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Srpski arhiv za celokupno lekarstvo
2018, vol. 146, br. 1-2, str. 81-85
jezik rada: engleski
vrsta rada: prikaz slučaja
doi:10.2298/SARH170131099P


Limfoproliferativna bolest posle transplantacije bubrega
aUniversity of Novi Sad, Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Faculty of Medicine, Novi Sad
bUniversity of Novi Sad, Clinical Center of Vojvodina, Clinic of Haematology, Faculty of Medicine, Novi Sad

e-adresa: lada.petrovic@mf.uns.ac.rs

Sažetak

Uvod Posttransplantaciona limfoproliferativna bolest (PTLB) ozbiljna je i često fatalna komplikacija koja se razvija kod primaoca posle transplantacije solidnih organa ili koštane srži. Prikaz bolesnika Prikazan je slučaj bolesnika rođenog 1989. godine kome je urađena transplantacija bubrega od živog, srodnog davaoca u 16. godini života. Indukciona terapija je obuhvatila primenu antitimocitnog globulina i kortikosteroida, a terapija održavanja je bila kombinacija tri imunosupresivna leka: takrolimus, mikofenolat-mofetil i kortikosteroid. Prve tegobe se javljaju šest meseci posle transplantacije u vidu pogoršanja hroničnog tonzilitisa, a zatim i pojave disfagičnih tegoba. Posle tonzilektomije patohistološkim i imunohistohemijskim ispitivanjem dobijen je nalaz koji ukazuje na polimorfni oblik PTLB sa visokim stepenom ekspresije Epstajn-Bar virusnog antigena. Definitivna dijagnoza difuznog krupnoćelijskog limfoma porekla B limfocita (CD20+) postavljena je analizom biopsije jednjaka. Primenjena je antivirusna terapija uz redukciju postojećih imunosupresiva, rituximab, hemioterapija: ciklofosfamid, doksorubicin (hydroxydaunomycin), vinkristin i prednizon (terapija CHOP). Složenim dijagnističkim procedurama potvrđeni su odsustvo recidiva bolesti i stabilna funkcija grafta pet godina posle završene terapije PTLB. Zaključak Kod bolesnika sa razvijenom PTLB posle transplantacije bubrega, pravovremenom dijagnozom, redukcijom imunosupresivnog režima i pažljivom primenom imunomodulatorne i hemioterapije može se postići kompletna remisija bolesti uz održavanje stabilne funkcije transplantata.

Ključne reči

transplantacija bubrega; post-transplantaciona limfoproliferativna bolest; imunosupresija

Reference

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