher of the Department of Kidney and Pancreas Transplantation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202119062021132165178Copyright © Хубутия Б.З., Ржевская О.Н., Лисенок А.А., 20212021Хубутия Б.З., Ржевская О.Н., Лисенок А.А.Khubutiya B.Z., Rzhevskaya O.N., Lisenok A.A.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/574

Введение. Во всем мире и в России увеличивается количество больных с хронической почечной недостаточностью в терминальной стадии заболевания, требующей диализной терапии и трансплантации почки. Во многих странах мира количество диализных больных, чей возраст превышает 60 лет, составляет от 30 до 45% от всех больных с хронической почечной недостаточностью. При этом с учетом совершенствования методов ранней диагностики хронической почечной недостаточности и методов лечения хронической болезни почек, в том числе с помощью заместительной почечной терапии, ожидается увеличение числа пожилых потенциальных реципиентов почечного трансплантата. Вероятность получения почечного трансплантата у пожилых больных существенно ниже, чем у молодых реципиентов. Известно, что у пожилых больных более высокий риск смерти в период ожидания почечного трансплантата в связи с более высокой заболеваемостью и летальностью на диализе. По этой причине актуальность повышения доступности трансплантации почки пожилым больным с течением времени все больше возрастает. Одним из путей решения является использование почек от субоптимальных доноров, имеющих неидеальные показатели качества трансплантата, которые могли бы обеспечить потребности в трансплантационной помощи пациентов старшей возрастной группы. Пожилой возраст реципиента вносит определенный риск развития дисфункции трансплантата вследствие наличия сопутствующих заболеваний, а при пересадке почки от доноров с расширенными критериями потенциальный риск еще больше возрастает. При выявлении сниженного функционального резерва почек, удаленных у доноров с расширенными критериями, возможна пересадка двух почек, что обеспечивает достаточно хорошие отдаленные результаты. Для уменьшения риска утраты почечного трансплантата необходима тщательная селекция реципиентов с учетом их коморбидности, в том числе наличия урологических заболеваний, ухудшающих функцию верхних и нижних мочевыводящих путей. Своевременное их выявление и коррекция позволяют повысить доступность трансплантации почки для пожилых больных и улучшить ее результаты. В обзоре представлены результаты исследований, проведенных в различных зарубежных трансплантационных центрах, с определением показателей летальности, выживаемости реципиентов и почечных трансплантатов.Цель исследования. Объединить актуальные данные и результаты исследования трансплантации почки у пациентов старшей возрастной группы с урологической патологией.

Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.

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