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Lebendspende-Lebertransplantation beim Erwachsenen

Living donor liver transplantation in adults

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Zusammenfassung

Vor dem Hintergrund des weltweit bestehenden Spendermangels bietet die Lebendspende-Lebertransplantation eine wertvolle Therapiealternative zur Leichenspende. Neben der chirurgisch-technischen Komplexität des Verfahrens stellt die adäquate Auswahl der geeigneten Spender und Empfänger die größte Herausforderung dar. Die Spendersicherheit ist oberste Prämisse, der alle weiteren Entscheidungen untergeordnet werden müssen. Den in Europa und Nordamerika seit einigen Jahren leicht rückläufigen Lebendspendezahlen stehen sehr erfolgreiche und expandierende Lebendspendeprogramme im asiatischen Raum gegenüber. Die zunehmende Erfahrung hat gezeigt, dass insbesondere technische Aspekte der Gallengangsanastomose sowie des venösen Abstroms aus dem Teiltransplantat eine entscheidende Rolle für das Empfänger-Outcome spielen. So zeigt sich im Vergleich zur Leichenspende zwar eine erhöhte früh-postoperative Morbidität, das langfristige Organ- und Patientenüberleben ist jedoch dem der Kadaverspende mindestens ebenbürtig. Insbesondere für Patienten, die unter den Bedingungen des MELD-Allokationssystems sehr lange auf eine Leichenspende warten müssen, stellt die Leberlebendtransplantation eine geeignete Therapieoption dar. Eine Ausweitung der sog. „Milan-Kriterien“ für HCC-Patienten mit Lebendspendeoption wird derzeit kontrovers diskutiert.

Abstract

The worldwide shortage of adequate donor organs implies that living donor liver transplantation represents a valuable alternative to cadaveric transplantation. In addition to the complex surgical procedure the correct identification of eligible donors and recipients plays a decisive role in living donor liver transplantation. Donor safety must be of ultimate priority and overrules all other aspects involved. In contrast to the slightly receding numbers in Europe and North America, in recent years Asian programs have enjoyed constantly increasing living donor activity. The experience of the past 15 years has clearly demonstrated that technical challenges of both bile duct anastomosis and venous outflow of the graft significantly influence postoperative outcome. While short-term in-hospital morbidity remains increased compared to cadaveric transplantation, long-term survival of both graft and patient are comparable or even better than in deceased donor transplantation. Especially for patients expecting long waiting times under the MELD allocation system, living donor liver transplantation offers an excellent therapeutic alternative. Expanding the so-called „Milan criteria“ for HCC patients with the option for living donor liver transplantation is currently being controversially debated.

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Authors and Affiliations

  1. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Universitätsklinikum Aachen der Rheinland-Westfälischen Technischen Hochschule, Pauwelsstraße 30, 52074, Aachen, Deutschland

    U.P. Neumann & M. Schmeding

  2. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland

    P. Neuhaus

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  1. U.P. Neumann
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  2. P. Neuhaus
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  3. M. Schmeding
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Correspondence to U.P. Neumann.

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Neumann, U., Neuhaus, P. & Schmeding, M. Lebendspende-Lebertransplantation beim Erwachsenen. Chirurg 81, 804–812 (2010). https://doi.org/10.1007/s00104-009-1874-x

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