Betreuung von Patienten nach Nierentransplantation

ZUSAMMENFASSUNG

Zur Durchführung einer Nierentransplantation (NTx) ist die Zusammenarbeit im multiprofessionellen Team grundlegend. Bezogen auf Mortalität und Lebensqualität der Patienten kann die NTx als bestes Nierenersatzverfahren angesehen werden. Mit den Fortschritten in der immunsuppressiven Therapie kann mittlerweile ein sehr gutes Transplantatüberleben im ersten Jahr (> 95 %) erreicht werden, das sich bisher jedoch nicht in den Langzeitverlauf übertragen lässt. Vor der Aufnahme auf die Warteliste für eine NTx wird die Transplantationsfähigkeit durch ein multidisziplinäres Evaluationsprogramm festgestellt und in interdisziplinären Transplantationskonferenzen beraten. Die Wartezeit auf eine NTx in Deutschland ist sehr lang und beträgt 8–10 Jahre. Deshalb steigt die Anzahl von Wartelistenabgängen aufgrund von einer Transplantationsunfähigkeit, die häufig von kardiovaskulären Komplikationen durch Adipositas und Gebrechlichkeit („frailty“) herrührt. Dieser Artikel widmet sich den Strukturen sowie dem interdisziplinären Risikomanagement typischer Komplikationen, Komorbiditäten und Risiken nierentransplantierter Patienten. Der Fokus liegt auf internistischen und urologischen Problemfeldern vor dem Hintergrund der Komplexität und Immunsuppression (IS) von nierentransplantierten Patienten.

Publikationsverlauf

Artikel online veröffentlicht:
06. September 2024

• Literatur

• 1 Wyld M, Morton RL, Hayen A. et al A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med 2012; 09: e1001307
• 2 Wolfe RA, Ashby VB, Milford EL. et al Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341: 1725-1730
• 3 Zecher D, Tieken I, Wadewitz J. et al Regional differences in waiting times for kidney transplantation in Germany. Dtsch Arztebl Int 2023; 120: 393-399
• 4 Roshanravan B, Khatri M, Robinson-Cohen C. et al A prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis 2012; 60: 912-921
• 5 Mellon L, Doyle F, Hickey A. et al Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients. Cochrane Database Syst Rev 2022; 09: CD012854
• 6 Klein A, Loupy A, Stegall M. et al Qualifying a novel clinical trial endpoint (iBOX) predictive of long-term kidney transplant outcomes. Transpl Int 2023; 36: 11951
• 7 Bhandari SK, Zhou H, Shaw SF. et al Causes of death in end-stage kidney disease: comparison between the United States Renal Data System and a large integrated health care system. Am J Nephrol 2022; 53: 32-40
• 8 Bharati J, Anandh U, Kotton CN. et al Diagnosis, prevention, and treatment of infections in kidney transplantation. Semin Nephrol 2023; 43: 151486
• 9 Birdwell KA, Park M. Post-transplant cardiovascular disease. Clin J Am Soc Nephrol 2021; 16: 1878-1889
• 10 Meier-Kriesche H-U, Schold JD, Srinivas TR. et al Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant 2004; 04: 378-383
• 11 King EA, Bowring MG, Massie AB. et al Mortality and graft loss attributable to readmission after kidney transplantation: immediate and long-term risk. Transplantation 2017; 101: 2520-2526
• 12 Aakhus S, Dahl K, Widerøe TE. Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5-yr follow-up. Clin Transplant 2004; 18: 596-604
• 13 Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009; 09 (Suppl. 03) S1-S155
• 14 Kasiske BL, Anjum S, Shah R. et al Hypertension after kidney transplantation. Am J Kidney Dis 2004; 43: 1071-1081
• 15 Krusemark H, Schiffer M. Rundumversorgung Nierentransplantation – Optimierung der interdisziplinären Betreuung vor und nach Nierentransplantation. Urologie 2024; 63: 333-340
• 16 Cosio FG, Kudva Y, van der Velde M. et al New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int 2005; 67: 2415-2421
