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Notfall & Hausarztmedizin 2006; 32(4): 176-182
DOI: 10.1055/s-2006-943528
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© Georg Thieme Verlag Stuttgart · New York

Gesicherte Indikationen zur Plasmapherese-Therapie bei internistischen und neurologischen Notfällen

Elimination pathogener SubstanzenElimination of pathogenic substances - confirmed indications for plasmapheresis in internistic and neurological emergenciesMichael J. Koziolek1 , Gerhard A. Müller1
  • 1Abteilung Nephrologie und Rheumatologie, Georg-August-Universität Göttingen
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Publication History

Publication Date:
17 May 2006 (online)

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Die Apherese-Therapie besteht aus der extrakorporalen Elimination pathogener Proteine, proteingebundener pathogener Substanzen oder pathogener Zellen des Blutes. Die gegenwärtige Situation der Apherese ist durch wachsende technische Möglichkeiten und Erfolge bei schwerwiegenden Erkrankungen gekennzeichnet. Leider fehlen für viele Indikation prospektive, randomisierte Studien. Dies schränkt einen breiteren Einsatz der zum Teil doch recht kostenintensiven Verfahren erheblich ein. Für einige wenige Indikationen liegen Studien der Evidenzklasse I vor beziehungsweise sind initiiert.

Apheresis treatment comprises the extracorporeal elimination of pathogenic proteins, protein-bound pathogenic substances or pathogenic blood cells. The current situation with regard to therapeutic apheresis is characterised by an increase in the technical possibilities available, and successful outcomes in serious diseases. Unfortunately, however, prospective randomized studies are lacking for numerous indications. This places considerable constraints on a more widespread application of this far from inexpensive procedure. For a limited number of indications, evidence class I studies are available or have been initiated.

