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 Federation10.15825/1995-1191-2017-1-57-62vtio-734Research ArticleКлинические наблюденияClinical CasesОбратимая легочная гипертензия у пациентки после трансплантации почки с длительно функционирующей артериовенозной фистулойReversible pulmonary hypertension in post -renaltransp lantation patient with longst anding arteriovenous fistulaЗелтынь-АбрамовЕ. М.Zeltyn-AbramovE. M.

Адрес: 123182, Москва, ул. Пехотная, д. 3/2. Тел. (916) 656-80-93

Address: 3/2, Pekhotnaya st., Moscow, 123182, Russian Federation. Tel. (916) 656-80-93

ezeltyn@mail.ruИсхаковР. Т.IskhakovR. T.

Москва, Российская Федерация

Moscow, Russian Federation

АртюхинаЛ. Ю.ArtyukhinaL. Yu.

Москва, Российская Федерация

Moscow, Russian Federation

ИвановаЕ. С.IvanovaE. S.

Москва, Российская Федерация

Moscow, Russian Federation

МанченкоО. В.ManchenkoO. V.

Москва, Российская Федерация

Moscow, Russian Federation

БелавинаН. И.BelavinaN. I.

Москва, Российская Федерация

Moscow, Russian Federation

ТомилинаН. А.TomilinaN. A.

Москва, Российская Федерация

Moscow, Russian Federation

ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России ГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»РоссияN.I. Pirogov Russian National Research Medical University Moscow City Hospital № 52Russian FederationГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»РоссияMoscow City Hospital № 52Russian FederationФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» ГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»РоссияV.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation A.I. Evdokimov Moscow State University of Medicine and Dentistry Moscow City Hospital № 52Russian Federation2017140420171915762Copyright © Зелтынь-Абрамов Е.М., Исхаков Р.Т., Артюхина Л.Ю., Иванова Е.С., Манченко О.В., Белавина Н.И., Томилина Н.А., 20172017Зелтынь-Абрамов Е.М., Исхаков Р.Т., Артюхина Л.Ю., Иванова Е.С., Манченко О.В., Белавина Н.И., Томилина Н.А.Zeltyn-Abramov E.M., Iskhakov R.T., Artyukhina L.Y., Ivanova E.S., Manchenko O.V., Belavina N.I., 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/734

Представлено описание клинического случая обратимой высокой легочной гипертензии (ЛГ) у пациентки с успешной трансплантацией почки (ТП), особенностью которого было функционирование артериовенозной фистулы (АВФ) с избыточным кровотоком в течение 15 лет при отсутствии показаний к проведению гемодиализа. ЛГ сопровождалась развитием тяжелой застойной сердечной недостаточности (ЗСН) с высоким сердечным выбросом. Лигирование АВФ привело к полному регрессу клинико-инструментальных и лабораторных признаков ЛГ и ЗСН в течение 2 недель. Обсуждается патогенетическая роль избыточного кровотока по АВФ в формировании ЛГ и ЗСН. Рекомендуется лигирование АВФ с избыточным кровотоком в случае формирования симптомной ЛГ у пациентов после успешной ТП.

Case report of reversible high pulmonary hypertension (PH) in patient with successful kidney transplantation (KT) is presented. The distinction of the case was the functioning arteriovenous fistula (AVF) with excessive blood flow during 15 years in the absence of indications for hemodialysis. Consequently, PH was complicated by serious congestive heart failure (CHF) with high cardiac output. Surgical closure of AVF resulted in complete regression of clinical, instrumental and laboratory signs and symptoms of PH and CHF within 2 weeks. The pathogenic role of excessive AVF blood flow in PH and CHF formation is a point of discussion. Surgical closure of AVF with excessive blood flow is recommended in cases of presence of symptomatic PH and CHF in patients after successful KT.

