МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПОЗДНЕГО ОТТОРЖЕНИЯ ТРАНСПЛАНТИРОВАННОЙ ПОЧКИ И ИХ ПРОГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ

Отторжение трансплантата остается одной из наиболее частых причин дисфункции почечного трансплантата в поздние сроки после АТП. Цель исследования: проанализировать частоту встречаемости различных вариантов позднего отторжения трансплантата, выявить особенности их клинических проявлений и течения, а также определить морфологические и клинические факторы, определяющие прогноз нефропатии при различных типах позднего отторжения трансплантата. Материалы и методы. Проанализированы материалы 265 пациентов, которым в связи с поздней дисфункцией почечного трансплантата было выполнено 294 биопсии (в среднем через 48,8 ± 46,1 мес. после АТП), на основании чего верифицирован диагноз острого (n = 193) или хронического (n = 78) отторжения трансплантата либо (в 23 случаях) их сочетание. Результаты. Свечение C4d выявлялось в 36% случаев острого отторжения и в 62% случаев при ХОТ (в том числе при ХТГ – 67%, при васкулопатии – 50%). 5-летняя выживаемость трансплантатов составила 47, 13 и 25% при ООТ, ХОТ и сочетании ООТ+ХОТ соответственно (р < 0,01). При этом в случаях острого отторжения прогноз C4d+-форм был хуже, чем при отсутствии свечения C4d (53% vs 33%; р = 0.002), тогда как при хроническом отторжении подобная закономерность отсутствовала (36% vs 34%; p = NS). Выводы. Свечение C4d чаще выявляется при хроническом отторжении трансплантата, не влияя, однако, на его прогноз. При остром отторжении трансплантата свечение C4d отмечается реже, но является самостоятельным прогностическим фактором.

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