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Lebertransplantation

Indikationen und Ergebnisse

Liver transplantation: indications and results

Der Internist volume 50, pages 550–560 (2009)Cite this article

Zusammenfassung

Mit rund 64.000 Transplantationen in Europa seit 1988 ist die Lebertransplantation mittlerweile eine Standardtherapie für fortgeschrittene, anderweitig nicht heilbare chronische Lebererkrankungen. Die Hauptindikationsgruppe umfasst Leberzirrhosen verschiedener Ätiologien. In dieser Patientengruppe sind nach 5 Jahren 72% und nach 10 Jahren 62% der Patienten am Leben. Zu den wichtigsten Indikationen in Deutschland zählen dabei die alkoholische Zirrhose, in jüngster Zeit mit zunehmender Tendenz Tumorerkrankungen und viral induzierte Zirrhosen. Seit Dezember 2006 wird die Priorität für eine Lebertransplantation durch das „model for end stage liver disease“ (MELD) und nicht durch die Wartezeit festgelegt. MELD ist ein statistisches Modell, das basierend auf dem Serumkreatinin, der Gerinnung und dem Serumbilirubin die 3-Monats-Mortalität eines potenziellen Transplantatempfängers beschreibt. Nicht alle Lebererkrankungen werden in ihrer Schwere durch MELD adäquat gewürdigt. Daher wird zusätzlich ein Regelwerk standardisierter Ausnahmen („standard exceptions“) verwendet, das zuletzt 2008 im Transplantationsgesetz novelliert wurde. Indikationsstellung, Empfängerauswahl und Wartelistenmanagement innerhalb der Transplantationshepatologie haben sich dadurch entscheidend gewandelt.

Abstract

After around 64 000 transplantations in Europe since 1988 liver transplantation has emerged as a standard treatment option for otherwise incurable chronic liver diseases. Cirrhosis of different etiologies represents the most frequent transplant indication. Overall survival in this group amounts to 72% after 5 years, and 62% after 10 years. In Germany, the main indications include alcoholic liver cirrhosis, tumors with increasing numbers in recent years, as well as viral diseases leading to cirrhosis. Since December 2006 the priority for liver transplantation is determined by the model for end stage liver disease (MELD) and not by the length of waiting time. MELD is a statistical model based on serum creatinine, serum bilirubin and coagulation, which describes the probability of 3-month mortality of a potential transplant candidate. Not all liver diseases are adequately represented by MELD necessitating the additional use of a defined number of standard exceptions that have been last updated in 2008. As a consequence of these developments indications, selection of recipients and the management of the waiting list have seen profound change.

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  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    C.P. Strassburg & M.P. Manns

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  1. C.P. Strassburg
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  2. M.P. Manns
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Correspondence to C.P. Strassburg.

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Strassburg, C., Manns, M. Lebertransplantation. Internist 50, 550–560 (2009). https://doi.org/10.1007/s00108-008-2268-8

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