Riediger Carina, Schweipert Johannes, Weitz Jürgen
Klinik und Poliklinik für Viszeral-, Thorax-, und Gefäßchirurgie, Technische Universität Dresden, Dresden, Deutschland.
Klinik und Poliklinik für Viszeral-, Thorax-, und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Deutschland.
Zentralbl Chir. 2022 Aug;147(4):369-380. doi: 10.1055/a-1866-4197. Epub 2022 Jul 21.
Liver transplantation is the only curative treatment option for end stage liver disease. Moreover, oncological liver disease (hepatocellular carcinoma) is an important relevant indication for liver transplantation, together with acute liver failure.Since the first successful liver transplantation by Professor Thomas Starzl in 1967, liver transplantation has changed in many aspects. This concerns not only surgical, anaesthesiological and immunological improvements and further technical developments, but also altered patient characteristics. Patients undergoing liver transplantation are nowadays often more challenging, due to their age and relevant comorbidities.The number of liver transplantations is constantly rising. However, there are more patients in need of liver transplantation than donor grafts are available. Discrepancies between liver transplant candidates and organ supply can only partially be compensated by split liver transplantation and liver transplantation from living donors.To boost the pool of donor grafts, even marginal organs within the extended donor criteria (EDC) are being increasingly allocated. In some countries, even "donation after cardiac death (DCD) organs" are allocated as well.Marginal donor grafts are often associated with reduced graft and patient survival after liver transplantation. To improve the quality of poor liver grafts, innovations in organ conservation with development of new techniques as the machine perfusion techniques have been established in recent years.In summary, the constellation of risk factors of donor grafts as well as transplant recipients has become more challenging in recent decades. It is important to know the specific risk factors and predictors for liver transplantation, in order to obtain the best possible graft and patient survival after liver transplantation.This review gives an overview of predictors for liver transplantation, specific risk scores and indices for donor/recipient match as well as new technical devices in liver transplantation.
肝移植是终末期肝病唯一的治愈性治疗选择。此外,肿瘤性肝病(肝细胞癌)与急性肝衰竭一样,是肝移植的重要相关指征。自1967年托马斯·斯塔兹尔教授首次成功进行肝移植以来,肝移植在许多方面都发生了变化。这不仅涉及外科、麻醉和免疫学方面的改进以及进一步的技术发展,还涉及患者特征的改变。如今,接受肝移植的患者由于年龄和相关合并症,往往更具挑战性。肝移植的数量在不断增加。然而,需要肝移植的患者比可获得的供体器官更多。肝移植候选者与器官供应之间的差异只能通过劈离式肝移植和活体供体肝移植来部分弥补。为了增加供体器官库,越来越多地分配扩展供体标准(EDC)范围内的边缘器官。在一些国家,甚至也分配“心脏死亡后捐赠(DCD)器官”。边缘供体器官通常与肝移植后移植物和患者生存率降低有关。为了提高质量较差的肝移植物的质量,近年来随着机器灌注技术等新技术的发展,器官保存方面有了创新。总之,近几十年来,供体器官以及移植受者的危险因素组合变得更具挑战性。了解肝移植的具体危险因素和预测指标很重要,以便在肝移植后获得尽可能好的移植物和患者生存率。本综述概述了肝移植的预测指标、供体/受体匹配的特定风险评分和指数以及肝移植中的新技术设备。