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DOI: 10.1055/s-2007-981231
© Georg Thieme Verlag Stuttgart · New York
Indikation und Technik der Lebertransplantation bei primären und sekundären Lebertumoren
Indication and Technique of Liver Transplantation in Primary and Secondary Liver TumorsPublikationsverlauf
Publikationsdatum:
23. August 2007 (online)
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Zusammenfassung
Die Lebertransplantation stellt heutzutage neben der Leberteilresektion einen integralen Bestandteil des chirurgischen Behandlungskonzeptes bei Malignomen der Leber dar. Dabei ist die Indikation zur Lebertransplantation aufgrund unterschiedlicher Langzeitergebnisse bei den verschiedenen Tumorentitäten, aber auch bei unterschiedlichen Tumorstadien der einzelnen Malignome, sowie des Mangels an Spenderorganen, differenziert zu betrachten. Beim hepatozellulären Karzinom (HCC) in zirrhotischer Leber stellt die Lebertransplantation in frühen Tumorstadien derzeit die Therapie der Wahl dar. Als Selektionskriterien zur Auswahl geeigneter Patienten sind nach wie vor die „Milan-Kriterien” allgemein anerkannt. Gegenwärtig erfahren diese Selektionskriterien eine vorsichtige Erweiterung, wobei eine abschließende Beurteilung hinsichtlich einer Neufassung der Indikationsstellung zum momentanen Zeitpunkt noch nicht absehbar erscheint. Aufgrund von Langzeitergebnissen, welche im Vergleich zu benignen Lebererkrankungen oder frühen Tumorstadien des HCCs eher ungünstig ausfallen und gleichwertigen oder überlegenen Ergebnissen nach Leberteilresektion, stellen Gallengangskarzinome zur Zeit keine allgemein akzeptierte Indikation zur Lebertransplantation dar. Da jedoch aufgrund zugrunde liegender Leberpathologien und lokal fortgeschrittener Tumoren zahlreiche Patienten einer Resektion nicht zugänglich sind, erfährt die Transplantation, insbesondere unter dem Eindruck deutlich verbesserter Langzeitergebnisse nach neoadjuvanter Therapie, eine Neubewertung im therapeutischen Gesamtkonzept. Im Gegensatz hierzu sind Metastasen gegenwärtig nicht als eine Indikation zur Lebertransplantation anzusehen, wobei die Transplantation in einzelnen selektionierten Patienten eine sinnvolle Option darstellen kann.
Abstract
Liver transplantation represents presently beside liver resection an essential part of the surgical treatment strategy in malignancies of the liver. Because of different long-term survival rates according to tumour type and stage as well as the organ donor shortage, the indication for liver transplantation varies between the different tumour entities. In early tumour stages, liver transplantation represents the treatment of choice for hepatocellular carcinoma (HCC) in cirrhotic livers. The “Milan-Criteria” are still the generally accepted policies for the selection of suitable patients. Presently, these criteria experience a careful expansion, but a final decision about a new definition of these selection policies has not been made so far. Due to long-term results, which are considered rather poor compared to survival rates in benign liver diseases and early HCCs and comparable or even superior results after liver resection, cholangiocarcinomas represent not a generally accepted indication for liver transplantation today. However, multiple patients are not suitable for liver resection due to underlying liver pathologies or local tumour extension and recent studies indicate clearly improved survival figures by using new neoadjuvant treatment approaches. Therefore, liver transplantation is presently re-evaluated in the treatment strategy for cholangiocarcinoma and can be considered in patients who are not suitable for liver resection. In contrast, liver metastases are currently considered a contraindication to liver transplantation and only in highly selected patients it may be an useful treatment option.
Schlüsselwörter
Lebertransplantation - hepatozelluläres Karzinom - Gallengangskarzinom - Lebermetastasen - Indikation
Key words
Liver transplantation - hepatocellular carcinoma - cholangiocarcinoma - liver metastases - indication
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Prof. Dr. med. P. Neuhaus
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie · Charité - Universitätsmedizin Berlin · Campus Virchow-Klinikum
Augustenburger Platz 1
13353 Berlin
Telefon: 0 30/4 50 55 20 01
Fax: 0 30/4 50 55 29 00
eMail: peter.neuhaus@charite.de