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Nachsorge nach Nierentransplantation

Aftercare of kidney transplant patients

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Eine optimale Nachsorge nach Nierentransplantation ist die Grundlage für den langfristigen Erhalt der Transplantatfunktion sowie das Überleben der Patienten. Trotz vieler Verbesserungen und einem Einjahresüberleben von nahezu 100 % geht langfristig die Hälfte der Nierentransplantate durch den Tod der Empfänger mit einem funktionierenden Transplantat verloren. Ursachen dafür sind v. a. kardiovaskuläre Erkrankungen, Infektionen und Tumoren. Daher ist es wesentlich, im Verlauf nach Transplantation die kardiovaskulären Risikofaktoren zu erkennen und zu behandeln. Dazu gehören v. a. die arterielle Hypertonie, ein Diabetes mellitus sowie Störungen des Fettstoffwechsels. Da Calcineurininhibitoren das kardiovaskuläre Risiko ungünstig beeinflussen, wären alternative Immunsuppressiva wie z. B. Kostimulationsblocker hilfreich. Weiterhin ist es wichtig, Infektionserkrankungen v. a. mit opportunistischen Keimen rechtzeitig zu erkennen und zu behandeln (s. Beitrag „Infektionen nach Transplantation“ in diesem Heft). Eine immunsuppressive Therapie ist auch mit einer erhöhten Tumorinzidenz verbunden. Wesentlich sind in diesem Zusammenhang vor allem Hauttumoren und lymphoproliferative Erkrankungen. mTOR(„mechanistic target of rapamycin“)-Inhibitoren können bei bestimmten Hauttumoren im Vergleich mit anderen Immunsuppressiva von Vorteil sein. Insgesamt muss bei der Nachsorge besonderes Gewicht auf die Erkennung und Behandlung kardiovaskulärer Risikofaktoren und von Infektions- sowie Tumorerkrankungen gelegt werden, um eine optimale Transplantatfunktion zu erreichen und zu erhalten.

Abstract

An optimal care after kidney transplantation is crucial in order to maintain graft function as well as patient survival over the long term. Despite many improvements and a 1-year survival of nearly 100%, in the long term approximately one half of kidney grafts are lost due to death of patients with a functioning graft. This is mostly related to cardiovascular diseases, infections and malignant tumors. Thus, after transplantation it is important to control for cardiovascular risk factors, such as arterial hypertension, post-transplantation diabetes mellitus and disorders of lipid metabolism. As calcineurin inhibitors unfavorably influence the cardiovascular risks, alternative immunosuppressive substances such as co-stimulation blockers would be helpful. Furthermore, it is important to diagnose and treat infectious diseases particularly with opportunistic pathogens at an early time point (see article “infectious diseases after kidney transplantation” in this issue). An immunosuppressive therapy is also related to an increased incidence of malignancies. This is due to an increase of skin tumors as well as lymphoproliferative disorders. The mTOR inhibitors could be advantageous in comparison to other immunosuppressive substances. Altogether, the diagnosis and treatment of cardiovascular risk factors, infectious diseases and malignancies should be the focus of care of patients after kidney transplantation in order to achieve and maintain the graft function.

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Authors and Affiliations

  1. Klinik für Innere Medizin Nephrologie-Infektiologie, Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenzer Straße 115–155, 56073, Koblenz, Deutschland

    J. Lutz, A. Rieke & B. Schamberger

  2. Universitätsmedizin Mainz, Mainz, Deutschland

    D. Sollinger & J. Weinmann-Menke

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Correspondence to J. Lutz.

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J. Lutz, D. Sollinger, J. Weinmann-Menke, A. Rieke und B. Schamberger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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J. Lutz, Mainz

O. Witzke, Essen

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Lutz, J., Sollinger, D., Weinmann-Menke, J. et al. Nachsorge nach Nierentransplantation. Nephrologe 13, 167–172 (2018). https://doi.org/10.1007/s11560-018-0242-6

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  • DOI: https://doi.org/10.1007/s11560-018-0242-6

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