diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13393diaendo-13393Research ArticleКлинический случайCase reportПовторная трансплантация почки у пациентки с сахарным диабетом 1 типа и хроническим пиелонефритом: клинический случайRepeat kidney transplantation in a patient with type 1 diabetes mellitus and chronic pyelonephritis: a clinical casehttps://orcid.org/0000-0003-1247-3481ЗвягинцеваА. Н.ZvyagintsevaA. N.

Звягинцева Анастасия Николаевна 

117292, Москва, ул. Дм. Ульянова, д. 11 

Anastasia N. Zvyagintseva 

11 Dm. Ulyanova street, 117292 Moscow 

zvyagintsevaanastasia@mail.ruhttps://orcid.org/0009-0001-0616-2444ИвановаД. В.Ivanova D. V.

Иванова Дарья Вячеславовна 

Москва 

Daria V. Ivanova 

Moscow 

dar.ivanova22@gmail.comhttps://orcid.org/0000-0002-0296-4933СеверинаА. С.SeverinaA. S.

Северина Анастасия Сергеевна, к.м.н., в.н.с. 

Москва 

Anastasia S. Severina, MD, PhD, leading research associate 

Moscow 

ansev1@mail.ruhttps://orcid.org/0000-0002-5057-127XСухареваО. Ю.SukharevaO. Y.

Сухарева Ольга Юрьевна, к.м.н., доцент 

Москва 

Olga Y. Sukhareva, MD, PhD, Associate Professor 

Moscow 

olgasukhareva@mail.ruhttps://orcid.org/0000-0002-3433-0142ШамхаловаМ. Ш.ShamkhalovaM. S.

Шамхалова Минара Шамхаловна, д.м.н.  

Москва 

Minara S. Shamkhalova, MD, PhD 

Moscow 

shamkhalova@mail.ruГНЦ РФ ФГБУ «Национальный медицинский исследовательский центр эндокринологии им. академика И.И. Дедова»РоссияEndocrinology Research CentreRussian Federation202503122025285480486Copyright © Звягинцева А.Н., Иванова Д.В., Северина А.С., Сухарева О.Ю., Шамхалова М.Ш., 20252025Звягинцева А.Н., Иванова Д.В., Северина А.С., Сухарева О.Ю., Шамхалова М.Ш.Zvyagintseva A.N., Ivanova  D.V., Severina A.S., Sukhareva O.Y., Shamkhalova M.S.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/13393

В настоящее время аллотрансплантация трупной почки представляет собой наиболее эффективный и безопасный метод лечения терминальной почечной недостаточности у пациентов с сахарным диабетом. Для предотвращения отторжения трансплантата необходимо учитывать множество факторов, способствующих его повреждению. Особое внимание следует уделить снижению риска инфекционных осложнений трансплантата, возникающих на фоне иммуносупрессивной терапии.

В данной статье представлен клинический случай пациентки с отторжением почечного трансплантата, которое произошло вскоре после эпизода острого пиелонефрита и повторной аллотрансплантации трупной почки.

Cadaveric kidney allotransplantation remains the most effective and safest therapeutic option for end-stage renal disease in patients with diabetes mellitus. Successful graft survival requires consideration of multiple factors that may contribute to transplant injury. Particular emphasis should be placed on minimizing the risk of transplant-associated infectious complications arising in the context of immunosuppressive therapy. We report a clinical case of kidney graft rejection in a female patient, occurring shortly after an episode of acute pyelonephritis and subsequent repeat cadaveric kidney allotransplantation.

