Autor: PD Dr. Barten - Datum: 02.07.2019

Die Bedeutung der donorspezifischen Antikörper in der Herztransplantation

Donorspezifische Antikörper (DSA) sind ein Kriterium für eine Antikörper-basierte Abstoßung nach Herztransplantation und haben prognostische Bedeutung. Bisher erfolgten Diagnostik und Therapie meist zentrumsabhängig. PD Dr. med. Markus Barten fasst den aktuellen Kenntnisstand zusammen und plädiert für die Etablierung eines interdisziplinären Expertengremiums zur individuellen Diagnostik und Beurteilung von Patienten mit DSA vor und nach Herztransplantation. 

Die Antikörper-basierte Abstoßung (AMR) ist eine der Hauptursachen für ein verringertes Langzeitüberleben nach Herztransplantation (HTx). Dabei sind donorspezifische Antikörper (DSA) im Blut ein Kriterium für eine AMR nach HTx. Der Nachweis von DSA im Blut ist ein prognostischer Marker für den Verlauf nach HTx, da Empfänger mit de novo DSA nach HTx ein dreifach erhöhtes Sterblichkeitsrisiko haben. Trotz des zunehmenden Bewusstseins über die Auswirkungen und Prognose von DSA im letzten Jahrzehnt variiert der Umgang mit DSA zwischen den Herzzentren erheblich und beruht meistens auf der Erfahrung des Transplantationsarztes.

Es wäre vorteilhaft, wenn gemeinsame Strategien für jeden HTx-Empfänger etabliert werden könnten. Eine wichtige Voraussetzung dazu wäre die Einführung eines Expertenpanels, bestehend aus einem Vertreter auf dem Gebiet der HLA-Genetik, der Transplantationsimmunologie und der klinischen Transplantation. Dieses Expertenpanel bestimmt für jeden Patienten das präoperative immunologische Risiko und beurteilt den postoperativen Verlauf. Für eine Beurteilung ist die gezielte, individuelle Anwendung der neuesten invasiven und nicht invasiven diagnostischen Testverfahren entsprechend des klinischen Verlaufs des HTx-Empfängers notwendig. Diese individuelle Untersuchungsstrategie eröffnet dann wiederum die Möglichkeit für eine gezielte Therapie.

Als neuer Standard in der Behandlung von DSA in HTx-Empfängern dient ein interdisziplinäres Expertengremium zur Anwendung gezielter Diagnostik für eine personalisierte Therapie. 

Autor: Privatdozent Dr. med. Markus J. Barten

Privatdozent Dr. med. Markus J. Barten
Universitäres Herz- und Gefäßzentrum Hamburg
Klinik und Poliklinik für Herz- und Gefäßchirurgie

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Disclosures

Honorare für Vorträge von Therakos und Biotest.

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