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 Federation10.15825/1995-1191-2011-2-29-36vtio-371Research ArticleТрансплантомикаTransplantomicsКОНВЕРСИЯ НА ТАКРОЛИМУС У ПАЦИЕНТОВ С ПОЗДНИМ ОСТРЫМ И ХРОНИЧЕСКИМ ОТТОРЖЕНИЕМ ТРАНСПЛАНТИРОВАННОЙ ПОЧКИCONVERSION TO TACROLIMUS IN PATIENTS WITH LATE ACUTE AND CHRONIC REJECTION OF TRANSPLANTED KIDNEYСтоляревичЕ. С.StolyarevichE. S.АртюхинаЛ. Ю.ArtjukhinaL. Y.КимИ. Г.KimI. G.КуренковаЛ. Г.KurenkovaL. G.ФедороваН. Д.FedorovaN. D.ФроловА. В.FrolovA. V.ФроловаН. Ф.FrolovaN. F.ТомилинаН. А.TomilinaN. A.natomilina@yandex.ruФГУ «Федеральный научный центр трансплантологии и искусственных органов им. академика В.И. Шумакова» Минздравсоцразвития РФРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, MoscowRussian FederationГКБ No 52 г. МосквыРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, MoscowRussian FederationФГУ «Федеральный научный центр трансплантологии и искусственных органов им. академика В.И. Шумакова» Минздравсоцразвития РФ кафедра нефрологии ФПДО МГМСУРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, MoscowRussian Federation201116062014132ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XIII No 2–20112936Copyright © Столяревич Е.С., Артюхина Л.Ю., Ким И.Г., Куренкова Л.Г., Федорова Н.Д., Фролов А.В., Фролова Н.Ф., Томилина Н.А., 20112011Столяревич Е.С., Артюхина Л.Ю., Ким И.Г., Куренкова Л.Г., Федорова Н.Д., Фролов А.В., Фролова Н.Ф., Томилина Н.А.Stolyarevich E.S., Artjukhina L.Y., Kim I.G., Kurenkova L.G., Fedorova N.D., Frolov A.V., Frolova N.F., Tomilina N.A.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/371

Острое отторжение почечного аллотрансплантата, развивающееся в поздние сроки после транспланта- ции почки (ТП), в большинстве случаев бывает резистентным к терапии и лишь частично обратимым. Целью настоящего исследования было оценить эффективность конверсии с циклоспорина (ЦиА) на та- кролимус (Tac) у пациентов с поздним острым и активным хроническим отторжением. В исследование были включены 176 пациентов с поздним отторжением, 115 из которых продолжали терапию циклоспо- рином (группа ЦиА), а 61 был переведен на такролимус (группа Тас). Длительность наблюдения состав- ляла не менее 6 мес. В течение первого месяца с момента выявления и лечения отторжения в обеих груп- пах отмечалось снижение креатинина крови с 0,27 (0,18; 0,4) до 0,25 (0,16; 0,41) ммоль/л на циклоспори- не и с 0,25 (0,18; 0,3) до 0,18 (0,14; 0,25) на такролимусе. В последующем в группе Тас наблюдалась ста- билизация функции трансплантата на уровне 0,17 (0,14; 0,3) ммоль/л, тогда как у пациентов, продолжав- ших прием ЦиА, отмечалось прогрессирование дисфункции до 0,33 (0,19; 0,8) ммоль/л. Выживаемость трансплантатов к 3 годам наблюдения составляла в группах Тас и ЦиA 57,1 и 40,9% соответственно (р < 0,01). Конверсия с циклоспорина на такролимус при позднем отторжении трансплантата позволяет повы- сить эффективность его лечения и замедлить темпы прогрессирования нефропатии. 

Tасrolimus (Tac) has been used for rescuing of renal allografts from refractory rejection that occurred during treatment with conventional cyclosporine A (CsA) mostly in the early posttransplant period. Less is known about effect of Tac in cases of late acute rejection. Aim of the study was to examine the long-term effects of switching from CyA-based therapy to Tac-based therapy versus continuation of CsA in renal transplant patients with acute rejection occurred 3 month after transplantation or later. In this comparative prospective clinical study 176 patients experiencing a late biopsy-proven acute or active chronic rejection were followed-up for up to 6 months. 61 pati- ents were converted from a CуA-based therapy to the Tac one; in 115 patients CsA-based therapy was continued. During the first month after the rejection episode the median serum creatinine concentration had decreased in both groups (from 0.27 (0.18; 0.4) to 0.25 (0.16; 0.41) mmol/l in the CsA group and from 0.25 (0.18; 0.3) to 0.18 (0.14; 0.25) mmol/l in the Tac group. During the follow-up graft function remained stable in the Tac group 0,17 (0,14; 0,3) mmol/l, while in the CsA group a trend to progression of graft failure was observed 0.33 (0.19; 0.8) mmol/l. The 3-year Kaplan-Meier estimates for graft loss were 57,1% (Tac) and 40,9% (CsA), respectively (р < 0.01). Conclusion: early switch from the CsA- to the Tac-based therapy after a late biopsy-confirmed rejection resulted in a significant improvement in the clinical output in renal graft recipients compared to patients for whom the CyA therapy was continued. 

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