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DOI: 10.1055/s-0035-1564848
Immunsuppression nach Nierentransplantation – Einführung und Übersicht
Immunosuppression after renal transplantation – Current aspectsPublication History
Publication Date:
22 September 2015 (online)
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Die optimale Immunsuppression stellt eine schmale Gratwanderung dar mit dem Ziel einer lang anhaltenden Abstoßungsfreiheit einerseits und nur geringen Nebenwirkungen andererseits. Heutzutage konzentrieren sich die Bemühungen nach allogener Nierentransplantation auf die Optimierung des Langzeitüberlebens, denn unverändert ist die chronische Transplantatnephropathie ein ernsthaftes Problem der Transplantationsmedizin. Zudem müssen Nebenwirkungen der Immunsuppressiva ein spezifisches Spender- und Empfängerprofil gerade bei der Lebendspende, die Altersentwicklung und somit die Zunahme kardiovaskulärer Komplikationen bei der Auswahl des immunsuppressiven Regimes berücksichtigt werden. Es wird derzeit untersucht, ob verträglichere und individualisierte Behandlungsstrategien möglich sind, um die Nephrotoxizität etablierter immunsuppressiver Therapien zu minimieren
Currently, chronic allograft nephropathy (CAN) is the major challenge in transplantation medicine. Further challenges have to be considered when choosing therapeutic regimens are the side effects of immunosuppressants, the changing demographics and donor and recipient profiles, and the increasing incidence of cardiovascular complications. Thus, researchers are investigating whether more tolerable and individualized treatment strategies will render nephrotoxic immunosuppressive regimens unnecessary. Optimal immunosuppression is a small grad to be free of rejection on the one side and to be free of complications on the other side. Today, all efforts after allogenic kidney transplantation are concentrated on optimal long-time survival, because chronical transplant nephropathy represents an ongoing problem. Even in the focus are the side effects of immunosuppression, the changed donor and recipient profile, just as well in living kidney donation, the significance of cardiovascular complications and elder patients have to be considered in the choice of immunosuppression. Therefore, we examine the question if compliant individual treatment modalities and individual strategies in immunosuppression could prevent from nephrotoxicity caused so long by established immunosuppression.
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Literatur
- 1 Webster AC, Woodroffe RC, Taylor RS et al. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ 2005; 331: 810-810
- 2 Hariharan S, Johnson CP, Bresnahan BA et al. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000; 342: 605-612
- 3 Bäckman L, Aselius H, Lindberger K et al. Steroid-free immunosuppression in kidney transplant recipients and prograf monotherapy: an interim analysis of a prospective multicenter trial. Transplant Proc 2006; 38: 2654-2656
- 4 Ekberg H, Tedesco-Silva H, Demirbas A. ELITE-Symphony Study. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007; 357: 2562-2575
- 5 Vincenti F, Schena FP, Paraskevas S et al. FREEDOM Study Group. A randomized, multicenter study of steroid avoidance, early steroid withdrawal or standard steroid therapy in kidney transplant recipients. Am J Transplant 2008; 8: 307-316
- 6 Kasiske BL, Chakkera HA, Louis TA, Ma JZ. A meta-analysis of immunosuppression withdrawal trials in renal transplantation. J Am Soc Nephrol 2000; 11: 1910-1917
- 7 Lebranchu Y, Thierry A, Toupance O et al. Efficacy on renal function of early conversion from cyclosporine to sirolimus 3 months after renal transplantation: concept study. Am J Transplant 2009; 9: 1115-1123
- 8 Midtvedt K, Hjelmesaeth J, Hartmann A. Insulin resistance after renal transplantation: the effect of steroid dose reduction and withdrawal. J Am Soc Nephrol 2004; 15: 3233-3239
- 9 Cole E, Landsberg D, Russell D et al. A pilot study of steroid-free immunosuppression in the prevention of acute rejection in renal allograft recipients. Transplantation 2001; 72: 845-850
- 10 Woodle ES, First MR, Pirsch J et al. Astellas Corticosteroid Withdrawal Study Group. A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term low-dose corticosteroid therapy. Ann Surg 2008; 248: 564-577
- 11 Stallone G, Infante B, Schena A et al. Rapamycin for treatment of chronic allograft nephropathy in renal transplant patients. J Am Soc Nephrol 2005; 16: 3755-3762
- 12 Pallet N, Anglicheau D, Martinez F. Comparison of sequential protocol using basiliximab versus antithymocyte globulin with high-dose mycophenolate mofetil in recipients of a kidney graft from an expanded-criteria donor. Transplantation 2006; 81: 949-952