легочная гипертензиясердечная недостаточностьлигирование артериовенозной фистулытрансплантация почкиpulmonary hypertensionheart failurearteriovenous fistula closurekidney transplantReferencesAgarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol. Dial. Transplant. 2012; 27: 3908–3914.Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol. Dial. Transplant. 2012; 27: 3908–3914.Ramasubbu K, Deswal A, Herdejurgen C, Aquilar D, Frost AE. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. 2010; 3: 279–286.Ramasubbu K, Deswal A, Herdejurgen C, Aquilar D, Frost AE. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. 2010; 3: 279–286.Yigla M, Fruchter O, Aharonson D, Yanay N, Reisner SA et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int. 2009; 75: 969–975.Yigla M, Fruchter O, Aharonson D, Yanay N, Reisner SA et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int. 2009; 75: 969–975.Navaneethan SD, Roy J, Tao K, Brecklin CS, Chen J, Deo R et al. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD. J. Am. Soc. Nephrol. 2016 Mar; 27 (3): 877–886.Navaneethan SD, Roy J, Tao K, Brecklin CS, Chen J, Deo R et al. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD. J. Am. Soc. Nephrol. 2016 Mar; 27 (3): 877–886.Alhamad NE, Al-Ghonaim M, Alfaleh HF, Cal J.P, Said N. Pulmonary hypertention in end-stage renal desease and post renal transplantation patients. J. Thorac. Dis. 2014; 6 (6): 606–616.Alhamad NE, Al-Ghonaim M, Alfaleh HF, Cal J.P, Said N. Pulmonary hypertention in end-stage renal desease and post renal transplantation patients. J. Thorac. Dis. 2014; 6 (6): 606–616.Casas-Aparicio G, Castillo-Martinez L, Orea-Tejeda A, Abasta-Jiménez M, Keirns-Davies C, Rebollar-González V. The effect of Successful Kidney Transplantation on ventricular Dysfunction and Pulmonary Hypertention. Transplant. Proc. 2010; 42: 3524–3528.Casas-Aparicio G, Castillo-Martinez L, Orea-Tejeda A, Abasta-Jiménez M, Keirns-Davies C, Rebollar-González V. The effect of Successful Kidney Transplantation on ventricular Dysfunction and Pulmonary Hypertention. Transplant. Proc. 2010; 42: 3524–3528.Abedini M, Sadeghi M, Naini AE, Atappur A, Golshahi S. Pulmonary hypertention among patients on dialysis and kidney transplant recipients Ren Fail 2013; 35: 560–565.Abedini M, Sadeghi M, Naini AE, Atappur A, Golshahi S. Pulmonary hypertention among patients on dialysis and kidney transplant recipients Ren Fail 2013; 35: 560–565.Bozbas SS, Kanyilmaz S, Akcay S, Bozbas H, Altin C, Karacaglar E et al. Renal transplant improves pulmonary hypertension in patients with end stage renal disease. Multidisciplinary Respiratory Medicine. 2011; 6 (3): 155–160.Bozbas SS, Kanyilmaz S, Akcay S, Bozbas H, Altin C, Karacaglar E et al. Renal transplant improves pulmonary hypertension in patients with end stage renal disease. Multidisciplinary Respiratory Medicine. 2011; 6 (3): 155–160.Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M et al. Updated clinical classification of pulmonary hypertension. J. Am. Coll. Cardiol. 2009; 54: 43–54.Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M et al. Updated clinical classification of pulmonary hypertension. J. Am. Coll. Cardiol. 2009; 54: 43–54.Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol. Dial. Transplant. 2005; 20: 1686–1692.Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol. Dial. Transplant. 2005; 20: 1686–1692.Manca O, Pisano GL, Carta P, Manca EM, Piredda GB, Pili G et al. The management of haemodialysis arteriovenous fistulas in well functioning renal transplanted patients: Many doubts, few certainties. J. Vasc. Acc. 2005; 6: 182–186.Manca O, Pisano GL, Carta P, Manca EM, Piredda GB, Pili G et al. The management of haemodialysis arteriovenous fistulas in well functioning renal transplanted patients: Many doubts, few certainties. J. Vasc. Acc. 2005; 6: 182–186.Ori Y, Korzets A, Katz M, Perek Y, Zahavi I, Gafter U. Haemodialysis arteriovenous access – a prospective haemodynamic evaluation. Nephrol. Dial. Transplant. 1996 Jan; 11 (1): 94–97.Ori Y, Korzets A, Katz M, Perek Y, Zahavi I, Gafter U. Haemodialysis arteriovenous access – a prospective haemodynamic evaluation. Nephrol. Dial. Transplant. 