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Nierentransplantation im Kindesalter

Renal transplantation in childhood

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Zusammenfassung

Prinzipiell ist bei jeder Form der terminalen Niereninsuffizienz im Kindes- und Jugendalter die Nierentransplantation die Behandlungsmethode der Wahl. Im Vergleich zur chronischen Dialysetherapie werden v. a. die Überlebenszeit deutlich gesteigert und die Lebensqualität verbessert. Derzeit kann mit einer 5-Jahres-Nierentransplantatüberlebensrate von 90% nach Lebend- und von 82% nach Verstorbenenspende gerechnet werden. Trotz dieser Erfolge verbleibt eine Reihe wichtiger Problemfelder: Vermeidung einer Organschädigung v. a. durch chronische Rejektion, Entwicklung von Toleranz induzierenden Protokollen, Minimierung der Langzeittoxizität der immunsuppressiven Therapie, Vermeidung kardiovaskulärer Sekundärmorbidität, Prävention der posttransplantationalen lymphoproliferativen Erkrankung, Optimierung des Längenwachstums, Verbesserung der Lebensqualität, Förderung der Compliance und Verbesserung der Konzepte zum strukturierten Übergang (Transition) der Betroffenen in die Erwachsenenmedizin. Weitere Fortschritte sind hier v. a. durch interdisziplinäre Lösungsansätze und eine zunehmende Professionalisierung der pädiatrischen Transplantationsmedizin und der begleitenden klinischen Forschung zu erwarten.

Abstract

Renal transplantation is the optimal treatment modality for children with end-stage renal disease. Compared to chronic dialysis patient survival and quality of life can be strikingly improved. The results of paediatric renal transplantation have been improved markedly in the last 10 years. The current 5-year transplant survival rate is 90% after living donation and 82% after deceased donation. Despite this success a number of unmet relevant clinical problems remain: prevention of organ toxicity particularly by chronic rejection, development of tolerance-inducing protocols, minimisation of long-term toxicity of immunosuppressive therapy, avoidance of secondary cardiovascular comorbidity, prevention of posttransplant lymphoproliferative disease, optimisation of longitudinal growth, improvement of quality of life, enhancement of adherence to the immunosuppressive medication and improved concepts for a structured transition to adult care. Further progress can be expected through interdisciplinary collaborative approaches and through an increase in professionalised paediatric transplant medicine and accompanying clinical research.

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Authors and Affiliations

  1. Klinik Kinderheilkunde I, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland

    B. Tönshoff, H. Billing, S. Rieger & B. Höcker

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  1. B. Tönshoff
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  2. H. Billing
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  3. S. Rieger
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  4. B. Höcker
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Correspondence to B. Tönshoff.

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Tönshoff, B., Billing, H., Rieger, S. et al. Nierentransplantation im Kindesalter. Monatsschr Kinderheilkd 160, 335–342 (2012). https://doi.org/10.1007/s00112-011-2562-8

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