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State of the Art: internistisches Lebertransplantationsmanagement

  • Armin Finkenstedt
  • Ivo Graziadei
Originalien

Zusammenfassung

Die Lebertransplantation stellt heute ein Standardverfahren zur Behandlung fortgeschrittener Lebererkrankungen und des hepatozellulären Karzinoms dar. Der folgende Artikel schildert die wichtigsten Aspekte im Management von lebertransplantierten Patienten, da nur mit einer optimalen Nachsorge 5‑Jahres-Überlebensraten von über 70 % erreicht werden können. In der Frühphase während des ersten Jahrs nach Transplantation liegt das Hauptaugenmerk der Nachsorge in der frühzeitigen Erkennung von Komplikationen, wie Thrombosen der Arteria hepatica, Stenosen der Gallenwege, und infektiologischer Probleme. Neben bakteriellen Infektionen sind auch Reaktivierungen latenter Infektionen, insbesondere die Zytomegalievirus(CMV)-Erkrankung, prognostisch bedeutsam und erfordern je nach Risikokonstellation eine entsprechende Prophylaxe. Abstoßungsreaktionen treten ebenfalls in den ersten postoperativen Monaten am häufigsten auf, sind dank moderner, kalzineurininhibitorbasierter Immunsuppressionsregime aber nur mehr selten Ursache für einen Verlust des Transplantats. Mit zunehmender Dauer nach Transplantation rücken dann De-novo-Malignome, kardiovaskuläre Erkrankungen und chronische Abstoßung als Hauptursache für Morbidität und Mortalität im Langzeitverlauf in den Vordergrund der Nachsorge. Die akute und chronische Nephrotoxizität der Kalzineurininhibitoren stellt letztlich sowohl in der Früh- wie auch in der Spätphase eine Herausforderung dar und erfordert oftmals den Wechsel auf eine kalzineurininhibitorfreie Immunsuppression.

Schlüsselwörter

Lebertransplantation Immunsuppression Abstoßung Hepatozelluläres Karzinom Kalzineurininhibitoren 

State of the Art: Liver Transplantation Management from an Internist’s Point of View

Abstract

Liver transplantation has become a standard procedure for various acute and chronic liver diseases including hepatocellular carcinoma. The following review highlights the most important aspects in the short- and long-term management of patients undergoing liver transplantation because only with optimal follow-up 5‑year survival rates of more than 70% can be achieved. During the first postoperative year, hepatic artery thrombosis, stenosis of the bile ducts, and infectious complications are the leading causes of graft loss and mortality. Not only bacterial infections, but also reactivation of latent infections, especially cytomegalovirus (CMV) disease, are prognostic, and specific prophylaxis is mandatory depending on the patient’s risk factors. Rejection episodes are also more common during the early period following transplantation but are rarely the cause of graft loss due to potent, calcineurin-inhibitor-based immunosuppression. After the first postoperative year, de novo malignancy, cardiovascular disease and chronic rejection are the leading causes of morbidity and mortality. Prevention and early detection of these immunosuppression-associated complications are important aspects regarding long-term aftercare. Acute and chronic nephrotoxicity of calcineurin inhibitors remains a challenge in the early and long-term posttransplant period, often requiring conversion of the immunosuppression to a calcineurin-inhibitor-free regimen.

Keywords

Liver transplantation Immunosuppression Rejection Hepatocellular carcinoma Calcineurin inhibitors 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Finkenstedt und I. Graziadei geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Innere Medizin 1Landeskrankenhaus InnsbruckInnsbruckÖsterreich
  2. 2.Akademisches Lehrkrankenhaus HallHall in TirolÖsterreich

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