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DOI: 10.1055/s-0043-109355
Intestinales Versagen und Darmtransplantation
Publication History
Publication Date:
30 November 2017 (online)
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Das Darmversagen ist ein ernst zu nehmendes Krankheitsbild; etwa die Hälfte der Betroffenen sind Kinder. Dieser Artikel soll einen Überblick über die Definition, Klassifikation, Epidemiologie und Ätiologie des Darmversagens bieten mit einem kurzen Einblick in konservative Therapiemöglichkeiten. Einen Schwerpunkt bildet die chirurgische Therapie und insbesondere die Darmtransplantation als Ultima Ratio.
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Ziel der Therapie des intestinalen Versagens (IV) ist die Adaptation und Rehabilitation, um die vielfältigen Komplikationen zu vermeiden oder zumindest zu verringern.
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Die Standardtherapie des intestinalen Versagens besteht aus einer im interdisziplinären Setting gestalteten Optimierung der enteralen und parenteralen Ernährung und Elongationsverfahren.
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Wenn die oben genannten Optionen erschöpft sind, ist eine Darmtransplantation (DT) allein oder als kombinierte Leber-Darm-Transplantation (LDT) oder sogar Multiviszeraltransplantion mit/ohne Leber (MVT) indiziert.
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Die Darmtransplantation (DT) in ihren verschiedenen Varianten ist mittlerweile ein standardisiertes Verfahren, welches jedoch unbedingt in einem hochspezialisierten Umfeld durchgeführt werden sollte.
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Aufgrund der nach wie vor hohen Abstoßungsrate ist das Langzeitüberleben der Transplantate begrenzt.
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