Transplantat-gegen-Wirt-Reaktion

 

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Zusammenfassung

Eine Immunreaktion gegen Empfängergewebe (GvHD) wird durch die Aktivierung von Spender-T-Lymphozyten durch ein inflammatorische Milieu induziert. Eine GvHD kann in zwei Formen auftreten: in den ersten Monaten akut, u. U. fulminant lebensbedrohlich, im ersten Jahr nach Transplantation chronisch, u. U. langwierig, das Spektrum der Autoimmunerkrankungen immitierend. Auftreten und Ausmaß hängt von patienten-, krankheits- und spenderspezifischen Faktoren ebenso ab wie von der Durchführung der Transplantation und der Nachbehandlung. Die Primärtherapie der chronischen GvHD erfolgt mit topischen (bei milden Formen) und systemischen (Prednison 0,5–1 mg/kg KG/d) Glukokortikoiden. Für die Zweitlinientherapie gibt es keinen bisher durch Phase 3 Studien belegten Standard. An die klinische Situation angepasste Auswahl und Dosierung zusätzlicher Immunsuppressiva, Vermeidung längerer höherdosierter Steroiddosen und vor allem Prophylaxen von und Frühintervention bei opportunistischen Infektionen sind von größter Bedeutung.

Abstract

GvHD is the reaction of donor T lymphocytes against recipient tissues induced by inflammation. Two forms of GvHD manifest acutely early after transplant and chronic within the first year mimicking the full spectrum of autoimmune disease. Manifestation and severity depend on patient-, donor-, disease- and transplant-related factors. Primary therapy are systemic (Prednison 0,5–1 mg/kg KG/d) and topical glucocorticoids. There is no established standard for 2nd line therapy. Avoidance of longer exposure to steroids and of opportunistic infections are imminently important.

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