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Dtsch Med Wochenschr 2014; 139(17): 878-882
DOI: 10.1055/s-0034-1369932
Originalarbeit | Original article
Hepatologie
© Georg Thieme Verlag KG Stuttgart · New York

Medikamentös-toxische Schädigung als wichtigste Ätiologie des akuten Leberversagens

Beobachtungen über 10 Jahre an einem deutschen TransplantationszentrumDrug-induced liver injury as predominant cause of acute liver failure in a monocenter study
L. P. Bechmann
1   Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen
,
P. Manka
1   Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen
,
J. Best
1   Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen
,
F. H. Saner
2   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen
,
A. Paul
2   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen
,
A. Canbay
1   Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen
,
G. Gerken
1   Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen
› Author Affiliations
Further Information

Publication History

06 December 2013

13 March 2014

Publication Date:
23 April 2014 (online)

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Zusammenfassung

Hintergrund und Fragestellung: Die spezifische Therapie und Prognoseeinschätzung von Patienten mit akutem Leberversagen (ALV) ist abhängig von der Ätiologie. Traditionell gilt die fulminante Hepatitis B als wichtigste Ursache. In den letzten Jahren kamen aus dem angloamerikanischen und europäischen Raum Hinweise auf eine Zunahme der medikamentös-toxisch bedingten ALV („drug-induced liver injury“, DILI). Ziel dieser Arbeit ist die Identifikation aktueller Ätiologien des ALV in einem großen deutschen Transplantationszentrum.

Patienten und Methodik: Zwischen 1/2002 und 12/2012 wurden retrospektiv in die Daten von 161 Patienten analysiert, welche die Kriterien der „Acute-Liver-Failure Study Group Germany“ erfüllten (International normalized ratio [INR] ≥ 1,5; hepatische Enzephalopathie ≥ 1.  Grades). Erfasst wurden der klinische Verlauf und die Ätiologie.

Ergebnisse: DILI ist die häufigste Ursache des ALV in der untersuchten Kohorte. Bis zu 20 % der Patienten mit DILI sterben oder müssen eine Lebertransplantation erhalten. Patienten mit ALV unklarer Genese und ohne spezifische Therapieoption haben die schlechteste Prognose.

Folgerungen: In Europa besteht ein Nord-Süd-Gefälle bezüglich der Genese des ALV. Die idiosynkratische Medikamentenintoxikation (d.h. eine starke Überreaktion bzw. Unverträglichkeit, die nicht durch eine Immunreaktion ausgelöst wird) ist in Deutschland die häufigste Ursache, gefolgt von einer akuten Hepatitis B.

Abstract

Background and aim: Clinical course and mortality of acute liver failure (ALF) are determined by its causes. Traditionally, fulminant hepatitis B infection (HBV) was thought to be the predominant etiology of ALF in Germany. However, recent studies, conducted in American and European cohorts pointed to drug-induced liver injury (DILI) as the major cause. Aim of this study was to identify currently predominant etiologies of ALF in a monocenter study at a leading transplant center in Germany.

Patients and Methods: The data of 161 patients admitted with ALF from 1/2002 to 12/2012 were analyzed retrospectively. All patients fulfilled the criteria of the „Acute Liver Failure Study Group Germany“ (international normalized ratio (INR) ≥ 1.5, hepatic encephalopathy ≥ stage 1).

Results: DILI was the leading cause of ALF in this cohort. About 20 % of ALF patients with DILI died or received liver transplantats. Mortality rate was highest in ALF patients with unknown etiology and those without specific therapy available.

Conclusions: In Europe ALF etiologies exhibit a North-South divide. In Germany the most common cause for ALF is idiosyncratic pharmacological intoxication followed by acute hepatitis B.

Schlüsselwörter

akutes Leberversagen - Lebertransplantation - DILI

Keywords

acute liver failure - liver transplantation - DILI
 

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