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Systemische Immunsuppressiva nach perforierender Keratoplastik

Systemic immunosuppressives after penetrating keratoplasty

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Zusammenfassung

Die immunologische Abstoßungsreaktion ist der wichtigste Grund für ein Transplantatversagen nach Hornhauttransplantation. Ohne systemische Immunsuppression kommt es in einer Hochrisikosituation in über 50% der Fälle zu einer Eintrübung des Transplantats innerhalb des ersten postoperativen Jahres. Die klonale Expansion von alloreaktiven Lymphozyten findet in lymphoiden Organen statt. Da topische Steroide die sekundären lymphatischen Gewebe nicht erreichen und auch systemische Steroide nicht ausreichend die klonale Expansion von aktivierten T-Zellen unterdrücken, ist der Einsatz von systemischen Immunsuppressiva unumgänglich, um ein klares Transplantatüberleben zu erreichen. Es ist allerdings besonders nach Hochrisikokeratoplastik, einer nicht lebensrettenden Transplantation wichtig, die Vor- und Nachteile einer immunsuppressiven Therapie abzuwägen.

Abstract

Immunologic rejection is the main cause of corneal graft failure. If corneal transplantation is performed in a high-risk situation without the use of systemic immunosuppression, corneal graft failure has to be expected in over 50% of patients within the first postoperative year. The clonal expansion of graft-specific lymphocytes occurs in lymphoid tissues. As topical steroids do not reach the secondary lymphoid organs, and even systemic steroids do not interfere sufficiently with the clonal expansion of activated T cells, it is essential to administer systemic immunosuppressives in order to achieve clear graft survival. As corneal transplantation is not a life-saving procedure, the profile of side-effects is a central issue when choosing an immunosuppressive medication.

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  1. Universitätsaugenklinik, Freiburg, Deutschland

    A. Reis, F. Birnbaum & T. Reinhard

  2. Reis Medical Institution Est., Liechtenstein, Landstraße 310, 9495, Triesen, Fürstentum Liechtenstein

    A. Reis

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Correspondence to A. Reis.

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Reis, A., Birnbaum, F. & Reinhard, T. Systemische Immunsuppressiva nach perforierender Keratoplastik. Ophthalmologe 104, 373–380 (2007). https://doi.org/10.1007/s00347-007-1517-x

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