Calcineurininhibitoren

Die Entdeckung und flächenhafte Verwendung der Calcineurininhibitoren (CNI) hat die Prognose der Patienten nach solider Organtransplantation entscheidend verbessert. Mit Ciclosporin A und Tacrolimus stehen uns 2 Medikamente aus der Gruppe der CNI zur Verfügung, die zwar insgesamt gut verträglich sind, jedoch individuelle Nebenwirkungsprofile aufweisen. Die Kenntnis dieser Nebenwirkungen ist im Umgang mit diesen Medikamenten unabdingbar. Insbesondere die CNI-assoziierte Nephrotoxizität kann entscheidend für die Langzeitprognose des Transplantates sein, sodass inzwischen zahlreiche Evidenzen zur Niedrigdosis-CNI oder zu CNI-freien Regimes generiert wurden. Zu beachten ist jedoch, dass durch die Reduktion der CNI-Dosis oder das Absetzen von CNI das Risiko für Abstoßungsreaktionen (insbesondere chronische humorale Abstoßung) steigen kann, was das Transplantatüberleben limitiert.

The discovery and extended use of calcineurin inhibitors (CNI) improved the survival of the kidney allograft after transplantation significantly. Ciclosporin and tacrolimus – available CNI agents – appear to be well tolerated. However, both agents show different side effects profiles. The knowledge of these side effects is mandatory for the choice of the particular agent. Especially CNI-associated nephrotoxicity is an important issue and can impair the long-term allograft survival. Thus, several low-dose CNI or CNI-spare regimes have been developed. Usage of such regimes may improve long-term kidney function. However, increased risk of rejection, in particular chronic humoral rejection, should be noted.

Key words

calcineurin inhibitors - immunosuppression - kidney transplantation - nephrotoxicity - allograft survival

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