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Lifrarígræðsla

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Authors
Sigurður Ólafsson
Issue Date
2000-09-01

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Other Titles
Liver transplantaion
Citation
Læknablaðið 2000, 86(9):579-82
Abstract
In recent years, liver transplantation has become the treatment of choice for end-stage liver disease. Chronic viral hepatitis, alcoholic cirrhosis and chronic cholestatic diseases are the most common liver diseases requiring transplantation. Complications of cirrhosis such as variceal bleeding are important indications. Prognostic survival models are also used to determine the optimal timing of transplantation. Pretransplant evaluation is designed to assess the patients general health and the condition of the vital organs. The operation is complicated but most patients recover rapidly. Postoperative complications such as hepatic artery thrombosis may require retransplantation. Following transplantation, the patient is maintained on a regimen of immunosuppressive medications. Acute cellular rejection is common but usually responds to additional immunosuppression. One and five years survival has increased to 80-90% and 65-70% respectively. Recurrent liver disease is a common problem but rarely affects short term survival. Several Icelandic patients have undergone liver transplantation. Indications are similar to other European countries.
Lifrarígræðsla hefur á undanförnum árum valdið byltingu í meðferð bráðra og langvinnra lifrarsjúkdóma á lokastigi. Árlega eru nú framkvæmdar þúsundir slíkra aðgerða. Algengustu sjúkdómarnir eru langvinnar lifrarbólgur af völdum veira, skorpulifur af völdum áfengis og langvinnir gallvegasjúkdómar. Fylgikvillar skorpulifrar svo sem blæðingar frá æðagúlum eru algengar ábendingar en við mat á ígræðsluþörf er einnig stuðst við flokkanir og reiknilíkön sem spá fyrir um lifun sjúklinga. Fyrir aðgerð er oft þörf ítarlegra rannsókna til þess að kanna hvort sjúklingurinn þoli aðgerðina. Aðgerðin sjálf er allflókin en sjúklingar ná sér oftast fljótt. Margir fá bráða höfnun en hún er oftast auðveld viðureignar. Veitt er ónæmisbælandi meðferð ævilangt. Lifun sjúklinga sem fengið hafa nýja lifur hefur batnað stöðugt á undanförnum árum. Eins árs lifun er 80-90% og fimm ára lifun 65-70%. Endurkoma sjúkdóms í hina nýju lifur er algengt vandamál en hefur lítil áhrif á lifun fyrstu árin. Nokkrir Íslendingar hafa gengist undir lifrarskipti og eru ábendingar svipaðar og annars staðar í Evrópu.
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