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Fortschritte in der Immunsuppression

Progress in immunosuppression

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Zusammenfassung

Die Erfolge der Transplantationsmedizin mit gutem Langzeitüberleben sind eng mit der medikamentösen Möglichkeit einer iatrogenen Immunsuppression verbunden. Fortschritte der Immunsuppression verbinden grundlagenwissenschaftliche Erkenntnisse der Alloimmunität mit dem praktischen klinischen Management transplantierter Patienten, ihren Grunderkrankungen und den Nebenwirkungen der Immunsuppressiva. Basis der gängigen Immunsuppression bei der Lebertransplantation ist der Einsatz von Kalzineurininhibitoren und Steroiden. Zur Vermeidung von Steroidnebenwirkungen und vor allem der Nephrotoxizität hat die Rolle der Antimetaboliten, wie der Mycophenolsäure, und der Kalzineurininhibitorreduktion zugenommen. Die Entwicklungen der 1990er Jahre haben überdies durch gezielte Antikörper gegen den Interleukin-2-Rezeptor zur Entwicklung von Induktionsprotokollen geführt, die eine verzögerte Gabe von Kalzineurininhibitoren ermöglichen und Nebenwirkungen vermeiden können. Vor dem Hintergrund eines Spektrums von Indikationen, das von chronischer Virusinfektion bis hin zu Tumoren reicht, sind die Fortschritte der Immunsuppression durch die sinnvolle Kombination synergistischer Einzelimmunsuppressiva gekennzeichnet. Neue Wirkprinzipien sowie Strategien zur Toleranzinduktion sind in Entwicklung.

Abstract

The success of transplantation with good long-term outcome is closely related to the possibilities of iatrogenic immunosuppression. Progress in immunosuppression combines basic scientific research of alloimmunity with practical clinical management of transplantated patients, their underlying diseases, and management of immunosuppressant side effects. Calcineurin inhibitors and steroids form the basis of immunosuppression in liver transplantation. To prevent steroid side effects and most importantly nephrotoxicity, the roles of antimetabolites such as mycophenolate and calcineurin inhibitor reduction have become more important. Developments in the 1990s provided specific antibodies and induction protocols renabling the delayed application of calcineurin inhibitors and a reduction in side effects. Against the background of a range of indications reaching from chronic viral infection to tumors, the progress of immunosuppression is characterized by the calculated combination of synergistic individual immunosuppressants. Novel drugs and strategies for the induction of tolerance are under development.

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Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    C.P. Strassburg, M.J. Bahr & M.P. Manns

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    T. Becker & J. Klempnauer

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  1. C.P. Strassburg
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  2. M.J. Bahr
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  3. T. Becker
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Correspondence to M.P. Manns.

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Strassburg, C., Bahr, M., Becker, T. et al. Fortschritte in der Immunsuppression. Chirurg 79, 149–156 (2008). https://doi.org/10.1007/s00104-007-1456-8

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