diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13323diaendo-13323Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESРанние и отдаленные результаты трансплантационного лечения пациентов с хронической болезнью почек 4–5 стадий в исходе сахарного диабета 1 типаEarly and long-term results of transplantation treatment of patients with stage 4–5 chronic kidney disease in the outcome of type 1 diabetes mellitushttps://orcid.org/0000-0002-5731-3310ДмитриевИ. В.DmitrievI. V.

.

Дмитриев Илья Викторович - д.м.н.

Москва

Дмитриев Илья Викторович - д.м.н.

Москва

DmitrievIV@sklif.mos.ruhttps://orcid.org/0000-0002-0473-9932ЛазареваК. Е.LazarevaK. E.

Лазарева Ксения Евгеньевна - к.м.н., доцент.

Москва

Ksenia E. Lazareva - MD, PhD, Associate Professor.

Moscow

i@dr-lazareva.ruhttps://orcid.org/0000-0002-1396-7048БалкаровА. Г.BalkarovA. G.

Балкаров Аслан Галиевич - к.м.н.

Москва

Aslan G. Balkarov - MD, PhD.

Moscow

BalkarovAG@sklif.mos.ruhttps://orcid.org/0000-0002-0156-2107ЖуравельН. С.ZhuravelN. S.

Журавель Никита Сергеевич, к.м.н. - ст.н.с.

129090, Москва, Большая Сухаревская площадь, д. 3

Nikita S. Zhuravel, MD, PhD, senior researcher.

3 Bolshaya Sukharevskaya square, 129090 Moscow

zhuravelns@sklif.mos.ruhttps://orcid.org/0000-0002-8199-905XШмаринаН. В.ShmarinaN. V.

Шмарина Нонна Валерьевна - к.м.н., ст.н.с.

Москва

Nonna V. Shmarina - MD, PhD, senior researcher.

Moscow

shmarinanv@sklif.mos.ruНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; N.I. Pirogov Russian National Research Medical UniversityRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Российский университет медициныРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Russian University of MedicineRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского; Российский национальный исследовательский медицинский университет им. Н.И. Пирогова; Научно-исследовательский институт организации здравоохранения и медицинского менеджментаРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; N.I. Pirogov Russian National Research Medical University; Research Institute for Healthcare Organization and Medical ManagementRussian Federation202509102025284332341Copyright © Дмитриев И.В., Лазарева К.Е., Балкаров А.Г., Журавель Н.С., Шмарина Н.В., 20252025Дмитриев И.В., Лазарева К.Е., Балкаров А.Г., Журавель Н.С., Шмарина Н.В.Dmitriev I.V., Lazareva K.E., Balkarov A.G., Zhuravel N.S., Shmarina N.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/13323ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Пациенты с диабетической природой хронической болезни почек (ХБП) 5 стадии являются наиболее тяжелой группой диализной популяции, период полужизни которых с момента начала заместительной почечной терапии не превышает 3,5–5 лет. Трансплантационное лечение является методом выбора в лечении указанной категории пациентов.

ЦЕЛЬ

ЦЕЛЬ. Систематический анализ ранних и отдаленных результатов трансплантационного лечения пациентов с сахарным диабетом 1 типа (СД1) и ХБП 4–5 стадий.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. За 17-летний период (с 2007 по 2023 гг.) в отделении трансплантации почки и поджелудочной железы было выполнено 146 трансплантаций почки (ТП) и 84 сочетанных трансплантаций почки и поджелудочной железы (СТПиПЖ) пациентам с ХБП в исходе СД1.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. За весь период наблюдения общая выживаемость пациентов, перенесших ТП, составила 67,1% (n=98), почечных трансплантатов — 59,6% (n=87); среди пациентов, перенесших СТПиПЖ, эти показатели составили 76,2% (n=64) и 70,2% (n=59) соответственно, при этом выживаемость трансплантата поджелудочной железы составила 64,3% (n=54).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Представлены результаты трансплантационного лечения пациентов с СД1 и ХБП 4–5 стадий.

BACKGROUND

BACKGROUND. Patients with diabetic chronic kidney disease (CKD) stage 5 comprise the most severe group of dialysis patients. The half-life of this group from the moment of starting renal replacement therapy is between 3.5 and 5 years. Transplantation treatment is the preferred method for treating this category of patients.

AIM

AIM. The objective of the study was to methodically examine the preliminary and long-term outcomes of transplantation treatment in patients diagnosed with type 1 diabetes mellitus (DM1) and stage 4–5 chronic kidney disease.

MATERIALS AND METHODS

MATERIALS AND METHODS. From 2007 to 2023, the kidney and pancreas transplant unit performed 146 kidney transplantations and 84 simultaneous pancreas-kidney transplantations (SPKT) in patients with CKD as an outcome of DM1.

