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Erschienen in: Der Gastroenterologe 4/2019

14.05.2019 | Graft-versus-Host-Krankheit | Schwerpunkt

Langzeitkomplikationen nach viszeraler Organtransplantation

verfasst von: F. Darstein, Prof. Dr. T. Zimmermann, MHBA, H. Lang

Erschienen in: Die Gastroenterologie | Ausgabe 4/2019

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Zusammenfassung

Die Prävention und die Behandlung von Langzeitkomplikationen nach viszeraler Organtransplantation gewinnen im Kontext von Organmangel und steigenden Überlebensraten zunehmend an Bedeutung. Der vorliegende Artikel gibt eine Übersicht über die verfügbare Literatur, Leitlinien und Expertenempfehlungen zu diesem Thema. Die Rekurrenz der Grunderkrankung, Infektionen, maligne Erkrankungen und kardiovaskuläre Ereignisse stellen die Hauptursachen für eine erhöhte Mortalität im Langzeitverlauf nach viszeraler Organtransplantation dar. Erkrankungen wie Diabetes mellitus, arterielle Hypertonie, Adipositas und Hyperlipidämie treten im Vergleich zur Normalbevölkerung gehäuft auf. Weiterhin müssen Abstoßungsreaktionen in Betracht gezogen werden. Eine adäquate Evaluation vor Lebertransplantation sowie eine intensive postoperative Nachsorge mit regelmäßigem Screening auf Langzeitkomplikationen sowie deren Therapie ist notwendig, um das Langzeitüberleben nach viszeraler Organtransplantation zu optimieren.
Literatur
2.
Zurück zum Zitat Gambato M, Frigo AC, Rodríguez Castro, Kryssia I, Senzolo M, Nadal E, D’Amico F et al (2013) Who fares worse after liver transplantation? Impact of donor and recipient variables on outcome: data from a prospective study. Transplantation 95(12):1528–1534CrossRef Gambato M, Frigo AC, Rodríguez Castro, Kryssia I, Senzolo M, Nadal E, D’Amico F et al (2013) Who fares worse after liver transplantation? Impact of donor and recipient variables on outcome: data from a prospective study. Transplantation 95(12):1528–1534CrossRef
3.
Zurück zum Zitat Watson CJE, Dark JH (2012) Organ transplantation: historical perspective and current practice. Br J Anaesth 108(1):29–42CrossRef Watson CJE, Dark JH (2012) Organ transplantation: historical perspective and current practice. Br J Anaesth 108(1):29–42CrossRef
4.
Zurück zum Zitat Gondos A, Döhler B, Brenner H, Opelz G (2013) Kidney graft survival in Europe and the United States: strikingly different long-term outcomes. Transplantation 95(2):267–274CrossRef Gondos A, Döhler B, Brenner H, Opelz G (2013) Kidney graft survival in Europe and the United States: strikingly different long-term outcomes. Transplantation 95(2):267–274CrossRef
5.
Zurück zum Zitat Adam R, Karam V, Delvart V, O’Grady J, Mirza D, Klempnauer J et al (2012) Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 57(3):675–688CrossRef Adam R, Karam V, Delvart V, O’Grady J, Mirza D, Klempnauer J et al (2012) Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 57(3):675–688CrossRef
6.
Zurück zum Zitat Gelson W, Hoare M, Dawwas MF, Vowler S, Gibbs P, Alexander G (2011) The pattern of late mortality in liver transplant recipients in the United Kingdom. Transplantation 91(11):1240–1244CrossRef Gelson W, Hoare M, Dawwas MF, Vowler S, Gibbs P, Alexander G (2011) The pattern of late mortality in liver transplant recipients in the United Kingdom. Transplantation 91(11):1240–1244CrossRef
7.
Zurück zum Zitat Anastácio LR, Ribeiro, Hélem de Sena, Ferreira LG, Lima AS, Vilela EG, Toulson Davisson Correia, María I (2013) Incidence and risk factors for diabetes, hypertension and obesity after liver transplantation. Nutr Hosp 28(3):643–648PubMed Anastácio LR, Ribeiro, Hélem de Sena, Ferreira LG, Lima AS, Vilela EG, Toulson Davisson Correia, María I (2013) Incidence and risk factors for diabetes, hypertension and obesity after liver transplantation. Nutr Hosp 28(3):643–648PubMed
8.
Zurück zum Zitat Watt KDS, Pedersen RA, Kremers WK, Heimbach JK, Charlton MR (2010) Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 10(6):1420–1427CrossRef Watt KDS, Pedersen RA, Kremers WK, Heimbach JK, Charlton MR (2010) Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 10(6):1420–1427CrossRef
9.
