Skip to main content

Advertisement

SpringerLink
Log in

Langzeitprobleme in der Nierentransplantation

Long-term problems in kidney transplantation

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Dem in der Regel hohen initialen therapeutische Erfolg der Nierentransplantation und der zunehmenden Kontrolle akuter Abstoßungsreaktionen gegenüber stehen die nach wie vor unbefriedigenden langfristigen Ergebnisse bezüglich des Transplantatüberlebens. Zur rechtzeitigen Detektion der Entstehung einer chronischen Transplantatnephropathie sind bisher verwendete Parameter nicht ausreichend sensitiv. Ein weiteres Problem nach Transplantation liegt bei den Patienten. Denn die bei der Mehrzahl dieses Kollektivs erheblich ausgeprägte kardiovaskuläre Morbidität und Mortalität kann zwar durch die Transplantation gesenkt werden, doch bleibt sie nach wie vor ausgesprochen hoch. Therapeutische Strategien werden sich orientieren müssen sowohl an Problemen des Transplantatüberlebens als auch an Aspekten der (Sekundär-)Prävention von Herz-Kreislauf-Ereignissen, Infektionen und Neoplasien.

Abstract

The generally high rate of initial success of treatment by kidney transplantation and the improving control over acute rejection reactions are offset by the persisting unsatisfactory long-term results in terms of transplant survival. Parameters applied thus far for detection of a chronic transplant nephropathy are not sufficiently sensitive. A further problem after transplantation is rooted in the patient: in the majority of patients in this collective in this sample very intensive cardiovascular morbidity and mortality can be lowered by the transplantation, but it is still extremely high. Treatment strategies will need to be slanted towards problems of transplant survival and on aspects of (secondary) prevention of cardiovascular events, infections and neoplasms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Hariharan S, Johnson CP, Bresnahan BA et al. (2000) Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 342: 605–612

    Article  PubMed  Google Scholar 

  2. Meier-Kriesche HU, Schold JD, Srinivas TR, Kaplan B (2004) Lack of improvement in renal allograft survival despie a marked decrease in in acute rejection rates over the most recent era. Am J Transplant 4: 378–383

    Article  PubMed  Google Scholar 

  3. Keith DS, deMattos A, Golconda M et al. (2005). Factors associated with improvement in deceased donor renal allograft function in the 1990s. J Am Soc Nephrol 16: 15212–1521

    Article  Google Scholar 

  4. Foley RN, Parfrey RS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in patients with endstage renal disease. Am J Kidney Dis 32: S112–119

    PubMed  Google Scholar 

  5. Wolfe RA, Ashby WB, Milford EL et al. (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of a first cadaveric transplant. N Engl J Med 341: 1725–1730

    Article  PubMed  Google Scholar 

  6. Rigatto C, Parfrey P, Foley R et al. (2002) Congestive heart failure in renal transplant recipients: risk factors, outcomes, relationship with ischemic heart disease. J Am Soc Nephrol 13: 1084–1090

    PubMed  Google Scholar 

  7. Lentine KL, Brennan DC, Schnitzler MA (2005) Incidence and predictors of myocardial infarction after kidney transplantation. J Am Soc Nephrol 16: 496–506

    Article  PubMed  Google Scholar 

  8. Ojo AO, Hanson JA, Wolfe RA et al. (2000) Long-term survival in renal transplant recipients with graft function. Kindey Int 57: 307–313

    Article  Google Scholar 

  9. Kasiske BL (1988) Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Medicalm 84: 985–993

    Article  Google Scholar 

  10. Hegeman RL, Hunsicker LG (1995) Chronic rejection in renal allografts: importance of cardiovacular risk factors. Clin Tranplant 9: 135–139

    Google Scholar 

  11. Opelz G, Wujciak T, Ritz E (1998) Association of chronic kidney graft failure with recipient blood pressure. Kidney Int 53: 217–222

    Article  PubMed  Google Scholar 

  12. Prommool S, Jhangri GS, Cockfiled SM, Halloran PF (2000) Time dependency of factors affecting renal allograft survival. J Am Soc Nephrol 11: 565–573

    PubMed  Google Scholar 

  13. Meier-Kriesche HU, Ojo AO, Hanson JA et al. (2000) Increase impact of acute rejection on chronic allograft failure in recent era. Transplantation 70: 1098–1100

    Article  PubMed  Google Scholar 

  14. Zeier M, Dohler B, Opelz G, Ritz E (2002) The effect of donor gender on graft survival. J Am Soc Nephrol 13: 2570–2576

