Skip to main content

Advertisement

SpringerLink
Log in

Multiviszeraltransplantationen – Indikationen, Technik und Outcome

Multivisceral transplantations—indications, techniques and outcomes

  • Schwerpunkt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Hintergrund

Die Multiviszeraltransplantation (MuTx) ist eine heute etablierte Therapieoption für Patienten mit einem chronischen Mehrorganversagen. Insbesondere die Indikationsstellung, unter Beachtung der Grund- und Nebenerkrankungen des Empfängers, hat einen entscheidenden Einfluss auf das Outcome.

Ziel der Arbeit

Es sollen kombinierte Organtransplantationen in Verbindung mit einer Lebertransplantation beschrieben und Besonderheiten hinsichtlich Indikationsstellung, Technik und Outcome beleuchtet werden.

Material und Methoden

Die Grundlage der vorliegenden Arbeit bilden aktuelle Empfehlungen und eine Literaturrecherche in den medizinisch relevanten Datenbanken. In diesem Artikel wird auf Lebertransplantationen in Kombination mit mindestens einem thorakalen oder abdominellen Organ fokussiert. Hauptaugenmerk liegt auf der Darstellung operationsspezifischer Besonderheiten und des Outcomes.

Ergebnisse

Das Spektrum der Indikationen für eine MuTx ist heterogen und die Indikationsstellung eine patientenspezifische Einzelfallentscheidung. Die simultane Leber- und Nierentransplantation ist die am häufigsten durchgeführte kombinierte Organtransplantation. Das Langzeitüberleben nach Multiorgantransplantation ist durchschnittlich geringer als bei Patienten nach einer isolierten Lebertransplantation. Im Langzeitverlauf zeigen sich organspezifische Unterschiede. Patienten nach einer simultanen Leber-Nieren-Transplantation erreichen ein 5‑Jahres-Überleben von 86 %, wohingegen z. B. nur 63 % der Patienten nach einer kombinierten Leber- und Lungentransplantation die ersten 3 Jahre überleben.

Diskussion

Die Indikation zur Multiorgantransplantation ist eine Individualentscheidung. Aufgrund der komplexen Grund- und Nebenerkrankungen ist ein Vergleich der postoperativen Morbidität und Mortalität mit der Einzelorgantransplantation nicht möglich.

Abstract

Background

Multivisceral transplantation (MuTx) is an established method for patients suffering from chronic multiorgan failure. The main influence on the outcome after MuTx comes from the indication, considering the underlying disease as well as the recipient-specific comorbidities.

Objectives

Illustrating simultaneous solid organ transplantations evermore in combination with a liver transplantation as well as describing special characteristics regarding indication, technique, and outcome is the main aim of this publication.

Materials and methods

A systematic review was performed utilizing Medline (PubMed), Embase, and the current guidelines for standard of care in transplantation medicine until January 31, 2019. Special attention is given to liver transplantation in combination with at least one thoracic or abdominal organ in this article. The main issue is to identify procedure-specific characteristics and postoperative outcomes.

Results

The rationale for taking MuTx into consideration for a patient as one or maybe the only treatment option varies. Combined liver and kidney transplantation is the most frequently performed simultaneous solid organ transplant. Invariable long-term graft and patient survival after MuTx is reduced compared to single organ transplantation. Organ-specific differences typically appear in long-term follow-up. While patients after simultaneous liver and kidney transplantation attain a 5-year survival rate of 86%, only 63% of all patients after simultaneous liver and lung transplants survive more than 3 years.

Conclusion

The indication for MuTx is always an individual decision. Due to the complexity of the underlying disease in combination with the comorbidities of patients after MuTx, a reliable comparison with single organ transplantation is not feasible either for postoperative morbidity or for mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Starzl TE, Bilheimer DW, Bahnson HT, Shaw BW, Hardesty RL, Griffith BP, Iwatsuki S, Zitelli BJ, Gartner JC, Malatack JJ (1984) Heart-liver transplantation in a patient with familial hypercholesterolaemia. Lancet 1(8391):1382–1383

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Health Resources and Services Administration, U.S. Department of Health & Human Services (2019) Organ Procurement and Transplantation Network: Uses of data. https://optn.transplant.hrsa.gov/data/about-data/uses-of-data/. Zugegriffen: 13.03.2019

