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Spezifische Infektionen bei Organtransplantationen

Specific infections in organ transplantation

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Zusammenfassung

Dieser Beitrag widmet sich der wichtigen Thematik von Infektionen im Zusammenhang mit Organtransplantationen. Erörtert werden vier Teilbereiche. Der erste Teil beschreibt die aktuellen Möglichkeiten in der Prävention und Therapie von Virushepatitiden im Rahmen der Lebertransplantation. Eingegangen wird auf Infektionen mit Hepatitis B, C, Delta und E, wobei ein besonderes Augenmerk auf der interferonfreien Behandlung der Hepatitis C mit den neuen direkt antiviralen Medikamenten liegt.

Im zweiten Teil werden Pseudomonas-aeruginosa(PA)-Infektionen nach Lungentransplantation (LuTx) thematisiert. Der Erreger gehört zu den Keimen, die nach LuTx am häufigsten in den Atemwegen nachgewiesenen werden. Betroffen sind insbesondere Patienten mit zystischer Fibrose. Von Bedeutung ist dies, da Studien eine deutliche Korrelation zwischen chronischen PA-Infektionen nach LuTx und der Entwicklung eines chronischen Transplantatversagens ergeben haben. Wenn auch die Datenlage noch spärlich ist, werden Empfehlungen zu Präventions- und Therapiestrategien formuliert.

Die hohe Bedeutung von Virusinfekten nach Nierentransplantation ist das Thema des dritten Teils. Neben erworbenen Infekten kann sowohl das übertragene Organ als auch der Empfänger selbst die Infektionsquelle sein. Je besser das transplantierte Organ bei maßvoller Immunsuppression toleriert wird, desto seltener und weniger schwer werden die Virusinfekte sein. Der Fokus des Beitragsteils liegt auf drei häufigen Erregern: dem Zytomegalievirus, dem Polyoma-BK-Virus und Hepatitisviren.

Der letzte Teil widmet sich Aspergillus-Infektionen nach Transplantation verschiedener Organe. Aspergillus spp. gehören in diesem Kontext zu den häufigsten Pilzerkrankungen. Besprochen werden Epidemiologie, Risikofaktoren, Diagnostik, Prophylaxe und Therapie einer invasiven Aspergillose.

Abstract

This article is concerned with the important topic of infections associated with organ transplantation and includes a discussion on four subtopics. The first section describes the current options in the prevention and therapy of viral hepatitis in association with liver transplantation. Infections with hepatitis B, C, D (delta) and E are discussed with special emphasis on the interferon-free treatment of hepatitis C with the new antiviral drugs.

The second section deals with Pseudomonas aeruginosa (PA) infections following lung transplantation (LuTx), which is one of the most frequently detected pathogens in the airway after LuTx. Patients with cystic fibrosis are particularly affected. This is important because studies have shown a clear correlation between chronic PA infections after LuTx and development of chronic transplant failure. Even if the data are still sparse, recommendations on prevention and therapeutic strategies are given.

The theme of the third section is the high importance of viral infections after kidney transplantation. In addition to acquired infections, the transplanted organ as well as the recipient can be the source of the infection. The better the transplanted organ is tolerated under moderate immunosuppression, the less common and severe virus infections are. The focus of this section is on three common pathogens: cytomegalovirus, polyomavirus BK and hepatitis viruses.

The final section deals with Aspergillus infections following transplantation of various organs. In this context Aspergillus spp. are one of the most commonly occurring fungal diseases. The epidemiology, risk factors, diagnostics, prophylaxis and therapy of invasive aspergillosis are presented.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Schlevogt, J. Rademacher, A. Schwarz und M. Sandherr geben an, dass kein Interessenkonflikt besteht. M. Cornberg hat Honorare für Vorträge und Beratung von AbbVie, Bristol-Myers Squibb, Gilead, Janssen-Cilag, MSD Sharp & Dohme und Roche erhalten. G. Maschmeyer erhielt Honorare für Vortragstätigkeiten von Pfizer, Gilead und Astellas; Beratungen: Gilead und F2G (unkompensiert).

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30623, Hannover, Deutschland

    M. Cornberg & B. Schlevogt

  2. Klinik für Pneumologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Rademacher

  3. Klinik für Nieren- und Hochdruckerkrankungen, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    A. Schwarz

  4. Gemeinschaftspraxis für Hämatologie und Onkologie, Röntgenstr. 4, 82362, Weilheim, Deutschland

    M. Sandherr

  5. Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland

    G. Maschmeyer

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  1. M. Cornberg
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  2. B. Schlevogt
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  3. J. Rademacher
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  4. A. Schwarz
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  6. G. Maschmeyer
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Correspondence to M. Cornberg, J. Rademacher, A. Schwarz or M. Sandherr.

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Cornberg, M., Schlevogt, B., Rademacher, J. et al. Spezifische Infektionen bei Organtransplantationen. Internist 57, 38–48 (2016). https://doi.org/10.1007/s00108-015-3807-8

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