Zusammenfassung
Hintergrund
Immunsuppressiva sind aus der modernen Medizin nicht mehr wegzudenken. Allerdings führt diese wirksame Medikamentenklasse zu einer erheblichen Gefährdung durch Infektionen. Vor allem opportunistische und virale Infektion stellen eine therapeutische Herausforderung dar und sind eine Ursache für Morbidität und Mortalität bei immunsuppressiver Therapie, besonders wenn der Erreger reaktivieren kann oder zu chronischen Infektionen neigt.
Fragestellung
Empfehlungen zur Vermeidung bzw. Behandlung opportunistischer oder viraler Infektionen bei Einleitung einer immunsuppressiven Therapie.
Material und Methode
Selektive Literaturrecherche in der Datenbank PubMed.
Ergebnisse
In diesem Übersichtsartikel werden das Management und die prophylaktischen Strategien bei Tuberkulose, Zytomegalievirus und viralen Hepatitiden bei Einleitung einer immunsuppressiven Therapie beschrieben.
Schlussfolgerungen
Für alle diese Erkrankungen stehen geeignete Maßnahmen bereit. Besonders die neuen Entwicklungen bei der Therapie der Hepatitis C geben Anlass zur Hoffnung, die signifikante Morbidität und Mortalität der Hepatitis C bei Immunsuppression zu senken.
Abstract
Background
Immunosuppressive therapy is indispensable in the modern era of medicine; however, immunosuppression also causes significant life-threatening infectious complications. Viral and opportunistic infections in particular pose a major therapeutic challenge and are responsible for increased morbidity and mortality in patients under immunosuppressive therapy, especially when the infection has the potential to reactivate or cause chronic infections.
Objectives
This article presents recommendations for avoidance and therapy of viral and opportunistic infections when initiating immunosuppressive therapy.
Methods
A selective literature review of the PubMed database was carried out.
Results
A summary of the management and prophylactic strategies for tuberculosis, cytomegalovirus and viral hepatitis in patients undergoing immunosuppressive therapy is given.
Conclusion
Appropriate measures are available for all these forms of infection. Especially the new treatment options for hepatitis C raise hopes for a significant decrease in the morbidity and mortality of hepatitis C in patients undergoing immunosuppressive therapy.
This is a preview of subscription content, log in via an institution to check access.
Literatur
http://www.rki.de/tuberkulose. Zugegriffen: 10. Nov. 2014
Bodro M, Sabe N, Santin M et al (2012) Clinical features and outcomes of tuberculosis in solid organ transplant recipients. Transplant Proc 44:2686–2689
Degos F, Lugassy C, Degott C et al (1988) Hepatitis B virus and hepatitis B-related viral infection in renal transplant recipients. A prospective study of 90 patients. Gastroenterology 94:151–156
Eid AJ, Razonable RR (2010) New developments in the management of cytomegalovirus infection after solid organ transplantation. Drugs 70:965–981
Enders G, Daiminger A, Lindemann L et al (2012) Cytomegalovirus (CMV) seroprevalence in pregnant women, bone marrow donors and adolescents in Germany, 1996–2010. Med Microbiol Immunol 201:303–309
Feld JJ (2014) Interferon-free strategies with a nucleoside/nucleotide analogue. Semin Liver Dis 34:37–46
George MJ, Snydman DR, Werner BG et al (1997) The independent role of cytomegalovirus as a risk factor for invasive fungal disease in orthotopic liver transplant recipients. Boston Center for Liver Transplantation CMVIG-Study Group. Cytogam, MedImmune, Gaithersburg, Maryland. Am J Med 103:106–113
Girndt M (2008) Zytomegalievirusinfektion nach Nierentransplantation. Nephrologe 3:51–62
Hadaya K, Bridevaux PO, Roux-Lombard P et al (2013) Contribution of interferon-gamma release assays (IGRAs) to the diagnosis of latent tuberculosis infection after renal transplantation. Transplantation 95:1485–1490