сахарный диабетхроническая болезнь почекаллотрансплантацияповторная трансплантацияdiabetes mellituschronic kidney diseasekidney allotransplantationrepeat transplantationРабота проведена в рамках выполнения государственного задания Минздрава России (№123021000038-6).ReferencesWang Y., Hemmelder M.H., Bos W.J.W., et al. Mapping health-related quality of life after kidney transplantation by group comparisons: a systematic review. Nephrology Dialysis Transplantation. 2021;36(12): 2327–2339. doi: 10.1093/ndt/gfab232.Wang Y., Hemmelder M.H., Bos W.J.W., et al. Mapping health-related quality of life after kidney transplantation by group comparisons: a systematic review. Nephrology Dialysis Transplantation. 2021;36(12): 2327–2339. doi: 10.1093/ndt/gfab232.Grochowiecki T., Gałązka Z., Madej K., et al. Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation. Transplantation Proceedings. 2014; 46 (8): 2818–2821. doi: 10.1016/j.transproceed.2014.08.012.Grochowiecki T., Gałązka Z., Madej K., et al. Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation. Transplantation Proceedings. 2014; 46 (8): 2818–2821. doi: 10.1016/j.transproceed.2014.08.012.Sansalone C.V., Maione G., Aseni P., et al. Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients. Transplantation Proceedings. 2005; 37 (6); 2651–2653. doi: 10.1016/j.transproceed.2005.06.103.Sansalone C.V., Maione G., Aseni P., et al. Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients. Transplantation Proceedings. 2005; 37 (6); 2651–2653. doi: 10.1016/j.transproceed.2005.06.103.Michalak G., Kwiatkowski A., Czerwinski J., et al. Surgical complications of simultaneous pancreas-kidney transplantation: a 16-year-experience at one center. Transplantation Proceedings. 2005; 37 (8.); 3555–3557. doi: 10.1016/j.transproceed.2005.09.077.Michalak G., Kwiatkowski A., Czerwinski J., et al. Surgical complications of simultaneous pancreas-kidney transplantation: a 16-year-experience at one center. Transplantation Proceedings. 2005; 37 (8.); 3555–3557. doi: 10.1016/j.transproceed.2005.09.077.Nambiar P., Silibovsky R., Belden K.A. Infection in Kidney Transplantation. Contemporary Kidney Transplantation. 2018; 307–327. doi:10.1007/978-3-319-19617-6_22.Nambiar P., Silibovsky R., Belden K.A. Infection in Kidney Transplantation. Contemporary Kidney Transplantation. 2018; 307–327. doi:10.1007/978-3-319-19617-6_22.Goldman J.D., Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation. 2019; 33 (9). doi:10.1111/ctr.13507.Goldman J.D., Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation. 2019; 33 (9). doi:10.1111/ctr.13507.Евлоева М.И., Арутюнова М.С., Северина А.С., и др. Хроническая болезнь почек у пациентов с длительным течением сахарного диабета 1 типа // Сахарный диабет. –2023. – Т. 26. – №6 – С. 504–514. [Evloeva M.I., Arutyunova M.S., Severina A.S., i dr. Xronicheskaya bolezn` pochek u pacientov s dlitel`ny`m techeniem saxarnogo diabeta 1 tipa. Saxarny`j diabet. 2023; 26 (6): 504–514. (In Russ).]. doi:10.14341/DM13108.Evloeva M.I., Arutyunova M.S., Severina A.S., i dr. Xronicheskaya bolezn` pochek u pacientov s dlitel`ny`m techeniem saxarnogo diabeta 1 tipa. Saxarny`j diabet. 2023; 26 (6): 504–514. (In Russ). doi:10.14341/DM13108.Черников А.А., Северина А.С., Шамхалова М.Ш., и др. Роль механизмов «метаболической памяти» в развитии и прогрессировании сосудистых осложнений сахарного диабета // Сахарный диабет. – 2017. – Т. 20. – № 2 – С. 126–134. doi:10.14341/7674.Chernikov A.A., Severina A.S., Shamxalova M.Sh., i dr. Rol` mexanizmov «metabolicheskoj pamyati» v razvitii i progressirovanii sosudisty`x oslozhnenij saxarnogo diabeta. Saxarny`j diabet. 