Der Chirurg

, Volume 79, Issue 2, pp 157–163

Model for end-stage liver disease

Neue Grundlage der Allokation für die Lebertransplantation
Leitthema

Zusammenfassung

Im Dezember 2006 wurden in Deutschland und anderen Eurotransplant (ET)-Ländern die Vermittlungsregeln für postmortale Spenderlebern weiterentwickelt. Das zuvor von ET angewandte Allokationssystem basierte auf der Child-Turcotte-Pugh (CTP)-Klassifikation, wobei darüber hinaus der Wartezeit eine besondere Bedeutung zukam. Aktuell wurde es durch ein primär dringlichkeitsorientiertes, auf dem „model for end-stage liver disease“ (MELD) basierenden Allokationssystem ersetzt. Die MELD-Klassifikation ist – wie erste Erfahrungen in den USA gezeigt haben – in der Lage, die Prognose der Mehrzahl der Indikationen zur Lebertransplantation gut abzubilden. Durch die MELD-basierte Allokation konnten in den USA die Wartezeit der transplantierten Patienten und die Mortalität auf der Warteliste reduziert werden. Die MELD-Klassifikation wird jedoch nicht allen Lebererkrankungen gerecht. Aus diesem Grund sind in dem durch ET eingeführten Allokationssystem Ausnahmeregelungen vorgesehen. Zudem wird angestrebt, im Sinne eines lernenden Systems, durch fortlaufende Analyse der Allokation, eine kontinuierliche Feinabstimmung der Verteilungsregeln zu erzielen, um eine gerechte und effiziente Verteilung der Spenderorgane zu gewährleisten.

Schlüsselwörter

Allokation Model for end-stage liver disease Lebertransplantation Eurotransplant 

Abkürzungen

ACO

Approved combined organ

CTP

Child-Turcotte-Pugh-Klassifikation

ELAC

Eurotransplant Liver Advisory Committee

ET

Eurotransplant

ELAS

Eurotransplant Liver Allocations System

HU

High urgency

INR

International standardized ratio

LTX

Lebertransplantation

MELD

Model for end-stage liver disease

SE

Standard exceptions

UNOS

United Network for Organ Sharing

Model for end-stage liver disease

New basis of allocation for liver transplantations

Abstract

In December 2006 the allocation of livers from deceased donors in Germany and several other Eurotransplant countries was reset. The previous allocation system relied on CTP score to assess the need of transplantation, but it also assigned to waiting time a prominent role in prioritization. That system was replaced by the primarily urgency-oriented model of end-stage liver disease (MELD) allocation system. First experience with this classification in the U.S.A. shows that MELD scores are able to identify the urgency of liver transplantation correctly in most types of liver disease. Due to the MELD-based allocation, the growing waiting time and waiting-list mortality could be counteracted. At the same time it became evident however that MELD scores do not reflect mortality on the waiting list or thus the urgency for all types of liver diseases. Therefore the new allocation system introduced in the Eurotransplant countries contains standardized and flexible exceptions for these diseases. In addition the new allocation rules were created as a learning system. Repeated “fine tuning” of the allocation process based on continuous monitoring of daily allocation practice and clinical studies aim at just and effective distribution of the precious and limited supply of donor organs.

Keywords

Allocation Model for end-stage liver disease Liver transplant Eurotransplant 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik für Allgemein-, Viszeral- und TransplanationschirurgieUniversität HeidelbergHeidelbergDeutschland
  2. 2.Eurotransplant International FoundationLeidenNiederlande

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