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Экстракорпоральный фотоферез при трансплантации солидных органов

https://doi.org/10.18786/2072-0505-2020-48-046

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Аннотация

Несмотря на применение современных иммуносупрессивных препаратов эпизоды отторжения трансплантата встречаются достаточно часто и представляют серьезную угрозу для тысяч реципиентов солидных органов. Длительное применение различных комбинаций иммуносупрессивных препаратов вызывает тяжелые осложнения, такие как артериальная гипертензия, посттрансплантационный сахарный диабет, почечная недостаточность, повышенный риск инфекций, злокачественных новообразований и др. При попытках желаемой или вынужденной минимизации иммуносупрессии трансплантата сохраняется угроза его отторжения, что вызывает необходимость поиска менее токсичных, немедикаментозных, иммунологических, в том числе клеточных, методов лечения. К перспективным методам, основанным на клеточных технологиях, относится экстракорпоральный фотоферез (ЭКФ), хорошо зарекомендовавший себя в качестве терапии второй линии и рекомендуемый для профилактики и лечения рефрактерного отторжения сердечного трансплантата. Применение ЭКФ позволяет улучшить функцию легочных аллотрансплантатов у пациентов с резистентностью к лечению синдрома облитерирующего бронхиолита. Однако его значение для профилактики этого синдрома пока не ясно. Эффективность ЭКФ в качестве индукционной, поддерживающей или антикризовой терапии при трансплантации почек, печени или других солидных органов достаточно убедительна, но отсутствие рандомизированных многоцентровых исследований ограничивает его применение. Оптимальная тактика проведения ЭКФ пока не установлена, тем не менее современного понимания патофизиологических и иммунологических аспектов метода достаточно для разработки стандартной методологии и технологии проведения самой процедуры, а также системы контроля качества проведения ЭКФ реципиентам трансплантата почки и печени. Авторы обзора также обсуждают возможные механизмы иммуномодулирующего действия ЭКФ.

Сегодня ЭКФ все активнее изучается в проспективных рандомизированных исследованиях с достаточно крупными выборками. Благодаря этому становится возможным расширить клинические показания метода с определением четких критериев, а также изучить лежащий в его основе сложный иммуномодулирующий механизм действия. Необходимы дальнейшие исследования по выявлению биомаркеров, которые могут быть предикторами эффективности ЭКФ при трансплантации солидных органов.

Об авторах

А. В. Кильдюшевский
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»
Россия

Кильдюшевский Александр Вадимович – д-р мед. наук, профессор, вед. науч. сотр. отделения клинической гематологии и иммунотерапии

129110, г. Москва, ул. Щепкина, 61/2

Тел.: +7 (903) 614 86 65



Я. Г. Мойсюк
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»
Россия

Мойсюк Ян Геннадиевич – д-р мед. наук, профессор, руководитель отдела трансплантологии

129110, г. Москва, ул. Щепкина, 61/2



А. В. Молочков
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»
Россия

Молочков Антон Владимирович – д-р мед. наук, профессор, заместитель директора по науке и международным связям

129110, г. Москва, ул. Щепкина, 61/2



Т. А. Митина
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»
Россия

Митина Татьяна Алексеевна – д-р мед. наук, руководитель отделения клинической гематологии и иммунотерапии

129110, г. Москва, ул. Щепкина, 61/2



А. П. Фаенко
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»
Россия

Фаенко Александр Павлович – канд. мед. наук, доцент курса клинической трансфузиологии при кафедре анестезиологии и реанимации факультета усовершенствования врачей

129110, г. Москва, ул. Щепкина, 61/2



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Для цитирования:


Кильдюшевский А.В., Мойсюк Я.Г., Молочков А.В., Митина Т.А., Фаенко А.П. Экстракорпоральный фотоферез при трансплантации солидных органов. Альманах клинической медицины. 2020;48(3):207-224. https://doi.org/10.18786/2072-0505-2020-48-046

For citation:


Kildyushevsky A.V., Moysyuk Y.G., Molochkov A.V., Mitina T.A., Faenko A.P. Extracorporeal photopheresis in solid organ transplantation. Almanac of Clinical Medicine. 2020;48(3):207-224. (In Russ.) https://doi.org/10.18786/2072-0505-2020-48-046

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