nach oben

Langenbeck's Archives of Surgery

Erschienen in:

01.12.2014 | Review Article

Current strategies for immunosuppression following liver transplantation

verfasst von: Daniel Nils Gotthardt, Helge Bruns, Karl Heinz Weiss, Peter Schemmer

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

New strategies for immunosuppression (IS) after liver transplantation (LTx) are in part responsible for the increased patient and graft survival seen over time. With a few basic exceptions—notably the continued use of steroids and calcineurin inhibitors (CNIs)—IS drugs and regimens being used today are different from those used 30 years ago. While graft loss due to acute or chronic rejection has become rare, the side effect burden of IS drugs exerts a significant toll on patients.

Concepts/trends

CNIs continue to form the backbone of IS regimens, although their use is hampered by nephrotoxicity and other adverse effects. Consequently, a variety of CNI reduction or withdrawal strategies have formed the basis of clinical trials or entered into clinical practice. These trials have included the use of everolimus, an mTOR inhibitor, and anti-interleukin-2 receptor antibodies. Basiliximab, as well as other lymphocyte nondepleting and depleting agents, have shown benefit in induction regimens.

Summary

Along with steroid reduction or elimination, current strategies for IS after LTx continue to explore novel combinations of agents, with an aim toward striking a balance between diminution of rejection and the need for avoiding adverse effects of the IS drugs. Long-term maintenance strategies are also discussed in this review, as is development of tolerance and antibody-mediated rejection.

Starzl TE, Groth CG, Brettschneider L, Penn I, Fulginiti VA, Moon JB, Blanchard H et al (1968) Orthotopic homotransplantation of the human liver. Ann Surg 168:392–415PubMedCentralPubMedCrossRef

Adam R, McMaster P, O'Grady JG, Castaing D, Klempnauer JL, Jamieson N, Neuhaus P et al (2003) Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 9:1231–1243. doi:10.1016/j.lts.2003.09.018 PubMedCrossRef

Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K, Abu-Elmagd K et al (2000) Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg 232:490–500PubMedCentralPubMedCrossRef

Schoening WN, Buescher N, Rademacher S, Andreou A, Kuehn S, Neuhaus R, Guckelberger O et al (2013) Twenty-year longitudinal follow-up after orthotopic liver transplantation: a single-center experience of 313 consecutive cases. Am J Transplant 13:2384–2394. doi:10.1111/ajt.12384 PubMedCrossRef

Dienstag JL, Cosimi AB (2012) Liver transplantation—a vision realized. N Engl J Med 367:1483–1485. doi:10.1056/NEJMp1210159 PubMedCrossRef

Alex Bishop G, Bertolino PD, Bowen DG, McCaughan GW (2012) Tolerance in liver transplantation. Best Pract Res Clin Gastroenterol 26:73–84. doi:10.1016/j.bpg.2012.01.003 PubMedCrossRef

Sanchez-Fueyo A (2011) Hot-topic debate on tolerance: immunosuppression withdrawal. Liver Transpl 17(Suppl 3):S69–73. doi:10.1002/lt.22421 PubMedCrossRef

Scherer MN, Banas B, Mantouvalou K, Schnitzbauer A, Obed A, Kramer BK, Schlitt HJ (2007) Current concepts and perspectives of immunosuppression in organ transplantation. Langenbeck's Arch Surg/Deutsche Gesellschaft fur Chirurgie 392:511–523. doi:10.1007/s00423-007-0188-z CrossRef

Londono MC, Rimola A, O'Grady J, Sanchez-Fueyo A (2013) Immunosuppression minimization vs. complete drug withdrawal in liver transplantation. J Hepatol 59:872–879. doi:10.1016/j.jhep.2013.04.003 PubMedCrossRef

10.

Wiesner RH, Fung JJ (2011) Present state of immunosuppressive therapy in liver transplant recipients. Liver Transpl 17(Suppl 3):S1–9. doi:10.1002/lt.22410 PubMedCrossRef

11.