2017; 20 (2); 126–134. (In Russ). doi:10.14341/7674.Piani F., Melena I., Severn C., et al. Tubular injury in diabetic ketoacidosis: Results from the diabetic kidney alarm study. Pediatric Diabetes. 2021; 22 (7); 1031–1039. doi:10.1111/pedi.13259.Piani F., Melena I., Severn C., et al. Tubular injury in diabetic ketoacidosis: Results from the diabetic kidney alarm study. Pediatric Diabetes. 2021; 22 (7); 1031–1039. doi:10.1111/pedi.13259.Melena I., Piani F., Tommerdahl K.L., et al. Aminoaciduria and metabolic dysregulation during diabetic ketoacidosis: Results from the diabetic kidney alarm (DKA) study. Journal of Diabetes and Its Complications. 2022; 36 (6). doi: 10.1016/j.jdiacomp.2022.108203.Melena I., Piani F., Tommerdahl K.L., et al. Aminoaciduria and metabolic dysregulation during diabetic ketoacidosis: Results from the diabetic kidney alarm (DKA) study. Journal of Diabetes and Its Complications. 2022; 36 (6). doi: 10.1016/j.jdiacomp.2022.108203.de Boer I.H., Khunti K., Sadusky T., et al. Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022; 45 (12); 3075–3090. doi: 10.2337/dci22-0027.de Boer I.H., Khunti K., Sadusky T., et al. Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022; 45 (12); 3075–3090. doi: 10.2337/dci22-0027.Шестакова М.В., Шамхалова М.Ш., Ярек-Мартынова И.Я., и др. Сахарный диабет и хроническая болезнь почек: достижения, нерешенные проблемы и перспективы лечения // Сахарный диабет. – 2011. – Т. 14. – № 1 – С. 81–88 . doi:10.14341/2072-0351-6254Shestakova M.V., Shamxalova M.Sh., Yarek-Marty`nova I.Ya., i dr. Saxarny`j diabet i xronicheskaya bolezn` pochek: dostizheniya, nereshenny`e problemy` i perspektivy` lecheniya. Saxarny`j diabet. 2011; 14 (1); 81–88. (In Russ). doi:10.14341/2072-0351-6254Галиев Ш.Р. Медикаментозная индукция иммуносупрессии и иммуносупрессивная терапия при трансплантации почки: Дис. докт. мед. наук. – Москва; 2024. Доступно по: https://transpl.ru/upload/medialibrary/6c9/6c9e9591e9508ae0e2fca010735f9f63.pdf. Ссылка активна на 01.06.2025Galiev Sh.R. Medikamentoznaya indukciya immunosupressii i immunosupressivnaya terapiya pri transplantacii pochki. [dissertation] Moskva; 2024. (In Russ).. Доступно по: https://transpl.ru/upload/medialibrary/6c9/6c9e9591e9508ae0e2fca010735f9f63.pdf. Ссылка активна на 01.06.2025Lim K., Lee Y.J., Gwon J.G., et al. Impact of Donor Age on the Outcomes of Kidney Transplantation From Deceased Donors With Histologic Acute Kidney Injury. Transplantation Proceedings. 2019; 51(8); 2593–2597. doi: 10.1016/j.transproceed.2019.03.074.Lim K., Lee Y.J., Gwon J.G., et al. Impact of Donor Age on the Outcomes of Kidney Transplantation From Deceased Donors With Histologic Acute Kidney Injury. Transplantation Proceedings. 2019; 51(8); 2593–2597. doi: 10.1016/j.transproceed.2019.03.074.Zachary A.A., Leffell M.S. HLA Mismatching Strategies for Solid Organ Transplantation – A Balancing Act. Frontiers in Immunology. 2016; 7. doi:10.3389/fimmu.2016.00575.Zachary A.A., Leffell M.S. HLA Mismatching Strategies for Solid Organ Transplantation – A Balancing Act. Frontiers in Immunology. 2016; 7. doi:10.3389/fimmu.2016.00575.Sandal S., Ahn J.B., Segev D.L., et al. Comparing outcomes of third and fourth kidney transplantation in older and younger patients. American Journal of Transplantation. 2021; 21 (12); 4023–4031. doi: 10.1111/ajt.16786.Sandal S., Ahn J.B., Segev D.L., et al. Comparing outcomes of third and fourth kidney transplantation in older and younger patients. American Journal of Transplantation. 2021; 21 (12); 4023–4031. doi: 10.1111/ajt.16786.Matas A.J., Smith J.M., Skeans M.A., et al. OPTN/SRTR 2013 Annual Data Report: kidney. American Journal of Transplantation. 