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Transfusionsmedizin 2012; 2(4): 197-208
DOI: 10.1055/s-0032-1324855
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Management hochimmunisierter Nierentransplantatempfänger

C. Morath
1   Sektion Nephrologie, Medizinische Klinik, Universitätsklinikum Heidelberg
,
C. Süsal
2   Abteilung Transplantationsimmunologie, Institut für Immunologie, Universitätsklinikum Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
21 November 2012 (online)

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Zusammenfassung

Die Hinweise häufen sich, dass die antikörpervermittelte Abstoßung im Langzeitverlauf die Hauptursache der Nierentransplantatverluste darstellt. Die Vermeidung des antikörperbedingten Schadens beginnt bereits vor der Transplantation mit der Vermeidung von immunisierenden Ereignissen. Wenn der Patient jedoch bereits immunisiert ist, werden die präzise Charakterisierung der in seinem Blut zirkulierenden Alloantikörper und die in diesem Rahmen notwendige genaue Typisierung der HLA-Merkmale (HLA: Human Leukocyte Antigen, humanes Leukozytenantigen) des Fremdorgans unerlässlich. Um eine möglichst schnelle und erfolgreiche Transplantation hochimmunisierter Patienten zu gewährleisten, müssen mehrere Möglichkeiten wie Desensibilisierung und Anmeldung zu speziellen Allokationsprogrammen in Betracht gezogen werden. Nach der Transplantation stellen wiederum die engmaschige Überwachung der Nierenfunktion und der De-novo-Antikörperbildung sowie die Vermeidung von Unterimmunsuppression die wichtigsten Maßnahmen dar.

Schlüsselwörter

Nierentransplantation - HLA - Desensibilisierung - humorale Abstoßung - Acceptable-Mismatch-Programm
 

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