Immunsuppression nach Organtransplantation: Essentials

Dieser Artikel soll einen Überblick über den Einsatz und mögliche Probleme der immunsuppressiven Therapie nach solider Organtransplantation (SOT) geben. Für einige Immunsuppressiva sind andere Empfehlungen bezüglich der angestrebten Talblutspiegel angegeben, als dies in der Fachinformation empfohlen ist. Wir möchten ausdrücklich darauf hinweisen, dass es sich hierbei um die persönliche Meinung der Autor*innen handelt.

Abstract

Patients who have undergone a transplantation have a significantly increased risk of developing a malignancy compared to the normal population. The risk of tumour development depends mainly on the type of the transplanted organ, the dose and duration of immunosuppression, as well as the patient’s medical history, and may require individualised pre-transplant and post-transplant care. Standard immunosuppression is usually based on a combination of tacrolimus with mycophenolic acid/enteric-coated mycophenolic acid or, more rarely, a mTor inhibitor. Induction therapy may allow baseline immunosuppression to be delayed and/or started at a reduced dose. The most frequent long-term complications after liver transplantation include calcineurin inhibitor-associated nephrotoxicity; in addition, transplanted patients have an increased cardiovascular (kidney transplantation), infection and tumour risk (liver, kidney transplantation), depending on the time course after transplantation and the type of immunosuppression. To minimise long-term complications, individualised immunosuppression is recommended, taking comorbidities into account.

Schlüsselwörter

Immunsystem - Transplantation - Immunsuppressiva - Organempfänger - Abstoßungsreaktion

Key words

immune system - transplantation - immunosuppressants - organ recipient - rejection reaction

Publication History

Article published online:
16 November 2022

• Literatur

• 1 Braun F, Lorf T, Ringe B. Update of current immunosuppressive drugs used in clinical organ transplantation. Transpl Int 1998; 11: 77-81 DOI: 10.1007/s001470050108.
• 2 Braun F, Becker T, Renders L, Ringe B. Immunosuppressive Drugs. eLS. Chichester: Wiley & Sons, Ltd.; 2012. DOI: 10.1002/9780470015902.a0001243.pub3
• 3 Neuberger JM, Bechstein WO, Kuypers DR. et al. Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation 2017; 101: S1-S56 DOI: 10.1097/TP.0000000000001651.
• 4 Klawitter J, Nashan B, Christians U. Everolimus and sirolimus in transplantation-related but different. Expert Opin Drug Saf 2015; 14: 1055-1070 DOI: 10.1517/14740338.2015.1040388.
• 5 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 DOI: 10.1038/ki.2009.377.
• 6 Seger C, Shipkova M, Christians U. et al. Assuring the proper analytical performance of measurement procedures for immunosuppressive drug concentrations in clinical practice: recommendations of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology Immunosuppressive Drug Scientific Committee. Ther Drug Monit 2016; 38: 170-189 DOI: 10.1097/FTD.0000000000000269.
• 7 Dodds-Ashley E. Management of drug and food interactions with azole antifungal agents in transplant recipients. Pharmacotherapy 2010; 30: 842-854 DOI: 10.1592/phco.30.8.842.
• 8 Ojo AO, Held PJ, Port FK. et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349: 931-940 DOI: 10.1056/NEJMoa021744.
• 9 Allen AM, Kim WR, Therneau TM. et al. Chronic kidney disease and associated mortality after liver transplantation-a time-dependent analysis using measured glomerular filtration rate. J Hepatol 2014; 61: 286-292 DOI: 10.1016/j.jhep.2014.03.034.
• 10 Nashan B, Schemmer P, Braun F. et al. Early Everolimus-Facilitated Reduced Tacrolimus in Liver Transplantation: Results From the Randomized HEPHAISTOS Trial. Liver Transpl 2021; DOI: 10.1002/lt.26298.
• 11 Saliba F, Duvoux C, Gugenheim J. et al. Efficacy and safety of everolimus and mycophenolic acid with early tacrolimus withdrawal after liver transplantation: a multicenter randomized trial. Am J Transplant 2017; 17: 1843-1852 DOI: 10.1111/ajt.14212.
• 12 Tacke F, Kroy DC, Barreiros AP. et al. Liver transplantation in Germany. Liver Transpl 2016; 22: 1136-1142 DOI: 10.1002/lt.24461.
• 13 Herzer K, Sterneck M, Welker MW. et al. Current challenges in the post-transplant care of liver transplant recipients in Germany. J Clin Med 2020; 9: 3570 DOI: 10.3390/jcm9113570.
• 14 Charlton M, Levitsky J, Aqel B. et al. International Liver Transplantation Society Consensus Statement on Immunosuppression in liver transplant recipients. Transplantation 2018; 102: 727-743 DOI: 10.1097/TP.0000000000002147.
• 15 Roeb E, Steffen HM, Bantel H. et al. S2k-Leitlinie nicht alkoholische Fettlebererkrankungen. Z Gastroenterol 2015; 53: 668-723 DOI: 10.1055/s-0035-1553193.
• 16 Engelmann C, Sterneck M, Weiss KH. et al. Prevention and management of CMV infections after liver transplantation: current practice in German transplant centers. J Clin Med 2020; 9: 2352 DOI: 10.3390/jcm9082352.
• 17 Finkenstedt A, Graziadei IW, Oberaigner W. et al. Extensive surveillance promotes early diagnosis and improved survival of de novo malignancies in liver transplant recipients. Am J Transplant 2009; 9: 2355-2361 DOI: 10.1111/j.1600-6143.2009.02766.x.
• 18 Gutierrez-Dalmau A, Campistol JM. Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review. Drugs 2007; 67: 1167-1198 DOI: 10.2165/00003495-200767080-00006.
• 19 Wolf SAJ. Infektionen und Tumorerkrankungen nach Transplantation. Allgemein- und Viszeralchir up2date 2019; 13: 227-237
• 20 Rodriguez-Peralvarez M, Tsochatzis E, Naveas MC. et al. Reduced exposure to calcineurin inhibitors early after liver transplantation prevents recurrence of hepatocellular carcinoma. J Hepatol 2013; 59: 1193-1199 DOI: 10.1016/j.jhep.2013.07.012.
• 21 Geissler EK, Schnitzbauer AA, Zulke C. et al. Sirolimus use in liver transplant recipients with hepatocellular carcinoma: a randomized, multicenter, open-label phase 3 trial. Transplantation 2016; 100: 116-125 DOI: 10.1097/TP.0000000000000965.