Immunsuppression: Warum Blutspiegel schwanken und was wir dagegen unternehmen können

Zusammenfassung

Calcineurininhibitoren (CNIs) wie Tacrolimus und Ciclosporin und die mTOR-Inhibitoren Everolimus und Sirolimus (mTOR: „mammalian target of rapamycin“) gehören zu den Medikamenten, die eine enge therapeutische Breite aufweisen. Deshalb wird ein regelmäßiges Monitoring ihrer Bluttalspiegel empfohlen. Denn eine hohe intraindividuelle Variabilität (IPV: "intra-patient variability") als Maß schwankender Bluttalspiegel ist mit einem reduzierten Transplantatüberleben assoziiert. Ursächlich findet sich an erster Stelle die Nichtadhärenz, gefolgt vom Einfluss durch die Nahrungsaufnahme oder Diarrhö. Interaktionen mit Medikamenten, die ähnlich metabolisiert werden, inklusive mancher Immunsuppressiva, können ebenso wie die Änderung der Galenik eine erhöhte intraindividuelle Variabilität bewirken. Deshalb muss eine hohe IPV individuell evaluiert werden, und Risikosituationen erfordern ein engmaschiges Monitoring.

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