Renale und pulmonale Komplikationen der Leberzirrhose

Der Übergang von einer kompensierten in eine dekompensierte Leberzirrhose ist für die betroffenen Patienten mit einer deutlichen Prognoseverschlechterung verbunden. Komplikationen, die diesen Übergang definieren, sind Aszites, hepatische Enzephalopathie, Ösophagusvarizenblutung und Ikterus. Aber auch renale und pulmonale Komplikationen, die dieser Beitrag genauer vorstellt, beeinflussen die Prognose von Patienten mit Leberzirrhose negativ.

Schlüsselwörter

Leberzirrhose - hepatischer Hydrothorax - hepatopulmonales Syndrom - portopulmonale Hypertonie - hepatorenales Syndrom

• Literatur

• 1 Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician 2006; 74: 756-762
• 2 Sörensen HT, Thulstrup AM, Mellemkjar L. et al. Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol 2003; 56: 88-93
• 3 DʼAmico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44: 217-231
• 4 Hourani JM, Bellamy PE, Tashkin DP. et al. Pulmonary dysfunction in advanced liver disease: frequent occurrence of an abnormal diffusing capacity. Am J Med 1991; 90: 693-700
• 5 Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine (Baltimore) 2014; 93: 135-142
• 6 Lazaridis KN, Frank JW, Krowka MJ. et al. Hepatic hydrothorax: pathogenesis, diagnosis, and management. Am J Med 1999; 107: 262-267
• 7 Gerbes AL, Gülberg V, Sauerbruch T. et al. German S3-guideline “ascites, spontaneous bacterial peritonitis, hepatorenal syndrome”. Z Gastroenterol 2011; 49: 749-779
• 8 Siegerstetter V, Deibert P, Ochs A. et al. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol 2001; 13: 529-534
• 9 Dhanasekaran R, West JK, Gonzales PC. et al. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol 2010; 105: 635-641
• 10 Huang PM, Kuo SW, Chen JS. et al. Thoracoscopic mesh repair of diaphragmatic defects in hepatic hydrothorax: a 10-year experience. Ann Thorac Surg 2016; 101: 1921-1927
• 11 Kennedy TC, Knudson RJ. Exercise-aggravated hypoxemia and orthodeoxia in cirrhosis. Chest 1977; 72: 305-309
• 12 Schenk P, Schöniger-Hekele M, Fuhrmann V. et al. Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology 2003; 125: 1042-1052
• 13 Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology 2005; 41: 1122-1129
• 14 Arguedas MR, Abrams GA, Krowka MJ. et al. Prospective evaluation of outcomes and predictors of mortality in patients with hepatopulmonary syndrome undergoing liver transplantation. Hepatology 2003; 37: 192-197
• 15 Hadengue A, Benhayoun MK, Lebrec D. et al. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991; 100: 520-528
• 16 Benjaminov FS, Prentice M, Sniderman KW. et al. Portopulmonary hypertension in decompensated cirrhosis with refractory ascites. Gut 2003; 52: 1355-1362
• 17 Hoeper MM, Krowaka ML, Strasburg CP. Portopulmonary hypertension and hepatopulmonary syndrom. Lancet 2004; 363: 1461-1468
• 18 Lebrec D, Capron JP, Dhumeaux D. et al. Pulmonary hypertension complicating portal hypertension. Am Rev Respir Dis 1979; 120: 849-856
• 19 Machicao VI, Balakrishnan M, Fallon MB. Pulmonary complications in chronic liver disease. Hepatology 2014; 59: 1627-1637
• 20 Krowka MJ, Plevak DJ, Findlay JY. et al. Pulmonary hemodynamics and perioperative cardiopulmonary-related mortality in patients with portopulmonary hypertension undergoing liver transplantation. Liver Transpl 2000; 6: 443-450
• 21 Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology 2008; 48: 2064-2077
• 22 Koppel MH, Coburn JW, Mims MM. et al. Transplantation of cadaveric kidneys from patients with hepatorenal syndrome. Evidence for the functional nature of renal failure in advanced liver disease. N Engl J Med 1969; 280: 1367-1371
• 23 Markwardt D, Holdt L, Steib C. et al. Plasma cystatin C is a predictor of renal dysfunction, acute-on-chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis. Hepatology 2017; 66: 1232-1241
• 24 Iwakiri Y. The molecules: mechanisms of arterial vasodilatation observed in the splanchnic and systemic circulation in portal hypertension. J Clin Gastroenterol 2007; 41 (Suppl. 03) S288-S294
• 25 Martín-Llahí M, Pépin MN, Guevara M et al.; TAHRS Investigators. Terlipressin and albumin vs. albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008; 134: 1352-1359
• 26 Sanyal AJ, Boyer T, Garcia-Tsao G. et al. Terlipressin Study Group. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology 2008; 134: 1360-1368
• 27 Allegretti AS, Parada XV, Eneanya ND. et al. Prognosis of patients with cirrhosis and AKI who initiate RRT. Clin J Am Soc Nephrol 2018; 13: 16-25
• 28 Brensing KA, Textor J, Strunk H. et al. Transjugular intrahepatic portosystemic stent-shunt for hepatorenal syndrome. Lancet 1997; 349: 697-698
• 29 Guevara M, Ginès P, Bandi JC. et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology 1998; 28: 416-422