Lebertransplantation mit postmortalen Organen

Abstract

Deceased donor liver transplantation is nowadays a routine procedure for the treatment of terminal liver failure and often represents the only chance of a cure. Under given optimal conditions excellent long-term results can be obtained with 15-year survival rates of well above 60 %.In Germany the outcome after liver transplantation has deteriorated since the introduction of an allocation policy, which is based on the medical urgency. At present 25 % of liver graft recipients die within the first year after transplantation. In contrast 1-year survival in most other countries, e.g. in the USA or the United Kingdom is around 90 % and therefore significantly better. Reasons for the inferior results in Germany are on the one hand an increasing number of critically ill recipients and on the other hand an unfavorable situation for organ donation. In comparison with other countries the organ donation rate is low and moreover the risk profile of these donors is above average. This combination of organ shortage and organ allocation represents a big challenge for the future orientation of liver transplantation and creates the potential for conflict. These cannot be solved on a medical basis but require a social consensus.Because of the present inferior results and because of the high expenses of the present system we suggest a discussion on future allocation policies as well as on future centre structures in Germany. In addition to the medical urgency the maximum benefit should also be considered for organ allocation.

Volume and outcome relation in German liver transplant centers: what lessons can be learned?

“…We propose the definition of a quality catalogue that includes accuracy of reporting to AQUA, success rate represented by 1-year patient and graft survival data [15], incidence of re-transplantations and audit results. Certification of centers with an evaluated minimum standard infrastructure, structured education of transplant specialists and reconsideration of budgeting of transplant medicine are further important steps that need to be accomplished.…”

Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era?

“…The limited amount of donor organs led to the implementation of different liver allocation policies[ 10 , 11 ] and a more liberal acceptance of extended criteria donor (ECD) organs[ 12 , 13 ]. The implementation of Model for end-stage liver disease (MELD) allocation in 2006 within the Eurotransplant area has reduced waiting list mortality to about 10%[ 14 ], but has also increased the one-year mortality in many European centers, e.g ., at our center from 8.2% to about 17.4%[ 15 ]. Donor-recipient-matching has become crucial to achieving reasonable one year mortality[ 16 ] and acceptable waiting list mortality, especially when allocating marginal organs to progressively sicker recipients.…”

The new liver allocation score for transplantation is validated and improved transplant survival benefit in Germany but not in the United Kingdom

“…(1)(2)(3)(4)(5)(6)(7)(8)12) This study was also prompted by concerns over the outcomes after liver transplantation in Germany compared with those in the United States and the United Kingdom (14) that had become more apparent since the introduction of Model for End-Stage Liver Disease (MELD) score-based donor liver allocation policies in Germany at the end of 2006. (16)(17)(18) The patient survival rate after 1 year is currently only 72% in Germany, which is 20% lower than in the United States and the United Kingdom; Germany has more transplant centers and fewer organ donors per capita. (14) In the United Kingdom, there is a widely accepted and applied consensus to transplant only those patients who have a realistic chance of surviving more than 5 years after transplantation, so centers are trying to balance need with utility and benefit.…”