Lebertransplantation - chirurgische Techniken

Zusammenfassung

Die Spenderkriterien wurden bei der Lebertransplantation wie bei anderen Organen wegen des persistierenden Organmangels ständig erweitert. Die Schädigung des Transplantats kommt multifaktoriell zustande. Alter, eine mäßige Steatose und andere Faktoren sind allein kein Ablehnungsgrund für ein Transplantat. Obwohl die Technik der Lebertransplantation weitgehend standardisiert ist, sind ca. 10 % der Letalität innerhalb des ersten Monats auf technische Komplikationen zurückzuführen. Die Transplantation erfolgt in Deutschland jeweils zur Hälfte in konventioneller und Huckpacktechnik. Die Komplikationsrate und die Gesamtergebnisse sind gleich. Die Split-Transplantation hat nach dem European Liver Transplant Registry einen hochsignifikanten Einfluss auf das Transplantatüberleben. Probleme mit Arterien- und Gallenwegsanastomosen, Leckagen und Blutungen an der Absetzungsfläche und anatomische Normvarianten sind in 20-30 % nach Split-Transplantation zu erwarten und bedeuten eine besondere Herausforderung für das Transplantationsteam.

Abstract

The increasing shortage of available grafts led to expanding donor criteria. Graft damage in transplantation is a multifactorial process. High donor age or mild to moderate steatosis allone do not justify to refuse a liver graft. Technique of liver transplantation is considered standardized. Nevertheless, according to the European Transplant Registry 10 % of mortality is caused by technical complications. In Germany liver transplantation is performed in equal parts using the conventional and the piggy back technique. Complications and results are comparable. The influence of split liver transplantation on patient survival is low but highly significant. Problems arise in 20 to 30 % from arterial or biliary anastomoses and from leakage or hemorrhage at the cut parenchyma. So fare, split liver transplantation is a challenge for a transplant team and justifies the restriction of this approach to particular centers.

Lebertransplantation - Technik - Splitting - Spender

Liver transplantation - technique - split - donor

Literatur

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