Zusammenfassung
Durch die operative Entfernung einer chronisch geschädigten Leber und die Implantation einer gesunden Spenderleber können das Überleben und die Lebensqualität der betroffenen Patienten wesentlich gebessert werden. Die Lebertransplantation ist für das lebensbedrohliche akute und chronische Leberversagen derzeit die einzig langfristig erfolgreiche therapeutische Option. Dies gilt auch für einige genetisch bedingte Stoffwechselerkrankungen. Die 5-Jahres-Überlebenszeit liegt bei 70 % und führt bei drei von vier Transplantierten zu einem weitgehend normalen Leben mit Wiedereingliederung in den Arbeitsprozess. Nachteile dieses Verfahrens sind die lebenslange Abhängigkeit von Medikamenten und ärztlicher Betreuung sowie das mit der Transplantation und der dauerhaften Immunsuppression verbundene Risiko von Komplikationen oder Nebenwirkungen. Insbesondere in den ersten drei Monaten nach Operation sind eine erhöhte Mortalität und Morbidität gegeben. Diese Nachteile und die limitierte Verfügbarkeit von Spenderorganen erfordern die Ausschöpfung aller konservativer Maßnahmen, bevor bei deren Versagen die Indikation zur Lebertransplantation gestellt werden sollte. Umgekehrt darf die Indikation nicht zu spät gestellt werden, um die Erfolgsaussichten der Operation nicht zu schmälern. Genaue Kenntnisse der Prognose einer chronischen Lebererkrankung und ihre Beeinflussung durch konservative Therapiemaßnahmen sind erforderlich, die korrekte Indikation zur Lebertransplantation und deren Zeitpunkt festzulegen.
Abstract
Surgical resection of the diseased liver together with the implantation of a new donor organ allows patients with chronic liver failure to survive longer as well as to achieve a better quality of life. In life-threatening acute and chronic hepatic failure liver transplantation represents the only causal and long-term therapeutic option. This is also true for several genetically defined liver diseases. Five-year survival approaches 70 % in most cases. Three of four patients regain a nearly normal life with complete reintegration into their professional work. Drawbacks of this therapeutic option relate to a life-long dependence on drugs and medical services as well as to the risks associated with the surgical procedure and the side-effects of a continuous drug-induced immunosuppression. Mortality and morbidity are considerably increased during the first three months after operation. These limitations and the dramatically low availability of donor organs necessitate the application of all conservative measures before a transplantation procedure should be performed. However, the surgical option should be evaluated early enough to allow for a good chance of success. Profound knowledge of prognosis and medical treatment of each individual liver disease is a prerequisite for correct indication and timing of liver transplantation.
Schlüsselwörter
Lebertransplantation - chronische Leberkrankheiten - Leberversagen - chronische Hepatitis - Leberzirrhose - Indikation zur Lebertransplantation
Key words
Liver transplantation - chronic liver disease - liver failure - chronic hepatitis - liver cirrhosis - indication for liver transplantation
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Prof. Dr. Axel Holstege
Medizinische Klinik 1, Klinikum Landshut
Robert-Koch-Straße 1
84034 Landshut