    Google Scholar 

  3. Eurotransplant (2017) Statistical Report 2017. 1. Eurotransplant: Donation, waiting lists and transplants

    Google Scholar 

  4. Cannon RM, Hughes MG, Jones CM, Eng M, Marvin MR (2012) A review of the United States experience with combined heart-liver transplantation. Transpl Int 25(12):1223–1228

    Article  PubMed  Google Scholar 

  5. Belghiti J, Panis Y, Sauvanet A, Gayet B, Fékété F (1992) A new technique of side to side caval anastomosis during orthotopic hepatic transplantation without inferior vena caval occlusion. Surg Gynecol Obstet 175(3):270–272

    CAS  PubMed  Google Scholar 

  6. Rauchfuss F, Breuer M, Dittmar Y, Heise M, Bossert T, Hekmat K, Settmacher U (2011) Implantation of the liver during reperfusion of the heart in combined heart-liver transplantation: Own experience and review of the literature. Transplant Proc 43(7):2707–2713

    Article  CAS  PubMed  Google Scholar 

  7. Hill AL, Maeda K, Bonham CA, Concepcion W (2012) Pediatric combined heart-liver transplantation performed en bloc: A single-center experience. Pediatr Transplant 16(4):392–397

    Article  PubMed  Google Scholar 

  8. Barreiros A‑P, Post F, Hoppe-Lotichius M, Linke RP, Vahl CF, Schäfers H‑J, Galle PR, Otto G (2010) Liver transplantation and combined liver-heart transplantation in patients with familial amyloid polyneuropathy: A single-center experience. Liver Transpl 16(3):314–323

    PubMed  Google Scholar 

  9. Barrio IM, Mtnez de Guereñu MA, Real MI, Del Campo I, Pérez-Cerdá F, Moreno E (2007) Anesthetic management of a combined heart and liver transplantation in an amyloidotic patient: A case report. Transplant Proc 39(7):2458–2459

    Article  CAS  PubMed  Google Scholar 

  10. Pilato E, Dell’Amore A, Botta L, Arpesella G (2007) Combined heart and liver transplantation for familial amyloidotic neuropathy. Eur J Cardiothorac Surg 32(1):180–182

    Article  PubMed  Google Scholar 

  11. Bryant R, Rizwan R, Zafar F, Shah SA, Chin C, Tweddell JS, Morales DL (2018) Contemporary outcomes of combined heart-liver transplant in patients with congenital heart disease. Transplantation 102(2):e67–e73

    Article  PubMed  Google Scholar 

  12. Atluri P, Gaffey A, Howard J, Phillips E, Goldstone AB, Hornsby N, MacArthur JW, Cohen JE, Gutsche J, Woo YJ (2014) Combined heart and liver transplantation can be safely performed with excellent short- and long-term results. Ann Thorac Surg 98(3):858–862

    Article  PubMed  Google Scholar 

  13. Freischlag K, Schroder PM, Ezekian B, Cox ML, Mulvihill MS, Hartwig MG, Knechtle SJ (2018) Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation. J Surg Res 231:395–402

    Article  PubMed  Google Scholar 

  14. Egan TM, Murray S, Bustami RT, Shearon TH, McCullough KP, Edwards LB, Coke MA, Garrity ER, Sweet SC, Heiney DA, Grover FL (2006) Development of the new lung allocation system in the United States. Am J Transplant 6(5p2):1212–1227

    Article  CAS  PubMed  Google Scholar 

  15. Barshes NR, DiBardino DJ, McKenzie ED, Lee TC, Stayer SA, Mallory GB, Karpen SJ, Quiros-Tejeira RE, Carter BA, Fraser CD, Goss JA (2005) Combined lung and liver transplantation: The United States experience. Transplantation 80(9):1161–1167

    Article  PubMed  Google Scholar 

  16. Barbara D, Rehfeldt K, Heimbach J, Rosen C, Daly R, Findlay J (2014) Perioperative management of patients undergoing combined heart-liver transplantation. Crit Care 18(1):P205

    Article  PubMed Central  Google Scholar 

  17. Daly AB, Wallis JM, Borg ZD, Bonvillain RW, Deng B, Ballif BA, Jaworski DM, Allen GB, Weiss DJ (2012) Initial binding and recellularization of decellularized mouse lung scaffolds with bone marrow-derived mesenchymal stromal cells. Tissue Eng Part A 18(1/2):1–16

