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Psychiatrische Begutachtung zur Transplantationsfähigkeit bei Patienten mit alkoholischer Leberzirrhose

Welche Prognosekriterien sind empirisch gesichert?

Psychiatric assessment of alcoholic patients on a waiting list for liver transplantation

Which prognostic criteria are empirically proven?

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Zusammenfassung

Leberfunktionsstörungen sind die häufigste körperliche Folgestörung bei Alkoholismus. Eine Leberzirrhose entwickeln 10–20% aller alkoholkranken Patienten, eine der häufigsten Todesursachen bei Alkoholismus. Die alkoholische Leberzirrhose ist mittlerweile eine anerkannte Indikation für eine Lebertransplantation und in Deutschland die häufigste medizinische Ursache dafür.

Die Untersuchung zur Indikationsstellung vor Durchführung einer Lebertransplantation beinhaltet in aller Regel auch eine psychiatrische Untersuchung. Die dabei zugrunde gelegten Prognosekriterien sind international umstritten, insbesondere die sogenannte 6-Monats-Regel (6-monatige Abstinenz vor Transplantation) wird kontrovers diskutiert. Prädiktoren für eine eher ungünstige Prognose sind vor dem Hintergrund der vorliegenden Studienergebnisse und Metaanalysen eine Alkoholabhängigkeit (nicht Alkoholmissbrauch), relativ geringe Abstinenzdauer, familiäre Belastung mit Alkoholismus, eher junges Alter, komorbider weiterer Substanzgebrauch, Non-Compliance, koexistente psychiatrische Erkrankungen sowie soziale Instabilität und evtl. weibliches Geschlecht. Insbesondere die Abstinenzdauer von 6 Monaten ist dabei nicht unumstritten. Der aktuelle Wissensstand zu diesem Thema wird dargestellt und kritisch diskutiert. Schließlich werden auch mögliche suchttherapeutische Interventionen bei Patienten mit alkoholischer Leberzirrhose dargestellt.

Summary

Liver disorders are the most frequent somatic complications of alcoholism. As 10‑20% of alcoholic patients will develop liver cirrhosis, this is the most frequent reason for premature death in alcoholic patients. Liver transplantation is now an accepted therapy for alcoholic liver cirrhosis but psychiatric assessment is usually required for patients entering a waiting list for transplantation. Prognostic criteria are controversially discussed, especially the so-called 6-month rule. Numerous studies and recent meta-analyses have indicated that duration of alcoholism, family history, age, sex, comorbid substance use and psychiatric disorders, noncompliance and social instability are outcome predictors. The 6-month criterion is not well proven but some studies are indicative. Possible therapeutic interventions for alcoholic patients on a waiting list are discussed.

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Authors and Affiliations

  1. Privatklinik Meiringen, 612, 3860, Meiringen, Schweiz

    M. Soyka

  2. Psychiatrische Klinik, Universität München, Nussbaumstr. 7, 80336, München, Deutschland

    M. Soyka

  3. Universitätsklinik für Viszerale Chirurgie und Medizin, Inselspital Bern, Murtenstr. 35, 3010, Bern, Schweiz

    F. Stickel

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Soyka, M., Stickel, F. Psychiatrische Begutachtung zur Transplantationsfähigkeit bei Patienten mit alkoholischer Leberzirrhose. Nervenarzt 84, 1075–1080 (2013). https://doi.org/10.1007/s00115-012-3665-8

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