Zusammenfassung
Hintergrund
Organtransplantierte Patienten haben ein erhöhtes Risiko, maligne Tumoren zu entwickeln. Im langfristigen Verlauf nach Organtransplantation stellen maligne Tumoren nach den kardiovaskulären Erkrankungen die zweithäufigste Todesurasche dar. Ziel dieses Reviews ist eine überblickende Darstellung der Zusammenhänge zwischen Immunmodulation und Tumorentstehung nach Organtransplantation.
Ergebnisse und Schlussfolgerung
Neben individuellen Risikofaktoren werden die immunologischen Veränderungen nach Organtransplantation als Ursache des erhöhten Krebsrisikos angesehen. Histokompatibilität, HLA-Status, die kumulative Immunsuppressionsdosis in der Induktions-, Erhaltungs- und Abstoßungsbehandlung, das mit spezifischen Immunsuppressiva assoziierte Malignitätsrisiko sowie eine erhöhte Inzidenz onkogener viraler Infektionen scheinen zum erhöhten Krebsrisiko nach Organtransplantation beizutragen. Ein gründliches Tumorscreening vor und nach Transplantation, antivirale Prophylaxen und eine so niedrig wie möglich dosierte Immunsuppression sind gegenwärtige Strategien, um das Risiko für die Entstehung maligner Tumore nach Transplantation zu senken. Die Entwicklung neuer Immunsuppressiva und Protokolle zur Toleranzinduktion und klinische Erfahrungen mit systemischen und lokalen immunbasierten Tumortherapien können zukünftig ebenso dazu beitragen wie ein besseres Verständnis der Pathomechanismen der Kanzerogenese unter Immunsuppression.
Abstract
Background
Organ transplant patients are at an increased risk to develop de novo or recurrent malignancies. In the long-term course after organ transplantation, malignancies are the second most frequent cause of mortality after cardiovascular diseases. The aim of this review is to summarize and highlight aspects of the development of malignancies in the context of immunomodulation after organ transplantation.
Results and Conclusion
In addition to individual risk factors, the immunological changes after organ transplantation are considered to be the cause for the increased incidence of malignant diseases. Histocompatibility, HLA status, the cumulative dosage of immunosuppressants for induction, maintenance and rejection therapy, the cancer risks associated with specific immunosuppressants as well as an increased incidence of oncogenic viral infections, all seem to contribute to the overall increased cancer risk of organ transplant patients. Thorough pretransplantation and posttransplantation cancer screening, antiviral prophylaxis and the lowest possible level of immunosuppression while still avoiding rejection are currently available strategies to prevent cancer in organ transplant patients. Research into new immunosuppressive drugs and induction of tolerance, systemic and local immune-based tumor therapies are potential future strategies as well as basic research to have a better understanding of the pathomechanisms of cancerogenesis under immunosuppression.
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J. Mittler und H. Lang geben an, dass kein Interessenkonflikt besteht.
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Mittler, J., Lang, H. Entwicklungen der Immunmodulation nach Transplantation im Hinblick auf De-novo-Malignome und Tumorrezidive. Onkologe 22, 461–468 (2016). https://doi.org/10.1007/s00761-016-0051-3
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DOI: https://doi.org/10.1007/s00761-016-0051-3