    Article  CAS  PubMed  Google Scholar 

  18. Ceulemans LJ, Monbaliu D, Verslype C, van der Merwe S, Laleman W, Vos R, Neyrinck A, Van Veer H, De Leyn P, Nevens F, Pirenne J, Verleden G, Van Raemdonck D (2014) Combined liver and lung transplantation with extended normothermic lung preservation in a patient with end-stage emphysema complicated by drug-induced acute liver failure. Am J Transplant 14(10):2412–2416

    Article  CAS  PubMed  Google Scholar 

  19. Arnon R, Annunziato RA, Miloh T, Padilla M, Sogawa H, Batemarco L, Willis A, Suchy F, Kerkar N (2011) Liver and combined lung and liver transplantation for cystic fibrosis: Analysis of the UNOS database. Pediatr Transplant 15(3):254–264

    Article  PubMed  Google Scholar 

  20. Kornberg A, Küpper B, Bärthel E, Tannapfel A, Müller UA, Thrum K, Kloos C, Wolf G (2009) Combined en-bloc liver-pancreas transplantation in patients with liver cirrhosis and insulin-dependent type 2 diabetes mellitus. Transplantation 87(4):542–545

    Article  PubMed  Google Scholar 

  21. Vianna R, Beduschi T (2016) Multivisceral transplantation for diffuse splanchnic venous thrombosis. Curr Opin Organ Transplant 21(2):201–208

    Article  PubMed  Google Scholar 

  22. Farmer DG, McDiarmid SV, Edelstein S, Yersiz H, Vargas J, Cortina G, Renz JF, Fondevila C, Hisatake G, Reyen L, Correa M, Rhodes S, Zafar A, Chavez Y, Busuttil RW (2004) Improved outcome after intestinal transplantation at a single institution over 12 years. Transplant Proc 36(2):303–304

    Article  CAS  PubMed  Google Scholar 

  23. Müller AR, Pascher A, Platz K‑P, Neuhaus P (2003) Small bowel transplantation—Current status and initial results. Zentralbl Chir 128(10):849–855

    Article  PubMed  Google Scholar 

  24. Starzl TE, Rowe MI, Todo S, Jaffe R, Tzakis A, Hoffman AL, Esquivel C, Porter KA, Venkataramanan R, Makowka L (1989) Transplantation of multiple abdominal viscera. JAMA 261(10):1449–1457

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Starzl TE, Todo S, Tzakis A, Podesta L, Mieles L, Demetris A, Teperman L, Selby R, Stevenson W, Stieber A (1989) Abdominal organ cluster transplantation for the treatment of upper abdominal malignancies. Ann Surg 210(3):374–385 (discussion 385–386)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Young AL, Peters CJ, Toogood GJ, Davies MH, Millson CE, Lodge JPA, Pollard SG, Prasad KR (2005) A combined liver-pancreas en-bloc transplant in a patient with cystic fibrosis. Transplantation 80(5):605–607

    Article  PubMed  Google Scholar 

  27. Trotter JF, Bak TE, Wachs ME, Everson GT, Kam I (2000) Combined liver-pancreas transplantation in a patient with primary sclerosing cholangitis and insulin-dependent diabetes mellitus. Transplantation 70(10):1469–1471

    Article  CAS  PubMed  Google Scholar 

  28. Mayes JT, Boyle JT, Schulak JA (1991) Simultaneous orthotopic liver and heterotopic pancreas transplantation. Transplantation 52(1):146–147

    Article  CAS  PubMed  Google Scholar 

  29. Schnitzbauer AA, Woeste G, Ulrich F, Bechstein WO (2012) Indikationen und Komplikationen bei Multiorgantransplantationen. Viszeralmedizin 28(5):324–329

    Article  Google Scholar 

  30. Bandsma RHJ, Bozic MA, Fridell JA, Crull MH, Molleston J, Avitzur Y, Mozer-Glassberg Y, Gonzalez-Peralta RP, Hodik M, Fecteau A, de Angelis M, Durie P, Ng VL (2014) Simultaneous liver-pancreas transplantation for cystic fibrosis-related liver disease: A multicenter experience. J Cyst Fibros 13(4):471–477

    Article  CAS  PubMed  Google Scholar 

  31. Miguel M, Andres AM, Lopez-Santamaria M, Barrena S, Hierro L, Hernandez F, Ramírez M, Frauca E, Encinas JL, Lopez-Fernandez S, Jara P, Tovar JA (2012) Liver transplantation in children with cystic fibrosis: Experience in our centre and preliminary results with a combined en bloc liver-pancreas graft. Eur J Pediatr Surg 22(1):60–66

