Wolff M, Kalff J C, Schwarz N T, Lauschke H, Minor T, Tolba R H, Hirner A
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn.
Zentralbl Chir. 2003 Oct;128(10):831-41. doi: 10.1055/s-2003-44344.
As in other western countries the major challenge of liver transplantation in Germany is to expand the number of liver transplantations in respect to the increasing disparity of qualified patients on the waiting list and the still static availability of brain death donor organs. The problem of death on the waiting list has become overt since the German transplantation law has been installed, which has changed the former center-oriented to a patient-oriented allocation weighting waiting time over medical urgency criteria. The more liberal acceptance of so called marginal cadaveric donor livers will probably impair further improvements in the acute and long-term outcome of liver transplantation. This problem can be partially compensated by the use of novel surgical techniques, such as splitting a donor liver to be transplanted into two adult recipients or, more commonly and safe, into an adult and one child. Another alternative to increase the donor pool is living donor liver transplantation, which was first introduced for pediatric recipients but is now increasingly used in adults. In 2001, a constant number of 757 liver transplantations were performed in Germany, including 12.5 % living donor transplantations. Recently, general guidelines for the selection of patients with end-stage liver disease and acute liver failure have been published by the Bundesärztekammer. Additional developments have contributed to improve the results of liver replacement including individualized immunosuppression strategies and novel treatment options to avoid recurrent viral disease following transplantation.
与其他西方国家一样，德国肝移植面临的主要挑战是，鉴于等待名单上合格患者数量差距不断扩大，而脑死亡供体器官的可获得量仍停滞不前，要增加肝移植的数量。自德国移植法颁布以来，等待名单上的死亡问题变得明显起来，该法律已将以前以中心为导向的分配方式转变为以患者为导向，将等待时间置于医疗紧急标准之上。对所谓边缘性尸体供肝更为宽松的接受可能会损害肝移植急性和长期效果的进一步改善。通过使用新的外科技术，这个问题可以得到部分弥补，比如将一个供肝分割后移植给两个成年受者，或者更常见、更安全的做法是分割给一个成年人和一个儿童。增加供体库的另一种选择是活体供肝移植，这种移植最初是用于儿童受者，但现在越来越多地用于成年人。2001年，德国共进行了757例肝移植，其中活体供肝移植占12.5%。最近，德国医师协会公布了终末期肝病和急性肝衰竭患者选择的一般指南。其他进展也有助于改善肝移植结果，包括个体化免疫抑制策略以及避免移植后病毒疾病复发的新治疗方案。
