Vaskuläre Problemkonstellationen und ihre operationstaktischen Lösungsansätze im Rahmen der postmortalen Lebertransplantation^[*]

 

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Zusammenfassung

Gefäßprobleme im Rahmen der Lebertransplantation können sowohl bei Spender und Empfänger als auch während der Entnahme und der Transplantation auftreten. Sie beeinflussen das Ergebnis der Transplantation erheblich. Neben anatomischen Varianten müssen arteriosklerotische Gefäßerkrankungen, Komplikationen des portalen Hochdrucks, Gefäßläsionen durch Entnahmefehler, Komplikationen infolge von Interventionen bzw. Bridgingverfahren erkannt und therapiert werden. Für die Diagnostik sind neben der Duplexsonografie und der Kontrastmittel-Computertomografie die invasive Gefäßdiagnostik (digitale Subtraktionsangiografie) etabliert. Problemkonstellationen sollten vor der Transplantation bekannt sein und die Technik sowohl der Entnahme als auch der Transplantation entsprechend angepasst werden. Die nach Transplantation diagnostizierten Probleme können entweder interventionell oder offen-chirurgisch angegangen werden. Nicht selten führen Gefäßkomplikationen zum Verlust des Transplantats oder zum Versterben des Empfängers im Rahmen eines postoperativen Organversagens.

Abstract

In liver transplantation, vascular problems may occur in the donor as well as in the recipient and during the donor operation as well as during the transplantation. They have a major influence on the outcome of the transplantation. In addition to anatomic variants, arteriosclerotic vascular diseases, complications from portal hypertension, vascular lesions from mistakes during the donor operation, complications from interventions and bridging procedures need to be identified and treated. In addition to duplex sonography and contrast enhanced computed tomography, invasive vascular diagnostics (digital subtraction angiography) are established for diagnostic purposes. Problem constellations should be identified prior to transplantation and the technique of the donor operation and the transplantation should be adjusted accordingly. Problems that are diagnosed after transplantation may be treated interventionally or with open surgery. In a number of cases, vascular complications lead to loss of the transplant or death of the recipient from post-operative organ failure.

^* Dieser Artikel ist Herrn Prof. Dr. Dr. H. Lippert gewidmet.

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