Immunsuppression nach Nierentransplantation – Aktuelle Aspekte

Abstract

Convincing clinical data allow us to conclude that standard therapy after a renal transplant should be, initially, a combined treatment based on calcineurin inhibitors during the early post-transplantation period while observing any possible contra-indications. An elimination of calcineurin inhibitors and conversion to mTOR inhibitors is indicated in the early phase only in patients with a severe and significant side effect associated with chronic renal insufficiency. In case of a chronic long-time course the calcineurin inhibitors should be reduced as far as possible. Conversion to a therapeutic regimen with mycophenolic acid or mTOR inhibitors is indicated during the maintenance period if there is a chronic calcineurin inhibitor toxicity; this conversion is not associated with a significantly enhanced risk of rejection. In case there is already an advanced glomerulosclerosis and a proteinuria exceeding 800-1000 mg, patients do not benefit from an immunosuppression based on mTOR without chronic renal insufficiency. Over and above this, patients will benefit from an individualised immunosuppressive therapy involving reduced side effects of the medication. Nevertheless, it remains absolutely mandatory to promote development and testing of new therapeutic procedures.