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Z Gastroenterol 2006; 44(1): 33-37
DOI: 10.1055/s-2005-858785
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© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Therapierefraktäre schwere pulmonal-arterielle Hypertonie nach Lebertransplantation bei HCV-Leberzirrhose

Severe Refractory Pulmonary Hypertension after Liver Transplantation for Hepatitis C CirrhosisC. G. Dietrich1 , C. Gartung1 , E. Siewert1 , F. Lammert1 , S. Matern1 , A. Geier1
  • 1Medizinische Klinik III, Klinikum der RWTH Aachen
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Publication History

Manuskript eingetroffen: 02.05.2005

Manuskript akzeptiert: 11.10.2005

Publication Date:
05 January 2006 (online)

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Zusammenfassung

Hintergrund: Wir berichten über einen 43-jährigen Patienten mit einer Leberzirrhose auf dem Boden einer Hepatitis C, bei dem nach Lebertransplantation erstmals Dyspnoe mit rechtsventrikulärer Herzbelastung auftrat. Fallvorstellung: Während vor der Transplantation echokardiographisch rechtsventrikuläre Drücke von 36 mm Hg (+ ZVD) gemessen worden waren, bestimmten sich diese post transplantationem deutlich höher und korrelierten dabei invers mit der Transplantatfunktion. Nach Diagnosestellung einer portopulmonalen Hypertonie wurden Therapieversuche mit intravenösem Epoprostenol und inhalativem Iloprost unternommen, die jedoch bei ausgeprägten systemischen Nebenwirkungen nicht toleriert wurden. Bevor der Patient einer kombinierten Herz-Lungen-Transplantation zugeführt werden konnte, verstarb er im Kreislaufversagen. Schlussfolgerung: Der Fallbericht diskutiert den gegenwärtigen diagnostischen und therapeutischen Stand der portopulmonalen Hypertonie und zeigt Schwächen in der derzeitigen Screeningstrategie auf.

Abstract

Background: We report the case of a 43-year-old male with liver cirrhosis based on a chronically active hepatitis C. Case Report: Before liver transplantation right-ventricular pressure values of 36 mmHg (+ central venous pressure) were measured whereas, after transplantation, he developed severe pulmonary hypertension with pressure values up to 90 mmHg. These elevated pressure values correlated inversely with graft function. Given the diagnosis of portopulmonary hypertension, we initiated treatment with intravenous epoprostenol and inhalative iloprost but both treatments were not tolerated because of systemic side effects. A combined heart-lung transplantation was considered but the patient died from insufficient cardiac function. Conclusions: The case report discusses the present diagnostic and therapeutic state of the art in portopulmonary hypertension and reveals basic problems of the present screening strategy.

Schlüsselwörter

Hepatitis C - Lebertransplantation - portopulmonale Hypertonie

Key words

Hepatitis C - liver transplantation - portopulmonary hypertension

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PD Dr. Andreas Geier

Medizinische Klinik III der RWTH

Pauwelsstr. 30

52057 Aachen

Phone: 02 41/8 08 86 34

Fax: 02 41/8 08 24 55

Email: ageier@ukaachen.de

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