Strassburg C P, Manns M P
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover.
Internist (Berl). 2009 May;50(5):550-60. doi: 10.1007/s00108-008-2268-8.
After around 64,000 transplantations in Europe since 1988 liver transplantation has emerged as a standard treatment option for otherwise incurable chronic liver diseases. Cirrhosis of different etiologies represents the most frequent transplant indication. Overall survival in this group amounts to 72% after 5 years, and 62% after 10 years. In Germany, the main indications include alcoholic liver cirrhosis, tumors with increasing numbers in recent years, as well as viral diseases leading to cirrhosis. Since December 2006 the priority for liver transplantation is determined by the model for end stage liver disease (MELD) and not by the length of waiting time. MELD is a statistical model based on serum creatinine, serum bilirubin and coagulation, which describes the probability of 3-month mortality of a potential transplant candidate. Not all liver diseases are adequately represented by MELD necessitating the additional use of a defined number of standard exceptions that have been last updated in 2008. As a consequence of these developments indications, selection of recipients and the management of the waiting list have seen profound change.
自1988年以来，欧洲进行了约64000例肝脏移植手术，肝脏移植已成为治疗其他无法治愈的慢性肝病的标准治疗选择。不同病因的肝硬化是最常见的移植指征。该组患者5年总体生存率为72%，10年为62%。在德国，主要指征包括酒精性肝硬化、近年来数量不断增加的肿瘤以及导致肝硬化的病毒性疾病。自2006年12月起，肝脏移植的优先权由终末期肝病模型（MELD）决定，而非等待时间的长短。MELD是一种基于血清肌酐、血清胆红素和凝血功能的统计模型，描述了潜在移植候选人3个月内死亡的概率。并非所有肝病都能通过MELD充分体现，因此需要额外使用一定数量的标准例外情况，这些例外情况最近一次更新是在2008年。这些发展的结果是，指征、受者选择和等待名单管理都发生了深刻变化。
