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Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen 4/2018

24.10.2018 | Originalien

Lebertransplantation: Indikationen und Abklärung

verfasst von: PD Dr. Armin Finkenstedt, Maria Effenberger, Heinz Zoller

Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen | Ausgabe 4/2018

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Zusammenfassung

Akute, chronische oder onkologische Lebererkrankungen können eine Indikation zur Lebertransplantation darstellen, wenn sich dadurch die Lebensqualität und/oder die Überlebenszeit der Patienten verbessern lässt. Entscheidend für den Erfolg einer Transplantation ist dabei, den richtigen Zeitpunkt für den Beginn der Transplantationsevaluierung zu wählen. Bei Patienten mit Leberzirrhose besteht in der Regel ab einem MELD(Model for End-Stage Liver Disease)-Score von mindestens 15 oder bei klinischen Zeichen der Dekompensation wie Aszites, Sarkopenie oder Enzephalopathie eine klare Transplantationsindikation. Bei Patienten mit akut auf chronischem Leberversagen ist aufgrund der hohen Mortalität eine besonders dringliche Transplantationsindikation gegeben, im Gegensatz zum akuten Leberversagen besteht aber keine Möglichkeit zur „High-urgency-Listung“. Bei Patienten mit hepatozellulärem Karzinom oder weiteren, auf die Leber beschränkten Tumorentitäten besteht auch bei normaler Leberfunktion unter bestimmten Voraussetzungen die Möglichkeit, mithilfe einer Lebertransplantation ein kuratives Therapieziel zu erreichen. Eine umfangreiche Abklärung mit genauer kardiopulmonaler Evaluierung sowie der Ausschluss unkontrollierter infektiologischer oder onkologischer Komorbiditäten sind in jedem Fall Voraussetzung für eine Listung zur Lebertransplantation. Auch auf der Warteliste sind regelmäßige klinische und laborchemische Kontrollen erforderlich, um die Transplantationsindikation zu reevaluieren, neu aufgetretene Kontraindikationen zu erkennen und um MELD-Updates zur Reihung auf der Warteliste durchzuführen. Die Indikationsstellung, die Abklärung zur Transplantation und die notwendigen Kontrollen auf der Warteliste werden in dieser Übersichtsarbeit im Detail erläutert.
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Metadaten
Titel
Lebertransplantation: Indikationen und Abklärung
verfasst von
PD Dr. Armin Finkenstedt
Maria Effenberger
Heinz Zoller
Publikationsdatum
24.10.2018
Verlag
Springer Vienna
Erschienen in
Journal für Gastroenterologische und Hepatologische Erkrankungen / Ausgabe 4/2018
Print ISSN: 1728-6263
Elektronische ISSN: 1728-6271
DOI
https://doi.org/10.1007/s41971-018-0038-6

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