diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12509diaendo-12509Research ArticleКлинический случайCase reportСочетанная трансплантация почки и поджелудочной железы при сахарном диабете 1 типа. Серия наблюденийSimultaneous pancreas‐kidney transplantation in type 1 diabetes mellitus. Clinical optionshttps://orcid.org/0000-0002-0296-4933СеверинаАнастасия СергеевнаSeverinaA. S.

к.м.н., в.н.с.

MD, PhD, leading research associate

ansev1@mail.ruhttps://orcid.org/0000-0001-6783-4200ЛаринаИрина ИгоревнаLarinaI. I.

н.с.

MD, research associate

irina.larina1993@mail.ruhttps://orcid.org/0000-0003-0047-7223ШутоваАлександра СергеевнаShutovаA. Sshutova.aleksandra@gmail.comhttps://orcid.org/0000-0002-3433-0142ШамхаловаМинара ШамхаловнаShamkhalovaM. S.

д.м.н.

MD, PhD

shamkhalova@mail.ruhttps://orcid.org/0000-0002-5731-3310ДмитриевИлья ВикторовичDmitrievI. V.

к.м.н.

MD, PhD

ildmi@mail.ruhttps://orcid.org/0000-0001-9019-9567ПинчукАлексей ВалерьевичPinchukAleksey V.

к.м.н

MD, PhD

avpin@rambler.ruhttps://orcid.org/0000-0001-7358-3364АрзумановСергей ВикторовичArzumanovS. V.

д.м.н.

MD, PhD

kidneytranspl@gmail.comhttps://orcid.org/0000-0002-5057-127XШестаковаМарина ВладимировнаShestakovaM. V.

д.м.н., профессор, академик РАН

MD, PhD, Professor

nephro@endocrincentr.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. СклифосовскогоРоссияSklifosovsky Research Institute for Emergency MedicineRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Научно-исследовательский институт организации здравоохранения и медицинского менеджментаРоссияSklifosovsky Research Institute for Emergency Medicine; Research Institute for Healthcare Organization and Medical ManagementRussian FederationНаучно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «НМИЦ радиологии»РоссияN.A. Lopatkin Research Institute of Urology and Interventional Radiology - branch of the National Medical Radiological Research Centre of the Ministry of HealthcareRussian Federation202010082020233275282Copyright © Северина А.С., Ларина И.И., Шутова А.С., Шамхалова М.Ш., Дмитриев И.В., Пинчук А.В., Арзуманов С.В., Шестакова М.В., 20202020Северина А.С., Ларина И.И., Шутова А.С., Шамхалова М.Ш., Дмитриев И.В., Пинчук А.В., Арзуманов С.В., Шестакова М.В.Severina A.S., Larina I.I., Shutovа A.S., Shamkhalova M.S., Dmitriev I.V., Pinchuk A.V., Arzumanov S.V., Shestakova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12509

Сочетанная трансплантация почки и поджелудочной железы (СТПиПЖ) в современном мире выступает наиболее перспективным методом лечения пациентов с сахарным диабетом 1 типа (СД1) и терминальной стадией диабетической нефропатии (ДН). Результатом успешной трансплантации является одномоментная ликвидация уремической интоксикации и гипергликемии – ведущего триггера сосудистых осложнений. Эугликемия в этом отношении, являясь важным метаболическим изменением у пациентов после операции, остается лишь одним из факторов удовлетворительного функционирования почечного аллотрансплантата. В случае возобновления заместительной почечной терапии (ЗПТ) посредством диализа у реципиентов после СТПиПЖ вопросы ведения и мониторинга состояния трансплантата поджелудочной железы (ТПЖ) остаются открытыми. Отдельное внимание к функции ТПЖ обусловлено не только потенциальным риском развития хирургических осложнений, но и некоторой вероятностью рецидива сахарного диабета 1 типа с необходимостью возобновления инсулинотерапии. У пациентов с сохранной функцией обоих трансплантатов превалирующее значение приобретает оценка динамики диабетических осложнений в целом. Результаты немногочисленных исследований в этом отношении остаются противоречивыми. Таким образом, клинические варианты могут быть непредсказуемо разнообразными и требовать не только поиска первопричины, но и оптимизации реабилитационной тактики, даже в случае достижения ожидаемой компенсации.

Simultaneous pancreas-kidney transplantation (SPKT) is the most promising treatment option for patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) due to diabetic nephropathy (DN). Successful SPKT eliminates uremic intoxication and hyperglycemia – the leading trigger of vascular diabetic complications. Therefore, euglycemia is an important metabolic change in patients after surgery and remains only one of the factors for the saved renal allograft functioning. In the case of resuming renal replacement therapy by dialysis after SPKT, the management and monitoring of the pancreatic graft remains open. Special attention to the pancreatic graft’s function is due to both the potential risk of surgical complications, and some probability of T1DM relapse with the need to resume insulin therapy. In patients with saved function of both transplants, the assessment of the dynamics of diabetic complications in general becomes more important. The results of few studies in this regard remain contradictory. Thus, clinical options can be unpredictably diverse and require not only search for the root cause, but also optimization of rehabilitation tactics, even if the expected results are achieved.

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