Hahne SJ, Veldhuijzen IK, Wiessing L et al (2013) Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening. BMC Infect Dis 13:181
Kotton CN, Kumar D, Caliendo AM et al (2013) Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 96:333–360
Lefebure AF, Verpooten GA, Couttenye MM et al (1993) Immunogenicity of a recombinant DNA hepatitis B vaccine in renal transplant patients. Vaccine 11:397–399
Lens S, Gambato M, Londono MC et al (2014) Interferon-free regimens in the liver-transplant setting. Semin Liver Dis 34:58–71
Levitsky J, Doucette K (2013) Viral hepatitis in solid organ transplantation. Am J Transplant 13(Suppl 4):147–168
Marker-Hermann E, Schmidt RE (2010) Infection: causes, triggers and complications of rheumatic disease. Z Rheumatol 69:863
Nicot F, Kamar N, Mariame B et al (2010) No evidence of occult hepatitis C virus (HCV) infection in serum of HCV antibody-positive HCV RNA-negative kidney-transplant patients. Transpl Int 23:594–601
Nunes J, Marinho RT, Fonseca JE et al (2011) Prophylaxis of hepatitis B reactivation with immunosuppressive therapy in rheumatic diseases. Orientations for clinical practice. Acta Reumatol Port 36:110–118
Opelz G, Dohler B (2012) Association of HLA mismatch with death with a functioning graft after kidney transplantation: a collaborative transplant study report. Am J Transplant 12:3031–3038
Opelz G, Döhler B (2014) Reduced rate of cardiovascular death after cytomegalovirus prophylaxis in renal transplant recipients. Transplantation
Razonable RR, Humar A (2013) Cytomegalovirus in solid organ transplantation. Am J Transplant 13(Suppl 4):93–106
Robert-Koch-Institut (2014) Epidemiologisches Bulletin Nr. 3, Januar 2014
Sagedal S, Hartmann A, Nordal KP et al (2004) Impact of early cytomegalovirus infection and disease on long-term recipient and kidney graft survival. Kidney Int 66:329–337
Shim TS (2014) Diagnosis and treatment of latent tuberculosis infection in patients with inflammatory bowel diseases due to initiation of anti-tumor necrosis factor therapy. Intest Res 12:12–19
Smiley ML, Wlodaver CG, Grossman RA et al (1985) The role of pretransplant immunity in protection from cytomegalovirus disease following renal transplantation. Transplantation 40:157–161
Subramanian AK, Morris MI (2013) Mycobacterium tuberculosis infections in solid organ transplantation. Am J Transplant 13(Suppl 4):68–76
Tsutsumi Y, Yamamoto Y, Shimono J et al (2013) Hepatitis B virus reactivation with rituximab-containing regimen. World J Hepatol 5:612–620
Walker RC, Marshall WF, Strickler JG et al (1995) Pretransplantation assessment of the risk of lymphoproliferative disorder. Clin Infect Dis 20:1346–1353
Yap DY, Tang CS, Yung S et al (2010) Long-term outcome of renal transplant recipients with chronic hepatitis B infection-impact of antiviral treatments. Transplantation 90:325–330
Yazici O, Sendur MA, Aksoy S (2014) Hepatitis C virus reactivation in cancer patients in the era of targeted therapies. World J Gastroenterol 20:6716–6724
Einhaltung ethischer Richtlinien
Interessenkonflikt. TF ist als Referent tätig für die Firmen Alexion, Amgen, Astellas, B Braun, Bristol-Myers-Squibb, Cellpharm, Novartis, Otsuka, Roche, Teva und erhält/erhielt Forschungsstipendien von den Firmen Astute Medical France, B Braun, Fresenius Kabi und Roche. OW hat Studienunterstützungen, Honorare für Vorträge, Reisekostenübernahmen und Unterstützungen für die Anfertigung und Präsentation medizinisch/wissenschaftlicher Vorträge von den Firmen Amgen, Astellas, Bristol-Myers Squibb, Chiesi, Novartis, Roche, Pfizer und Sanofi erhalten.
Dieser Beitrag enthält keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Feldkamp, T., Witzke, O. Infektiöse Komplikationen der immunsuppressiven Therapie. Nephrologe 10, 38–45 (2015). https://doi.org/10.1007/s11560-014-0908-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11560-014-0908-7