• 17 Kasiske BL, Snyder JJ, Gilbertson D. et al Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003; 03: 178-185
• 18 Sharif A, Hecking M, Vries APJ de. et al Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant 2014; 14: 1992-2000
• 19 Hecking M, Haidinger M, Döller D. et al Early basal insulin therapy decreases new-onset diabetes after renal transplantation. J Am Soc Nephrol 2012; 23: 739-749
• 20 Chewcharat A, Prasitlumkum N, Thongprayoon C. et al Efficacy and safety of SGLT-2 inhibitors for treatment of diabetes mellitus among kidney transplant patients: a systematic review and meta-analysis. Med Sci (Basel) 2020; 08: 47
• 21 Pham P-T, Sarkar M, Pham P-M. et al Diabetes mellitus after solid organ transplantation. In: Feingold KR, Anawalt B, Blackman MR, et al., Hrsg. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000
• 22 Sharif A, Moore R, Baboolal K. Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia. Transplantation 2008; 85: 353-358
• 23 Fellström BC, Jardine AG, Schmieder RE. et al Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009; 360: 1395-1407
• 24 Mach F, Baigent C, Catapano AL. et al 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
• 25 Holdaas H, Fellström B, Cole E. et al Long-term cardiac outcomes in renal transplant recipients receiving fluvastatin: the ALERT extension study. Am J Transplant 2005; 05: 2929-2936
• 26 Westhoff TH. Lipidmanagement nach Nierentransplantation. Nieren- und Hochdruckkrankheiten 2021; 50: 549-557
• 27 Ong SC, Gaston RS. Thirty years of tacrolimus in clinical practice. Transplantation 2021; 105: 484-495
• 28 Wiebe C, Gibson IW, Blydt-Hansen TD. et al Rates and determinants of progression to graft failure in kidney allograft recipients with de novo donor-specific antibody. Am J Transplant 2015; 15: 2921-2930
• 29 Béland M-A, Lapointe I, Noël R. et al Higher calcineurin inhibitor levels predict better kidney graft survival in patients with de novo donor-specific anti-HLA antibodies: a cohort study. Transpl Int 2017; 30: 502-509
• 30 Berger SP, Sommerer C, Witzke O. et al Two-year outcomes in de novo renal transplant recipients receiving everolimus-facilitated calcineurin inhibitor reduction regimen from the TRANSFORM study. Am J Transplant 2019; 19: 3018-3034
• 31 Durrbach A, Pestana JM, Pearson T. et al A phase III study of belatacept versus cyclosporine in kidney transplants from extended criteria donors (BENEFIT-EXT study). Am J Transplant 2010; 10: 547-557
• 32 Masson P, Henderson L, Chapman JR. et al Belatacept for kidney transplant recipients. Cochrane Database Syst Rev 2014; 2014: CD010699
• 33 Opelz G, Döhler B. Association of HLA mismatch with death with a functioning graft after kidney transplantation: a collaborative transplant study report. Am J Transplant 2012; 12: 3031-3038
• 34 Ye C, Li J, Liu X. et al The incidence of cytomegalovirus and BK polyomavirus infections in kidney transplant patients receiving mTOR inhibitors: a systematic review and meta-analysis. Pharmacotherapy 2023; 43: 552-562
• 35 Kotton CN, Fishman JA. Viral infection in the renal transplant recipient. J Am Soc Nephrol 2005; 16: 1758-1774
• 36 Kasiske BL, Zeier MG, Chapman JR. et al KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int 2010; 77: 299-311
• 37 Au EH, Chapman JR, Craig JC. et al Overall and site-specific cancer mortality in patients on dialysis and after kidney transplant. J Am Soc Nephrol 2019; 30: 471-480
• 38 Cherikh WS, Kauffman HM, McBride MA. et al Association of the type of induction immunosuppression with posttransplant lymphoproliferative disorder, graft survival, and patient survival after primary kidney transplantation. Transplantation 2003; 76: 1289-1293
