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Infektion nach Nierentransplantation

Infection after renal transplantation

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Infekte nach Nierentransplantation können von der Dialysezeit mitgebracht (Hepatitis, HIV), durch das Transplantat übertragen worden (Hepatitis, HIV, Rabies, Zytomegalie, Epstein-Barr-Virus) oder bei der Transplantation erworben sein (infiziertes Perfusat, Kathetersepsis, frühe Harnwegsinfekte, Wund- und Lymphozeleninfekte, Candidiasis). Vorwiegend frühe Infekte sind demnach Wundprobleme, Harnwegsinfekte, Herpes 1 und 2, Zytomegalie (ohne Prophylaxe), und Polyoma-BK-Virus. Früh und spät auftretende Infekte sind rezidivierende Harnwegsinfekte, infektiöse Diarrhöen, bakterielle und virale Infekte der Luftwege, Polyoma-BK-Virus (über 2 Jahre), Zytomegalie (Reaktivierung), Epstein-Barr-Virus, Varizella-zoster-Virus, Pneumocystis-jirovecii-Pneumonie, Nokardiose, Tuberkulose (Reaktivierung), Hepatitis E sowie fungale Infekte. Die spiralenartige Entwicklung von steigendem immunologischem Risiko des Empfängers, immer potenteren Immunsuppressiva und mehr infektiösen Komplikationen kann nur durch die Entwicklung einer effektiven immunologischen Phänotypisierung mit Minimierung der Immunsuppression und Methoden der Empfängertoleranz überwunden werden.

Abstract

Complications due to infections after renal transplantation may be persistent from dialysis time (hepatitis, HIV), transmitted by the transplant (hepatitis, HIV, rabies, cytomegalovirus, Epstein-Barrvirus) or may be acquired from the transplantation (contamination of organ preservation solution, septicemia by central venous catheter, early urinary tract infection and wound and lymphocele infection). Thus, early infections are mainly urinary tract infections, herpes virus 1 and 2, cytomegalovirus and polyoma BK virus. Early as well as delayed infections are urinary tract infections, diarrhea, infections of the respiratory tract, polyoma BK virus (2 years post-transplantation), cytomegalovirus, Epstein-Barr virus and Varicella zoster virus infection, Pneumocystis jirovecii pneumonia, nocardiosis, tuberculosis (reactivation), hepatitis E as well as fungal infections. The spiral development of increasing immunological recipient risks, more and more potent immunosuppressive regimens and increasing infectious complications should be counteracted by effective monitoring of immune function and thus minimization of immunosuppression and finally by developing methods for recipient tolerance.

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

    A. Schwarz

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Schwarz, A. Infektion nach Nierentransplantation. Nephrologe 7, 307–313 (2012). https://doi.org/10.1007/s11560-012-0655-6

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  • DOI: https://doi.org/10.1007/s11560-012-0655-6

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