Update: Immunsuppression bei Organtransplantationen

Zusammenfassung

Die Immunsuppression ist eine wesentliche Grundvoraussetzung für eine erfolgreiche Transplantation. Zur Reduktion der teils beträchtlichen Nebenwirkungen werden Kombinationstherapien mit unterschiedlichen Wirkstoffen durchgeführt. Dieser Beitrag soll einen aktuellen Überblick zur Immunsuppression nach Leber- und Nierentransplantation geben.

Abstract

Solid organ transplantation is surgical routine treating patients with end-stage organ disease. For a long-term success of this therapy, both multidisciplinary and multiprofessional patient care and follow-up is crucial. Immunosuppression plays a central role, especially in the follow-up care of the organ recipients. In the past, the major goal of immunosuppression was to prevent acute rejection. Today, the focus is reducing the side effects of immunosuppression in order to optimize long-term survival. New strategies include the reduction or elimination of steroids or calcineurin inhibitors, combinations with new substances and patient-specific therapeutic approaches. The demanding, changed donor and recipient profiles with increasing age on both sides, living donation, donor organs with extended criteria, increased cardiovascular comorbidities and complex immunological conditions require individualized treatment strategies for tailored immunosuppression. Concepts for patient-oriented therapy still have to be developed.

Kernaussagen

• Etablierte Strategien zur Immunsuppression nach Organtransplantation haben in den letzten Jahren zu guten Ergebnissen geführt.

• Eine Hauptrolle bei Immunsuppression nach Organtransplantation spielen Calcineurininhibitoren (CNI), die vor allem nephrotoxisch sind.

• Es gibt mehrere Ansätze, die CNI-assoziierten Nebenwirkungen zu reduzieren und somit die Langzeitergebnisse weiter zu verbessern.

• Konzepte für eine patientenorientierte Therapie müssen noch entwickelt werden.

Schlüsselwörter

Langzeitüberleben - Nebenwirkungen - Behandlungsstrategien - patientenorientiert

Key words

Long-term survival - side effects - treatment strategy - patient-oriented

Publication History

Article published online:
16 November 2020

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