Strassburg C P
Medizinischen Klinik und Poliklinik I, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
Chirurg. 2013 May;84(5):363-71. doi: 10.1007/s00104-012-2418-3.
Liver transplantation represents an established component of the therapeutic repertoire for irreversible chronic liver diseases. Liver transplantation is confronted by a shortage of donor allografts as well as by an increasing overall number of potentially useful indications, which leads to a rationing of this therapeutic option. 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. The evaluation of indications which are prioritized according to laboratory values (serum creatine, serum bilirubin and coagulation) and the so-called standard exception categories which have to fulfil specific criteria place increased demands on the interdisciplinary transplantation team, on the evaluation for liver transplantation and the prediction of the success of transplantation required by the Transplantation Act. The establishment and implementation of robust, objective and transparent systems to assess not only preoperative priorities but also postoperative benefits represents a major challenge for transplantation medicine.
肝移植是不可逆慢性肝病治疗方法中的既定组成部分。肝移植面临供体移植物短缺以及潜在可用适应症总数不断增加的问题，这导致了这种治疗选择的分配。自2006年12月以来，肝移植的优先级由终末期肝病模型（MELD）决定，而非等待时间的长短。根据实验室值（血清肌酐、血清胆红素和凝血）确定优先级的适应症评估以及必须满足特定标准的所谓标准例外类别，对跨学科移植团队、肝移植评估以及《移植法》要求的移植成功预测提出了更高要求。建立并实施强大、客观且透明的系统，不仅用于评估术前优先级，还用于评估术后益处，这对移植医学来说是一项重大挑战。
