Gerinnungsanalyse bei Transplantationspatienten

Zusammenfassung

Bei Patienten nach Organtransplantation können sich aufgrund der zur Transplantation führenden Grundkrankheit als auch transplantationsbedingt sowohl vorbestehende Hämostasestörungen maskieren als auch entwickeln. Da die Leber den Hauptbildungsort für die Gerinnungsfaktoren darstellt, prädestiniert die orthotope Lebertransplantation für den Erwerb bzw. Verlust eines genetisch determinierten Gerinnungsdefektes. Hier kann es in der Gerinnungsdiagnostik zur Diskrepanz zwischen funktionellen Tests im Plasma und molekularbiologischen Befunden kommen, sofern diese wie üblich aus kernhaltigen Zellen des peripheren Blutes erhoben werden.

Die Seltenheit der meisten Defekte und die fehlenden Konsequenzen bei Nachweis der häufigeren Gerinnungsstörungen führen dazu, dass kein prinzipielles Screening vor oder nach Transplantation gefordert wird. Der Umstand einer zur Transplantation führenden Grundkrankheit ist ebenso wie die Transplantation selbst in die Interpretation von Befunden einzubeziehen.

Summary

In patients post organ transplantation, the underlying disorder necessitating the transplantation, as well as the transplantation itself, can both mask pre-existing haemostatic abnormalities or lead to them. Since the liver is the main production site for coagulation factors, orthotopic liver transplantion predestines for acquiring or losing a genetically determined coagulation defect. In coagulation diagnostics, this may lead to a discrepancy between functional plasma tests and molecular biologic findings if these are gathered from nucleated cells of the peripheral blood, as is the standard. Due to the rareness of most defects and the lack of consequences in case of diagnosis of a more common coagulation disorder, no general screening before or after transplantation is required. Underlying diseases leading to liver transplantation as well as the actual transplantation must be considered when interpreting the findings.

Schlüsselwörter

Lebentransplantation

Keywords

Liver transplantation

• Literatur

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