    Article  CAS  PubMed  Google Scholar 

  32. Pirenne J, Aerts R, Yoong K, Gunson B, Koshiba T, Fourneau I, Mayer D, Buckels J, Mirza D, Roskams T, Elias E, Nevens F, Fevery J, McMaster P (2001) Liver transplantation for polycystic liver disease. Liver Transpl 7(3):238–245

    Article  CAS  PubMed  Google Scholar 

  33. Seckinger J, Tönshoff B, Stremmel W, Zeier M, Schmidt J (2010) Combined liver-kidney and kidney after liver transplantation: Indications and experiences from a nephrological perspective at a single center. Dtsch Med Wochenschr 135(40):1973–1978

    Article  CAS  PubMed  Google Scholar 

  34. Margreiter R, Kramar R, Huber C, Steiner E, Niederwieser D, Judmaier G, Vogel W (1984) Combined liver and kidney transplantation. Lancet 1(8385):1077–1078

    Article  CAS  PubMed  Google Scholar 

  35. Jochmans I, Monbaliu D, Ceulemans LJ, Pirenne J, Fronek J (2017) Simultaneous liver kidney transplantation and (bilateral) nephrectomy through a midline is feasible and safe in polycystic disease. PLoS ONE 12(3):1–10

    Article  Google Scholar 

  36. Gunabushanam V, Clendenon J, Aldag E, Chadha M, Kramer D, Steers J, Sahajpal A (2016) En bloc liver kidney transplantation using donor splenic artery as inflow to the kidney: Report of two cases. Am J Transplant 16(10):3046–3048

    Article  CAS  PubMed  Google Scholar 

  37. Felgendreff P, Tautenhahn H-M, Lux S, Schindler C, Dondorf F, Aschenbach R, Rauchfuß F, Settmacher U (2018) Simultaneous right-sided nephrectomy with orthotopic liver/kidney transplantation—An alternative method for patients with ADPLKD. in preparation

  38. Puri V, Eason J (2015) Simultaneous liver-kidney transplantation. Curr Transplant Rep 2(4):297–302

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bundesärztekammer (2010) Richtlinien für die Wartelistenführung und die Organvermittlung zur Nierentransplantation

    Google Scholar 

  40. Formica RN, Aeder M, Boyle G, Kucheryavaya A, Stewart D, Hirose R, Mulligan D (2016) Simultaneous liver-kidney allocation policy: A proposal to optimize appropriate utilization of scarce resources. Am J Transplant 16(3):758–766

    Article  CAS  PubMed  Google Scholar 

  41. Oppert M, Neumann U, Pascher A, Storm C, Lang T, Neuhaus R, Frei U, Neuhaus P, Kahl A (2010) Langzeitüberleben nach kombinierter Leber- und Nierentransplantation. Transplantationsmedizin 22(3):170–175

    Google Scholar 

  42. Kirchner GI, Rifai K, Cantz T, Nashan B, Terkamp C, Becker T, Strassburg C, Barg-Hock H, Wagner S, Lück R, Klempnauer J, Manns MP (2006) Outcome and quality of life in patients with polycystic liver disease after liver or combined liver-kidney transplantation. Liver Transpl 12(8):1268–1277

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland

    P. Felgendreff, H.-M. Tautenhahn, F. Dondorf, F. Rauchfuß & U. Settmacher

  2. Research Programme „Else Kröner-Forschungskolleg AntiAge“, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland

    P. Felgendreff & H.-M. Tautenhahn

Authors
  1. P. Felgendreff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-M. Tautenhahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Dondorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Rauchfuß
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Settmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Felgendreff.

Ethics declarations

Interessenkonflikt

P. Felgendreff, H.-M. Tautenhahn, F. Dondorf, F. Rauchfuß und U. Settmacher geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

G. Gerken, Essen

S. Zeuzem, Frankfurt am Main

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Felgendreff, P., Tautenhahn, HM., Dondorf, F. et al. Multiviszeraltransplantationen – Indikationen, Technik und Outcome. Gastroenterologe 14, 282–288 (2019). https://doi.org/10.1007/s11377-019-0350-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-019-0350-5

Schlüsselwörter

Keywords

Search

Navigation