vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2025-1-40-49vtio-1828Research ArticleКлиническая трансплантологияClinical TransplantologyАнализ распространенности и роли дезадаптивного ремоделирования левого желудочка сердца в риске развития ранней дисфункции почечного трансплантатаAnalysis of the prevalence and role of maladaptive left ventricular remodeling in the risk of early renal graft dysfunctionhttps://orcid.org/0000-0002-0992-0802ИбадовР. А.IbadovR. A.

Ташкент 

Tashkent 

tmsravshan@mail.ruhttps://orcid.org/0000-0002-8689-3641ЧерновД. А.ChernovD. A.

Чернов Денис Андреевич 

100115, Ташкент, Чиланзарский район, ул. Кичик Халка Йули, 10  Тел. +998 (91) 185-35-99 

Denis Chernov

10, Kichik Khalka Yuli str., Chilonzor District, Tashkent, 100115 Phone: +998 (91) 185-35-99

dionis8501@gmail.comhttps://orcid.org/0000-0003-2876-411XИбрагимовС. Х.IbragimovS. Kh.

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Tashkent 

dr.sardor.ibragimov@gmail.comАбдугафуровЗ. У.AbdugafurovZ. U.

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Tashkent 

zafarbek1992@gmail.comhttps://orcid.org/0009-0008-2594-8195МаткаримовЗ. Т.MatkarimovZ. T.

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Tashkent 

dok.mzt@gmail.comГУ «Республиканский специализированный научно-практический центр хирургии имени академика В. Вахидова»УзбекистанVakhidov Republican Specialized Research and Practical Medical Center of SurgeryUzbekistan2025260320252714049Copyright © Ибадов Р.А., Чернов Д.А., Ибрагимов С.Х., Абдугафуров З.У., Маткаримов З.Т., 20252025Ибадов Р.А., Чернов Д.А., Ибрагимов С.Х., Абдугафуров З.У., Маткаримов З.Т.Ibadov R.A., Chernov D.A., Ibragimov S.K., Abdugafurov Z.U., Matkarimov Z.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1828

Цель: изучить распространенность дезадаптивных типов ремоделирования левого желудочка (ДРЛЖ) среди кандидатов почечного трансплантата, определить их значение в развитии ранней дисфункции трансплантата (РДТ). Материалы и методы. Исследование основано на ретроспективном анализе результатов лечения 650 пациентов, перенесших ТП от живого родственного донора. На основании результатов трансторакальной эхокардиографии выявлены различные типы ремоделирования ЛЖ, распространение которых изучено в контексте влияния общепопуляционных и специфических «ренальных» факторов риска. Также выделено 2 группы пациентов: I группа (n = 82) – с РДТ; II группа (n = 79) – с первично функционирующим трансплантатом (ПФТ), сопоставимые по демографическим и клинико-лабораторным данным (p > 0,1). Проведен расчет относительного шанса развития РДТ в зависимости от наличия дезадаптивного ремоделирования. Результаты. Концентрическая гипертрофия ЛЖ (кГЛЖ) выявлена у 341 (52,46%), эксцентрическая (эГЛЖ) у 174 (26,77%) пациентов. Концентрическое ремоделирование (КР) и нормальная геометрия ЛЖ выявлены у 86 (13,23%) и 49 (7,54%) пациентов соответственно. ДРЛЖ (кГЛЖ + эГЛЖ) чаще выявлялись среди мужчин (p = 0,003). При стаже диализной терапии до 1 года шансы развития ДРЛЖ были выше в 5,6 раза, от 1 года до 2 лет – в 8 раз, более 2 лет – в 4,5 раза выше по сравнению с пациентами на додиализной стадии (p < 0,05). Функционирующая артериовенозная фистула повышала шансы развития ДРЛЖ в 8 раз (p < 0,001). По мере снижения диуреза шансы развития ДРЛЖ возрастали в 4–15,8 раза (p < 0,001). Шансы развития ДРЛЖ у лиц с анемией в зависимости от ее степени в 2,7–13,8 раза выше, чем среди пациентов без анемии (p < 0,05). Сравнительный анализ выявил высокую распространенность ДРЛЖ в группе пациентов с РДТ (p = 0,01). Наличие ДРЛЖ увеличивало шансы развития РДТ в посттрансплантационном периоде в 8,5 раза для кГЛЖ (p = 0,049) и в 14,5 раза для эГЛЖ (p = 0,011). Выводы. Выявление у кандидата почечного трансплантата ДРЛЖ указывает на тяжесть поражения сердечно-сосудистой системы вследствие прогрессирования ХБП, а также может рассматриваться как один из факторов риска развития РДТ.

Objective: to study the prevalence of maladaptive left ventricular remodeling (MLVR) among kidney transplant (KT) candidates and the role of MLVR in the development of early graft dysfunction (EGD). Materials and methods. The study is based on a retrospective analysis of treatment outcomes in 650 patients who underwent a living related KT. Transthoracic echocardiogram revealed different types of left ventricular (LV) remodeling, whose prevalence was studied in the context of influence on the general population and specific «renal» risk factors. Two patient groups were also identified: Group I had EGD (n = 82) and Group II had primary graft function (PGF) (n = 79). These groups were comparable in terms of demographics, clinical data, and laboratory results (p > 0.1). The relative risk of developing EGD was calculated depending on whether maladaptive remodeling was present. Results. Concentric LV hypertrophy (cLVH) was detected in 341 (52.46%), eccentric (eLVH) in 174 (26.77%) patients. Concentric remodeling (CR) and normal LV geometry were detected in 86 (13.23%) and 49 (7.54%) patients, respectively. MLVR (cLVH + eLVH) was more common in men (p = 0.003). Compared to patients in the pre-dialysis stage, the risk of developing MLVR was 5.6 times higher for dialysis therapy durations up to 1 year, 8 times higher for durations 1 to 2 years, and 4.5 times higher for durations greater than 2 years (p < 0.05). The likelihood of developing MLVR was 8-fold higher in those with a functioning arteriovenous fistula (p < 0.001). As diuresis decreased, the odds of developing MLVR increased 4 to 15.8 times (p < 0.001). Depending on the severity of their anemia, patients with anemia had 2.7–13.8 times the chances of developing MLVR compared to those without anemia (p < 0.05). According to comparative analysis, the EGD group had a high prevalence of MLVR (p = 0.01). MLVR raised the risk of developing EGD in the post-transplant period by 8.5 times for cLVH (p = 0.049) and 14.5 times for eLVH (p = 0.011). Conclusion. The presence of MLVR in a KT candidate indicates the severity of cardiovascular disease brought on by progression of chronic kidney disease, and can also be regarded as one of the risk factors for EGD.

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