    Article  PubMed  Google Scholar 

  15. Nankivell BJ, Fenton-Lee CA, Kuypers DR et al. (2001) Effect of histological damage on long-term kidney transplant outcome. Transplantation 71: 515–523

    Article  PubMed  Google Scholar 

  16. Schwarz A, Mengel M, Gwinner W et al. (2005) Risk factors for chronic allograft nephropathy after renal transplantation: a protocol biopsy study. Kidney Int. 67(1): 341–348

    Google Scholar 

  17. Waller JR, Nicholson ML (2001) Molecular mechanisms of renal allograft fibrosis. Br J Surg 88: 1429–1441

    Article  PubMed  Google Scholar 

  18. Mas V, Alvarellos T, Giraudo C et al. (2002) Intragraft messenger RNA expression of angiotensinogen: relationship with transforming growth factor beta-1 and chronic allograft nephropathy in kidney transplant patients. Transplantation 74: 718–721

    Article  PubMed  Google Scholar 

  19. Baboolal K, Jones GA, Janezic A et al. (2002) Molecular and structural consequences of early renal allograft injury. Kidney Int 61: 686–696

    Article  PubMed  Google Scholar 

  20. Gueler F, Gwinner W, Schwarz A, Haller H (2004) Long-term effects of acute ischemia and reperfusion injury. Kidney Int 66(2): 523–527

    Article  PubMed  Google Scholar 

  21. Racusen LC, Solez K, Colvin R (2002) Fibrosis and atrophy in the renal allograft: interim report and new directions. Am J Transplant 2: 203–206

    Article  PubMed  Google Scholar 

  22. Mauiyyedi S, Pelle PD, Saidman S et al. (2001): Chronic humoral rejection: identification of antibody-mediated chronic renal allograft rejection by C4d deposits in peritubular capillaries. J Am Soc Nephrol 12: 574–582

    PubMed  Google Scholar 

  23. Mengel M, Bogers J, Bosmans JL et al. (2005) Incidence of c4d stain in protocol biopsies from renal allografts: results from a multicenter trial. Am J Transplant 5(5): 1050–1056

    Article  PubMed  Google Scholar 

  24. Gwinner W, Suppa S, Mengel M et al. (2005) Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J transplant. 5(8): 1934–1941

    Google Scholar 

  25. Seron D, Moreso F, Fulladosa X et al. (2002) Reliability of chronic allograft nephropathy diagnosis in sequenzial protocol biopsies. Kidney Int 61: 727–733

    Article  PubMed  Google Scholar 

  26. Serinsoz E, Bock O, Kirsch T et al. (2005) Compartment-specific quantitative gene expression analysis after laser microdissection from archival renal allograft biopsies. Clin Nephrol 63(3): 193–201

    PubMed  Google Scholar 

  27. Schwarz A, Gwinner W, Hiss M et al. (2005) Safety and adequacy of renal transplant protocol biopsies. Am J Transplant 5(8): 1992–19

    Article  PubMed  Google Scholar 

  28. Mange KC, Cizman B, Joffe M, Feldman HI (2000) Arterial hypertension and renal allograft survival. Am J Med 283: 633–637

    Article  Google Scholar 

  29. Opelz et al. (2005) Am J Transplant 5: 2725

    Google Scholar 

  30. Mailloux LU, Levey JS (1998) Hypertension in patients with chronic renal disease. Am J Kidney Dis 32: S120–S141

    PubMed  Google Scholar 

  31. Rahn KH, Barenbrock M, Fritschka E et al. (1999) Effect of nitren-dipine on renal function in renal-transplant patients treated with cyclosporin: A randomised trial. Lancet 354: 1415–1420

    Article  PubMed  Google Scholar 

  32. Danovitch GM (2001) Can ACE inhibitors prevent chronic allograft failure? Am J Kidney Dis 37: 866–870

    PubMed  Google Scholar 

  33. Midtvedt K, Hartmann A, Foss A et al. (2001) Sustained improvement of renal graft function for two years in hypertensive renal transplant recipients treated with nifedipine as compared to lisinopril. Transplantation 72: 1787–1792

    Article  PubMed  Google Scholar 

  34. Cosio FG, Pesavento TE, Osei K et al. (2001) Post-transplant diabetes mellitus: Increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 59: 732–737,

    Article  PubMed  Google Scholar 

  35. Weir MR, Fink JC (1999) Risk for posttransplant diabetes mellitus with current immunosuppressive medications. Am J Kidney Dis 34: 1–13

    PubMed  Google Scholar 

  36. Davidson J, Wilkinson A, Dantal J et al; International Expert Panel (2003) New-onset diabetes after transplantation: 2003 International consensus guidelines. Transplantation 75 (10 Suppl): SS3–24.