Schlitt HJ, Loss M, Scherer MN, Becker T, Jauch KW, Nashan B, Schmidt H et al (2011) Current developments in liver transplantation in Germany: MELD-based organ allocation and incentives for transplant centres. Z Gastroenterol 49:30–38. doi:10.1055/s-0029-1245946 PubMedCrossRef

12.

Weismuller TJ, Fikatas P, Schmidt J, Barreiros AP, Otto G, Beckebaum S, Paul A et al (2011) Multicentric evaluation of model for end-stage liver disease-based allocation and survival after liver transplantation in Germany—limitations of the 'sickest first'-concept. Transpl Int 24:91–99. doi:10.1111/j.1432-2277.2010.01161.x PubMedCrossRef

13.

Geissler EK, Schlitt HJ (2009) Immunosuppression for liver transplantation. Gut 58:452–463. doi:10.1136/gut.2008.163527 PubMedCrossRef

14.

Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) (2012) OPTN/SRTR 2011 Annual Data Report in Excel. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation. http://srtr.transplant.hrsa.gov/annual_reports/2011/. Accessed 5 January 2014

15.

Rodriguez-Peralvarez M, Germani G, Papastergiou V, Tsochatzis E, Thalassinos E, Luong TV, Rolando N et al (2013) Early tacrolimus exposure after liver transplantation: relationship with moderate/severe acute rejection and long-term outcome. J Hepatol 58:262–270. doi:10.1016/j.jhep.2012.09.019 PubMedCrossRef

16.

Turner AP, Knechtle SJ (2013) Induction immunosuppression in liver transplantation: a review. Transpl Int 26:673–683. doi:10.1111/tri.12100 PubMedCrossRef

17.

Cai J, Terasaki PI (2010) Induction immunosuppression improves long-term graft and patient outcome in organ transplantation: an analysis of United Network for Organ Sharing registry data. Transplant 90:1511–1515. doi:10.1097/TP.0b013e3181fecfcb CrossRef

18.

Mangus RS, Fridell JA, Vianna RM, Kwo PY, Chen J, Tector AJ (2012) Immunosuppression induction with rabbit anti-thymocyte globulin with or without rituximab in 1000 liver transplant patients with long-term follow-up. Liver Transpl 18:786–795. doi:10.1002/lt.23381 PubMedCrossRef

19.

Beckebaum S, Cicinnati VR, Radtke A, Kabar I (2013) Calcineurin inhibitors in liver transplantation—still champions or threatened by serious competitors? Liver Int 33:656–665. doi:10.1111/liv.12133 PubMedCrossRef

20.

Neuhaus P, Clavien PA, Kittur D, Salizzoni M, Rimola A, Abeywickrama K, Ortmann E et al (2002) Improved treatment response with basiliximab immunoprophylaxis after liver transplantation: results from a double-blind randomized placebo-controlled trial. Liver Transpl 8:132–142. doi:10.1053/jlts.2002.30302 PubMedCrossRef

21.

Calmus Y, Scheele JR, Gonzalez-Pinto I, Jaurrieta EJ, Klar E, Pageaux GP, Scudamore CH et al (2002) Immunoprophylaxis with basiliximab, a chimeric anti-interleukin-2 receptor monoclonal antibody, in combination with azathioprine-containing triple therapy in liver transplant recipients. Liver Transpl 8:123–131. doi:10.1053/jlts.2002.30882 PubMedCrossRef

22.

Xing T, Huang L, Yu Z, Zhong L, Wang S, Peng Z (2013) Comparison of steroid-free immunosuppression and standard immunosuppression for liver transplant patients with hepatocellular carcinoma. PLoS One 8:e71251. doi:10.1371/journal.pone.0071251 PubMedCentralPubMedCrossRef

23.

