Download PDF
Viszeralchirurgie 2004; 39(2): 109-113
DOI: 10.1055/s-2004-818769
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Lebertransplantation und Lebendspende bei Tumoren

Liver Transplantation and Living Organ Donation in Patients with Malignant Liver TumorsC. E. Broelsch1 , A. Frilling1 , G. C. Sotiropoulos1 , S. Nadalin1 , F. Weber1 , S. Beckebaum1 , M. Malago1
  • 1Klinik für Allgemein- und Transplantationschirurgie, Universitätsklinikum Essen
Further Information

Publication History

Publication Date:
21 April 2004 (online)

    Permissions and Reprints

Zusammenfassung

Lebertransplantation stellt für selektionierte Patienten mit bestimmen histologischen Typen von nicht resektablen Lebertumoren eine etablierte therapeutische Option dar. Bei den primären Tumoren handelt es sich hauptsächlich um hepatozelluläre Karzinome und im Einzelfall auch um cholangiozelluläre Karzinome. Die Indikation zur Transplantation besteht bei Lebermetastasen neuroendokriner Tumoren und der gastrointestinalen Stromatumoren. Für das hepatozelluläre Karzinom ist die Lebertransplantation theoretisch die beste Behandlung, da dabei sowohl das potenziell multizentrisch wachsende Karzinom als auch die häufig begleitende Leberzirrhose radikal beseitigt werden. Wegen des Mangels an Spenderorganen ist es wichtig Kriterien zu definieren, die eine Selektion geeigneter Transplantationskandidaten erlauben. Lebendorganlebertransplantation umgeht die Problematik des Organmangels und bietet die Möglichkeit die geltenden Transplantationskriterien zu erweitern. Die Sicherheit des Spenders nimmt den zentralen Stellenwert in diesem neuen Therapiekonzept ein.

Abstract

Liver transplantation is a generally accepted therapeutic option for selected non resectable primary liver tumors and liver metastases. In general, patients with small hepatocellular carcinoma in hepatitis associated liver cirrhosis and selected patients with cholangiocellular carcinoma are candidates for liver transplantation. Liver transplantation might be also indicated in hepatic metastases of neuroendocrine tumors or gastrointestinal stroma tumors. For hepatocellular carcinoma liver transplantation presents the best therapeutic option since it provides radical tumor elimination and normal liver function. Due to worldwide organ shortage criteria for selection of suitable candidates for transplantation are necessary. Living donor organ transplantation omits the problem of waiting time for a suitable graft and offers a possibility of expansion of criteria for transplantation in tumor patients. Donor safety presents a key issue of this new therapeutic strategy.

