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Orthotope Lebertransplantation

Technik und Ergebnisse

Orthotopic liver transplantation

Techniques and results

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Zusammenfassung

Seit 1963 hat sich die orthotope Lebertransplantation (OLT) zu einem etablierten interdisziplinären Therapiekonzept für Patienten mit terminaler Leberinsuffizienz, akutem irreversiblem Leberversagen und bei streng selektionierten Patienten mit Malignomen entwickelt. Jährlich werden in Deutschland an 26 Zentren rund 900 Vollorgan-OLT durchgeführt. Die klassische Technik wird zunehmend durch die „Piggyback-Technik“ abgelöst und hat sich an vielen Zentren als Standardtechnik entwickelt und ist bei nahezu allen Patienten anwendbar. Durch Verbesserungen der Organkonservierung, der chirurgischen Technik, des peri- und postoperativen Managements, Einführung neuer immunsuppressiver Medikamente und frühe adäquate Therapie von Infektionen und Transplantatabstoßungen werden aktuell Einjahresüberlebensraten von 80–90% erreicht. Dies hat zu einer Erweiterung des Indikationsspektrums der OLT geführt. Trotz jahrzehntelanger Erfahrung sind ca. 10% der Letalität innerhalb der ersten 3 Monate auf technische Komplikationen zurückzuführen.

Abstract

Since 1963, orthotopic liver transplantation (OLT) has developed into an established interdisciplinary therapy concept for patients with end-stage liver disease, acute irreversible liver failure, and hepatic malignancies in selected cases. In 26 centers in Germany, around 900 full-size OLTs are performed annually. The classic technique has been replaced by the “piggyback” method, which has become the standard in many centres. Improvements in surgical techniques, anaesthetic protocols, and medical management along with the introduction of new immunosuppressive regimens and early adequate therapy against infections and transplant rejection have increased patient survival. These factors have resulted in 1-year survival rates of 80–90% and led to an increase in indications for OLT. Despite decades of experience, approximately 10% of the mortality in the first 3 months still can be traced to technical complications.

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  1. Viszerale Organtransplantation, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    J. Schmidt, S.A. Müller, A. Mehrabi, P. Schemmer & M.W. Büchler

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  1. J. Schmidt
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  2. S.A. Müller
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  3. A. Mehrabi
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  4. P. Schemmer
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  5. M.W. Büchler
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Correspondence to J. Schmidt.

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J.S. und S.A.M. sind gleichberechtigte Erstautoren.

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Schmidt, J., Müller, S., Mehrabi, A. et al. Orthotope Lebertransplantation. Chirurg 79, 112–120 (2008). https://doi.org/10.1007/s00104-007-1452-z

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