Læknablaðið - 15.09.2000, Síða 20

FRÆÐIGREINAR / LÍFFÆRAFLUTNINGAR
halda steraskammti í lágmarki, fitusnauðu fæði og
kólesteróllækkandi lyfjameðferð (74). Statín eru
kjörlyf sökum virkni þeirra og lítilla aukaverkana.
Nýrnabilun: Cýklósporín og takrólímus geta leitt
til langvinnrar nýmabilunar hjá líffæraþegum
(75,76). Eldri rannsóknir á hjartaþegum sýndu að allt
að 10% fengu lokastigsnýrnabilun eftir átta ára
cýklósporínmeðferð (77). Nýlegri rannsóknir benda
til mun lægri áhættu samfara lægri skömmtum
cýklósporíns eða innan við 3% (78). Mikilvægt er að
forðast önnur lyf sem geta haft skaðleg áhrif á nýru.
Beinsjúkdómar: Beinþynning er algengt vanda-
mál meðal líffæraþega. Sterar valda minnkun
beinmassa og cýklósporín og takrólímus hafa einnig
áhrif í þá veru (77). Mikilvægt er að fylgjast með
beinþéttni. Meðferð er svipuð og hjá öðrum sjúk-
lingum með beinþynningu, það er kalsíum og D
vítamín, bisfosfonöt, ásamt estrógen uppbótar-
meðferð hjá konum eftir tíðahvörf. Beindrep, oftast í
lærleggshaus, sést hjá allt að 15% líffæraþega og
krefst yfirleitt ísetningar gerviliðs. Það er talið
tengjast sterameðferð.
Niðurlag
Skammtíma lifun ígræddra líffæra er nú mjög góð en
hægfara tap græðlinga af völdum langvinnrar höfn-
unar er mikið vandamál. Framfarir á sviði ónæmis-
bælandi meðferðar hafa ekki haft nein teljandi áhrif á
það ferli. Nauðsynlegt er að finna sértækari ónæmis-
bælandi lyf sem fyrirbyggja höfnun hins ígrædda
líffæris en hafa ekki í för með sér alvarlega fylgikvilla
eins og sýkingar og krabbamein. Endanlegt markmið
er að þróa aðferðir til að framkalla þol (tolerance)
gegn ígræddum líffærum. Takist það verður ónæmis-
bælandi meðferð væntanlega óþörf og þá munu þær
alvarlegu aukaverkanir sem henni fylgja verða úr
sögunni.
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