Literatur

  • 1 Bosch T. New trends in apheresis.  Ther Apher. 2001;  5 323-324
    PubMedGoogle Scholar
  • 2 Koziolek MJ, Strutz F, Kochsiek T, Müller GA. Therapieoptionen mittels Apherese bei internistischen und neurologischen Krankheitsbildern.  Nephro News. 2004;  6 1-6
    PubMedGoogle Scholar
  • 3 Sanjay R, Flanagan J, Sodano D. et al. .The acute phase reactant, fibrinogen, as a guide to plasma exchange therapy for acute Guillain-Barré syndrome. J Clin Apher [Epub ahead of print] 2005
    Google Scholar
  • 4 Schilling S, Linker RA, Konig FB, Koziolek M. et al. .Plasma exchange therapy for steroid-unresponsive multiple sclerosis relapses Clinical experience with 16 patients. Nervenarzt 2005
    Google Scholar
  • 5 Keegan M, König F, McCelland R. et al. . Relations in humoral patholgical changes in multiple sclerosis and response to therapeutic plasma exchange.  Lancet. 2005;  366 579-582
    CrossrefPubMedGoogle Scholar
  • 6 Wyllie BF, Garg AX, Macnab J, Rock GA, Clark WF. Members of the Canadian Apheresis Group. . Thrombotic thrombozytopenic purpura/haemolytic uremic syndrome: a new index prediciting response to plasma exchange.  BJH. 2005;  132 204-209
    PubMedGoogle Scholar
  • 7 Kassenärztliche Bundesvereinigung: Mitteilungen: Zum Beschluss des Bundesausschusses der Ärzte und Krankenkassen vom 24. 3. 2003 zu den therapeutischen Apheresen.  Deutsches Ärzteblatt. 2003;  30 2035-2036
    PubMedGoogle Scholar
  • 8 Bosch T. Recent advances in therapeutic apheresis.  J Artif Organs. 2003;  6 1-8
    CrossrefPubMedGoogle Scholar
  • 9 Sasso EH, Merrill C, Furst TE. Immunoglobulin binding properties of the Prosorba immunoadsorption column for treatment of refractory arthritis.  Ther Apher. 2001;  5 84-91
    PubMedGoogle Scholar
  • 10 Felson DT, LaValley MP, Baldassare AR. et al. . The Prosorba column for treatment of refractory rheumatoid arthritis.  Ther Apher. 1999;  42 2153-2159
    PubMedGoogle Scholar
  • 11 Gendreau RM. A randomized dopple-blind sham-controlled trial of the Prosorba immunoadsoprtion column in treatment of rheumatoid arthritis.  Ther Apher. 2001;  5 79-83
    PubMedGoogle Scholar
  • 12 Klingel R, Fassbender C, Fassbender T. et al. . Rheopheresis: rheologic, functional and structural aspects.  Ther Apher. 2000;  4 348-357
    CrossrefPubMedGoogle Scholar
  • 13 Klingel R, Fassbender C, Fischer I. et al. . Rheopheresis for age-related macular degeneration: a novel indication for therapeutic apheresis in opthalmology.  Ther Apher. 2002;  6 271-281
    PubMedGoogle Scholar
  • 14 The Multicenter Investigation of Rheopheresis for AMD (MIRA-1) Study Group. . Multicenter prospective, randomized, douple-masked, placebo-controlled study of rheopheresis to treat non-exudative age-related macular degeneration: interin analysis.  Trans Am Opthalm Soc. 2002;  100 85-108
    PubMedGoogle Scholar
  • 15 Fell AJ, Engelmann K, Richard G. et al. . Rheopherese: Ein systemischer Therapieansatz für die altersabhängige Makuladegeneration?.  Ophthalmologe. 2002;  99 780-784
    CrossrefPubMedGoogle Scholar
  • 16 Suckfüll M, Seidel D, Thiery J. et al. . Behandlung des Hörsturzes durch Fibrinogen-LDL-Apherese.  Z Kardiol. 2003;  92 59-63
    PubMedGoogle Scholar
  • 17 Suckfüll M. Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomized multicenter trial.  Lancet. 2002;  360 1811-1817
    CrossrefPubMedGoogle Scholar
  • 18 Klingel R, Mumme C, Fassbender T. et al. . Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial.  Ther Apher Dial. 2003;  7 444-455
    CrossrefPubMedGoogle Scholar
  • 19 Ramunni A, Giancipoli G, Saracino A. et al. . LDL-apheresis in acute anterior ischemic optic neuropathy.  Int J Artif Organs. 2004;  27 337-341
    PubMedGoogle Scholar
  • 20 Staudt A, Staudt Y, Dörr M. et al. . Potential role of humoral immunity in cardiac dysfunction of patients suffering from dilated cardiomyopathy.  JACC. 2004;  44 829-836
    CrossrefPubMedGoogle Scholar
  • 21 Felix FB, Staudt A, Dörffel WV. et al. . Haemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilatated cardiomyopathy.  Am J Coll Cardiol. 2000;  35 1590-1598
    PubMedGoogle Scholar
  • 22 Knebel F, Böhm M, Staudt A. et al. . Reduction of morbidity by immunoadsorption therapy in patients with dilated cardiomyopathy.  Int J Cardiol. 2004;  97 517-520
    CrossrefPubMedGoogle Scholar
  • 23 Dörffel DV, Wallukat G, Dörffel Y. et al. . Immunoadsoprtion in idiopathic cardiomyopathy, a 3-year follow-up.  Int J Cardiol. 2004;  97 529-534
    CrossrefPubMedGoogle Scholar
  • 24 Hessel FP, Wegner C, Müller J. et al. . Economic evaluation and survival of immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy.  Eur J Health Econom. 2004;  5 58-63
    CrossrefPubMedGoogle Scholar
  • 25 Bohmig GA, Regele H, Exner M. et al. . C4d-positive acute humoral renal allograft rejection: effecitve treatment by immunoadsorption.  J Am Soc Nephrol. 2001;  12 2482-2489
    PubMedGoogle Scholar
  • 26 Shah A, Nadasdy T, Arend L. et al. . Treatment of C4d-positive acute humoral rejection with plasmapheresis and rabbit polyclonal antithymocyte globulin.  Transplantation. 2004;  77 1399-1405
    PubMedGoogle Scholar
  • 27 Yamaji K, Tsuda H, Hashimoto H. Current topics on cytapheresis technologies.  Ther Apher. 2001;  5 287-292
    PubMedGoogle Scholar
  • 28 Shibata H, Kuriyama T, Yamawaki N. Cellsorba.  Ther Apher Dial. 2003;  7 44-47
    CrossrefPubMedGoogle Scholar
  • 29 Shirokaze J. Leukocytapheresis using a leukocyte removal filter.  Ther Apher. 2002;  6 261-266
    PubMedGoogle Scholar
  • 30 Saniabadi AR, Hanai H, Takeuchi K. et al. . Adacolumn, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory diseases associated with leukocytes.  Ther Apher Dial. 2004;  7 48-59
    PubMedGoogle Scholar
  • 31 Hasegawa M, Kawamura M, Kasugai M. et al. . Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis: report of five cases.  Ther Apher. 2002;  6 443-449
    CrossrefPubMedGoogle Scholar
  • 32 Nakamura T, Suzuki Y, Koide H. Granulocyte and monocyte adsorption apheresis in a patient with antglomerular basement membrane glomerulonephritis and active ulcerative colitis.  Am J Med Sci. 2003;  325 296-298
    PubMedGoogle Scholar
  • 33 Yamasaki S, Ueki Y, Nakamura H. et al. . Effect of filtration leukocyteapheresis therapy: modulation of white blood cell enzyme activities in patients with rheumatoid arthritis.  Artif Organs. 2002;  26 378-384
    CrossrefPubMedGoogle Scholar
  • 34 Yokoyama H, Shimizu M, Wada T. et al. . The beneficial effect of lymphocytapheresis for treatment of nephrotic syndrome.  Ther Apher. 2002;  6 167-173
    PubMedGoogle Scholar
  • 35 Hanai H, Watanabe F, Takeuchi K. et al. . Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: a prospective, uncontrolled, pilot study.  Clin Gastroenterol Hepatol. 2003;  1 28-35
    CrossrefPubMedGoogle Scholar
  • 36 Nagase K, Sawada K, Ohnishi K. et al. . Complication of leukocytapheresis.  Ther Apher. 1998;  2 120-124
    PubMedGoogle Scholar
  • 37 Tsukada Y, Nakamura T, Iimura M. et al. . Cytokine profile in colonic mucosa of ulcerative colitis correlates with disease activity and response to granulocytapheresis.  Am J Gastroenterol. 2002;  97 2820-2828
    CrossrefPubMedGoogle Scholar
  • 38 Koziolek MJ, Strutz F, Kochsiek T, Bramlage CP, Müller GA. Indikationen zur Plasmapherese im internistischen und neurologischen Bereich.  Mitteilungen DAGKN. 2005;  XXXIV 151-166
    PubMedGoogle Scholar

Anschrift für die Verfasser

Dr. med. Michael J. Koziolek
Prof. Dr. med. Gerhard A. Müller

Abteilung Nephrologie und Rheumatologie

Georg-August-Universität Göttingen

Robert-Koch-Str. 40

37075 Göttingen

Phone: 0551/396331

Fax: 0551/398906

Email: mkoziolek@med.uni-goettingen.de