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Intensivmedizin up2date 2015; 11(03): 245-255
DOI: 10.1055/s-0041-103126
Operative Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Update: Immunsuppression bei Organtransplantationen

Georgios Polychronidis
,
Philipp Houben
,
Markus Mieth
,
Christian Morath
,
Daniel N. Gotthardt
,
Peter Schemmer
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Juli 2015 (online)

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Siehe auch:

Update: Immunsuppression bei OrgantransplantationenAllgemein- und Viszeralchirurgie up2date 2016; 10(01): 23-32
DOI: 10.1055/s-0042-100573

Kernaussagen

Während noch immer Konzepte für eine auf den einzelnen Patienten maßgeschneiderte Immunsuppression gesucht werden, gibt es mittlerweile gute Strategien zur Einsparung von CNIs, die mit einer Reduktion der CNI-assoziierten Nebenwirkungen einhergehen. Insbesondere durch eine Induktionstherapie bei der Nierentransplantation können frühe Abstoßungsperioden reduziert, CNIs verzögert appliziert und Steroide frühzeitig ausgeschlichen werden. Die steroidfreie Immunsuppression nach Nierentransplantationen hat allerdings in den nationalen Leitlinien aufgrund des unklaren Nutzen-Risikoprofiles bisher keinen Einzug gehalten.

 