Verna EC, Farrand ED, Elnaggar AS, Pichardo EM, Balducci A, Emond JC, Guarrera JV et al (2011) Basiliximab induction and delayed calcineurin inhibitor initiation in liver transplant recipients with renal insufficiency. Transplant 91:1254–1260. doi:10.1097/TP.0b013e318218f0f5 CrossRef

24.

Levitsky J, Thudi K, Ison MG, Wang E, Abecassis M (2011) Alemtuzumab induction in non-hepatitis C positive liver transplant recipients. Liver Transpl 17:32–37. doi:10.1002/lt.22180 PubMedCrossRef

25.

Rodriguez-Peralvarez M, Germani G, Darius T, Lerut J, Tsochatzis E, Burroughs AK (2012) Tacrolimus trough levels, rejection and renal impairment in liver transplantation: a systematic review and meta-analysis. Am J Transplant 12:2797–2814. doi:10.1111/j.1600-6143.2012.04140.x PubMedCrossRef

26.

Ramirez CB, Doria C, Frank AM, Armenti ST, Marino IR (2013) Completely steroid-free immunosuppression in liver transplantation: a randomized study. Clin Transplant 27:463–471. doi:10.1111/ctr.12119 PubMedCrossRef

27.

De Simone P, Nevens F, De Carlis L, Metselaar HJ, Beckebaum S, Saliba F, Jonas S et al (2012) Everolimus with reduced tacrolimus improves renal function in de novo liver transplant recipients: a randomized controlled trial. Am J Transplant 12:3008–3020. doi:10.1111/j.1600-6143.2012.04212.x PubMedCentralPubMedCrossRef

28.

Rodriguez-Peralvarez M, Manousou P, Lerut J, De la Mata M, Burroughs AK (2013) How much immunosuppression is needed after liver transplantation? Clin Transplant. doi:10.1111/ctr.12242 PubMed

29.

Rodriguez-Peralvarez M, Germani G, Darius T, Lerut J, Tsochatzis E, De la Mata M, Burroughs AK (2013) Tacrolimus exposure after liver transplantation in randomized controlled trials: too much for too long. Am J Transplant 13:1371–1372. doi:10.1111/ajt.12216 PubMedCrossRef

30.

Penninga L, Wettergren A, Chan AW, Steinbruchel DA, Gluud C (2012) Calcineurin inhibitor minimisation versus continuation of calcineurin inhibitor treatment for liver transplant recipients. Cochrane Database Syst Rev 3, CD008852. doi:10.1002/14651858.CD008852.pub2 PubMed

31.

Barbier L, Garcia S, Cros J, Borentain P, Botta-Fridlund D, Paradis V, Le Treut YP et al (2013) Assessment of chronic rejection in liver graft recipients receiving immunosuppression with low-dose calcineurin inhibitors. J Hepatol 59:1223–1230. doi:10.1016/j.jhep.2013.07.032 PubMedCrossRef

32.

Creput C, Blandin F, Deroure B, Roche B, Saliba F, Charpentier B, Samuel D et al (2007) Long-term effects of calcineurin inhibitor conversion to mycophenolate mofetil on renal function after liver transplantation. Liver Transpl 13:1004–1010. doi:10.1002/lt.21170 PubMedCrossRef

33.

Orlando G, Baiocchi L, Cardillo A, Iaria G, De LiguoriCarino N, De Luca L, Ielpo B et al (2007) Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension. Liver Transpl 13:46–54. doi:10.1002/lt.20926 PubMedCrossRef

34.

Boudjema K, Camus C, Saliba F, Calmus Y, Salame E, Pageaux G, Ducerf C et al (2011) Reduced-dose tacrolimus with mycophenolate mofetil vs. standard-dose tacrolimus in liver transplantation: a randomized study. Am J Transplant 11:965–976. doi:10.1111/j.1600-6143.2011.03486.x PubMedCrossRef

35.

