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Dünndarm-, Pankreas- und Inselzelltransplantation

Small intestine, pancreas and islet cell transplantation

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Zusammenfassung

Während des letzten Jahrzehnts wurden bedeutende Fortschritte bei der Dünndarmtransplantation (DDTX) durch Verbesserungen der Spender- und Empfängerselektion, des Patientenmanagements, der Immunsuppression und der Operationstechnik erzielt. Damit hat sich die DDTX als eine Behandlungsmethode des Kurzdarmsyndroms etabliert. Meilensteine waren die Entwicklung von Tacrolimus zur Immunsuppression und die Einführung einer Induktionstherapie mit immunmodulatorischen Substanzen wie IL-2-Rezeptor-Antagonisten und Antilymphozytenpräparationen. Erste Pankreastransplantationen (PTX) wurden in den 1960er und frühen 1970er Jahren durchgeführt. Neben Verbesserungen der Immunsuppression, antimikrobiellen Prophylaxe und Diagnose der Abstoßung sind vor allem bessere chirugischen Techniken für ein längeres Transplantatüberleben ausschlaggebend. Die PTX, meist in Kombination mit einer Nierentransplantation, ist eine therapeutische Option bei der Behandlung des labilen Diabetes mellitus (meist Typ 1). Die allogene Inselzelltransplantation (ITX) wurde in den 1990er Jahren als gering invasive Alternative zur PTX entwickelt. Dabei werden Langerhans-Inseln enzymatisch aus dem Spenderpankreas isoliert und meist über eine Infusion in die Pfortader in die Leber implantiert. Eine breitere Anwendung dieser Therapie wird durch technische und medizinische Probleme sowie hohe Kosten erschwert.

Abstract

The past decade has seen substantial improvements in patient and graft survival after intestinal transplantation. This improvement has been achieved by advances in donor and recipient selection, patient management, immunosuppression and surgical techniques. Intestinal transplantation is therefore considered a therapeutic option in the treatment of short bowel syndrome. Mile stones include the development of the calcineurin inhibitor Tacrolimus for immunosuppression as well as induction therapy using immune modulating substances like interleukin-2 receptor antagonists and antilymphocyte preparations. In addition to improvements in immunosuppression, antimicrobial prophylaxis and diagnosis of rejection, advances in surgical techniques have been crucial to achieving increased graft survival. Pancreas transplantation, generally with simultaneous kidney transplantation, is now available as a treatment option for patients with labile diabetes mellitus (usually type 1). Allogeneic islet transplantation was developed in the 1990s as a minimally invasive alternative to pancreas transplantation. Pancreatic islets are isolated enzymatically from the donor pancreas, in most cases infused into the portal vein and thus engrafted into the liver. Currently, technical and medical problems as well as high costs prevent the application of islet transplantation as a therapeutic option for a larger number of patients with diabetes mellitus.

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Authors and Affiliations

  1. Institut für Pathologie, Medizinische Universität Graz, Auenbruggerplatz 25, 8010, Graz, Österreich

    C. Lackner

  2. Universitäres Lehrkrankenhaus Feldkirch, Feldkirch, Österreich

    F. Offner

  3. Institut für Pathologie, Universität Rostock, Rostock, Deutschland

    H. Nizze

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  1. C. Lackner
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  2. F. Offner
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  3. H. Nizze
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Correspondence to C. Lackner.

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Lackner, C., Offner, F. & Nizze, H. Dünndarm-, Pankreas- und Inselzelltransplantation. Pathologe 32, 135–143 (2011). https://doi.org/10.1007/s00292-010-1410-2

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