Zurück zum Zitat Pham PT, Pham PT, Pham SV, Pham PT, Pham PT (2011) New onset diabetes after transplantation (NODAT): an overview. Diabetes Metab Syndr Obes Targets Ther 4:175–186CrossRef Pham PT, Pham PT, Pham SV, Pham PT, Pham PT (2011) New onset diabetes after transplantation (NODAT): an overview. Diabetes Metab Syndr Obes Targets Ther 4:175–186CrossRef
11.
Zurück zum Zitat Nicolau-Raducu R, Gitman M, Ganier D, Loss GE, Cohen AJ, Patel H et al (2015) Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 21(1):13–21 Nicolau-Raducu R, Gitman M, Ganier D, Loss GE, Cohen AJ, Patel H et al (2015) Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 21(1):13–21
12.
Zurück zum Zitat Gillis KA, Patel RK, Jardine AG (2014) Cardiovascular complications after transplantation: treatment options in solid organ recipients. Transplant Rev (Orlando) 28(2):47–55CrossRef Gillis KA, Patel RK, Jardine AG (2014) Cardiovascular complications after transplantation: treatment options in solid organ recipients. Transplant Rev (Orlando) 28(2):47–55CrossRef
13.
Zurück zum Zitat Fussner LA, Heimbach JK, Fan C, Dierkhising R, Coss E, Leise MD et al (2015) Cardiovascular disease after liver transplantation: When, What, and Who Is at Risk. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 21(7):889–896 Fussner LA, Heimbach JK, Fan C, Dierkhising R, Coss E, Leise MD et al (2015) Cardiovascular disease after liver transplantation: When, What, and Who Is at Risk. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 21(7):889–896
14.
Zurück zum Zitat Vanwagner LB, Bhave M, Te HS, Feinglass J, Alvarez L, Rinella ME (2012) Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events. Hepatology 56(5):1741–1750CrossRef Vanwagner LB, Bhave M, Te HS, Feinglass J, Alvarez L, Rinella ME (2012) Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events. Hepatology 56(5):1741–1750CrossRef
15.
Zurück zum Zitat Wanner C, Tonelli M (2014) KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int 85(6):1303–1309CrossRef Wanner C, Tonelli M (2014) KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int 85(6):1303–1309CrossRef
16.
Zurück zum Zitat Neuberger JM, Bechstein WO, Kuypers DRJ, Burra P, Citterio F, de Geest S et al (2017) Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation 101(4):1–56CrossRef Neuberger JM, Bechstein WO, Kuypers DRJ, Burra P, Citterio F, de Geest S et al (2017) Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation 101(4):1–56CrossRef
17.
Zurück zum Zitat Fishman JA (2013) Opportunistic infections—coming to the limits of immunosuppression? Cold Spring Harb Perspect Med 3(10):a15669CrossRef Fishman JA (2013) Opportunistic infections—coming to the limits of immunosuppression? Cold Spring Harb Perspect Med 3(10):a15669CrossRef
18.
Zurück zum Zitat Budde K, Matz M, Dürr M, Glander P (2011) Biomarkers of over-immunosuppression. Int J Clin Pharmacol Ther 90(2):316–322CrossRef Budde K, Matz M, Dürr M, Glander P (2011) Biomarkers of over-immunosuppression. Int J Clin Pharmacol Ther 90(2):316–322CrossRef
19.
Zurück zum Zitat Londoño M, Rimola A, O’Grady J, Sanchez-Fueyo A (2013) Immunosuppression minimization vs. complete drug withdrawal in liver transplantation. J Hepatol 59(4):872–879CrossRef Londoño M, Rimola A, O’Grady J, Sanchez-Fueyo A (2013) Immunosuppression minimization vs. complete drug withdrawal in liver transplantation. J Hepatol 59(4):872–879CrossRef
20.
Zurück zum Zitat Demetris AJ, Bellamy C, Hübscher SG, O’Leary J, Randhawa PS, Feng S et al (2016) 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 16(10):2816–2835CrossRef Demetris AJ, Bellamy C, Hübscher SG, O’Leary J, Randhawa PS, Feng S et al (2016) 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 16(10):2816–2835CrossRef
21.
Zurück zum Zitat Levitsky J, Goldberg D, Smith AR, Mansfield SA, Gillespie BW, Merion RM et al (2017) Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients. Clinical gastroenterology and hepatology the official clinical practice journal of the American Gastroenterological. Association 15(4):584–593.e2 Levitsky J, Goldberg D, Smith AR, Mansfield SA, Gillespie BW, Merion RM et al (2017) Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients. Clinical gastroenterology and hepatology the official clinical practice journal of the American Gastroenterological. Association 15(4):584–593.e2
22.