• 39 Hojo M, Morimoto T, Maluccio M. et al Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature 1999; 397: 530-534
• 40 Vajdic CM, McDonald SP, McCredie MRE. et al Cancer incidence before and after kidney transplantation. JAMA 2006; 296: 2823-2831
• 41 Mittal A, Colegio OR. Skin cancers in organ transplant recipients. Am J Transplant 2017; 17: 2509-2530
• 42 Lai M-N, Wang S-M, Chen P-C. et al Population-based case-control study of Chinese herbal products containing aristolochic acid and urinary tract cancer risk. J Natl Cancer Inst 2010; 102: 179-186
• 43 Li W-H, Chen Y-J, Tseng W-C. et al Malignancies after renal transplantation in Taiwan: a nationwide population-based study. Nephrol Dial Transplant 2012; 27: 833-839
• 44 Kumar D, Unger ER, Panicker G. et al Immunogenicity of quadrivalent human papillomavirus vaccine in organ transplant recipients. Am J Transplant 2013; 13: 2411-2417
• 45 Miao Y, Everly JJ, Gross TG. et al De novo cancers arising in organ transplant recipients are associated with adverse outcomes compared with the general population. Transplantation 2009; 87: 1347-1359
• 46 Dew MA, DiMartini AF, De Vito Dabbs A. et al Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007; 83: 858-873
• 47 Schäfer-Keller P, Steiger J, Bock A. et al Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients. Am J Transplant 2008; 08: 616-626
• 48 Johann B, Erhard J. Hrsg. Psychosomatische Betreuung von Transplantationspatienten. 1. Aufl. Lengerich, Berlin, Düsseldorf, Leipzig, Riga, Scottsdale (USA). Wien, Zagreb: Pabst Science Publishers; 1997
• 49 Morath C, Zeier M. KDIGO-Leitlinie zu Evaluation und Management von Nierentransplantationskandidaten: Kommentierte deutsche Übersetzung der Zusammenfassung. Nephrologe 2022; 17: 44-50
• 50 Nickeleit V, Singh HK, Randhawa P. et al The Banff Working Group Classification of Definitive Polyomavirus Nephropathy: morphologic definitions and clinical correlations. J Am Soc Nephrol 2018; 29: 680-693
• 51 Giessing M. Urologische Nachsorge und Entwicklung von Malignomen nach Nierentransplantation. Urologe A 2015; 54: 1393-1401
• 52 Kranz J, Anheuser P, Steffens JA. Hrsg. Komplikationen in der Urologie: Risiken erkennen und vermeiden. 1. Aufl. Berlin, Heidelberg: Springer; 2021
• 53 Cockfield SM, Wilson S, Campbell PM. et al Comparison of the effects of standard vs low-dose prolonged-release tacrolimus with or without ACEi/ARB on the histology and function of renal allografts. Am J Transplant 2019; 19: 1730-1744
• 54 Heinze G, Mitterbauer C, Regele H. et al Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation. J Am Soc Nephrol 2006; 17: 889-899
• 55 Langewisch E, Mannon RB. Chronic allograft injury. Clin J Am Soc Nephrol 2021; 16: 1723-1729
• 56 Uffing A, Pérez-Saéz MJ, Jouve T. et al Recurrence of IgA nephropathy after kidney transplantation in adults. Clin J Am Soc Nephrol 2021; 16: 1247-1255
• 57 Wetmore JB, Guo H, Liu J. et al The incidence, prevalence, and outcomes of glomerulonephritis derived from a large retrospective analysis. Kidney Int 2016; 90: 853-860
• 58 Titze S, Schmid M, Köttgen A. et al Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohort. Nephrol Dial Transplant 2015; 30: 441-451
• 59 Lv J, Wong MG, Hladunewich MA. et al Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA 2022; 327: 1888-1898
• 60 Barratt J, Lafayette R, Kristensen J. et al Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int 2023; 103: 391-402
• 61 Heerspink HJL, Radhakrishnan J, Alpers CE. et al Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial. Lancet 2023; 401: 1584-1594