    Article  PubMed  Google Scholar 

  37. First MR, Gerber DA, Hariharan S et al. (2002) Posttransplant diabetes mellitus in kidney allograft recipients: Incidence, risk factors, and management. Transplantation 73: 379 –386,

    Article  PubMed  Google Scholar 

  38. Revanur VK, Jardine AG, Kingsmore DB et al. (2002) Onset of diabetes mellitus on patient and graft survival in recipients of kidney transplantation. Clin Transplant 15: 89–94

    Article  Google Scholar 

  39. Kasiske BL, Guijarro C, Massy ZA et al. (1996) Cardiovascular disease after renal transplantation. J Am Soc Nephrol 7: 158–165

    PubMed  Google Scholar 

  40. Roodnat JI, Mulder PG, Zietse R et al. (2000) Cholesterol as an independent predictor of outcome after renal transplantation. Transplantation 69: 1704–1710

    Article  PubMed  Google Scholar 

  41. MacDonald AS (2001) A worldwide, phase III, randomized, controlled, safety and efficacy study of a sirolimus/cyclosporine regimen for prevention of acute rejection in recipients of primary mismatched renal allografts. Transplantation 71: 271–280

    Article  PubMed  Google Scholar 

  42. Roodnat JI, Mulder PG, Zietse R et al. (2000) Cholesterol as an independent predictor of outcome after renal transplantation. Transplantation 69: 1704 – 1710

    Article  PubMed  Google Scholar 

  43. Kasiske BL, Guijarro C, Massy ZA et al. (1996) Cardiovascular disease after renal transplantation. J Am Soc Nephrol 7: 158–165

    PubMed  Google Scholar 

  44. Kasiske BL, Vazquez MA, Harmon WE et al. (2000) Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation. J Am Soc Nephrol 11[Suppl 15]: S1– 86

  45. Cosio FG, Pesavento TE, Pelletier RP et al. (2002) Patient survival after renal transplantation III: The effects of statins. Am J Kidney Dis 40: 638–643

    Article  PubMed  Google Scholar 

  46. Ichimaru N, Takahara S, Kokado Y et al. (2001) Changes in lipid metabolism and effect of simvastatin in renal transplant recipients induced by cyclosporine or tacrolimus. Atherosclerosis 58: 417– 423

    Article  Google Scholar 

  47. Holdaas H et al. (2003) Lancet 361: 2024

    Article  PubMed  Google Scholar 

  48. Kasiske BL, Heim-Duthoy KL, Singer GG et al. (2001) The effects of lipid-lowering agents on acute renal allograft rejection. Transplantation 72: 223–227

    Article  PubMed  Google Scholar 

  49. Kasiske BL, Klinger D (2000) Cigarette smoking in renal transplant recipients. J Am Soc Nephrol 11: 753.759

    PubMed  Google Scholar 

  50. Ridker PM (2001) High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. N Engl J Med 103: 1813–1818

    Google Scholar 

  51. Arnadottir M, Hultberg B, Wahlber J et al. (1998) Serum total homocysteien concentration before and after renal transplantation. Kidney Int 54: 1280–1284

    Article  Google Scholar 

  52. Bostom AG (2000) Homocysteine: „expensive creatinine” or important modifiable risk factor for arteriosclerotic outcomes in renal trans-plant recipients? J Am Soc Nephrol 11: 149–151

    PubMed  Google Scholar 

  53. Ducloux D, Motte G, Challier B et al. (2000) Serum total homocysteine and cardiovascular disease occurrence in chronic, stable renal transplant recipients: a prospective study. J Am Soc Nephrol 11: 134–137

    PubMed  Google Scholar 

  54. Roodnat JL, Mulder PHG, Rischew-Vos et al. (2001) Proteinuria after renal transplantation affects not only graft survival but also patient survival. Transplantation 72: 488–494

    Article  Google Scholar 

  55. Humar A, Gillingham K, Payne WD et al. (2000) Increased incidence of cardiovascular complications in kidney transplant recipients with cytomegalovirus disease. Transplantation 70: 310–330

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Abteilung für Nephrologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30635, Hannover, Deutschland

    H. Haller

Authors
  1. H. Haller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Haller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haller, H. Langzeitprobleme in der Nierentransplantation. Nephrologe 2, 175–181 (2007). https://doi.org/10.1007/s11560-007-0085-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11560-007-0085-z

Schlüsselwörter

Keywords

Search

Navigation