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Immunsuppressiva nach Transplantation

Dermatologische Relevanz und Pathomechanismen

Immunosuppressive therapy after transplantation

Dermatologic relevance and pathomechanisms

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Zusammenfassung

Immunsuppressiva verhindern nach Transplantation solider Organe einer Abstoßung. Auf der Haut treten dabei Medikamentenreaktionen, entzündliche Erkrankungen und Infektionen gehäuft auf. Spezifische Nebenwirkungen von Immunsuppressiva können durch Wechsel von Substanz oder Medikamentenklasse vermieden werden. Immunsuppressiva sind neben ultraviolettem Licht die treibende Kraft für das häufige Auftreten von spinozellulärem Karzinom der Haut bei Organtransplantation. Neben der reinen Immunsuppression fördert Ciclosporin die Krebsentstehung über TGF-β und VEGF, wirken mTOR-Inhibitoren antiproliferativ und kann Azathioprin auf UVA lichtsensibilisieren und direkten DNS-Schaden ermöglichen. Klinische Daten ermutigen bei spinozellulärem Karzinom der Haut sicher zur Reduktion der Immunsuppression überhaupt, wahrscheinlich zu einem Wechsel von Kalzineurininhibitoren auf mTOR-Inhibitoren und möglicherweise zu einem Absetzen von Azathioprin.

Abstract

Immunosuppressive therapy keeps rejection in check following solid organ transplantation. Drug reactions, inflammatory and infectious skin conditions frequently follow. Specific side effects can be avoided by switching individual agents. In addition to UV light, immunosuppressants are the most important driver for squamous cell carcinoma of the skin (SCC). Beyond immunosuppression, cyclosporine A promotes carcinogenesis by TGF beta and VEGF, while mTOR inhibitors are antiproliferative. Azathioprine photosensitizes to UVA and enables UVA to damage DNA directly. To fight skin cancer, global reduction of immunosuppression is the most effective measure. Switching calcineurin inhibitors to mTOR inhibitors is probably to be recommended, while omitting azathioprine may potentially be advisable in recurrent SCC.

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  1. Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz

    G. Hofbauer

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  1. G. Hofbauer
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Correspondence to G. Hofbauer.

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Hofbauer, G. Immunsuppressiva nach Transplantation. Hautarzt 61, 214–219 (2010). https://doi.org/10.1007/s00105-009-1861-7

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  • DOI: https://doi.org/10.1007/s00105-009-1861-7

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