2015; 15 (2): 1–34.Matas A.J., Smith J.M., Skeans M.A., et al. OPTN/SRTR 2013 Annual Data Report: kidney. American Journal of Transplantation. 2015; 15 (2): 1–34.US Renal Data System. USRDS 2007 Annual Data Report. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2007.US Renal Data System. USRDS 2007 Annual Data Report. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2007.Kramer A., Pippias M., Noordzij M., et al. Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus. Clinical Kidney Journal. 2016; 9 (3): 457–469. doi: 10.1093/ckj/sfw031.Kramer A., Pippias M., Noordzij M., et al. Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus. Clinical Kidney Journal. 2016; 9 (3): 457–469. doi: 10.1093/ckj/sfw031.Eurotransplant International Foundation. Annual Report 2014. Leiden: Eurotransplant Foundation; 2015.Eurotransplant International Foundation. Annual Report 2014. Leiden: Eurotransplant Foundation; 2015.Сушков А.И. Повторная трансплантация почки // Вестник трансплантологии и искусственных органов. – 2016. – Т. 18. – № 4 – С. 157–169. doi: 10.15825/1995-1191-2016-4-157-169.Sushkov A.I. Povtornaya transplantaciya pochki. Vestnik transplantologii i iskusstvenny`x organov. 2016; 18 (4); 157–169. (In Russ). doi: 10.15825/1995-1191-2016-4-157-169.Argani H. Second and Third Kidney Transplants. Experimental and Clinical Transplantation. 2024; 22 (1); 60–65. doi: 10.6002/ect.MESOT2023.L45.Argani H. Second and Third Kidney Transplants. Experimental and Clinical Transplantation. 2024; 22 (1); 60–65. doi: 10.6002/ect.MESOT2023.L45.Бушма К. М., Спас В. В., Шапель И. А., и др. К вопросу о нефротоксичности аминогликозидов // Новости хирургии. – 2009. – №1.Bushma K. M., Spas V. V., SHapel' I. A., i dr. K voprosu o nefrotoksichnosti aminoglikozidov. Novosti hirurgii. 2009;(1). (In Russ).Kim H.S., Kim J.Y., Kang E.J., et al. Immunologic and non-immunologic complications of a third kidney transplantation. Korean Journal of Internal Medicine. 2015; 30 (5); 657–664. doi: 10.3904/kjim.2015.30.5.657.Kim H.S., Kim J.Y., Kang E.J., et al. Immunologic and non-immunologic complications of a third kidney transplantation. Korean Journal of Internal Medicine. 2015; 30 (5); 657–664. doi: 10.3904/kjim.2015.30.5.657.Telkes G., Piros L., Szabó J., et al. Outcomes of first versus third kidney transplantations: propensity score matching and paired subgroup analysis—a single-centre experience. Langenbeck's Archives of Surgery. 2021; 406 (3); 863–871. doi: 10.1007/s00423-020-02063-y.Telkes G., Piros L., Szabó J., et al. Outcomes of first versus third kidney transplantations: propensity score matching and paired subgroup analysis—a single-centre experience. Langenbeck's Archives of Surgery. 2021; 406 (3); 863–871. doi: 10.1007/s00423-020-02063-y.Roth D, Gaynor JJ, Reddy KR, et al. Effect of kidney transplantation on outcomes among patients with hepatitis C. J Am Soc Nephrol. 2011;22(6):1152-60. doi: 10.1681/ASN.2010060668.Roth D, Gaynor JJ, Reddy KR, et al. Effect of kidney transplantation on outcomes among patients with hepatitis C. J Am Soc Nephrol. 2011;22(6):1152-60. doi: 10.1681/ASN.2010060668.Yu TM, Lin CC, Shu KH, et al. Increased risk of hepatic complications in kidney transplantation with chronic virus hepatitis infection: A nationwide population-based cohort study. Sci Rep. 2016;19(6). doi: 10.1038/srep21312.Yu TM, Lin CC, Shu KH, et al. Increased risk of hepatic complications in kidney transplantation with chronic virus hepatitis infection: A nationwide population-based cohort study. Sci Rep. 2016;19(6). doi: 10.1038/srep21312.

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