Lebertransplantation und Lebendspende bei Tumoren

Zusammenfassung

Lebertransplantation stellt für selektionierte Patienten mit bestimmen histologischen Typen von nicht resektablen Lebertumoren eine etablierte therapeutische Option dar. Bei den primären Tumoren handelt es sich hauptsächlich um hepatozelluläre Karzinome und im Einzelfall auch um cholangiozelluläre Karzinome. Die Indikation zur Transplantation besteht bei Lebermetastasen neuroendokriner Tumoren und der gastrointestinalen Stromatumoren. Für das hepatozelluläre Karzinom ist die Lebertransplantation theoretisch die beste Behandlung, da dabei sowohl das potenziell multizentrisch wachsende Karzinom als auch die häufig begleitende Leberzirrhose radikal beseitigt werden. Wegen des Mangels an Spenderorganen ist es wichtig Kriterien zu definieren, die eine Selektion geeigneter Transplantationskandidaten erlauben. Lebendorganlebertransplantation umgeht die Problematik des Organmangels und bietet die Möglichkeit die geltenden Transplantationskriterien zu erweitern. Die Sicherheit des Spenders nimmt den zentralen Stellenwert in diesem neuen Therapiekonzept ein.

Abstract

Liver transplantation is a generally accepted therapeutic option for selected non resectable primary liver tumors and liver metastases. In general, patients with small hepatocellular carcinoma in hepatitis associated liver cirrhosis and selected patients with cholangiocellular carcinoma are candidates for liver transplantation. Liver transplantation might be also indicated in hepatic metastases of neuroendocrine tumors or gastrointestinal stroma tumors. For hepatocellular carcinoma liver transplantation presents the best therapeutic option since it provides radical tumor elimination and normal liver function. Due to worldwide organ shortage criteria for selection of suitable candidates for transplantation are necessary. Living donor organ transplantation omits the problem of waiting time for a suitable graft and offers a possibility of expansion of criteria for transplantation in tumor patients. Donor safety presents a key issue of this new therapeutic strategy.

Schlüsselwörter

Primäre und sekundäre Lebertumoren - Lebertransplantation - Lebendorganspende

Key words

Primary and secondary liver tumors - liver transplantation - living donation

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