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Aktuelles zur Nierenlebendspende

Living kidney donation today

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Eine Nierenlebendspende stellt für den Großteil der Transplantatempfänger die beste Behandlungsoption dar. In Deutschland herrscht das grundsätzliche Problem des Mangels an Organspenden. Die Anzahl der Verstorbenenspenden hat einen historischen Tiefstand erreicht. Zusätzlich ist die Gesamtzahl der Nierenlebendspenden in Deutschland seit 2011 rückläufig. Im Jahr 2017 wurden die revidierten KDIGO(Kidney Disease: Improving Global Outcomes)-Leitlinien zur Vorbereitung und Nachsorge des Nierenlebendspenders veröffentlicht, die eine sorgfältige somatische und psychische Evaluation umfassen. Die Auswahl eines Lebendspender sollte immer das individuelle Lebenszeitrisiko des potenziellen Spenders beachten. Intensive Diskussionen haben in den vergangenen Jahren Publikationen zum Thema Niereninsuffizienz und Mortalität nach Nierenlebendspende hervorgerufen. Nach jetzigem Stand scheint eine Nierenlebendspende keinen negativen Einfluss auf die Mortalität der Spender auch im Vergleich zu gesunden Nichtspendern zu haben. Das Risiko für das Eintreten eines terminalen Nierenversagens erscheint, verglichen mit gesunden Kontrollen, allerdings höher. Lebendnierenspenden bei AB0-Inkompatibilität werden heutzutage in vielen Transplantationszentren erfolgreich durchgeführt. Kontrovers diskutiert wird die Nierenlebendspende bei vorliegender Immunisierung gegen den Spender, d. h. bei Vorliegen spenderspezifischer HLA-Antikörper.

Abstract

Living kidney donation represents the best therapeutic option for most patients with end-stage renal failure. A main problem in Germany is the organ shortage. The number of deceased organs has reached a low level. In addition, the number of living donors in Germany has been declining since 2011. In 2017 the revised Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for the preparation and aftercare of living kidney donors were published, which include a comprehensive somatic and psychiatric evaluation. The selection of living donors should always consider the individual lifetime risk of the potential donor. Intensive discussions in recent years have led to publications on the topics of renal insufficiency and mortality after living kidney donation. According to the current state of knowledge, a living kidney donation does not seem to have a negative influence on the mortality of the donor even in comparison to healthy non-donors; however, the risk of occurrence of terminal renal failure seems to be higher in comparison with healthy controls. Nowadays, living kidney donations with AB0 incompatibility are successfully carried out in many transplantation centers. Living kidney donation in cases of immunization against the donor, i.e. in the presence of donor-specific HLA antibodies, is controversially discussed.

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  1. Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland

    C. Sommerer MSc

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Sommerer, C. Aktuelles zur Nierenlebendspende. Nephrologe 13, 173–185 (2018). https://doi.org/10.1007/s11560-018-0243-5

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