1996 Jan; 11 (1): 94–97.Savage MT, Ferro CJ, Sassano A et al. The impact of arteriovenous fistula formation on central hemodynamic pressures in chronic renal failure patients: a prospective study. Am. J. Kidney Dis. 2002; (40): 753–759.Savage MT, Ferro CJ, Sassano A et al. The impact of arteriovenous fistula formation on central hemodynamic pressures in chronic renal failure patients: a prospective study. Am. J. Kidney Dis. 2002; (40): 753–759.Clarkson MR, Giblin L, Brown A, Little D, Donohoe J. Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula. Am. J. Kidney Dis. 2002; 40: E8.Clarkson MR, Giblin L, Brown A, Little D, Donohoe J. Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula. Am. J. Kidney Dis. 2002; 40: E8.Rao N, Worthley M, Disney P, Faull R. Dramatic improvement in decompensated right heart failure due to severe tricuspid regurgitation following ligation of arteriovenous fistula in a renal transplant recipient. Semin. Dial. 2014; 27 (2): E24–E26.Rao N, Worthley M, Disney P, Faull R. Dramatic improvement in decompensated right heart failure due to severe tricuspid regurgitation following ligation of arteriovenous fistula in a renal transplant recipient. Semin. Dial. 2014; 27 (2): E24–E26.Kabitz H-J, Walterspacher S, Geyer M, Fischer K-G, Huber TB et al. Reversible pulmonary hypertension in a kidney transplant with patent A-V fistula. Clin. Kidney. J. 2012 Aug; 5 (4): 347–349.Kabitz H-J, Walterspacher S, Geyer M, Fischer K-G, Huber TB et al. Reversible pulmonary hypertension in a kidney transplant with patent A-V fistula. Clin. Kidney. J. 2012 Aug; 5 (4): 347–349.Ragupathi L, Johnson D, Marhefka GD. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients. Texas Heart Institute Journal. 2016; 43 (4): 350–353.Ragupathi L, Johnson D, Marhefka GD. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients. Texas Heart Institute Journal. 2016; 43 (4): 350–353.Khreiss M, Haddad FF, Musallam KM, Medawar W, Daouk M, Khalil I. High-output cardiac failure secondary to a large arteriovenous fistula: a persistent threat to the dialysis and kidney transplant patient. NDT Plus. 2009; 2 (2): 147–148.Khreiss M, Haddad FF, Musallam KM, Medawar W, Daouk M, Khalil I. High-output cardiac failure secondary to a large arteriovenous fistula: a persistent threat to the dialysis and kidney transplant patient. NDT Plus. 2009; 2 (2): 147–148.Raza F, Alkhouli M, Rogers F. Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access. Pulm. Circ. 2015 Jun; 5 (2): 398–406.Raza F, Alkhouli M, Rogers F. Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access. Pulm. Circ. 2015 Jun; 5 (2): 398–406.Voorzaat BM, van Schaik J, Siebelink HM, Tordoir JH, Rotmans JI. The pros and cons of preserving a functioning arteriovenous fistula after kidney transplantation. J. Vasc. Access. 2016 Mar; 17 Suppl 1: S16–S22.Voorzaat BM, van Schaik J, Siebelink HM, Tordoir JH, Rotmans JI. The pros and cons of preserving a functioning arteriovenous fistula after kidney transplantation. J. Vasc. Access. 2016 Mar; 17 Suppl 1: S16–S22.Yaffe HC, Greenstein SM. Should functioning AV fistulas be ligated after renal transplantation? J. Vasc. Access. 2012 Oct–Dec; 13 (4): 405–408.Yaffe HC, Greenstein SM. Should functioning AV fistulas be ligated after renal transplantation? J. Vasc. Access. 2012 Oct–Dec; 13 (4): 405–408.Patard JJ, Bensalah K, Lucas A, Rodriguez A, Manunta A, Rivalan J et al. Management of vascular access for hemodialysis after successful kidney transplantation. Scand. J. Urol. Nephrol. 2002; 36 (5): 373–376.Patard JJ, Bensalah K, Lucas A, Rodriguez A, Manunta A, Rivalan J et al. Management of vascular access for hemodialysis after successful kidney transplantation. Scand. J. Urol. Nephrol. 2002; 36 (5): 373–376.Amerling R, Ronco C, Kuhlmann M, Winchester JF. Arteriovenous fistula toxicity. Blood Purif. 2011; 31: 113–120.Amerling R, Ronco C, Kuhlmann M, Winchester JF. Arteriovenous fistula toxicity. Blood Purif. 2011; 31: 113–120.

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