Zurück zum Zitat Wiesner RH, Fung JJ (2011) Present state of immunosuppressive therapy in liver transplant recipients. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 17(3):1–9 Wiesner RH, Fung JJ (2011) Present state of immunosuppressive therapy in liver transplant recipients. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 17(3):1–9
23.
Zurück zum Zitat Collett D, Mumford L, Banner NR, Neuberger J, Watson C (2010) Comparison of the incidence of malignancy in recipients of different types of organ: a UK Registry audit. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 10(8):1889–1896CrossRef Collett D, Mumford L, Banner NR, Neuberger J, Watson C (2010) Comparison of the incidence of malignancy in recipients of different types of organ: a UK Registry audit. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 10(8):1889–1896CrossRef
24.
Zurück zum Zitat Wimmer CD, Angele MK, Schwarz B, Pratschke S, Rentsch M, Khandoga A et al (2013) Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. Transpl Int Off J Eur Soc Organ Transplant 26(10):999–1006CrossRef Wimmer CD, Angele MK, Schwarz B, Pratschke S, Rentsch M, Khandoga A et al (2013) Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. Transpl Int Off J Eur Soc Organ Transplant 26(10):999–1006CrossRef
25.
Zurück zum Zitat Chak E, Saab S (2010) Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic review. Liver Int Off J Int Assoc Study Liver 30(9):1247–1258CrossRef Chak E, Saab S (2010) Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic review. Liver Int Off J Int Assoc Study Liver 30(9):1247–1258CrossRef
26.
Zurück zum Zitat Fischer L, Saliba F, Kaiser GM, de Carlis L, Metselaar HJ, de Simone P et al (2015) Three-year Outcomes in De Novo Liver Transplant Patients Receiving Everolimus With Reduced Tacrolimus: Follow-Up Results From a Randomized, Multicenter Study. Transplantation 99(7):1455–1462CrossRef Fischer L, Saliba F, Kaiser GM, de Carlis L, Metselaar HJ, de Simone P et al (2015) Three-year Outcomes in De Novo Liver Transplant Patients Receiving Everolimus With Reduced Tacrolimus: Follow-Up Results From a Randomized, Multicenter Study. Transplantation 99(7):1455–1462CrossRef
27.
Zurück zum Zitat TruneČka P, Klempnauer J, Bechstein WO, Pirenne J, Friman S, Zhao A et al (2015) Renal Function in De Novo Liver Transplant Recipients Receiving Different Prolonged-Release Tacrolimus Regimens-The DIAMOND Study. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 15(7):1843–1854CrossRef TruneČka P, Klempnauer J, Bechstein WO, Pirenne J, Friman S, Zhao A et al (2015) Renal Function in De Novo Liver Transplant Recipients Receiving Different Prolonged-Release Tacrolimus Regimens-The DIAMOND Study. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 15(7):1843–1854CrossRef
28.
Zurück zum Zitat Macías-Gómez C, Dumonceau J (2015) Endoscopic management of biliary complications after liver transplantation: An evidence-based review. World J Gastrointest Endosc 7(6):606–616CrossRef Macías-Gómez C, Dumonceau J (2015) Endoscopic management of biliary complications after liver transplantation: An evidence-based review. World J Gastrointest Endosc 7(6):606–616CrossRef
29.
Zurück zum Zitat Nasralla D, Coussios CC, Mergental H, Akhtar MZ, Butler AJ, Ceresa CDL et al (2018) A randomized trial of normothermic preservation in liver transplantation. Nature 557(7703):50–56CrossRef Nasralla D, Coussios CC, Mergental H, Akhtar MZ, Butler AJ, Ceresa CDL et al (2018) A randomized trial of normothermic preservation in liver transplantation. Nature 557(7703):50–56CrossRef
30.
Zurück zum Zitat Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E et al (2013) Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 19(1):3–26 Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E et al (2013) Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 19(1):3–26
31.
Zurück zum Zitat Schoening WN, Buuescher N, Rademacher S et al (2013) Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases. WN et al. Am J Transplant 2013(13):2834–2394 Schoening WN, Buuescher N, Rademacher S et al (2013) Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases. WN et al. Am J Transplant 2013(13):2834–2394
Metadaten
Titel
Langzeitkomplikationen nach viszeraler Organtransplantation
verfasst von
F. Darstein
Prof. Dr. T. Zimmermann, MHBA
H. Lang
Publikationsdatum
14.05.2019

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