Die Transplantation marginaler Lebern: Ein Ausweg aus dem Organmangeldilemma?

Zusammenfassung

Die Transplantation marginaler Organe oder sogenannte Extended Donor Criteria (EDC) ist heute eine bedeutende Option zur Verminderung des Organmangels und zur Steigerung der Transplantationsrate, was mit einer Reduktion der Sterblichkeit auf der Warteliste einhergeht. Die Ver­größerung des Spenderpools ist jedoch mit der Gefahr einer erhöhten Rate an Organdysfunktionen und Empfängermortalität verbunden. Dieser Sachverhalt stellt ein ethisches Problem bei der Akzeptanz von marginalen Organen zur Transplantation dar, da die zu erwartende Sterblich­keit für einen individuellen Empfänger nicht ­ermittelt werden kann. Die Transplantation marginaler ­Organe in Spender mit hohem MELD-Score ­erscheint mit einer höheren Sterblichkeit verbunden zu sein. Insbesondere für die Kombination aus hohem Spenderalter und langer Ischämiezeit oder aus fortgeschrittenem Spenderalter und Hepatitis-C-Infektion des Empfängers konnte eine signifikante Verschlechterung des Organüberlebens nachgewiesen werden. Angesichts des eklatanten Organmangels sollten Anstrengungen unternommen werden, durch Verkürzung der Kaltischämiezeit und die Entwicklung von therapeutischen Strategien die Funktion und Nutzbarmachung marginaler Organe zu erhöhen und dadurch den Spenderpool zu erweitern. Die Ablehnung marginaler Organe auf dem Boden von einzelnen EDC ohne Berücksichtigung des Empfängerstatus erscheint nicht adäquat.

Abstract

The transplantation of marginal organs or those meeting the so-called extended donor criteria (EDC) is today a significant option to alleviate the low availability or organs and to increase the number of transplantation which in turn is ­accompanied by a lower mortality among wait­ing-list patients. However such an extension of the spender pool carries the risks of an increased incidence of organ dysfuntions and a higher recipient mortality. This situation presents an ethical problem when marginal organs are accepted for transplantation because the anticipated mortality for the individual recipient cannot be determined. The transplantation of marginal organs from ­donors with a high MELD score seems to be linked to a higher mortality. In particular, the combina­tions of high donor age and long ischaemic time or advanced donor age and hepatitis C infection in the recipient are definitively associated with a significantly poorer organ survival rate. In view of the serious lack of organs, efforts should be made, for example, by shortening of the is­chae­mic time and the development of therapeutic strategies, to improve the function and increase the number of usable marginal organs and thus to increase pool of donor organs. The refusal of marginal organs on the basis of individual EDC without consideration of the status of recipient does not seem to be adequate.

Schlüsselwörter

Transplantationschirurgie - Organtransplantation - Leberchirurgie - klinische Studie - Abdominalchirurgie

Key words

abdominal surgery - clinical study - liver surgery - organ transplantation - transplantation surgery

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