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Cholangiopathien nach Lebertransplantation

Cholangiopathy after liver transplantation

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Zusammenfassung

Biliäre Komplikationen treten in bis zu 30% aller Lebertransplantationen auf. Gallelecks lassen sich sehr erfolgreich mittels vorübergehender endoskopischer Stenteinlage therapieren. Eine gefürchtete Komplikation ist die Thrombose der A. hepatica, die häufig zu Gallenwegsnekrosen mit konsekutiven Leberabszessen und Sepsis führen kann. Gallenwegsstenosen können an der Anastomose (Anastomosenstenosen, AS) oder im Hilus- und/oder intrahepatischen Bereich als Ischemic Type Biliary Lesions (ITBL) auftreten. AS lassen sich mit hoher Erfolgsrate mit einer Kombination aus Ballondilatation und Endoprotheseneinlage behandeln. Bei den ITBL ist die Datenlage weniger eindeutig, eine wiederholte Ballondilatation scheint aber auch erfolgreich und kann zumindest eine erforderliche Retransplantation deutlich hinauszögern. Erste Daten zeigen, dass auch die sehr anspruchsvollen Anastomosenstenosen nach Leberlebendtransplantation mit gutem Erfolg endoskopisch therapiert werden können.

Abstract

Biliary complications occur in up to 30% of liver transplantations. Bile leaks can be treated successfully by transient endoscopic stenting. A severe complication is hepatic artery thrombosis, which can often lead to bile duct necrosis with consecutive liver abscess and sepsis. Bile duct strictures can occur at the anastomosis (anastomotic strictures – AS) or at the hilar and/or intrahepatic levels as ischemic type biliary lesions (ITBL). AS can be treated successfully with a combination of balloon dilatation and insertion of endoprostheses. In ITBL available data is more ambiguous, but repeated balloon dilatation seems to be successful and can at least considerably delay mandatory retransplantation. First results show that the challenging anastomotic strictures after living donor liver transplantation can be treated endoscopically with considerable success.

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  1. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    T. Zöpf & G. Gerken

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  1. T. Zöpf
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  2. G. Gerken
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Correspondence to T. Zöpf.

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Zöpf, T., Gerken, G. Cholangiopathien nach Lebertransplantation. Gastroenterologe 3, 39–44 (2008). https://doi.org/10.1007/s11377-007-0131-4

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