Immunsuppression nach Nierentransplantation – Einführung und Übersicht

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.

Key words

kidney transplantation - immunosuppression - allograft nephropathy

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