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 Federation10.15825/1995-1191-2011-2-110-121vtio-383Research ArticleОбзор литературыLiterature ReviewsПРИМЕНЕНИЕ СЫВОРОТОЧНОГО ИММУНОГЛОБУЛИНА ДЛЯ ДЕСЕНСИБИЛИЗАЦИИ ПЕРЕД ТРАНСПЛАНТАЦИЕЙ ПОЧКИ И ЛЕЧЕНИЯ ГУМОРАЛЬНОГО ОТТОРЖЕНИЯINTRAVENOUS IMMUNOGLOBULIN ADMINISTRATION FOR DESENSITIZATION BEFORE RENAL TRANSPLANTATION AND MANAGING ANTIBODY-MEDIATED REJECTIONСушковА. И.SushkovA. I.МойсюкЯ. Г.MoysyukY. G.moysyuktrans@list.ruФГУ «Федеральный научный центр трансплантологии и искусственных органов им. академика В.И. Шумакова» Минздравсоцразвития РФ, МоскваРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, MoscowRussian Federation201116062014132ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XIII No 2–2011110121Copyright © Сушков А.И., Мойсюк Я.Г., 20112011Сушков А.И., Мойсюк Я.Г.Sushkov A.I., Moysyuk Y.G.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/383

В последнее время стала актуальной проблема трансплантации почки пациентам, сенсибилизирован- ным к HLA-антигенам. Разработано несколько подходов для элиминации этих антител и осуществле- ния успешной пересадки почки. Применение сывороточного иммуноглобулина (ИГ) для лечения некото- рых аутоиммунных и воспалительных заболеваний (например, болезнь Кавасаки, синдром Гийена–Бар- ре) оказалось весьма эффективным. Недавно было описано явление снижения титра анти-HLA-антител после введения ИГ сенсибилизированным пациентам. Противовоспалительное действие сывороточно- го ИГ также может быть использовано для лечения гуморального отторжения аллотрансплантата почки. Разработано несколько протоколов применения сывороточного ИГ для десенсибилизации перед транс- плантацией и лечения гуморального отторжения: ИГ в высоких дозах, ИГ в низких дозах + плазмафе- рез (ПФ), ИГ + ПФ + ритуксимаб. Лечение по этим протоколам позволяет выполнить пересадку почки па- циентам, которые ранее по иммунологическим причинам считались неоперабельными, а их применение в совокупности с новыми диагностическими технологиями привело к появлению новых подходов в лече- нии гуморального отторжения. 

Much attention has been placed recently in transplantation in highly HLA-sensitized patients. In attempts to remove these antibodies and enable successful renal transplantation, several approaches have been developed. Intravenous immunoglobulin (IVIG) was found to be effective in the treatment of autoimmune and inflammatory disorders (e. g. Kawasaki disease, Guillain-Barre syndrome). Recently, a beneficial effect of IVIG on the reduc- tion of anti-HLA antibodies was described. The anti-inflammatory effect of IVIG provides hopeful opportunities in antibody-mediated rejection (AMR) management. There are several protocols of IVIG administration for pre-transplant desensitization and AMR treatment: high-dose IVIG, low-dose IVIG + plasmapheresis, IVIG + plasmapheresis + rituximab. These advancements have enabled transplantation in patients previously considered untransplantable and in concert with new diagnostic techniques has resulted in new approaches to management of AMR. 

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