clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2022-100-2-3-119-125clinmed-361Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSЧастота активации герпес-вирусных инфекций у реципиентов почечного трансплантатаFrequency of herpes virus infections activation in renal graft recipientsДжумабаеваБ. Т.DzhumabaevaB. T.

Джумабаева Болдукыз Толгонбаевна — д-р мед. наук, ведущий научный сотрудник отделения полиорганной патологии и гемодиализа

125167, Москва

Dzhumabaeva Boldukyz T.

125167, Moscow

bola.blood@yandex.ruБирюковаЛ. С.BiryukovaL. S.

125167, Москва

125167, Moscow

КапрановН. М.KapranovN. M.

125167, Москва

125167, Moscow

ТихомировД. С.TikhomirovD. S.

125167, Москва

125167, Moscow

ТуполеваТ. А.TupolevaT. A.

125167, Москва

125167, Moscow

ДавыдоваЮ. О.DavydovaYu. O.

125167, Москва

125167, Moscow

ГальцеваИ. В.Gal'cevaI. V.

125167, Москва

125167, Moscow

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава РоссииРоссияNational Research Center of HematologyRussian Federation2022250620221002-3119125Copyright © Джумабаева Б.Т., Бирюкова Л.С., Капранов Н.М., Тихомиров Д.С., Туполева Т.А., Давыдова Ю.О., Гальцева И.В., 20222022Джумабаева Б.Т., Бирюкова Л.С., Капранов Н.М., Тихомиров Д.С., Туполева Т.А., Давыдова Ю.О., Гальцева И.В.Dzhumabaeva B.T., Biryukova L.S., Kapranov N.M., Tikhomirov D.S., Tupoleva T.A., Davydova Y.O., Gal'ceva I.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.clinmedjournal.com/jour/article/view/361

У реципиентов почечного трансплантата на фоне иммуносупрессивной терапии в течение первого года после трансплантации наблюдается развитие вирусных инфекций, приводящих к дисфункции и потерe трансплантата. В настоящей работе приведены результаты исследований субпопуляций Т-лимфоцитов у реципиентов почечного трансплантата до и после операции, а также у доноров крови (контрольная группа). Показано влияние отклонений в Т-клеточном звене иммунитета на развитие цитомегаловирусной (ЦМВ) и Эпштейна–Барр-вирусной (ВЭБ) инфекции в посттрансплантационном периоде. В исследование включено 19 реципиентов почечного трансплантата, медиана возраста 43 года, мужчин — 14, женщин — 5. Контрольную группу составили 20 здоровых доноров крови. Через месяц после трансплантации аллогенной почки (ТАП) на фоне индукционной (метилпреднизолон, базиликсимаб) и базисной (преднизолон, такролимус, микофенолата мофетил) иммуносупрессивной терапии, обнаружены маркеры репликации ЦМВ у 10 (53%) и ВЭБ у 7 (36,9%) пациентов. Профиль обнаруженных маркеров ЦМВ и/или ВЭБ в подавляющем большинстве случаев соответствовал реактивации эндогенного вируса. ЦМВ- и/или ВЭБ-инфекция после ТАП развивались у пациентов, у которых до ТАП была значительно снижена доля лимфоцитов, абсолютное количество наивных CD4+ и СD8+, эффекторных CD4+ клеток памяти, регуляторных T-клеток (CD4+/CD25+/CD127–) по сравнению с контрольной группой. При ВЭБ-инфекции до ТАП определялось также достоверное снижение количества CD3+, абсолютного количества CD4+ и CD8+, увеличение доли центральных CD8+ клеток памяти по сравнению с контрольной группой. Таким образом, частота реактивации вирусной инфекции в первые месяцы после ТАП зависит не только от проводимой иммуносупрессивной терапии, но и от изменений субпопуляций Т-лимфоцитов до ТАП. Данные изменения могут быть учтены для профилактики возникновения вирусной инфекции после трансплантации почки.

Immunosuppressive treatment during the first year after renal transplantation leads to viral infection development in recipients, and graft dysfunction up to its loss. This original article gives data on comparison of T-lymphocytes subsets in healthy blood donors and renal graft recipients before and one month after transplantation. The influence of T-cell immunity impairment on CMV- and EBV-infection emergence were evaluated. 19 renal graft recipients were included in the study (average age — 43, m/f ratio — 14/5). 20 healthy blood donors were used as controls. A month after transplantation during induction (Methylprednisolone and Basiliximab) and basis (Prednisolone, Tacrolimus, Mycophenolate mofetil) therapy 10 (53%) patients had makers of CMV replication and 7 (36.9%) patients had markers of EBV replication. The majority of CMV- and EBV-positive patients proved reactivation of endogenous CMV and EBV (not primary infection). All patients, subsequently positive for CMV and EBV, demonstrated T-cells subpopulations discount before transplantation, such as a decrease in the total number of lymphocytes and absolute number of naïve CD4+ and СD8+ cells, effector memory CD4+ cells, T-regulatory cells (CD4+/CD25+/CD127–) in comparison to the control group. EBV-positive patients also showed the reduction of CD3+, absolute number of CD4+ and CD8+, but central memory CD8+ cells increased in comparison to the control group. Viral reactivation rate during first month after renal transplantation depends not only on immunosuppressive regimen but on T-cells subsets disproportions before graft. These indicators could be taken into account for viral infection expectancy.

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