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Langzeit-Outcome nach Lebertransplantation

Long-term results after liver transplantation

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Zusammenfassung

Bei ausgewählten Indikationen wurden exzellente Ergebnisse nach Lebertransplantation berichtet. Die Ergebnisse in unserem Zentrum wurden über 23 Jahre mit 2114 konsekutiven Lebertransplantationen in 1773 Patienten untersucht (Epochen I–III jeweils 5,5 Jahre, Epoche IV 6,5 Jahre). Nach 20 Jahren erreichte das Gesamtüberleben 29,8%. Die häufigsten führenden Todesursachen waren Infektionen unterschiedlicher Genese (30%), Tumorrezidive (14,2%) und Pneumonie (8,4%). Die häufigsten führenden Ursachen für den Transplantatverlust waren Infektionen unterschiedlicher Genese (19,6%), initiale Nichtfunktion des Transplantates (14,6%) und Tumorrezidive (9,6%). Das Patientenüberleben und das Transplantatüberleben waren beide signifikant besser nach primärer Transplantation als nach erster Retransplantation (p<0,001). Das Patienten- und Transplantatüberleben haben sich über die 4 konsekutiven Epochen signifikant verbessert (p<0,001). In der jüngsten Epoche IV erreichte das 5-Jahres-Überleben bei primärer biliärer Zirrhose (PBC) 96%, bei primärer sklerosierender Cholangitis (PSC) 89,4%, bei Gallengangsatresie 78,5%, bei akutem Leberversagen 70%, bei Hepatitis-B (HBV)-assoziierter Leberzirrhose 69,1%, bei hepatozellulärem Karzinom 61,3% und bei Hepatitis-C (HCV)-assoziierter Leberzirrhose 56%.

Abstract

Liver transplantation has been reported to reach excellent results for selected indications. We analysed the results of liver transplantation in our centre over a period of 23 years, with a total of 2,114 consecutive liver transplants in 1,773 patients (eras I–III 5.5 years each, era IV 6.5 years). Overall 20-year survival after liver transplantation was 29.8%. The most frequent leading causes of death were infections of various origins (30%), tumour recurrence (14.2%), and pneumonia (8.4%). The most frequent leading causes for graft loss were infection of various origins (19.6%), initial nonfunction of the graft (14.6%), and tumour recurrence (9.6%). Both long-term patient and graft survival were significantly better after primary liver transplantation than after first retransplantation (P<0.001). Patient and graft long-term survival improved significantly across all four consecutive eras (P<0.001). In era IV, the most recent, 5-year patient survival reached 96% for PBC, 89.4% for PSC, 78.5% for biliary atresia, 70% for acute liver failure, 69.1% for HBV-related cirrhosis, 61.3% for hepatocellular carcinoma, and 56% for HCV-related cirrhosis.

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Authors and Affiliations

  1. Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    H. Schrem, N. Till, T. Becker, H. Bektas & J. Klempnauer

  2. Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    M.P. Manns & C.P. Strassburg

Authors
  1. H. Schrem
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  2. N. Till
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  3. T. Becker
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  4. H. Bektas
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  5. M.P. Manns
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  6. C.P. Strassburg
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  7. J. Klempnauer
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Correspondence to H. Schrem.

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Schrem, H., Till, N., Becker, T. et al. Langzeit-Outcome nach Lebertransplantation. Chirurg 79, 121–129 (2008). https://doi.org/10.1007/s00104-007-1457-7

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