Schlüsselwörter

Primäre und sekundäre Lebertumoren - Lebertransplantation - Lebendorganspende

Key words

Primary and secondary liver tumors - liver transplantation - living donation

Literatur

  • 1 Starzl T E, Iwatsuki S, Van Thiel D H. et al . Evolution of liver transplantation.  Hepatology. 1982;  2 614-636
    PubMedGoogle Scholar
  • 2 Olthoff K M, Millis J M, Rosove M H. et al . Is liver transplantation justified for the treatment of hepatic malignancies?.  Arch Surg. 1990;  125 1261-1266
    CrossrefPubMedGoogle Scholar
  • 3 Ringe B, Wittekind C, Bechstein W O. et al . The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence.  Ann Surg. 1989;  209 88-98
    PubMedGoogle Scholar
  • 4 Busuttil R W, Farmer D G. The surgical treatment of primary hepatobiliary malignancy.  Liver Transpl Surg. 1996;  2 114-130
    PubMedGoogle Scholar
  • 5 Yokoyama I, Todo S, Iwatsuki S, Starzl T E. Liver transplantation in the treatment of primary liver cancer.  Hepatogastroenterology. 1990;  37 188-193
    PubMedGoogle Scholar
  • 6 Penn I. Hepatic transplantation for primary and metastatic cancers of the liver.  Surgery. 1991;  110 726-734
    PubMedGoogle Scholar
  • 7 Pichlmayr R. Is there a place for liver grafting in malignancy?.  Transplant Proc. 1988;  20 478-482
    PubMedGoogle Scholar
  • 8 European Liver Transplant Registry . www.eltr.org
  • 9 Mazzaferro V, Regalla E, Doci R. et al . Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.  N Engl J Med. 1996;  334 693-699
    CrossrefPubMedGoogle Scholar
  • 10 Van Thiel D H, Colantoni A, De Maria N. Liver transplantation for hepatocellular carcinoma?.  Hepatogastroenterology. 1998;  45 1944-1949
    PubMedGoogle Scholar
  • 11 Klintmalm G B. Liver transplantation for hepatocellular carcinoma. A registry report of the impact of tumor characteristics on outcome.  Ann Surg. 1998;  228 479-490
    CrossrefPubMedGoogle Scholar
  • 12 Iwatsuki S, Dvorchik I, Marsh J W, Madariaga J R, Carr B, Fung J J. Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring system.  J Am Coll Surg. 2000;  191 389-394
    CrossrefPubMedGoogle Scholar
  • 13 Figueras J, Ibanez L, Ramos E. et al . Selection criteria for liver transplantation in early-stage hepatocellular carcinoma with cirrhosis: results of a multicenter study.  Liver Transpl. 2001;  7 877-883
    CrossrefPubMedGoogle Scholar
  • 14 Jonas S, Bechstein W O, Steinmüller T. et al . Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma.  Hepatology. 2001;  33 1080-1086
    CrossrefPubMedGoogle Scholar
  • 15 Hemming A W, Cattral M S, Reed A I. et al . Liver transplantation for hepatocellular carcinoma.  Ann Surg. 2001;  233 652-659
    CrossrefPubMedGoogle Scholar
  • 16 Molmenti E P, Klintmalm G B. Liver transplantation in association with hepatocellular carcinoma: an update of the International Tumor Registry.  Liver Transpl. 2002;  8 736-748
    CrossrefPubMedGoogle Scholar
  • 17 Mayer C G, Penn I, James L. Liver transplantation for cholangiocarcinoma: results in 207 patients.  Transplantation. 2000;  69 1633-1637
    PubMedGoogle Scholar
  • 18 Casavilla F A, Marsh J W, Iwatsuki S. Hepatic resection and transplantation for peripheral cholangiocarcinoma.  J Am Coll Surg. 1997;  185 429-436
    CrossrefPubMedGoogle Scholar
  • 19 Abu-Elmagd K M, Selby R, Iwatsuki S. et al . Cholangiocarcinoma and sclerosing cholangitis: Clinical characteristics and effect on survival after liver transplantation.  Transplant Proc. 1993;  25 1124-1125
    PubMedGoogle Scholar
  • 20 Shimoda M, Farmer D G, Colquhoun S D. et al . Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature.  Liver Transpl. 2001;  7 1023-1033
    CrossrefPubMedGoogle Scholar
  • 21 De Vreede I, Steers J L, Burch P A. et al . Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma.  Liver Transpl. 2000;  6 309-316
