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Immunsuppressive Therapie nach Nierentransplantation

Vermeidung von Steroiden und Calcineurininhibitoren

Immunosuppressive therapy after kidney transplantation

Avoidance of steroids and calcineurin inhibitors

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Die Nierentransplantation stellt die Therapie der Wahl bei terminaler Niereninsuffizienz dar und geht seit der Einführung neuerer Immunsuppressiva in den letzten Jahrzehnten mit einer beeindruckenden Verbesserung der Morbidität und Mortalität einher. Trotz dieser Erfolge gehen viele Transplantate vor allem im Langzeitverlauf durch den Tod mit funktionierendem Transplantat oder chronisches Transplantatversagen verloren. Dies ist unter anderem durch die calcineurininhibitor (CNI)- und steroidinduzierte Erhöhung des kardiovaskulären Risikoprofils wie auch durch die Nephrotoxizität der CNI bedingt. Deswegen erscheint es zunächst vorteilhaft, diese Immunsuppressiva in ihrer Dosis zu reduzieren oder zu ersetzen. Allerdings ist eine weitere wichtige Ursache für den Verlust der Transplantate die chronische Abstoßung, welche durch eine im Langzeitverlauf zu geringe Immunsuppression getriggert wird. Diese tritt z. B. beim Absetzen von CNI oder Steroiden auf. Auf diese Weise kann eine Reduktion der Immunsuppression den Transplantatverlust provozieren. Ziel dieser Übersicht ist es, eine Zusammenfassung der Studienlage zur Reduktion von Steroiden und CNI zu geben.

Abstract

Kidney transplantation is the therapy of choice for patients with end stage renal disease. Kidney transplantation-associated morbidity and mortality have been greatly improved after introduction of new immunosuppressive agents over the last decades. Despite this success many kidney transplants are lost particularly in the long-term due to death with a functioning allograft and chronic allograft failure remains a major clinical challenge. This can be attributed to a calcineurin inhibitor (CNI) and steroid-induced increase in cardiovascular morbidity as well as CNI-induced nephrotoxicity. In this respect it might be advantageous to reduce the dose or withdraw steroids or CNI. This, however, should be handled with care as chronic rejection, an important factor in chronic allograft loss, can be triggered by underdosed immunosuppression especially on steroid or CNI withdrawal. Therefore, reduction of immunosuppression is associated with the risk of rejection-induced allograft loss. This review summarizes the results of the available studies regarding steroid and CNI reduction or withdrawal.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautoren auf folgende Beziehungen hin: TF ist als Referent tätig für die Firmen Alexion, Amgen, Astellas, B. Braun, Cellpharm, Novartis, Otsuka, Roche, Teva und erhält Forschungsstipendien von den Firmen Astute Medical France, B. Braun, Fresenius Kabi und Roche. AL erhielt Forschungsstipendien von Novartis und Honoraria von Otsuka, Astellas und Novartis.

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  1. Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Schittenhelmstr. 12, 24105, Kiel, Deutschland

    T. Feldkamp & A. Linkermann

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  1. T. Feldkamp
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  2. A. Linkermann
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Correspondence to T. Feldkamp.

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Feldkamp, T., Linkermann, A. Immunsuppressive Therapie nach Nierentransplantation. Nephrologe 8, 217–225 (2013). https://doi.org/10.1007/s11560-012-0713-0

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  • DOI: https://doi.org/10.1007/s11560-012-0713-0

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