Manousou P, Cholongitas E, Samonakis D, Tsochatzis E, Corbani A, Dhillon AP, Davidson J et al (2013) Reduced fibrosis in recurrent HCV with tacrolimus, azathioprine and steroids versus tacrolimus: randomised trial long term outcomes. Gut. doi:10.1136/gutjnl-2013-305606 PubMedCentralPubMed

36.

De Simone P, Carrai P, Precisi A, Petruccelli S, Baldoni L, Balzano E, Ducci J et al (2009) Conversion to everolimus monotherapy in maintenance liver transplantation: feasibility, safety, and impact on renal function. Transpl Int 22:279–286. doi:10.1111/j.1432-2277.2008.00768.x PubMedCrossRef

37.

Fischer L, Klempnauer J, Beckebaum S, Metselaar HJ, Neuhaus P, Schemmer P, Settmacher U et al (2012) A randomized, controlled study to assess the conversion from calcineurin-inhibitors to everolimus after liver transplantation—PROTECT. Am J Transplant 12:1855–1865. doi:10.1111/j.1600-6143.2012.04049.x PubMedCrossRef

38.

Masetti M, Montalti R, Rompianesi G, Codeluppi M, Gerring R, Romano A, Begliomini B et al (2010) Early withdrawal of calcineurin inhibitors and everolimus monotherapy in de novo liver transplant recipients preserves renal function. Am J Transplant 10:2252–2262. doi:10.1111/j.1600-6143.2010.03128.x PubMedCrossRef

39.

De Simone P, Metselaar HJ, Fischer L, Dumortier J, Boudjema K, Hardwigsen J, Rostaing L et al (2009) Conversion from a calcineurin inhibitor to everolimus therapy in maintenance liver transplant recipients: a prospective, randomized, multicenter trial. Liver Transpl 15:1262–1269. doi:10.1002/lt.21827 PubMedCrossRef

40.

Saliba F, De Simone P, Nevens F, De Carlis L, Metselaar HJ, Beckebaum S, Jonas S et al (2013) Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study. Am J Transplant 13:1734–1745. doi:10.1111/ajt.12280 PubMedCrossRef

41.

Vallin M, Guillaud O, Morard I, Gagnieu MC, Mentha G, Adham M, Morelon E et al (2011) Tolerability of everolimus-based immunosuppression in maintenance liver transplant recipients. Clin Transplant 25:660–669. doi:10.1111/j.1399-0012.2010.01370.x PubMedCrossRef

42.

Sterneck M, Kaiser GM, Heyne N, Richter N, Rauchfuss F, Pascher A, Schemmer P et al (2014) Everolimus and early calcineurin inhibitor withdrawal: 3-year results from a randomized trial in liver transplantation. Am J Transplant. doi:10.1111/ajt.12615 PubMed

43.

Yamanaka K, Petrulionis M, Lin S, Gao C, Galli U, Richter S, Winkler S et al (2013) Therapeutic potential and adverse events of everolimus for treatment of hepatocellular carcinoma—systematic review and meta-analysis. Cancer Med 2:862–871. doi:10.1002/cam4.150 PubMedCentralPubMedCrossRef

44.

Abdelmalek MF, Humar A, Stickel F, Andreone P, Pascher A, Barroso E, Neff GW et al (2012) Sirolimus conversion regimen versus continued calcineurin inhibitors in liver allograft recipients: a randomized trial. Am J Transplant 12:694–705. doi:10.1111/j.1600-6143.2011.03919.x PubMedCrossRef

45.

Teperman L, Moonka D, Sebastian A, Sher L, Marotta P, Marsh C, Koneru B et al (2013) Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial. Liver Transpl 19:675–689. doi:10.1002/lt.23658 PubMedCrossRef

46.

Dumortier J, Guillaud O, Boillot O (2013) Conversion from twice daily tacrolimus to once daily tacrolimus in long-term stable liver transplant recipients: a single-center experience with 394 patients. Liver Transpl 19:529–533. doi:10.1002/lt.23638 PubMedCrossRef

47.

