Посттрансплантационный сахарный диабет: механизмы развития, факторы риска, диагностика, лечение

Прогрессивное увеличение трансплантационной активности ожидаемо увеличивает частоту посттрансплантационных осложнений, в частности посттрансплантационного сахарного диабета (ПТСД). В обзоре проводится анализ эпидемиологии, факторов риска и ключевых механизмов развития указанного осложнения, таких как инсулинорезистентность, индуцированная иммуносупрессивной терапией, и нарушение секреции инсулина вследствие токсичности ингибиторов кальциневрина. Рассматриваются немодифицируемые и модифицируемые факторы риска. Особое внимание уделено эволюции терминологии и диагностических критериев ПТСД, их специфике в посттрансплантационном периоде, а также роли непрерывного мониторирования гликемии с целью активного скрининга реципиентов. Представлен сравнительный анализ современных терапевтических подходов, охватывающий модификацию иммуносупрессивных схем лечения, немедикаментозные вмешательства и применение инкретиномиметиков, ингибиторов натрий-глюкозного котранспортера 2 типа и других сахароснижающих препаратов в данной популяции. Обсуждаются дальнейшие перспективы в тактике ведения пациентов после трансплантации — замена препаратов на менее диабетогенные, усовершенствование протоколов иммуносупрессии, персонализированный подход, ранняя стратификация риска развития ПТСД. Подчеркивается клиническая значимость ПТСД как фактора, ассоциированного с ухудшением сердечно-сосудистого прогноза, снижением выживаемости трансплантата и реципиента. Обосновывается необходимость междисциплинарного взаимодействия трансплантологов, эндокринологов и терапевтов на всех этапах ведения пациента — от предтрансплантационной оценки метаболического статуса до длительного послеоперационного наблюдения.

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