RESULTS

RESULTS. During the entire follow-up period, the overall survival rate for kidney transplant patients was 67.1% (n=98) and 59.6% (n=87) for renal grafts; among SPKT patients, these rates were 76.2% (n=64) and 70.2% (n=59), respectively, with a pancreas graft survival rate of 64.3% (n=54).

CONCLUSION

CONCLUSION. The results of transplant treatment of patients with DM1 and stage 4-5 CKD are presented in this article.

сахарный диабет 1 типахроническая болезнь почектрансплантация почкисочетанная трансплантация почки и поджелудочной железыисходывыживаемость реципиентоввыживаемость почечного трансплантатавыживаемость трансплантата поджелудочной железыtype 1 diabetes mellituschronic kidney diseasekidney transplantationsimultaneous pancreas and kidney transplantationoutcomesrecipient survivalkidney graft survivalpancreas graft survivalРабота выполнена по инициативе авторов без привлечения финансовых средствReferencesKovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022;12(1):7-11. doi: https://doi.org/10.1016/j.kisu.2021.11.003Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022;12(1):7-11. doi: https://doi.org/10.1016/j.kisu.2021.11.003Jha V, Al-Ghamdi SMG, Li G, et al. Global Economic Burden Associated with Chronic Kidney Disease: A Pragmatic Review of Medical Costs for the Inside CKD Research Programme. Adv Ther. 2023;40(10):4405-4420. doi: https://doi.org/10.1007/s12325-023-02608-9Jha V, Al-Ghamdi SMG, Li G, et al. Global Economic Burden Associated with Chronic Kidney Disease: A Pragmatic Review of Medical Costs for the Inside CKD Research Programme. Adv Ther. 2023;40(10):4405-4420. doi: https://doi.org/10.1007/s12325-023-02608-9Андрусев А.М., Перегудова Н.Г., Шинкарев М.Б., Томилина Н.А. Заместительная почечная терапия хронической болезни почек 5 стадии в Российской Федерации 2016–2020 гг. Краткий отчет по данным Общероссийского Регистра заместительной почечной терапии Российского диализного общества // Нефрология и диализ. — 2022. — Т. 24. — №4. — С. 555–565. doi: https://doi.org/10.28996/2618-9801-2022-4-555-565Andrusev AM, Peregudova NG, Shinkarev MB, Tomilina NA. Kidney replacement therapy for end Stage Kidney disease in Russian Federation, 2016-2020. Russian National Kidney Replacement Therapy Registry Report of Russian Public Organization of Nephrologists Russian Dialysis Society. Nephrologу and Dialуsis. 2022;24(4):555-565. (In Russ.) doi: https://doi.org/10.28996/2618-9801-2022-4-555-565Данович Г.М. Трансплантация почки: руководство: пер. с англ. — Москва: ГЭОТАР-Медиа, 2013.Danovich GM. Transplantatsiya pochki: rukovodstvo: per. s angl. — Moscow: GEOTAR-Media, 2013. (In Russ.)Statista.com [Internet]. Estimated number of organ transplantations worldwide in 2023 [cited 2025 Jan 29]. Available from: https://www.statista.com/statistics/398645/global-estimation-of-organ-transplantations/Statista.com [Internet]. Estimated number of organ transplantations worldwide in 2023 [cited 2025 Jan 29]. Available from: https://www.statista.com/statistics/398645/global-estimation-of-organ-transplantations/Tingle SJ, Figueiredo RS, Moir JA, Goodfellow M, Talbot D, Wilson CH. Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation. Cochrane Database Syst Rev. 2019;3(3):CD011671. doi: https://doi.org/10.1002/14651858.CD011671.pub2Tingle SJ, Figueiredo RS, Moir JA, Goodfellow M, Talbot D, Wilson CH. Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation. Cochrane Database Syst Rev. 2019;3(3):CD011671. doi: https://doi.org/10.1002/14651858.CD011671.pub2Hosgood SA, Callaghan CJ, Wilson CH, et al. Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial. Nat Med. 2023;29(6):1511-1519. doi: https://doi.org/10.1038/s41591-023-02376-7Hosgood SA, Callaghan CJ, Wilson CH, et al. Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial. Nat Med. 2023;29(6):1511-1519. doi: https://doi.org/10.1038/s41591-023-02376-7Malinoski D, Saunders C, Swain S, et al. Hypothermia or Machine Perfusion in Kidney Donors. N Engl J Med. 2023;388(5):418-426. doi: https://doi.org/10.1056/NEJMoa2118265Malinoski D, Saunders C, Swain S, et al. Hypothermia or Machine Perfusion in Kidney Donors. N Engl J Med. 2023;388(5):418-426. doi: https://doi.org/10.1056/NEJMoa2118265International Diabetes Federation [Internet]. IDF Diabetes Atlas, 10th ed. [cited 2025 Jan 29]. Available from: https://diabetesatlas.org/data/en/International Diabetes Federation [Internet]. IDF Diabetes Atlas, 10th ed. [cited 2025 Jan 29]. Available from: https://diabetesatlas.org/data/en/Дедов И.