• 62 De Sousa MV. Post-transplant glomerulonephritis: challenges and solutions. Int J Nephrol Renovasc Dis 2024; 17: 81-90
• 63 Uffing A, Pérez-Sáez MJ, Mazzali M. et al Recurrence of FSGS after kidney transplantation in adults. Clin J Am Soc Nephrol 2020; 15: 247-256
• 64 Caravaca-Fontán F, Polanco N, Villacorta B. et al Recurrence of immune complex and complement-mediated membranoproliferative glomerulonephritis in kidney transplantation. Nephrol Dial Transplant 2023; 38: 222-235
• 65 Matas AJ, Gillingham KJ, Humar A. et al Immunologic and nonimmunologic factors: different risks for cadaver and living donor transplantation. Transplantation 2000; 69: 54-58
• 66 Fellström B, Holdaas H, Jardine AG. et al Risk factors for reaching renal endpoints in the assessment of Lescol in renal transplantation (ALERT) trial. Transplantation 2005; 79: 205-212
• 67 Hariharan S, McBride MA, Cherikh WS. et al Post-transplant renal function in the first year predicts long-term kidney transplant survival. Kidney Int 2002; 62: 311-318
• 68 Davis S, Mohan S. Managing patients with failing kidney allograft: many questions remain. Clin J Am Soc Nephrol 2022; 17: 444-451
• 69 Kabani R, Quinn RR, Palmer S. et al Risk of death following kidney allograft failure: a systematic review and meta-analysis of cohort studies. Nephrol Dial Transplant 2014; 29: 1778-1786
• 70 Schrezenmeier E, Lehner LJ, Merkel M. et al What happens after graft loss? A large, long-term, single-center observation. Transpl Int 2021; 34: 732-742
• 71 Budhiraja P, Nguyen M, Heilman R. et al The role of allograft nephrectomy in the failing kidney transplant. Transplantation 2023; 107: 2486-2496
• 72 Claus AM, Wiese BS. Interdisziplinäre Kompetenzen: Modellentwicklung und diagnostische Zugänge. Gr Interakt Org 2021; 52: 279-288
• 73 Bosmans J-L, Verpooten GA. Malignancy after kidney transplantation: still a challenge. Kidney Int 2007; 71: 1197-1199
• 74 Schrem H, Barg-Hock H, Strassburg CP. et al Aftercare for patients with transplanted organs. Dtsch Arztebl Int 2009; 106: 148-156
• 75 Taylor AL, Watson CJE, Bradley JA. Immunosuppressive agents in solid organ transplantation: mechanisms of action and therapeutic efficacy. Crit Rev Oncol Hematol 2005; 56: 23-46
• 76 Jardine AG, Gaston RS, Fellstrom BC. et al Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet 2011; 378: 1419-1427
• 77 Kern WV, Wagner D, Hirsch HH. Infektionen nach Organtransplantation. Internist (Berl) 2005; 46: 630-642
• 78 Santos CAQ, Brennan DC, Fraser VJ. et al Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation. Transplantation 2014; 98: 187-194
• 79 Hartmann A, Sagedal S, Hjelmesaeth J. The natural course of cytomegalovirus infection and disease in renal transplant recipients. Transplantation 2006; 82 (Suppl. 02) S15-S17
• 80 Hardinger KL, Koch MJ, Bohl DJ. et al BK-virus and the impact of pre-emptive immunosuppression reduction: 5-year results. Am J Transplant 2010; 10: 407-415
• 81 Hirsch HH, Knowles W, Dickenmann M. et al Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N Engl J Med 2002; 347: 488-496
• 82 Avery RK, Alain S, Alexander BD. et al Maribavir for refractory cytomegalovirus infections with or without resistance post-transplant: results from a phase 3 randomized clinical trial. Clin Infect Dis 2022; 75: 690-701
• 83 Kraft CS, Armstrong WS, Caliendo AM. Interpreting quantitative cytomegalovirus DNA testing: understanding the laboratory perspective. Clin Infect Dis 2012; 54: 1793-1797
• 84 Linder KA, Kovacs C, Mullane KM. et al Letermovir treatment of cytomegalovirus infection or disease in solid organ and hematopoietic cell transplant recipients. Transpl Infect Dis 2021; 23: e13687