vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2019-16-1-13-22vestim-472Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEИнфекционный статус детей после трансплантации почки и опыт применения этиотропного лечения вирусных осложненийInfectious status of children after renal transplantation and experience of etiotropic treatment of viral complicationsАмвросьеваТ. В.AmvrosievaT. V.

Амвросьева Тамара Васильевна – доктор медицинских наук, профессор, заведующий лабораторией

ул. Филимонова, 23, 220114, г. Минск

Tamara V. Amvrosieva – D. Sc. (Med.), Professor, Head of the Laboratory

23, Filimonov Str., 220114, Minsk

amvrosieva@gmail.comБогушЗ. Ф.BohushZ. F.

Богуш Зоя Федоровна – научный сотрудник

ул. Филимонова, 23, 220114, г. Минск

Zoja F. Bohush – Researcher

23, Filimonov Str., 220114, Minsk

labsanvir@gmail.comКишкурноЕ. П.KishkurnoE. P.

Кишкурно Елена Петровна – кандидат медицинских наук, доцент

ул. П. Бровки, 3/3, 220013, г. Минск

Elena P. Kishkurno – Ph. D. (Med.), Assistant Professor

3/3, P. Browka Str., 220013, Minsk

kishkurno@yandex.ruБайкоС. В.BaikoS. V.

Байко Сергей Валерьевич – кандидат медицинских наук, доцент

пр. Дзержинского, 83, 220116, г. Минск

Sergey V. Baiko – Ph. D. (Med.), Assistant Professor

83, Dzerzhinski Ave., 220116, Minsk

baico@vanolex.ruАриновичА. С.ArinovichA. S.

Аринович Александра Сергеевна – младший научный сотрудник

ул. Филимонова, 23, 220114, г. Минск

Alexandra S. Arinovich – Junior researcher

23, Filimonov Str., 220114, Minsk

labsanvir@gmail.comПоклонскаяН. В.PaklonskayaN. V.

Поклонская Наталья Владимировна – кандидат биологических наук, ведущий научный сотрудник

ул. Филимонова, 23, 220114, г. Минск

Natalia V. Paklonskaya – Ph. D. (Biol.), Leading researcher

23, Filimonov Str., 220114, Minsk

labsanvir@gmail.comСукалоА. В.SukaloA. V.

Сукало Александр Васильевич – академик, доктор медицинских наук, профессор, заведующий кафедрой

пр-т Независимости, 66, 220072, г. Минск

Alexandr V. Sukalo – Academician, D. Sc. (Med.), Professor, Head of the Department

66, Nezavisimosti Ave., 220072, Minsk

nasb@presidium.bas-net.byРеспубликанский научно-практический центр эпидемиологии и микробиологииRepublican Scientifc and Practical Center of Epidemiology and MicrobiologyБелорусская медицинская академия последипломного образованияBelarusian Medical Academy of Postgraduate EducationБелорусский государственный медицинский университетBelarusian State Medical UniversityПрезидиум Национальной академии наук БеларусиPresidium of the National Academy of Sciences of Belarus2019120320191611322Copyright © Амвросьева Т.В., Богуш З.Ф., Кишкурно Е.П., Байко С.В., Аринович А.С., Поклонская Н.В., Сукало А.В., 20192019Амвросьева Т.В., Богуш З.Ф., Кишкурно Е.П., Байко С.В., Аринович А.С., Поклонская Н.В., Сукало А.В.Amvrosieva T.V., Bohush Z.F., Kishkurno E.P., Baiko S.V., Arinovich A.S., Paklonskaya N.V., Sukalo A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/472

В статье изучены инфекционный статус детей в разные сроки после трансплантации почки и опыт этиотропного лечения посттрансплантационных осложнений. Приведены данные генодиагностики вирусных инфекций, возбудителями которых являются цитомегаловирус, полиомавирусы (ВКV, JCV), вирус Эпштейна–Барр, варицелла-зостер вирус, вирусы простого герпеса 1-го и 2-го типов, вирусы герпеса человека 6-го и 7-го типов, аденовирусы. Установлено, что частота их регистрации при исследовании крови в раннем послеоперационном периоде (первые 3 мес. после пересадки) составила 20,0 %, в позднем – 8,0, в условиях дисфункции трансплантата – 21,4 %. По результатам ПЦР-исследований мочи ВКV и/или JCV вирурия регистрировалась у 40,0 % реципиентов в раннем послеоперационном периоде, у 47,1 % – в позднем. Доминирующими возбудителями были полиомавирусы. При этом в раннем периоде преобладали ВКV (22,9 %), в позднем – JCV (36,8 %). Приведены примеры лечения острого отторжения трансплантата на фоне виремии ВГЧ 6 и дисфункции графта на фоне длительного персистирования ВКV инфекции. Применение валганцикловира в первом случае и перевод пациента с мофетила микофенолата на азатиоприн во втором случае позволили стабилизировать функцию пересаженного органа.

The article presents the results of viral infections monitoring in children at different times after renal transplantation and experience of their use in treatment of post-transplant complications. This study presents the results of virological investigation of relevant agents of viral infections (CMV, EBV, HSV 1, 2 tons, HHV 6, HHV 7, VZV, ADV, BKV and JCV). The frequency of identifying the viral infections in blood in the early postoperative period (the frst 3 months after transplantation) was 20.0 %, in the late postoperative period – 8.0 %, in the case of graft dysfunction – 21.4 %. According to the results of PCR tests of urine, BK and / or JC viruses were identifed in 40.0 % of recipients in the early postoperative period and in 47.1 % of recipients in the late postoperative period. The dominant pathogens were polyomaviruses, BKV (22.9 %) prevailed in the early postoperative period, and JCV (36.8 %) in the late postoperative period. There are the examples of treatment of acute transplant rejection combined with HHV 6 viremia and graft dysfunction combined with a long-term persistence of BKV infection. The use of vanganciclovir in the frst case and the replacement mycophenolate mofetil (MMF) by azathioprine in the second one allowed stabilizing the function of the transplanted organ.

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