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Aktuelle Probleme der Nierentransplantation

Current problems of kidney transplantation

  • Schwerpunkt: Transplantationsmedizin
  • Published:
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Zusammenfassung

Die Langzeitprobleme nach Nierentransplantation haben sich in den letzten Jahren wesentlich geändert. Während früher v. a. die Immunsuppression und die Verhinderung der akuten Abstoßung im Vordergrund stand, sind es nun die chronischen Veränderungen im Transplantat und das Langzeitüberleben der Patienten. Die eigentliche Transplantation ist zu einem standardisierten Verfahren auf hohem chirurgischem Niveau geworden. Probleme der Organpräservation und des Ischämie/Reperfusionsschadens spielen ebenfalls v. a. unter chronischen Gesichtspunkten eine Rolle. Die Überwachung der Langzeitprobleme muss zum einen durch ein Programm für das transplantierte Organ und zum anderen durch ein Patientenprogramm erfolgen. Die Überwachung der Nierenfunktion sollte genauer als bisher das Organ erfassen. Serumkreatinin und Proteinurie sind allein zu wenig aussagefähig und verändern sich erst lange nach dem Beginn der zellulären Schädigung. Entsprechend sind dringend neue Untersuchungsmethoden zu entwickeln. Eine Möglichkeit eröffnen Protokollbiopsien, bei denen die Niere regelmäßig histologisch und molekular analysiert werden kann. In den Patientenprogrammen steht die Diagnostik und Therapie der kardiovaskulären Erkrankungen im Vordergrund. Daneben müssen die Patienten bezüglich des Auftretens von Neoplasien gescreent werden. Für alle kardiovaskulären Risikofaktoren nach Nierentransplantation fehlen prospektive Studien. Dies gilt insbesondere für den Bereich der Hypertonie.

Abstract

The long-term problems after kidney transplantation have changed considerably in recent years. While formerly immunosuppression and prevention of acute rejection were of prime concern, now attention focuses on chronic alterations of the transplanted organ and long-term survival of the patients. The transplantation procedure itself has evolved into a standardized technique with a high level of surgical quality. Problems involving organ preservation and ischemia/reperfusion damage also play a role, especially in view of chronic aspects. Monitoring of long-term complications should follow a program for the transplanted organ as well as a program for the patient. Monitoring kidney function should address the organ more precisely than has previously been the case. Serum creatinine level and proteinuria alone provide insufficient information and only change long after cellular deterioration has begun. Hence it is imperative that new testing methods be developed. One possibility is offered by protocol biopsies that allow histological and molecular analysis of the kidney at regular intervals. The patient programs concentrate on diagnostics and treatment of the cardiovascular diseases. Furthermore, the patients must be screened for occurrence of neoplasia. There are no prospective studies covering all cardiovascular risk factors after kidney transplantation. This pertains particularly to the subject of hypertension.

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Authors and Affiliations

  1. Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    H. Haller, W. Gwinner, F. Gueler & A. Schwarz

  2. Klinik für Transplantations- und Abdominalchirugie, Medizinische Hochschule Hannover, Hannover, Deutschland

    N. Richter

  3. Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    V. Bröcker

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  1. H. Haller
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  2. N. Richter
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  3. V. Bröcker
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  4. W. Gwinner
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Correspondence to H. Haller.

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Haller, H., Richter, N., Bröcker, V. et al. Aktuelle Probleme der Nierentransplantation. Internist 50, 523–535 (2009). https://doi.org/10.1007/s00108-008-2269-7

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