Lebertransplantation in Deutschland

 

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Zusammenfassung

Das wesentliche Problem der Lebertransplantation (LT) in Deutschland wie auch in anderen westlichen Ländern ist die Diskrepanz zwischen der steigenden Zahl von Patienten auf der nationalen Warteliste und der stagnierenden Zahl verfügbarer Organe hirntoter Spender. Das Problem des Sterbens von Patienten auf der Warteliste ist offenkundig geworden seit Umsetzung des Transplantationsgesetzes, das eine patientenorientierte im Unterschied zur früheren Zentrums-orientierten Organallokation vorsieht und neben der medizinischen Dringlichkeit die Wartezeit als wesentliches Kriterium anwendet. Die liberalere Akzeptanz so genannter marginaler Spenderlebern kann die Ergebnisse der LT nicht verbessern. Durch neuere Techniken kann der Spendermangel teilweise kompensiert werden. Hierzu gehören die Teilung von Spenderlebern (Splitting) für zwei Erwachsene oder einen Erwachsenen und ein Kind. Eine weitere Alternative ist die Lebendspende von Leberteilen, die zunächst für Kinder entwickelt wurde, neuerdings aber auch in steigendem Umfang zur Versorgung von erwachsenen Empfängern eingesetzt wird. Im Jahr 2001 wurde eine relativ konstante Zahl von 757 Lebertransplantationen in Deutschland durchgeführt, hiervon ein steigender Anteil von 12,5 % Lebendspenden. Richtlinien zur Indikation und Meldung von Patienten mit chronischem oder akutem Leberversagen sind kürzlich von der Bundesärztekammer publiziert worden. Neuere Entwicklungen, die zu einer Verbesserung der Ergebnisse nach LT geführt haben, sind neben operationstechnischen Details Fortschritte in einer individuell angepassten Immunsuppression und Vermeidung eines Rezidivs bei viral bedingter Grundkrankheit.

Abstract

As in other western countries the major challenge of liver transplantation in Germany is to expand the number of liver transplantations in respect to the increasing disparity of qualified patients on the waiting list and the still static availability of brain death donor organs. The problem of death on the waiting list has become overt since the German transplantation law has been installed, which has changed the former center-oriented to a patient-oriented allocation weighting waiting time over medical urgency criteria. The more liberal acceptance of so called marginal cadaveric donor livers will probably impair further improvements in the acute and long-term outcome of liver transplantation. This problem can be partially compensated by the use of novel surgical techniques, such as splitting a donor liver to be transplanted into two adult recipients or, more commonly and safe, into an adult and one child. Another alternative to increase the donor pool is living donor liver transplantation, which was first introduced for pediatric recipients but is now increasingly used in adults. In 2001, a constant number of 757 liver transplantations were performed in Germany, including 12.5 % living donor transplantations. Recently, general guidelines for the selection of patients with end-stage liver disease and acute liver failure have been published by the Bundesärztekammer. Additional developments have contributed to improve the results of liver replacement including individualized immunosuppression strategies and novel treatment options to avoid recurrent viral disease following transplantation.

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Priv.-Doz. Dr. med. M. Wolff

Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie

Rheinische Friedrich-Wilhelms-Universität Bonn

Sigmund-Freud-Straße 25

53105 Bonn

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Fax: 02 28/2 87 48 56

Email: wolff@chir.uni-bonn.de