Akutes Leberversagen

Das akute Leberversagen ist eine schwere Form der Leberinsuffizienz, die selten als Komplikation einer akuten Leberschädigung bei zuvor lebergesunden Personen auftritt. Die häufigste Ursache in Deutschland ist die medikamentös-toxische Hepatitis. Das akute Leberversagen ist mit einer hohen Letalität assoziiert, wobei die frühe Diagnosestellung für die Prognose entscheidend ist.

Abstract

Acute liver failure (ALF) is a severe, potentially reversible form of liver insufficiency, which is defined by the occurrence of hepatic coagulopathy and hepatic encephalopathy in patients with no previous hepatic disease. Acute liver failure is preceded by severe acute liver injury (ALI) with an increase in transaminases, jaundice, and deterioration in general condition over a period of hours to weeks. Every year 200–500 people develop ALF in Germany, most frequently on the background of toxic liver injury (e.g. drug induced liver injury). Other potential causes include viral infections (e.g. hepatitis A and B), autoimmune hepatitis, Budd-Chiari Syndrome or Wilson’s disease. Patients usually present at the stage of acute liver damage. Initial diagnostics should include a detailed medical history, clinical examination, laboratory diagnostics and abdominal sonography. The course of acute liver failure is very difficult to predict, so all patients with severe acute liver damage should be evaluated for transfer to a center. At the latest when hepatic encephalopathy occurs and thus when all the definition criteria of acute liver failure are met, the patient should be transferred to a liver transplant center immediately. While specific medical therapies may be available in the early stages of the disease, depending on the etiology, the focus in advanced stages is on preventing complications and treating associated organ dysfunctions. In progressive cases, liver transplantation is often the only life-saving measure. Overall, the mortality rate in Germany is 47%, and approximately 8% of annual liver transplants in the European Union are performed due to ALF.

Kernaussagen

• Das akute Leberversagen ist durch das Auftreten einer hepatischen Koagulopathie und Enzephalopathie bei zuvor lebergesunden Personen definiert.

• Die Diagnose eines akuten Leberversagens sollte die sofortige Kontaktaufnahme mit einem Zentrum, mit Möglichkeit zur Lebertransplantation, begründen.

• Die häufigste Ursache des akuten Leberversagens in Deutschland ist die medikamentös-toxische Leberschädigung.

• Die Therapie des akuten Leberversagens richtet sich im Frühstadium nach der Ursache, sodass der frühen und vollständigen Differenzialdiagnostik eine besondere Bedeutung zukommt.

• Beim fortgeschrittenen akuten Leberversagen sind insbesondere infektiöse Komplikationen und extrahepatische Organ-Dysfunktionen entscheidend für die Prognose.

• Der MELD-Score und die King’s-College-Kriterien können zur Identifikation von Patienten mit ungünstigem Spontanverlauf und Indikation zur Lebertransplantation herangezogen werden.

• Die Kriterien zur Organvergabe bei akutem Leberversagen unterscheiden sich grundsätzlich von den Vergabekriterien bei anderen Indikationen. Die einzige absolute Kontraindikation für eine Lebertransplantation im akuten Leberversagen stellen irreversible Hirnschäden dar.

Schlüsselwörter

akute Leberschädigung - Leberinsuffizienz - Lebertransplantation

Keywords

acute liver injury - liver transplantation - liver insufficiency

Publikationsverlauf

Artikel online veröffentlicht:
14. März 2025

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