Strassburg C P, Bahr M J, Becker T, Klempnauer J, Manns M P
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover.
Chirurg. 2008 Feb;79(2):149-56. doi: 10.1007/s00104-007-1456-8.
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 transplanted 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.
移植手术取得良好长期效果的成功与医源性免疫抑制的可能性密切相关。免疫抑制方面的进展将同种异体免疫的基础科学研究与移植患者的实际临床管理、其基础疾病以及免疫抑制剂副作用的管理相结合。钙调神经磷酸酶抑制剂和类固醇构成了肝移植免疫抑制的基础。为了预防类固醇副作用，最重要的是预防肾毒性，霉酚酸酯等抗代谢物以及减少钙调神经磷酸酶抑制剂的作用变得更加重要。20世纪90年代的进展提供了特异性抗体和诱导方案，使得能够延迟应用钙调神经磷酸酶抑制剂并减少副作用。在从慢性病毒感染到肿瘤等一系列适应症的背景下，免疫抑制的进展以协同的个体免疫抑制剂的精心组合为特征。诱导耐受的新型药物和策略正在研发中。
