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Leberersatztherapie

Gesicherte Indikationen bei akutem Leberversagen

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Zusammenfassung

Extrakorporale Leberersatzverfahren sollen die therapeutische Lücke in der Behandlung des akuten Leberversagens schließen. Dieses dynamische Krankheitsbild ist immer noch mit einer hohen Mortalität behaftet. Insbesondere die Entgiftungsfunktion der Leber soll durch eine Vielzahl von Verfahren temporär bis zur Erholung der Leberfunktion oder bis zur Transplantation ersetzt werden. Sowohl rein artifizielle, maschinelle Verfahren mit verschiedenen Formen der Dialyse und Hämadsorbtion bzw. Plasmapherese als auch bioartifizielle Verfahren auf der Basis von Hepatozyten sind in Erprobung. Daneben wurden verschiedene Arten der extrakorporalen Leberperfusion geprüft. Die vorliegende Arbeit gibt einen Überblick über die verfügbare klinische Evidenz der verschiedenen Methoden und Apparaturen, um daraus eine Empfehlung für den Umgang mit den teuren Verfahren abzuleiten. Momentan wird ein Einsatz außerhalb von klinischen Studien an spezialisierten Zentren jedoch nicht empfohlen.

Abstract

Extracorporeal liver support devices aim at improving the therapeutical options for liver failure. Numerous artificial and bioartificial devices have been tested to reduce the high mortality of this dynamic disease. In particular, the detoxification function of the liver should be upheld, by means of a number of different procedures, either until liver function is restored or until transplantation. Both purely artificial, machine-based procedures including different forms of dialysis and hemoadsorption as well as bioartificial procedures based on hepatocytes are being tested, as are different types of extracorporeal liver perfusion. This paper provides an overview of the different methods and devices and their clinical evidence in order to give a recommendation for the handling of the expensive devices. There is no current indication for the application of liver support devices outside of clinical studies at specialised centres.

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Correspondence to M. P. Manns.

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Rifai, K., Ott, M., Bahr, M.M. et al. Leberersatztherapie. Internist 44, 1485–1490 (2003). https://doi.org/10.1007/s00108-003-1076-4

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  • DOI: https://doi.org/10.1007/s00108-003-1076-4

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