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Z Gastroenterol 2020; 58(10): 945-954
DOI: 10.1055/a-1199-7432
Originalarbeit

Nicht transplantierte Spenderorgane – eine bundesweite Auswertung aller Organangebote für die Lebertransplantation von 2010 bis 2018

Declined Liver Grafts – Analysis of the German Donor Population from 2010 to 2018
Simon Moosburner‡
1   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
,
Nathanael Raschzok‡
1   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
,
Christina Schleicher
2   Deutsche Stiftung Organtransplantation, DSO, Frankfurt am Main
,
Detlef Bösebeck
2   Deutsche Stiftung Organtransplantation, DSO, Frankfurt am Main
,
Joseph M.G.V. Gaßner
1   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
,
Paul V. Ritschl
1   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
,
Axel Rahmel
2   Deutsche Stiftung Organtransplantation, DSO, Frankfurt am Main
,
Igor M. Sauer
1   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
,
Johann Pratschke
1   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
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Zusammenfassung

Hintergrund Der Mangel an Spenderorganen für die Lebertransplantation limitiert die Verfügbarkeit dieser lebensrettenden Therapieoption in Deutschland. Die Qualität der potenziell verfügbaren Spenderorgane wurde bislang nicht bundesweit untersucht.

Methoden Analyse aller durch die Deutsche Stiftung Organtransplantation an Eurotransplant gemeldeten Spenderorgane für die Lebertransplantation im Zeitraum von 2010 bis 2018. Kategorisierung transplantierter und nicht transplantierter Organe anhand der histopathologischen Befunde und definierten erweiterten Spenderkriterien.

Ergebnisse Insgesamt wurden 8594 Spenderorgane für die Lebertransplantation gemeldet, wovon 15,2 % nicht transplantiert wurden. Im Untersuchungszeitraum stieg der Anteil von Spenderlebern, die mindestens ein erweitertes Spenderkriterium aufwiesen, von 65 % auf 70 % (p = 0,005). Im Jahr 2018 wurden 21 % der gemeldeten Spenderlebern nicht transplantiert; dabei erfüllte über die Hälfte (56 %) mehrere erweiterte Spenderkriterien. Nicht transplantierte Organe stammten signifikant häufiger von Spendern älter als 65 Jahre (41 % vs. 28 %) mit einem BMI > 30 kg/m2 (29 vs. 14 %) und mit erhöhten Leberenzymen (alle p < 0,001).

Schlussfolgerung Trotz des bestehenden Organmangels in Deutschland wird ein relevanter Anteil der angebotenen Spenderlebern aufgrund unterschiedlicher Qualitätseinschränkungen nicht transplantiert. Dies gibt Anreiz, Konzepte wie z. B. die normotherme Ex-vivo-Maschinenperfusion zur Evaluation, Sicherung und potenziell Verbesserung der Organqualität in den Vordergrund zu rücken.

Abstract

Background The lack of suitable allografts limits the availability of liver transplantation in Germany. The quality of potentially available German donor livers has to date not been analyzed.

Methods Analysis of all donors for potential liver transplantations reported to the Eurotransplant by the German Organ Transplantation Foundation from 2010 to 2018. Categorization of transplanted and discarded organs utilizing available histopathological reports and predefined extended criteria for organ donation.

Results A total of 8594 livers were offered for transplantation, of which 15.2 % were discarded. During the analysis period the proportion of donor livers from extended criteria donors increased from 65 % to 70 % (p = 0.005). In 2018, 21.3 % of offered donor livers were discarded, more than half (56.4 %) of these organs came from donors meeting multiple extended criteria. Livers were significantly more likely to be not transplanted, when from donors of older age (> 65 years; 41 vs. 28 %), BMI > 30 kg/m2 (29 vs. 14 %) or elevated transaminase levels (all p < 0,001).

Conclusion Despite the consistent organ scarcity in Germany, a relevant amount of livers cannot be transplanted due to a multitude of organ quality limitations. This should stimulate the search for concepts such as normothermic ex vivo machine perfusion to evaluate, protect and potentially improve organ quality.



Publication History

Article published online:
24 August 2020

© 2020. Thieme. All rights reserved.

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