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Moderne Immunsuppression nach Organtransplantation

Modern immunosuppression after solid organ transplantation

  • Arzneimitteltherapie
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Zusammenfassung

Der gemeinsame Nenner der Transplantation solider Organe ist die Notwendigkeit einer lebenslangen Immunsuppression. Das medikamentöse Regime nach Transplantation umfasst eine Kombinationstherapie mit verschiedenen Immunsuppressiva. Ziel ist die Verbesserung des Patienten- und Transplantatüberlebens unter Minimierung möglicher Nebenwirkungen der immunsuppressiven Medikation. Meist werden in einem Dreifachregime Medikamente verschiedener Substanzklassen mit unterschiedlichen Wirkmechanismen kombiniert. Basis der Immunsuppression sind heute Calcineurininhibitoren in Kombination mit Mycophenolsäure. Man unterscheidet verschiedene Phasen der Immunsuppression nach Transplantation solider Organe: die Induktionstherapie und Erhaltungstherapie. In jeder Phase erfolgt in Abhängigkeit vom Risikoprofil des einzelnen Patienten eine individuelle Einstellung der Immunsuppression, um einer Abstoßung bzw. einem Transplantatverlust vorzubeugen. Auf Basis dieser Überlegungen haben sich in den letzten Jahren die Konzepte der Calcineurininhibitor- bzw. Steroidreduktion in der Transplantationsmedizin etabliert. Schwerpunkt dieser Übersicht sind Daten zur häufigsten durchgeführten Organtransplantation, der Nierentransplantation. In der Entwicklung neuer immunsuppressiver Strategien kommt ihr eine tragende Rolle zu.

Abstract

The one common factor in solid organ transplantation is the need for lifelong maintenance immunosuppression. Drug regimens after organ transplantation typically comprise a combination of different immunosuppressive drugs. In most cases a triple drug regimen with different mechanisms of action is used. The aim is to improve both patient and graft survival while minimizing potential side effects of immunosuppressive medication. The basis of most immunosuppressive regimens is calcineurin inhibitors in combination with mycophenolic acid. There are various stages of immunosuppression after solid organ transplantation involving induction therapy, initial and long-term maintenance therapy. In each phase an individual combination of immunosuppressants is set up depending on the risk profile of the individual patient to prevent transplant rejection and organ loss. Based on these considerations, concepts of calcineurin inhibitor or steroid reduction have been established in transplant medicine in recent years. The key role in terms of development of new immunosuppressive strategies is taken by kidney transplantation, the most common solid organ transplantation performed

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Beimler: Vortragshonorare von Alexion, Bristol-Myers Squibb, Astellas und Novartis. C. Morath: Vortragshonorare von Fresenius Medical Care, Miltenyi Biotech, Astellas, Genzyme, Alexion und Novartis; Forschungsförderung: Dietmar Hopp Stiftung, Bundesministerium für Wirtschaft, Novartis, Fresenius Medical Care. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Sektion Nephrologie, Nierenzentrum Heidelberg, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland

    J. Beimler, C. Morath & M. Zeier

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Correspondence to J. Beimler.

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Beimler, J., Morath, C. & Zeier, M. Moderne Immunsuppression nach Organtransplantation. Internist 55, 212–222 (2014). https://doi.org/10.1007/s00108-013-3411-8

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