Editorial Article

Concerning Immunosuppression

Dr. Thomas Ryzlewicz,
ViaMedis Dialysis Center, Germany
*Corresponding author:

Dr. Thomas Ryzlewicz

Keywords:

Medical Technology resp., Dialysis Technology

Organ Transplantation had developed to a regular therapy since more than 35 years. Tremendous success had reached. Looking the results over the decades, a clear improvement of the survival of the organs had reached in the first years following the individual transplantation. An essential part of this great success have the Immunosuppressive Drugs. They became strong and stronger. Comparable to other drugs, these immunosuppressive drugs also have undesired secondary effects. That is quite regular.

Basics of every important Medical Treatment should a pro / con evaluation of the doctor for the individual concerned patient. Clearly spoken: The patient must have an advantage from a special therapy. A classic example will shows this: In Heart Transplantation a Calcineurin Inhibitor will frequently used as an immunosuppressive. Naturally, this is for many years successful. In Heart Transplantation, the five-fold dosage of this drug (in comparison to the kidney transplantation) has used, as there is no tissue matching in heart transplantation. So the secondary effect of the vascular damage is very strong accelerated in comparison to the status of a kidney transplantation. 

The problem? This Calcineurin Inhibitor will never stopped, even, when the kidney function is running from bad to worse (ESRD / CKD-5). Why is in this case no think-over to use another immunosuppressive drug in order to stop the manifest vascular injury?

Another important problem of this continued “carry-on” is the secondary effect of Tacrolimus (> development of Diabetes mellitus II). When Diabetes mellitus II appears as a drug-related disease, Tacrolimus should switched.

Many of the transplanted patients are included in studies. A well done pro / con evaluation for the individual patient is the better argument instead of the “carry-on” according to the study protocol.
A last example. It seems, that in the long-run, the transplanted patients do not need such a strong immunosuppressive therapy like in the begin after the transplantation. One step is a reduction of the dosage of the immunosuppressive therapy. The perhaps much better way is perhaps, to switch the modern immunosuppressive therapy to the old one with Cortison / Azathioprin. With this very old immunosuppressive therapy of lower immunosuppressive power, there does exist patients (in a smaller number) with a survival of more than 30 years without any problems. There is the question for shifting in the long-run to Cortison / Azathioprin in order to prevent long-term injury of the modern strong immunosuppressive drugs (even when there is no actual problem). 

This project has an economic disadvantage: You can make no study, as the industry will not support a long-run with Cortison / Azathioprin. Medical decisions according to the patient’s pro / cons should not done with economic aspects. In US, Clinical Pharmacologists can contribute to reach to best option for the single patient in case of switching the immunosuppression.

My best wishes to the new International Journal of Transplantation Research and Technology! This plant should grow to a forum of discussion of serious problems and to present primary results.

Published: 04 December 2015

Copyright: Copyright: © 2015 Thomas Ryzlewicz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.