И., Шестакова М.В., Викулова О.К., и др. Сахарный диабет в Российской Федерации: динамика эпидемиологических показателей по данным Федерального регистра сахарного диабета за период 2010 – 2022 гг. // Сахарный диабет. — 2023. — Т. 26. — №2. — С. 104-123. doi: https://doi.org/10.14341/DM13035Dedov II, Shestakova MV, Vikulova OK, et al. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal register of diabetes mellitus for the period 2010–2022. Diabetes Mellitus. 2023;26(2):104-123. (In Russ.) doi: https://doi.org/10.14341/DM13035Brunkhorst R, Lufft V, Dannenberg B, Kliem V, Tusch G, Pichlmayr R. Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study. Transplantation. 2003;76(1):115-119. doi: https://doi.org/10.1097/01.TP.0000070225.38757.81Brunkhorst R, Lufft V, Dannenberg B, Kliem V, Tusch G, Pichlmayr R. Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study. Transplantation. 2003;76(1):115-119. doi: https://doi.org/10.1097/01.TP.0000070225.38757.81Medina-Polo J, Domínguez-Esteban M, Morales JM, et al. Cardiovascular events after simultaneous pancreas-kidney transplantation. Transplant Proc. 2010;42(8):2981-2983. doi: https://doi.org/10.1016/j.transproceed.2010.07.046Medina-Polo J, Domínguez-Esteban M, Morales JM, et al. Cardiovascular events after simultaneous pancreas-kidney transplantation. Transplant Proc. 2010;42(8):2981-2983. doi: https://doi.org/10.1016/j.transproceed.2010.07.046Ziaja J, Chudek J, Kolonko A, et al. Does simultaneously transplanted pancreas improve long-term outcome of kidney transplantation in type 1 diabetic recipients?. Transplant Proc. 2011;43(8):3097-3101. doi: https://doi.org/10.1016/j.transproceed.2011.08.020Ziaja J, Chudek J, Kolonko A, et al. Does simultaneously transplanted pancreas improve long-term outcome of kidney transplantation in type 1 diabetic recipients?. Transplant Proc. 2011;43(8):3097-3101. doi: https://doi.org/10.1016/j.transproceed.2011.08.020King EA, Kucirka LM, McAdams-DeMarco MA, et al. Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors. Am J Transplant. 2016;16(2):541-549. doi: https://doi.org/10.1111/ajt.13485King EA, Kucirka LM, McAdams-DeMarco MA, et al. Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors. Am J Transplant. 2016;16(2):541-549. doi: https://doi.org/10.1111/ajt.13485Schreiber PW, Laager M, Boggian K, et al. Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study. J Hosp Infect. 2022;128:47-53. doi: https://doi.org/10.1016/j.jhin.2022.07.009Schreiber PW, Laager M, Boggian K, et al. Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study. J Hosp Infect. 2022;128:47-53. doi: https://doi.org/10.1016/j.jhin.2022.07.009Nagendra L, Fernandez CJ, Pappachan JM. Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives. World J Transplant. 2023;13(5):208-220. doi: https://doi.org/10.5500/wjt.v13.i5.208Nagendra L, Fernandez CJ, Pappachan JM. Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives. World J Transplant. 2023;13(5):208-220. doi: https://doi.org/10.5500/wjt.v13.i5.208Schreiber PW, Laager M, Boggian K, et al. Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study. J Hosp Infect. 2022;128:47-53. doi: https://doi.org/10.1016/j.jhin.2022.07.009Schreiber PW, Laager M, Boggian K, et al. Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study. J Hosp Infect. 2022;128:47-53. doi: https://doi.org/10.1016/j.jhin.2022.07.009Esmeijer K, Hoogeveen EK, van den Boog PJM, et al. Superior Long-term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort. Diabetes Care. 2020;43(2):321-328. doi: https://doi.org/10.2337/dc19-1580Esmeijer K, Hoogeveen EK, van den Boog PJM, et al. Superior Long-term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort. Diabetes Care. 2020;43(2):321-328. doi: https://doi.org/10.2337/dc19-1580Hamed MO, Chen Y, Pasea L, et al. Early graft loss after kidney transplantation: risk factors and consequences. Am J Transplant. 