  • Literatur

  • 1 Houben P, Gotthardt DN, Radeleff B et al. Complication management after liver transplantation: Increasing patient safety by standardized approach and interdisciplinary cooperation. Chirurg 2015; PMID: 25604306
    PubMedGoogle Scholar
  • 2 Starzl TE, Groth CG, Brettschneider L et al. Orthotopic homotransplantation of the human liver. Ann Surg 1968; 168: 392-415
    CrossrefPubMedGoogle Scholar
  • 3 Zand MS. Immunosuppression and immune monitoring after renal transplantation. Semin Dial 2005; 18: 511-519
    CrossrefPubMedGoogle Scholar
  • 4 Geissler EK, Schlitt HJ. Immunosuppression for liver transplantation. Gut 2009; 58: 452-463
    CrossrefPubMedGoogle Scholar
  • 5 Turner AP, Knechtle SJ. Induction immunosuppression in liver transplantation: a review. Transpl Int 2013; 26: 673-683
    CrossrefPubMedGoogle Scholar
  • 6 Mangus RS, Fridell JA, Vianna RM et al. Immunosuppression induction with rabbit anti-thymocyte globulin with or without rituximab in 1000 liver transplant patients with long-term follow-up. Liver Transpl 2012; 18: 786-795
    Google Scholar
  • 7 Gotthardt DN, Bruns H, Weiss KH et al. Current strategies for immunosuppression following liver transplantation. Langenbeck’s Arch Surg 2014; 399: 981-988
    CrossrefPubMedGoogle Scholar
  • 8 Préville X, Flacher M, LeMauff B et al. Mechanisms involved in antithymocyte globulin immunosuppressive activity in a nonhuman primate model. Transplantation 2001; 71: 460
    CrossrefPubMedGoogle Scholar
  • 9 Xing T, Huang L, Yu Z et al. Comparison of steroid-free immunosuppression and standard immunosuppression for liver transplant patients with hepatocellular carcinoma. PLoS One 2013; 8: e71251
    CrossrefPubMedGoogle Scholar
  • 10 Verna EC, Farrand ED, Elnaggar AS et al. Basiliximab induction and delayed calcineurin inhibitor initiation in liver transplant recipients with renal insufficiency. Transplant 2011; 91: 1254-1260
    CrossrefPubMedGoogle Scholar
  • 11 Ramirez CB, Doria C, Frank AM et al. Completely steroid-free immunosuppression in liver transplantation: a randomized study. Clin Transplant 2013; 27: 463-471
    CrossrefPubMedGoogle Scholar
  • 12 De Simone P, Nevens F, De Carlis L et al. Everolimus with reduced tacrolimus improves renal function in de novo liver transplant recipients: a randomized controlled trial. Am J Transplant 2012; 12: 3008-3020
    CrossrefPubMedGoogle Scholar
  • 13 Saliba F, De Simone P, Nevens F et al. Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study. Am J Transplant 2013; 13: 1734-1745
    Google Scholar
  • 14 Fischer L, Klempnauer J, Beckebaum S et al. A randomized, controlled study to assess the conversion from calcineurin-inhibitors to everolimus after liver transplantation (PROTECT). Am J Transplant 2012; 12: 1855-1865
    CrossrefPubMedGoogle Scholar
  • 15 Sterneck M, Kaiser GM, Heyne N et al. Everolimus and early calcineurin inhibitor withdrawal: 3-year results from a randomized trial in liver transplantation. Am J Transplant 2014; 14: 701-710
    CrossrefPubMedGoogle Scholar
  • 16 Rodriguez-Peralvarez M, Manousou P, Lerut J et al. How much immunosuppression is needed after liver transplantation?. Clin Transplant 2014; 28: 6-7
    CrossrefPubMedGoogle Scholar
  • 17 Kidney Disease:Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J of Transplant 2009; 9 (Suppl. 03) S1-S155
    PubMedGoogle Scholar
  • 18 Préville X, Flacher M, LeMauff B et al. Mechanisms involved in antithymocyte globulin immunosuppressive activity in a nonhuman primate model. Transplantation 2001; 71: 460
    CrossrefPubMedGoogle Scholar
  • 19 Pearl JP, Parris J, Hale DA et al. Immunocompetent T-cells with a memory-like phenotype are the dominant cell type following antibody-mediated T-cell depletion. Am J Transplant 2005; 5: 465
    CrossrefPubMedGoogle Scholar
  • 20 Tydén G, Ekberg H, Tufveson G et al. A randomized, double-blind, placebo-controlled study of single dose rituximab as induction in renal transplantation: a 3-year follow-up. Transplantation 2012; 94: e21
    CrossrefPubMedGoogle Scholar
  • 21 Morath C, Süsal C. Transplantation: rituximab induction only for sensitized kidney recipients?. Nat Rev Nephrol 2013; 9: 703-705
    CrossrefPubMedGoogle Scholar
  • 22 Webster AC, Playford EG, Higgins G et al. Interleukin 2 receptor antagonists for renal transplant recipients: a meta-analysis of randomized trials. Transplantation 2004; 77: 166
    CrossrefPubMedGoogle Scholar
  • 23 Wiland AM, Fink JC, Weir MR et al. Should living-unrelated renal transplant recipients receive antibody induction? Results of a clinical experience trial. Transplantation 2004; 77: 422
    CrossrefPubMedGoogle Scholar
  • 24 Brennan DC, Daller JA, Lake KD et al. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006; 355: 1967
    CrossrefPubMedGoogle Scholar
  • 25 Hardinger KL, Brennan DC, Schnitzler MA. Rabbit antithymocyte globulin is more beneficial in standard kidney than in extended donor recipients. Transplantation 2009; 87: 1372
    CrossrefPubMedGoogle Scholar
  • 26 Miller JT, Collins CD, Stuckey LJ et al. Clinical and economic outcomes of rabbit antithymocyte globulin induction in adults who received kidney transplants from living unrelated donors and received cyclosporine-based immunosuppression. Pharmacotherapy 2009; 29: 1166
    CrossrefPubMedGoogle Scholar
  • 27 Haider I, Cahill M. Fatal thrombocytopaenia temporally related to the administration of alemtuzumab (MabCampath) for refractory CLL despite early discontinuation of therapy. Hematology 2004; 9: 409
    CrossrefPubMedGoogle Scholar
  • 28 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
    CrossrefPubMedGoogle Scholar
  • 29 Atkison P, Joubert G, Barron A et al. Hypertrophic cardiomyopathy associated with tacrolimus in paediatric transplant patients. Lancet 1995; 345 : 894
    CrossrefPubMedGoogle Scholar
  • 30 Gaston RS. Maintenance immunosuppression in the renal transplant recipient: an overview. Am J Kidney Dis 2001; 38 (Suppl. 06) S25
    CrossrefPubMedGoogle Scholar
  • 31 Ekberg H, Tedesco-Silva H et al. ELITE-Symphony Study. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007; 357: 2562-2575
    CrossrefPubMedGoogle Scholar
  • 32 Vincenti F, Charpentier B, Vanrenterghem Y et al. A phase III study of belatacept-based immunosuppression regimens versus cyclosporine in renal transplant recipients (BENEFIT study). Am J Transplant 2010; 10: 535
    CrossrefPubMedGoogle Scholar
  • 33 Masson P, Henderson L, Chapman JR et al. Belatacept for kidney transplant recipients. Cochrane Database of Systematic Reviews 2014;
    PubMedGoogle Scholar
  • 34 Pascual J, Zamora J, Galeano C et al. Steroid avoidance or withdrawal for kidney transplant recipients. Cochrane Database of Systematic Reviews 2009;
    PubMedGoogle Scholar
  • 35 Montero N, Webster AC, Royuela A et al. Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients. Cochrane Database of Systematic Reviews 2014;
    PubMedGoogle Scholar
  • 36 Webb NJ, Douglas SE, Rajai A et al. Corticosteroid-Free Kidney Transplantation Improves Growth: 2-Year Follow-up of the TWIST Randomized Controlled Trial. Transplantation 2014; 99: 1178-1185
    PubMedGoogle Scholar
  • 37 Woodside KJ, Schirm ZW, Noon KA et al. Fever, infection, and rejection after kidney transplant failure. Transplantation 2014; 97: 648-653
    PubMedGoogle Scholar
  • 38 Augustine JJ, Woodside KJ, Padiyar A et al. Independent of nephrectomy, weaning immunosuppression leads to late sensitization after kidney transplant failure. Transplantation 2012; 94: 738-743
    PubMedGoogle Scholar
  • 39 Del Bello A, Congy-Jolivet N, Sallusto F et al. Donor-specific antibodies after ceasing immunosuppressive therapy, with or without an allograft nephrectomy. Clin J Am Soc Nephrol 2012; 7: 1310
    CrossrefPubMedGoogle Scholar
  • 40 Shapiro R, Carroll PB, Tzakis AG et al. Adrenal reserve in renal transplant recipients with cyclosporine, azathioprine, and prednisone immunosuppression. Transplantation 1990; 49: 1011
    CrossrefPubMedGoogle Scholar
  • 41 Ratcliffe PJ, Dudley CR, Higgins RM et al. Randomized controlled trial of steroid withdrawal in renal transplant recipients receiving triple immunosuppression. Lancet 1996; 348 : 643
    CrossrefPubMedGoogle Scholar
  • 42 Andrews PA. Standards Committee of the British Transplantation Society. Summary of the British Transplantation Society Guidelines for management of the failing kidney transplant. Transplantation 2014; 98: 1130
    CrossrefPubMedGoogle Scholar
  • 43 European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C. 2015 Im Internet: http://www.easl. eu/research/our-contributions/clinical-practice-guidelines/detail/recommendations-on-treatment-of-hepatitis-c-2015/report/1
    PubMedGoogle Scholar