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Immunosuppression – Causes, Risks and Treatment

Immunosuppression refers to the deliberate or disease-caused reduction of immune system activity. It is used, for example, after organ transplants or to treat autoimmune diseases.

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Things worth knowing about "Immunosuppression"

Immunosuppression refers to the deliberate or disease-caused reduction of immune system activity. It is used, for example, after organ transplants or to treat autoimmune diseases.

What is Immunosuppression?

Immunosuppression refers to the weakening or complete suppression of the body's immune defenses. It can be intentionally induced for medical purposes – such as preventing organ rejection after a transplant – or it can occur as a consequence of certain diseases or medications. A suppressed immune system is more vulnerable to infections, as the body can no longer adequately fight off pathogens.

Causes of Immunosuppression

The causes can be divided into two main categories:

Drug-Induced Immunosuppression

Immunosuppressive drugs such as corticosteroids, ciclosporin, tacrolimus, or mycophenolate mofetil are used following organ transplantation
Chemotherapy agents for cancer treatment can significantly weaken the immune system
Long-term corticosteroid therapy for inflammatory conditions
Biologics (e.g., TNF inhibitors) used in autoimmune diseases such as rheumatoid arthritis

Disease-Induced Immunosuppression

HIV/AIDS: The human immunodeficiency virus specifically destroys T-helper cells, leading to severe immune deficiency
Blood cancers (e.g., leukemia, lymphoma) impair the production of immune cells
Congenital immune defects (primary immunodeficiencies)
Severe malnutrition or chronic diseases such as diabetes mellitus
Radiation therapy

Symptoms and Consequences

A weakened immune system often manifests through:

Frequent, unusually severe, or prolonged infections (e.g., fungal infections, opportunistic infections)
Slow wound healing
Recurring bacterial or viral illnesses
General fatigue and exhaustion

Particularly concerning are so-called opportunistic infections – diseases that rarely affect people with a healthy immune system but can become life-threatening in immunocompromised patients (e.g., Pneumocystis pneumonia, cytomegalovirus infections).

Therapeutic Use

In medicine, immunosuppression is deliberately used to reduce immune activity in cases where the immune system attacks the body itself or rejects foreign tissue:

Organ transplantation: After kidney, heart, or liver transplantation, the immune system must be persistently suppressed to prevent rejection of the new organ
Autoimmune diseases: In conditions such as lupus erythematosus, Crohn's disease, multiple sclerosis, or rheumatoid arthritis, the immune system attacks the body's own tissue – immunosuppressants dampen this response
Bone marrow transplantation: Immunosuppression helps prevent graft-versus-host disease

Diagnosis and Monitoring

Patients undergoing immunosuppression require regular medical monitoring:

Complete blood counts to assess immune cell levels (e.g., leukocytes, lymphocytes)
Drug level measurements in the blood (e.g., tacrolimus levels)
Infection screenings and vaccination status reviews
Kidney and liver function tests due to potentially organ-toxic medications

Risks and Side Effects

In addition to an increased risk of infection, therapeutic immunosuppression carries further risks:

Elevated cancer risk (especially skin cancer and lymphatic tumors) due to reduced immune surveillance
Medication-specific side effects (e.g., kidney damage from ciclosporin, osteoporosis from corticosteroids)
Impaired vaccine response: live vaccines are contraindicated in severely immunocompromised patients

References

Abbas AK, Lichtman AH, Pillai S – Cellular and Molecular Immunology, 10th Edition, Elsevier (2022)
World Health Organization (WHO) – Immunosuppression and Infection Risk: Clinical Guidelines (2021)
European Society for Organ Transplantation (ESOT) – Guidelines on Immunosuppressive Therapy in Solid Organ Transplantation (2022)

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