2015;15(6):1632-1643. doi: https://doi.org/10.1111/ajt.13162Hamed MO, Chen Y, Pasea L, et al. Early graft loss after kidney transplantation: risk factors and consequences. Am J Transplant. 2015;15(6):1632-1643. doi: https://doi.org/10.1111/ajt.13162Grochowiecki T, Gałązka Z, Madej K, et al. Multivariate analysis of complications after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46(8):2806-2809. doi: https://doi.org/10.1016/j.transproceed.2014.08.010Grochowiecki T, Gałązka Z, Madej K, et al. Multivariate analysis of complications after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46(8):2806-2809. doi: https://doi.org/10.1016/j.transproceed.2014.08.010Grochowiecki T, Gałązka Z, Madej K, et al. Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46(8):2818-2821. doi: https://doi.org/10.1016/j.transproceed.2014.08.012Grochowiecki T, Gałązka Z, Madej K, et al. Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46(8):2818-2821. doi: https://doi.org/10.1016/j.transproceed.2014.08.012Grochowiecki T, Madej K, Gałązka Z, et al. Usefulness of Modified Dindo-Clavien Scale to Evaluate the Correlation Between the Severity of Surgical Complications and Complications Related to the Renal and Pancreatic Grafts After Simultaneous Kidney and Pancreas Transplantation. Transplant Proc. 2016;48(5):1677-1680. doi: https://doi.org/10.1016/j.transproceed.2016.01.091Grochowiecki T, Madej K, Gałązka Z, et al. Usefulness of Modified Dindo-Clavien Scale to Evaluate the Correlation Between the Severity of Surgical Complications and Complications Related to the Renal and Pancreatic Grafts After Simultaneous Kidney and Pancreas Transplantation. Transplant Proc. 2016;48(5):1677-1680. doi: https://doi.org/10.1016/j.transproceed.2016.01.091World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi: https://doi.org/10.1001/jama.2013.281053World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi: https://doi.org/10.1001/jama.2013.281053Khadjibaev F, Sultanov P, Ergashev D, et al. Frequency of Complications After Kidney Transplant in the Early Postoperative Period. Exp Clin Transplant. 2024;22(Suppl 1):195-199. doi: https://doi.org/10.6002/ect.MESOT2023.P25Khadjibaev F, Sultanov P, Ergashev D, et al. Frequency of Complications After Kidney Transplant in the Early Postoperative Period. Exp Clin Transplant. 2024;22(Suppl 1):195-199. doi: https://doi.org/10.6002/ect.MESOT2023.P25Timsit MO, Kleinclauss F, Richard V, Thuret R. Complications chirurgicales de la transplantation rénale [Surgical complications of renal transplantation]. Prog Urol. 2016;26(15):1066-1082. doi: https://doi.org/10.1016/j.purol.2016.09.052Timsit MO, Kleinclauss F, Richard V, Thuret R. Complications chirurgicales de la transplantation rénale [Surgical complications of renal transplantation]. Prog Urol. 2016;26(15):1066-1082. doi: https://doi.org/10.1016/j.purol.2016.09.052Gutiérrez P, Marrero D, Hernández D, et al. Surgical complications and renal function after kidney alone or simultaneous pancreas-kidney transplantation: a matched comparative study. Nephrol Dial Transplant. 2007;22(5):1451-1455. doi: https://doi.org/10.1093/ndt/gfl771Gutiérrez P, Marrero D, Hernández D, et al. Surgical complications and renal function after kidney alone or simultaneous pancreas-kidney transplantation: a matched comparative study. Nephrol Dial Transplant. 2007;22(5):1451-1455. doi: https://doi.org/10.1093/ndt/gfl771Treckmann JW, Goldenberg A, Malamutmann E, et al. Kidney transplantation in patients with diabetes mellitus: surgical complications. Hepatogastroenterology. 2011;58(107-108):738-739Treckmann JW, Goldenberg A, Malamutmann E, et al. Kidney transplantation in patients with diabetes mellitus: surgical complications. Hepatogastroenterology. 2011;58(107-108):738-739Siskind E, Huntoon K, Shah K, et al. Partial closure of skin wounds after kidney transplantation decreases the incidence of postoperative wound infections. Int J Angiol. 2012;21(2):85-88. doi: https://doi.org/10.1055/s-0032-1315797Siskind E, Huntoon K, Shah K, et al. Partial closure of skin wounds after kidney transplantation decreases the incidence of postoperative wound infections. Int J Angiol. 2012;21(2):85-88. doi: https://doi.org/10.1055/s-0032-1315797

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