Heffron TG, Pescovitz MD, Florman S, Kalayoglu M, Emre S, Smallwood G, Wisemandle K et al (2007) Once-daily tacrolimus extended-release formulation: 1-year post-conversion in stable pediatric liver transplant recipients. Am J Transplant 7:1609–1615. doi:10.1111/j.1600-6143.2007.01803.x PubMedCrossRef

48.

Trunecka P, Boillot O, Seehofer D, Pinna AD, Fischer L, Ericzon BG, Troisi RI et al (2010) Once-daily prolonged-release tacrolimus (ADVAGRAF) versus twice-daily tacrolimus (PROGRAF) in liver transplantation. Am J Transplant 10:2313–2323. doi:10.1111/j.1600-6143.2010.03255.x PubMedCrossRef

49.

Sgourakis G, Radtke A, Fouzas I, Mylona S, Goumas K, Gockel I, Lang H et al (2009) Corticosteroid-free immunosuppression in liver transplantation: a meta-analysis and meta-regression of outcomes. Transpl Int 22:892–905. doi:10.1111/j.1432-2277.2009.00893.x PubMedCrossRef

50.

Segev DL, Sozio SM, Shin EJ, Nazarian SM, Nathan H, Thuluvath PJ, Montgomery RA et al (2008) Steroid avoidance in liver transplantation: meta-analysis and meta-regression of randomized trials. Liver Transpl 14:512–525. doi:10.1002/lt.21396 PubMedCrossRef

51.

Moench C, Barreiros AP, Schuchmann M, Bittinger F, Thiesen J, Hommel G, Kraemer I et al (2007) Tacrolimus monotherapy without steroids after liver transplantation—a prospective randomized double-blinded placebo-controlled trial. Am J Transplant 7:1616–1623. doi:10.1111/j.1600-6143.2007.01804.x PubMedCrossRef

52.

Weiler N, Thrun I, Hoppe-Lotichius M, Zimmermann T, Kraemer I, Otto G (2010) Early steroid-free immunosuppression with FK506 after liver transplantation: long-term results of a prospectively randomized double-blinded trial. Transplantation 90:1562–1566. doi:10.1097/TP.0b013e3181ff8794 PubMedCrossRef

53.

Lerut J, Mathys J, Verbaandert C, Talpe S, Ciccarelli O, Lemaire J, Bonaccorsi-Riani E et al (2008) Tacrolimus monotherapy in liver transplantation: one-year results of a prospective, randomized, double-blind, placebo-controlled study. Ann Surg 248:956–967. doi:10.1097/SLA.0b013e31819009c9 PubMedCrossRef

54.

Manzia TM, Toti L, Angelico R, Di Cocco P, Orlando G, Tisone G (2010) Steroid-free immunosuppression after liver transplantation does not increase the risk of graft fibrosis. Transplant Proc 42:1237–1239. doi:10.1016/j.transproceed.2010.03.118 PubMedCrossRef

55.

Klintmalm GB, Davis GL, Teperman L, Netto GJ, Washburn K, Rudich SM, Pomfret EA et al (2011) A randomized, multicenter study comparing steroid-free immunosuppression and standard immunosuppression for liver transplant recipients with chronic hepatitis C. Liver Transpl 17:1394–1403. doi:10.1002/lt.22417 PubMedCrossRef

56.

Zaydfudim V, Feurer ID, Landman MP, Moore DE, Wright JK, Pinson CW (2012) Reduction in corticosteroids is associated with better health-related quality of life after liver transplantation. J Am Coll Surg 214:164–173. doi:10.1016/j.jamcollsurg.2011.10.006 PubMedCrossRef

57.

