Ранние и отдаленные исходы пересадки первично инфицированного почечного трансплантата

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. 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. 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. 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. 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.

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