    CrossrefPubMedGoogle Scholar
  • 22 Frilling A, Rogiers X, Malago M. et al . Treatment of liver metastases in patients with neuroendocrine tumors.  Langenbecks Arch Surg. 1998;  383 62-70
    CrossrefPubMedGoogle Scholar
  • 23 Le Treut Y P, Delpero J R, Dousset B. et al . Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report.  Ann Surg. 1997;  225 355-364
    CrossrefPubMedGoogle Scholar
  • 24 Yao F Y, Bass N M, Nikolai B. et al . Liver transplantation for hepatocellular carcinoma: Analysis of survival according to the intention-to-treat principle and dropout from the waiting list.  Liver Transpl. 2002;  8 873-883
    CrossrefPubMedGoogle Scholar
  • 25 Sarasin F P, Majno P E, Llovet J M, Bruix J, Mentha G, Hadengue A. Living donor liver transplantation for early hepatocellular carcinoma: a life-expectancy and cost-effectiveness perspective.  Hepatology. 2001;  33 1073-1079
    CrossrefPubMedGoogle Scholar
  • 26 Sharma P, Balan V, Hernandez J L. et al . Liver transplantation for hepatocellular carcinoma: The MELD impact.  Liver Transpl. 2004;  10 36-41
    CrossrefPubMedGoogle Scholar
  • 27 Broelsch C E, Frilling A, Nadalin S. et al . Leberlebendspende. Die Deutsche Erfahrung im internationalen Vergleich.  Chirurg. 2003;  74 510-522
    CrossrefPubMedGoogle Scholar
  • 28 Cheng S J, Pratt D S, Freeman R B. et al . Living-donor versus cadaveric liver transplantation for non-resectable small hepatocellular carcinoma and compensated cirrhosis: a decision analysis.  Transplantation. 2001;  72 861-868
    PubMedGoogle Scholar
  • 29 Fung J, Marsh W. The quandary over liver transplantation for hepatocellular carcinoma: The greater the sin?.  Liver Transpl. 2002;  8 775-777
    CrossrefPubMedGoogle Scholar
  • 30 Roberts J P. Role of adult living donation in patients with hepatocellular cancer.  Liver Transpl. 2003;  9 S60-S63
    CrossrefPubMedGoogle Scholar
  • 31 Kaihara S, Kiuchi T, Ueda M. et al . Living donor liver transplantation for hepatocellular carcinoma.  Transplantation. 2003;  75 S37-S40
    PubMedGoogle Scholar
  • 32 Gondolesi G, Munoz L, Matsumoto C. et al . Hepatocellular carcinoma. A prime indication for living donor liver transplantation.  J Gastrointest Surg. 2002;  6 102-107
    CrossrefPubMedGoogle Scholar
  • 33 Malago M, Testa G, Frilling A. et al . Right living donor liver transplantation: an option for adult patients. Single institution experience with 74 patients.  Ann Surg. 2003;  238 853-863
    PubMedGoogle Scholar
  • 34 Beavers K L, Sandler R S, Fair J H. et al . The living donor experience: donor health assessment and outcomes after living donor liver transplantation.  Liver Transpl. 2001;  7 943-947
    CrossrefPubMedGoogle Scholar
  • 35 Collela G, De Cartis L, Rondinara G F. et al . Is hepatocellular carcinoma in cirrhosis an actual indication for liver transplantation?.  Transpl Proc. 1997;  29 492-494
    PubMedGoogle Scholar
  • 36 Tamura S, Kato T, Berho M. et al . Impact of histological grade of hepatocellular carcinoma on the outcome of liver transplantation.  Arch Surg. 2001;  136 25-30
    PubMedGoogle Scholar
  • 37 American Liver Tumor Study Group .A randomized prospective multi-institutional trial of orthotopic liver transplantation or partial hepatic resection with or without adjuvant chemotherapy for hepatocellular carcinoma. Investigator Booklet and Protocol 1998
    Google Scholar
  • 38 Liver (including intrahepatic bile ducts). In: Beahrs OH, Henson DR, Hutter RVP (Hrsg). American Joint Committee on Cancer. Manual for staging of cancer, 4th edition. Lippincott, Philadelphia 1992; 89-90
    Google Scholar

Prof. Dr. med. A. Frilling

Klinik für Allgemein- und Transplantationschirurgie, Universitätsklinikum Essen

Hufelandstr. 55

45122 Essen

Phone: +49-2 01-7 23-11 11

Fax: +49-2 01-7 23-59 46

Email: frilling@uni-essen.de