ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
https://scientific-jl.org/obr
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Часть–2_ Мая –2025
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EVALUATION OF VITAL FUNCTIONAL INDICATORS OF IMMUNE
CELL ACTIVITY
Ismoilov Ibodjon Imomjonovich
Bukhara State Medical Institute
Abstract:
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
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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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
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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 therapy has revived in general
surgical practice, oncology, and pediatrics (Perepanova T.S. et al., 1995; Lakhno V.M.,
Bordunovsky V.N., 2001).
One of the most challenging tasks for transplantologists and nephrologists is the
management of renal transplant recipients with fever of unknown origin. The list of
possible causes of this condition is very large, and the clinical picture does not have
characteristic features that allow a nosological diagnosis to be established without the
use of complex laboratory methods of examination. Creation of an algorithm for
examination and treatment of renal transplant recipients with fever of unknown origin
can shorten the diagnosis time and improve the quality of treatment for this group of
patients.
One of the greatest achievements of the twentieth century is organ transplantation,
which has stepped into medicine as a therapeutic alternative for organ failure and
allows many patients to be saved from death for whom other options for survival do
not exist. Over 106,000 organ transplants were performed worldwide in 2010, and this
is an indicator of the level of development of medicine in the state. Over the past three
decades, the one-year survival rate of transplanted organs has reached 90% (kidneys,
liver), but the duration of their functioning due to the development of chronic transplant
rejection has changed insignificantly. Acute rejection even after liver transplantation
was noted in 1/3 of patients. In most cases, it is dealt with using only traditional therapy,
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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but in case of treatment-resistant rejection or contraindications to such treatment, it is
necessary to use other means [9]. Prevention and therapy of acute rejection are
effective, but are associated with significant risks, including opportunistic infections,
recipient intoxication, metabolic disorders, and malignant neoplasms. The
development of new therapies that do not compromise the immune system, but
specifically prevent damage to allogeneic tissues, is of paramount importance for the
future of transplant medicine. Induction of immunological tolerance will eliminate the
need to take medications without rejection and associated side effects [2].
To achieve a state of tolerance, researchers have focused on studying the
regulation of the immune response as the cornerstone of modern clinical
transplantation. Observations in veterinary medicine of induced hematopoietic
chimeras [3] and the pioneering work of M. Hasek and V. Demikhov, carried out back
in the 50s. XX century, allowed to come closer to understanding this issue [4, 5].
The immunological nature of graft rejection was demonstrated by Peter Medawar
in an experiment on the transplantation of a genetically alien skin graft in rabbits [8].
Both humoral and cellular mechanisms play a role in transplant rejection. Cellular
rejection mechanisms cause T-lymphocytes to become sensitized to the transplanted
antigens. These lymphocytes cause damage to cells of foreign tissue by either direct
cytotoxicity or secretion of lymphokines. T cell damage is characterized by
parenchymal cell necrosis, lymphocytic infiltration, and fibrosis. Humoral mechanisms
are mediated by antibodies that may be present in the serum of the recipient before
transplantation or develop after transplantation of foreign tissue. Humoral factors
damage the transplanted tissue through reactions that are equivalent to type II and III
hypersensitivity reactions. The interaction of antibodies with the antigen on the surface
of the transplanted cells leads to cell necrosis, and the accumulation of immune
complexes in the blood vessels activates complement, which leads to the development
of acute necrotizing vasculitis or chronic fibrosis of the intima with vasoconstriction.
Conclusion.
Renal transplantation, renal transplant complications, impaired
adaptation of the donor organism to the transplanted kidney are associated with the
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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immunogenesis of the individual organism. Changes in the physiological activity of
class T lymphocytes in the div after kidney transplantation are accompanied by
changes in all immunogenetic conditions in the div, which leads to a decrease in renal
vital signs, resulting in renal complications, decreased vital signs of renal
transplantation within three years.
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