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Zentralbl Chir 2017; 142(02): 161-168
DOI: 10.1055/s-0032-1328352
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Marker der Immunantwort bei Organtransplantation

Immunological Markers in Organ Transplantation
J. H. Beckmann
Klinik für Allgemeine, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, UKSH, Campus Kiel, Kiel, Deutschland
,
N. Heits
Klinik für Allgemeine, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, UKSH, Campus Kiel, Kiel, Deutschland
,
F. Braun
Klinik für Allgemeine, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, UKSH, Campus Kiel, Kiel, Deutschland
,
T. Becker
Klinik für Allgemeine, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, UKSH, Campus Kiel, Kiel, Deutschland
› Author Affiliations
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Publication History

Publication Date:
21 May 2013 (online)

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Zusammenfassung

Das immunologische Monitoring bei Organtransplantationen beruht schwerpunktmäßig auf der Bestimmung von Laborparametern als Surrogatmarker der Organdysfunktion. Goldstandard ist die invasive Biopsie des Transplantats, die strukturelle Schäden und Abstoßungsvorgänge sichert. Zwangsläufig kann die Diagnose einer Abstoßung anhand der histologischen Veränderungen erst verspätet gestellt werden. Wünschenswert wären neue nicht invasive Methoden und spezifische Marker, die bereits zu einem frühen Zeitpunkt, auf molekularer Ebene, Alloreaktivität und auch Toleranz erkennen lassen und eine frühzeitige Behandlung beziehungsweise ein kontrolliertes Absetzen der Immunsuppression ermöglichen. Zusätzlich werden neue prognostische Marker erwartet, die im Vorfeld einer Transplantation eine Risikostratifizierung zulassen und damit Einfluss auf Allokation und Immunsuppression haben werden. Neue Hochdurchsatz-Screeningverfahren erlauben die gleichzeitige Untersuchung von Hunderten von Eigenschaften und das Erstellen spezifischer biologischer Signaturen, die Vorhersagen bezüglich akuter Abstoßung, chronischer Organdysfunktion und Toleranz erlauben. Trotz wichtiger Fortschritte, die durch vielfältige Untersuchungen und Publikationen erzielt wurden, hat bislang so gut wie kein neuer Marker im klinischen Alltag Einzug gehalten. Dennoch werden neue Techniken, insbesondere Analysen des Genoms, des Transkriptoms, des Proteoms als auch des Metaboloms mittelfristig eine personalisierte Transplantationsmedizin erlauben und letztlich die bisherigen Ergebnisse und Transplantatüberlebenszeiten weiter verbessern. Dieser Artikel gibt einen Überblick über Grenzen und Möglichkeiten neuer biologischer Marker der Immunantwort bei Organtransplantationen.

Abstract

The immunological monitoring in organ transplantation is based mainly on the determination of laboratory parameters as surrogate markers of organ dysfunction. Structural damage, caused by alloreactivity, can only be detected by invasive biopsy of the graft, which is why inevitably rejection episodes are diagnosed at a rather progressive stage. New non-invasive specific markers that enable transplant clinicians to identify rejection episodes at an earlier stage, on the molecular level, are needed. The accurate identification of rejection episodes and the establishment of operational tolerance permit early treatment or, respectively, a controlled cessation of immunosuppression. In addition, new prognostic biological markers are expected to allow a pre-transplant risk stratification thus having an impact on organ allocation and immunosuppressive regimen. New high-throughput screening methods allow simultaneous examination of hundreds of characteristics and the generation of specific biological signatures, which might give concrete information about acute rejection, chronic dysfunction as well as operational tolerance. Even though multiple studies and a variety of publications report about important advances on this subject, almost no new biological marker has been implemented in clinical practice as yet. Nevertheless, new technologies, in particular analysis of the genome, transcriptome, proteome and metabolome will make personalised transplantation medicine possible and will further improve the long-term results and graft survival rates. This article gives a survey of the limitations and possibilities of new immunological markers in organ transplantation.

Schlüsselwörter

Transplantation - Marker - Abstoßung - chronische Dysfunktion - Toleranz - Immunmonitoring

Key words

transplantation - biomarker - rejection - chronic dysfunction - tolerance - immune monitoring
 

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