EVALUATION OF VITAL FUNCTIONAL INDICATORS OF IMMUNE CELL ACTIVITY

Аннотация

Kidney transplantation is the treatment of choice in patients with end- stage chronic renal failure (CRF). All over the world, there is a constant increase in the number of such patients. More than 370,000 patients receive renal replacement therapy in the United States. In 2002, more than 11 thousand kidney transplants were performed in the countries of the European Union, and in the USA - more than 12 thousand kidney transplants. Keywords: organ transplant, acute rejection, immunological tolerance, chronic renal failure. Even more urgent is the problem of treating end-stage chronic renal failure for our country, where the provision of patients with end-stage chronic renal failure with renal replacement therapy is insufficient. More than 10,800 patients are currently receiving treatment with hemodialysis and peritoneal dialysis in Russia, more than 2,500 patients with a functioning renal transplant are observed, however, the real need for renal replacement therapy is much higher (5). Kidney transplantation makes it possible not only to achieve a high quality of life for patients with end-stage chronic renal failure, but also to provide specialized care to a large number of patients in conditions of a shortage of dialysis sites. However, a number of important problems still remain in clinical transplantation, one of which is the problem of infectious complications after kidney transplantation. It was found that during the first year after LT, among all fatal complications, infections are the most significant, the proportion of which is at least 1/3 (1). Subsequently, infectious complications recede into second place after cardiovascular https://scientific-jl.org/obr 3 Выпуск журнала №-70 Часть–2_ Мая –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 complications, but they continue to remain the most important cause of morbidity and mortality in patients with kidney transplants. The development of infectious complications after transplantation depends on the immunological status and the epidemiological environment. Immunological status is determined by the type of immunosuppressive therapy used, doses and sequence of drugs used, and the duration of treatment. An important influence is also exerted by the presence of uremia, neutropenia, anemia, hypoprotsinemia, hyperglycemia, and damage to the skin (4). Infections are not only one of the most frequent complications of the post-transplant period, but are often characterized by a severe course, unusual symptoms, which complicates the diagnosis and choice of treatment tactics. Unfortunately, so far there are no immunosuppressive drugs that are absolutely free from infectious complications. The search continues for the most effective and at the same time safe regimens of immunosuppression after kidney transplantation (3). However, the incidence of infections with new immunosuppressive protocols is not fully understood. For example, there is still insufficient data on the frequency and nature of infectious complications when a new and already widely used drug mycophenolate mycophenolate mofetil (cellsept) is included in the immunosuppression protocol. Of particular importance after organ transplantation are viral infections, most often caused by herpes viruses, primarily cygomegalovirus, Herpes simplex (type 1, 2), Herpes zoster, Epstein Barr viruses, as well as hepatitis B, C, D viruses (7). It has been established that viruses are the cause of at least 50% of all infectious complications in renal transplant recipients. The clinical significance of these infections is determined not only by the primary damage to organs and systems, but also by their immunomodulatory effect, which creates the preconditions for the development of severe superinfections, including aspergillosis, pneumocystosis, and mycoplasmosis. A special place in clinical transplantation is occupied by cytomegalovirus infection (CMV infection), the causative agent of which is a virus from the beta- herpesvirus family. This is due to the high incidence of active CMV infection in the https://scientific-jl.org/obr 4 Выпуск журнала №-70 Часть–2_ Мая –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 post-transplant period - from 20 to 60% in various transplant centers and a serious prognosis if specific therapy is not prescribed on time (2). Treatment of patients with wound, pulmonary and urinary infections after kidney transplantation often becomes a difficult task due to the constantly changing sensitivity to antibiotics of pathogens of bacterial infections with a tendency to develop drug resistance, immunosuppressive status of patients (3). It is necessary to search for new strategies for the treatment and prevention of bacterial complications. There is no information in the available literature on the use of such a promising approach to the treatment of infectious-purulent complications as the use of bacteriophages in transplantation. At the same time, interest in phage the