Saliba F, Dharancy S, Lorho R, Conti F, Radenne S, Neau-Cransac M, Hurtova M et al (2011) Conversion to everolimus in maintenance liver transplant patients: a multicenter, retrospective analysis. Liver Transpl 17:905–913. doi:10.1002/lt.22292 PubMedCrossRef

58.

Wiesner RH, Shorr JS, Steffen BJ, Chu AH, Gordon RD, Lake JR (2005) Mycophenolate mofetil combination therapy improves long-term outcomes after liver transplantation in patients with and without hepatitis C. Liver Transpl 11:750–759. doi:10.1002/lt.20453 PubMedCrossRef

59.

Schmeding M, Kiessling A, Neuhaus R, Heidenhain C, Bahra M, Neuhaus P, Neumann UP (2011) Mycophenolate mofetil monotherapy in liver transplantation: 5-year follow-up of a prospective randomized trial. Transplant 92:923–929. doi:10.1097/TP.0b013e31822d880d CrossRef

60.

Chandrasekharan D, Issa F, Wood KJ (2013) Achieving operational tolerance in transplantation: how can lessons from the clinic inform research directions? Transpl Int 26:576–589. doi:10.1111/tri.12081 PubMedCrossRef

61.

Porrett P, Shaked A (2011) The failure of immunosuppression withdrawal: patient benefit is not detectable, inducible, or reproducible. Liver Transpl 17(Suppl 3):S66–68. doi:10.1002/lt.22377 PubMedCrossRef

62.

Feng S, Ekong UD, Lobritto SJ, Demetris AJ, Roberts JP, Rosenthal P, Alonso EM et al (2012) Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants. Jama 307:283–293. doi:10.1001/jama.2011.2014 PubMedCrossRef

63.

Benitez C, Londono MC, Miquel R, Manzia TM, Abraldes JG, Lozano JJ, Martinez-Llordella M et al (2013) Prospective multicenter clinical trial of immunosuppressive drug withdrawal in stable adult liver transplant recipients. Hepatology. doi:10.1002/hep.26426

64.

Martinez-Llordella M, Puig-Pey I, Orlando G, Ramoni M, Tisone G, Rimola A, Lerut J et al (2007) Multiparameter immune profiling of operational tolerance in liver transplantation. Am J Transplant 7:309–319. doi:10.1111/j.1600-6143.2006.01621.x PubMedCrossRef

65.

de la Garza RG, Sarobe P, Merino J, Lasarte JJ, D'Avola D, Belsue V, Delgado JA et al (2013) Trial of complete weaning from immunosuppression for liver transplant recipients: factors predictive of tolerance. Liver Transpl 19:937–944. doi:10.1002/lt.23686 PubMedCrossRef

66.

Paterno F, Shiller M, Tillery G, O'Leary JG, Susskind B, Trotter J, Klintmalm GB (2012) Bortezomib for acute antibody-mediated rejection in liver transplantation. Am J Transplant 12:2526–2531. doi:10.1111/j.1600-6143.2012.04126.x PubMedCrossRef

67.

Abu-Elmagd KM, Wu G, Costa G, Lunz J, Martin L, Koritsky DA, Murase N et al (2012) Preformed and de novo donor specific antibodies in visceral transplantation: long-term outcome with special reference to the liver. Am J Transplant 12:3047–3060. doi:10.1111/j.1600-6143.2012.04237.x PubMedCrossRef

Titel: Current strategies for immunosuppression following liver transplantation
verfasst von: Daniel Nils Gotthardt
Helge Bruns
Karl Heinz Weiss
Peter Schemmer
Publikationsdatum: 01.12.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 8/2014
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1191-9

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Concepts/trends

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2014

Surgical strategy for primary hyperparathyreoidism with thyroid hemiagenesis

The benefits of liver resection for non-colorectal, non-neuroendocrine liver metastases: a systematic review

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

Liver failure after hepatocellular carcinoma surgery

Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era

Surgical treatment of extrahepatic recurrence of hepatocellular carcinoma

Update Chirurgie