Prävention der Dekompensation bei einer fortgeschrittenen Lebererkrankung

Die Prävention der ersten Dekompensation bei fortgeschrittener chronischer Lebererkrankung ist entscheidend zur Verbesserung der Prognose der betroffenen Patient*innen. Dies setzt die frühzeitige Diagnose einer maßgeblich zur Entstehung von Dekompensationsereignissen beitragenden klinisch signifikanten portalen Hypertonie voraus. In diesem Artikel werden die pathophysiologischen Grundlagen der Dekompensation sowie therapeutische Optionen in der Primär- und Sekundärprävention zusammengefasst.

Abstract

The transition from compensated to decompensated advanced chronic liver disease (ACLD) is associated with increased mortality. Clinically significant portal hypertension (CSPH), defined by a hepatic venous pressure gradient (HVPG) ≥10 mmHg, is the main precondition of decompensation. Non-invasive tools like transient elastography help identifying patients at risk. Preventing the first decompensation, especially ascites, is a key therapeutic goal. Non-selective beta-blockers (NSBBs), particularly carvedilol, reduce portal pressure and have shown efficacy in preventing decompensation, independent of variceal status. Lifestyle modification and treating underlying liver disease (e.g., alcohol abstinence, viral eradication) remain essential. Early identification and initiation of therapy in CSPH can change the natural history of cirrhosis and improve patient outcomes.

Kernaussagen

• Das Auftreten einer akuten Dekompensation stellt eine entscheidende negative prognostische Landmarke bei der Leberzirrhose dar.

• In den letzten Jahren hat ein Paradigmenwechsel stattgefunden, weg von der reinen Sekundärprophylaxe von Dekompensationsereignissen, hin zur primären Prophylaxe einer Dekompensation.

• Ein zentrales Element dabei ist bei Patient*innen mit Nachweis einer klinisch signifikanten portalen Hypertonie, die heute auch mittels nichtinvasiver Verfahren diagnostiziert werden kann, eine Medikation mit nichtselektiven Betablockern.

• Der transjuguläre intrahepatische portosytemische Shunt (TIPS) ist eine effektive interventionelle Therapie der klinisch signifikanten portalen Hypertonie und kann bei Patient*innen mit dekompensierter Leberzirrhose das Auftreten weiterer Dekompensationsereignisse verhindern.

Schlüsselwörter

Leberzirrhose - portale Hypertension - Aszites - Varizenblutung

Keywords

cirrhosis - portal hypertension - ascites - variceal bleeding

Publikationsverlauf

Artikel online veröffentlicht:
10. Oktober 2025

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