emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2023.7.2.1975emcardio-15Research ArticleИнтересный клинический случайAn interesting clinical caseВопросы догоспитальной диагностики острой реакции отторжения у пациента, перенесшего ортотопическую трансплантацию сердцаIssues of outpatient diagnosis of acute cardiac rejection in a patient who underwent orthotopic heart transplantationГребенюкИ. А.GrebeniukI. A.

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dr.ira.larina@gmail.comКурлянскаяЕ. К.KurlyanskayaE. K.

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ОсмоловскаяТ. В.OsmolovskayaT. V.

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РусакТ. В.RusakT. V.

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РачокЛ. В.RachokL. V.

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ЗавалейЕ. А.ZavaleyE. A.

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ТрошинаА. М.TroshynaA. M.

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ДубовикТ. А.DubovikT. A.

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ХудницкаяВ. С.KhudnitskayaV. S.

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ВерасЯ. А.VerasY. A.

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КопытокИ. В.KopytokI. V.

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ГУ «Республиканский научно-практический центр «Кардиология»Republican Scientific and Practical Center “Cardiology”УО «Белорусский государственный медицинский университет»Belarussian State Medical UniversityУЗ «26-я городская поликлиника»Outpatient Clinic № 262023180620257219751979Copyright © Гребенюк И.А., Курлянская Е.К., Осмоловская Т.В., Русак Т.В., Рачок Л.В., Завалей Е.А., Трошина А.М., Дубовик Т.А., Худницкая В.С., Верас Я.А., Копыток И.В., 20252025Гребенюк И.А., Курлянская Е.К., Осмоловская Т.В., Русак Т.В., Рачок Л.В., Завалей Е.А., Трошина А.М., Дубовик Т.А., Худницкая В.С., Верас Я.А., Копыток И.В.Grebeniuk I.A., Kurlyanskaya E.K., Osmolovskaya T.V., Rusak T.V., Rachok L.V., Zavaley E.A., Troshyna A.M., Dubovik T.A., Khudnitskaya V.S., Veras Y.A., Kopytok 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://emcardio.bsmu.by/jour/article/view/15

Острый криз отторжения сердечного трансплантата – это реакция иммунной системы организма реципиента, в которую включается клеточный и/или гуморальный путь иммунного ответа. Данная реакция направлена против тканей «чужеродного» донорского органа. Настороженность клиницистов в отношении возможного развития острой реакции отторжения в течение первого года после пересадки сердца обусловлена крайне высоким риском развития жизнеугрожающих состояний, опосредованных дисфункцией трансплантата. К ним относятся различные нарушения сердечного ритма и прогрессирующее снижение сократительной способности миокарда. В случае несвоевременной диагностики данного серьёзного осложнения крайне высок риск летальности пациента, перенесшего ортотопическую трансплантацию сердца. Какие изменения клинико-лабораторных и инструментальных параметров обследования на амбулаторном этапе могут помочь практикующему кардиологу заподозрить наличие острой реакции отторжения сердечного трансплантата у пациента, перенесшего ортотопическую трансплантацию сердца? На сегодняшний день нет однозначного ответа на этот вопрос, а тема раннего выявления и прогнозирования развития острой реакции отторжения сердечного трансплантата является крайне актуальной для современных научных изысканий и представляет большой практический интерес в сфере трансплантологии и кардиологии, в частности.

An acute cardiac transplant rejection is a reaction of the recipient’s immune system, which includes the cellular and/or humoral pathway of the immune response. This reaction is directed against the tissues of the “alien” donor organ. The alertness of clinicians regarding the possible development of an acute rejection reaction during the first year after heart transplantation is due to the extremely high risk of developing life-threatening conditions mediated by graft dysfunction. These include various cardiac arrhythmias and a progressive decrease in myocardial contractility. In case of untimely diagnosis of this serious complication, the risk of mortality of the patient who underwent orthotopic heart transplantation is extremely high. What changes in clinical, laboratory and instrumental examination parameters at the outpatient stage can help a practicing cardiologist to suspect the presence of an acute rejection reaction of a heart transplant in a patient who has undergone orthotopic heart transplantation? At present, there is no unambiguous answer to this question, and the topic of early detection and prediction of the development of an acute heart transplant rejection reaction is extremely relevant for modern scientific research and is of great practical interest in the field of transplantology and cardiology, in particular.

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