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Aktuelle Aspekte der Immunsuppression nach Transplantation solider Organe

Current aspects of immunosuppression after solid organ transplantation

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Der Gastroenterologe Aims and scope

An Erratum to this article was published on 28 October 2020

This article has been updated

Zusammenfassung

Hintergrund

Durch die Einführung potenter Immunsuppressiva hat sich die Transplantation solider Organe zu einem etablierten Verfahren bei terminalem Organversagen entwickelt. Durch das verbesserte Überleben umfassen die Ansprüche an eine moderne Immunsuppression sowohl die Verhinderung und Behandlung von Abstoßungsepisoden als auch die Minimierung von Langzeitkomplikationen der Immunsuppressiva.

Ziel der Arbeit

Aktuelle Aspekte der Immunsuppression nach Transplantation solider Organe sollen exemplarisch am Beispiel der Lebertransplantation erläutert werden.

Material und Methoden

Es erfolgte eine auf PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) basierte Literaturrecherche hinsichtlich aktueller Studien und Analysen zur Immunsuppression nach Transplantation solider Organe mit besonderem Fokus auf die Immunsuppression nach Lebertransplantation.

Ergebnisse

Die Immunsuppression nach Transplantation solider Organe wird in eine Induktions- und Erhaltungstherapie unterteilt. Die Basis der Immunsuppression stellen Calcineurininhibitoren dar. Akute Abstoßungen sind in den ersten 3 Monaten nach Lebertransplantation am häufigsten, während im Langzeitverlauf Komplikationen der Immunsuppression die Prognose limitieren. Verschiedene Protokolle zur Minimierung der Calcineurininhibitorexposition sind verfügbar.

Diskussion

Ziel ist es heute, durch frühzeitige Reduktion der Immunsuppressiva bereits im ersten Jahr nach Transplantation das Risiko langfristiger Nebenwirkungen der immunsuppressiven Therapie zu minimieren. Die Möglichkeiten einer Individualisierung der Immunsuppression sind durch die limitierte Anzahl verfügbarer Medikamente begrenzt. Effektive Strategien zum Erreichen einer operationalen Toleranz sind mit den heute verfügbaren Medikamenten nicht etabliert.

Abstract

Background

With the development of potent immunosuppressants, solid organ transplantation has become an established therapy option in terminal organ failure. Improved survival requires modern immunosuppression concepts comprising prophylaxis and treatment of rejection episodes as well as minimization of long-term complications of immunosuppressants.

Objectives

Current aspects of immunosuppression after solid organ transplantation are discussed using the example of liver transplantation.

Materials and methods

A literature search in PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) was performed to identify recent studies and analyses of immunosuppression after solid organ transplantation with special interest in liver transplantation.

Results

Immunosuppression after solid organ transplantation is divided into induction and maintenance therapy. Immunosuppression is based on calcineurin inhibitors. Acute rejection episodes typically occur within the first 3 months after liver transplantation. However, prognosis is limited in the long-term by complications of immunosuppression. Various calcineurin inhibitor minimization protocols are available.

Conclusions

The current objective after solid organ transplantation is risk reduction of long-term side effects of immunosuppressive therapy by early reduction of immunosuppressive agents. Individualization of immunosuppression is restricted by the limited number of available immunosuppressive drugs. Effective strategies with respect to operational tolerance are not established with currently available medicine.

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Change history

Abbreviations

AMR:

Antikörpervermittelte Rejektion

AZA:

Azathioprin

CNI:

Calcineurininhibitor

CsA:

Cyclosporin A

DSA:

Donorspezifische Antikörper

EVR:

Everolimus

MELD:

„Model of end stage liver disease“

MHC:

Haupthistokompatibilitätskomplex (engl. „major histocompatibility complex“)

MMF:

Mycophenolat-Mofetil

mTOR :

„Mechanistic target of rapamycine“

LT:

Lebertransplantation

RAI:

„Rejection activity index“

SIR:

Sirolimus

TAC:

Tacrolimus

TCMR:

T-Zell-vermittelte Rejektion

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Authors and Affiliations

  1. Medizinische Klinik I, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    M.-W. Welker

  2. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    A. A. Schnitzbauer

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  1. M.-W. Welker
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Correspondence to M.-W. Welker.

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Interessenkonflikt

M.-W. Welker erhielt Beratungs- und Vortragshonorare von den Firmen AbbVie, Amgen, Bayer, Bristol-Myers Squibb, Gilead Sciences, Novartis, Roche und Sequana Medical, sowie Kongressunterstützung von den Firmen AbbVie, Astellas Pharma, Bayer, Bristol-Myers Squibb, Novartis, Janssen und Roche. A.A. Schnitzbauer erhielt Beratungshonorare von den Firmen Chiesi und Novartis.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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G. Gerken, Essen

S. Zeuzem, Frankfurt am Main

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Welker, MW., Schnitzbauer, A.A. Aktuelle Aspekte der Immunsuppression nach Transplantation solider Organe. Gastroenterologe 14, 289–295 (2019). https://doi.org/10.1007/s11377-019-0357-y

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