Organersatzverfahren - Leberunterstützungsverfahren

Zusammenfassung

Das Leberversagen geht mit einer hohen Mortalität einher. Oftmals ist eine Lebertransplantation das einzige kurative Verfahren. Seit Langem wird versucht, mittels Leberunterstützungsverfahren einerseits der Leber eine Regeneration zu ermöglichen, andererseits ein Bridging zur Transplantation zu erreichen. Der Artikel stellt die klinisch eingesetzten Verfahren vor (Molecular-Adsorbent-Recirculating-System [MARS], Prometheus-System, Single-Pass-Albumin-Dialyse [SPAD], Plasmapherese) und diskutiert deren Einsatzmöglichkeiten im Rahmen des Leberversagens.

Abstract

Liver failure is a disease with a high mortality rate. Often liver transplantation is the sole therapeutic option. On the one hand, liver support systems probably support the liver to allow regeneration, on the other hand they are an option to bridge for transplantation. This article gives an overview on the clinically used liver assist devices (molecular adsorbent recirculating system [MARS], Prometheus system, single-pass albumin dialysis [SPAD], plasmapheresis) and discusses the applications in liver failure.

Kernaussagen

• Das akute Leberversagen oder die Dekompensation einer chronischen Leberinsuffizienz gehen mit einer hohen Morbidität und Mortalität einher.

• Es gibt zellfreie, zellbasierte und Hybrid-Leberersatzverfahren, wobei bisher nur die zellfreien Verfahren zugelassen sind.

• Zu den zellfreien Systemen zählen das MARS (Molecular-Adsorbent-Recirculating-System), das Prometheus-System (Fractional-Plasma-Separation-Adsorption-and-Dialysis-System), das SPAD-System (Single-Pass-Albumin-Dialyse) und die Plasmapherese.

• Mit den Leberunterstützungsverfahren kann eine Reduktion des Bilirubins sowie ein positiver Effekt bei bestimmten Intoxikationen, bei Morbus-Wilson-Krisen und bei therapierefraktärem Juckreiz erreicht werden.

• Mögliche Nebenwirkungen sind Gerinnungsstörungen, hämodynamische Instabilität und katheterassoziierte Blutungen und Infektionen.

• Für keines der zugelassenen Leberunterstützungsverfahren konnte in plazebokontrollierten Studien eine Senkung der Mortalität nachgewiesen werden.

Schlüsselwörter:

Leberversagen - Molecular-Adsorbent-Recirculating-System (MARS) - Prometheus-System - Fractional-Plasma-Separation-Adsorption-and-Dialysis-System - Single-Pass-Albumin-Dialyse (SPAD) - Plasmapherese

Keywords:

liver failure - molecular adsorbent recirculating system (MARS) - Prometheus system - fractional plasma separation adsorption and dialysis system - single-pass albumin dialysis - plasmapheresis

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