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1 ГБОУ ВПО «Волгоградский государственный медицинский университет» Минздрава России, Волгоград, Российская Федерация 2 ГБОУ ВПО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России, Москва, Российская Федерация 3 ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская Федерация Материалы. Сорокапятилетнему пациенту с терминальной хронической почечной недостаточностью 02.04.2013 г. была выполнена аллотрансплантация почки от 31-летнего трупного асистолического донора. Стандартная стартовая иммуносупрессивная терапия включала такролимус, микофенолат натрия, метил-преднизолон. Через четыре недели пациент был выписан в удовлетворительном состоянии с креатини-ном плазмы 0,25 ммоль/л. Через пять месяцев после операции пациент обратился по поводу появившихся множественных опухолевидных образований на коже лица. В течение последующего месяца наблюдался прогрессивный рост образований. Выполненная биопсия подтвердила диагноз «саркома Капоши». Паци-енту одномоментно был отменен такролимус и назначен эверолимус. В течение следующего месяца не было отмечено появления новых образований. В последующем наблюдался постепенный регресс име-ющихся опухолей. Концентрацию эверолимуса в крови поддерживали на уровне 4-8 нг/мл. Результа-ты. Через два месяца после конверсии на эверолимус у пациента появилась протеинурия 0,5-0,7 г/сут, которая прогрессировала в течение последующего месяца до 1,8-2,4 г/сут. После увеличения ежеднев-ной дозы метилпреднизолона с 4 до 10 мг уровень протеинурии постепенно снизился до 0,5-0,6 г/сут. В течение всего периода наблюдения функция трансплантата оставалась стабильной. Креатинин плазмы 0,22-0,26 ммоль/л. Выводы. Применение эверолимуса в сочетании с одновременной отменой ингибито-ров кальциневрина может быть эффективным средством в лечении саркомы Капоши у пациентов после трансплантации почки без повышения риска развития острого отторжения. Materials. The forty fi ve y.o. man with ESRD had underwent kidney transplantation from cadaveric 31 y.o. non biting heart donor 02.04.2013. He has received standard immunosupression: MP+Tc+MMF and for 4 weeks was discharged from hospital with serum creatinine 0.25 mmol/1. On the fi fth post transplant month the patient discovered on the face skin multiple tumors. The tumors had moderate growth during next month. Kaposi's sarcoma had been proven by biopsy, so we stopped tacrolimus therapy in the recipient and started everolimus treatment. During next month there was no new skin lesions and the previously registered tumors had no futher growth. From that time we have seen gradual regression of skin lesions. We support everolimus blood level 4-8 ng/ml.Для корреспонденции: Cапожников Аркадий Давидович. Адрес: 404120, Волгоградская обл., г. Волжский,

Various research has shown that non-melanocytic malignant skin lesion is one of the most common post-kidney transplant neoplasms. Multiple lesions and a more aggressive clinical course are more common in kidney transplant patients than in the general population. This paper presents a case of malignant skin neoplasms in a patient 10 years after cadaveric kidney transplantation. The patient received standard 3-component immunosuppression with satisfactory graft function (serum creatinine level remained at 157–178 μmol/L). Scalp neoplasm was removed. Histological examination revealed a morphological picture characteristic of basal cell carcinoma with squamous differentiation. Subsequently, a relapse of the skin neoplasm of the temporal region, as well as new lesions in the frontal region and the skin of the anterior chest wall, were discovered. Despite surgical treatment and close-focus x-ray radiation, the disease rapidly progressed and eventually led to death. Squamous cell carcinoma can progress very rapidly in patients after solid organ transplantation, despite ongoing combination treatment. Perhaps in such cases, it is worth cancelling immunosuppressive therapy completely and removing the kidney graft in order to control progression of the malignant tumor process.

Background. With a constant increase in the number of renal transplant recipients and an increase in their life expectancy, the number of complications associated with immunosuppressive therapy is progressively increasing. The incidences of oncological diseases are approximately 100 times higher than the incidence in the general population. Skin neoplasms constitute a significant part of oncological diseases after kidney transplantation.Materials and methods. In our clinic in the period from 2010 to 2017, four patients with malignant neoplasms of the skin were observed. Three of them developed Kaposi’s sarcoma in the period from 6 months to 6 years after kidney transplantation, one was diagnosed with squamous cell skin cancer 10 years after the operation.Results. After histological verification, excision of neoplasms was performed in two cases, followed by a decrease in the dosage of immunosuppressive drugs; in one case, a complete conversion of immunosuppressive therapy was performed. During therapy, stabilization of the condition was noted, however, further deterioration in the function of the graft was noted, which led to the loss of kidney function and removal of the grafts. A patient with basal cell skin cancer underwent surgical treatment with a course X-ray radiation, but further progression led to the death of the patient.Conclusion. Kidney transplant patients are at high risk of developing skin malignancies and death from cancer. Early detection of the disease and complete withdrawal of immunosuppressive drugs – calcineurin inhibitors, despite the high probability of loss of graft function are still often remain necessary conditions for the treatment of patients with skin malignant neoplasms.

Background: COVID-19 in solid organ transplant recipients is usually characterized by more severe disease course and is often associated with life-threatening complications. Identification of additional factors that may affect the risk and severity of the new coronavirus infection could have a significant impact on choosing a management strategy for renal graft recipients. Aim: To evaluate the possibility of cross-immunity between skin manifestations of viral etiology and COVID-19. Materials and methods: From May 2020 to February 2021 we examined 180 renal graft recipients with a history of transplantation from 2 months to 26.5 years. All patients were categorized into two groups: groupI (n=68), those who had confirmed moderate or severe COVID-19 disease and groupII (n=112), those without any history of clinical manifestations of the new coronavirus infection (including those with potentially asymptomatic disease). During the study period which lasted for 71 months on average (range, 2 to 318 months), laboratory workupwas performed in all patients (on average, twice): dermatological examination and detection of serum antibodies to herpes simplex virus 1, 2, cytomegalovirus, human papilloma virus (HPV), Epstein-Barr virus, SARS-CoV-2. Results: In recipients with HPV-associated skin manifestations, the incidence of COVID-19 was significantly lower than in recipients who did not have them 30.4% (34/112) and 50% (34/68), respectively (p=0.011). The incidence of new coronavirus infection did not differ in the groups of patients with cutaneous manifestations caused by herpes simplex viruses type 1 and 2, and without them. Among recipients with Epstein-Barr virus seropositivity, there were significantly fewer cases of COVID-19 compared to seronegative patients 26.2% (28/107) and 54.8% (40/73), respectively (p=0.0002). Conclusion: HPV-associated dermal manifestations or serum Epstein-Barr virus-seropositivity in renal graft recipients is associated with lower incidence of moderate and severe COVID-19. Further studies are needed to confirm the possibility of cross-immunity against SARS-CoV-2 with other infections.