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CC BY 4.0 · Zentralbl Chir 2025; 150(03): 256-260
DOI: 10.1055/a-2563-3691
Thoraxchirurgie
Übersicht

Indikationsspektrum zur Lungentransplantation – Weiterentwicklungen seit den letzten ISHLT-Empfehlungen

Indications for Lung Transplantation – Updates Since the Last ISHLT Recommendations
Zsofia Kovacs
1   Thoraxchirurgie, Medizinische Universität Wien, Wien, Österreich (Ringgold ID: RIN27271)
,
Alberto Benazzo
1   Thoraxchirurgie, Medizinische Universität Wien, Wien, Österreich (Ringgold ID: RIN27271)
,
Peter Jaksch
1   Thoraxchirurgie, Medizinische Universität Wien, Wien, Österreich (Ringgold ID: RIN27271)
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Zusammenfassung

Die Lungentransplantation hat sich seit ihren ersten erfolgreichen Verfahren in den 1960er-Jahren kontinuierlich weiterentwickelt. Die aktuellen Empfehlungen der International Society for Heart and Lung Transplantation (ISHLT) betonen eine zunehmend individualisierte Patientenbewertung, die neben der zugrunde liegenden Lungenerkrankung auch Faktoren wie Begleiterkrankungen, Gebrechlichkeit, Alter und soziale Aspekte berücksichtigt. Die erweiterten Indikationen für Lungentransplantationen spiegeln sich in der verfeinerten Risikobewertung wider, die insbesondere Patienten mit fortgeschrittener chronisch obstruktiver Lungenerkrankung (COPD), idiopathischer pulmonaler Fibrose (IPF) und pulmonaler arterieller Hypertonie (PAH) einbezieht. Zudem wurden die Kriterien für Patienten mit einer Krebserkrankung in der Vorgeschichte sowie solchen mit Infektionen wie HIV oder multiresistenten Erregern flexibilisiert, was zu einer inklusiveren Transplantationspolitik führt. Ein wesentlicher Schwerpunkt liegt auf der frühzeitigen Transplantationsberatung, um den Patienten vor der Entwicklung von akuten Exazerbationen die Möglichkeit einer Transplantation zu eröffnen. Diese aktualisierten Richtlinien zielen darauf ab, sowohl die Überlebensraten als auch die Lebensqualität der Transplantationspatienten durch eine differenzierte und risikoangepasste Entscheidungsfindung zu maximieren.

Abstract

Lung transplantation has evolved continuously since its first successful procedures in the 1960 s. The current guidelines from the International Society for Heart and Lung Transplantation (ISHLT) emphasise increasingly individualised patient assessment, which, in addition to the underlying lung disease, considers factors such as comorbidities, frailty, age, and social aspects. The expanded indications for lung transplantation are reflected in the refined risk assessment, which particularly includes patients with advanced chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and pulmonary arterial hypertension (PAH). Furthermore, the criteria for patients with a history of cancer and those with infections such as HIV or multidrug-resistant organisms have been made more flexible, leading to a more inclusive transplantation policy. A key focus is on early transplant counselling, allowing patients the opportunity for transplantation before they develop acute exacerbations. These updated guidelines aim to maximise both the survival rates and the quality of life of transplant patients, through differentiated and risk-adjusted decision-making.

Schlüsselwörter

Transplantation - Immunsuppression - interdisziplinär

Keywords

transplantation - immune suppression - interdisciplinary


Publication History

Received: 22 January 2025

Accepted after revision: 17 March 2025

Article published online:
15 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Asthana S, Kute V, Shah U. et al. Consensus Statement on Organ Donation from COVID-Positive Deceased Donors – Indian Society of Organ Transplantation, Liver Transplant Society of India and Indian Society for Heart and Lung Transplantation. Indian J Transplant 2022; 16: 8-16
    CrossrefPubMedSearch in Google Scholar
  • 2 Crespo MM, Claridge T, Domsic RT. et al. ISHLT consensus document on lung transplantation in patients with connective tissue disease: Part III: Pharmacology, medical and surgical management of post-transplant extrapulmonary conditions statements. J Heart Lung Transpl 2021; 40: 1279-1300
    CrossrefPubMedSearch in Google Scholar
  • 3 Leard LE, Holm AM, Valapour M. et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transpl 2021; 40: 1349-1379
    CrossrefPubMedSearch in Google Scholar
  • 4 Weill D, Benden C, Corris PA. et al. A consensus document for the selection of lung transplant candidates: 2014-An update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transpl 2015; 34: 1-15
    CrossrefPubMedSearch in Google Scholar
  • 5 Montgomery E, Macdonald PS, Newton PJ. et al. Frailty in lung transplantation: a systematic review. Expert Rev Resp Med 2020; 14: 219-227
    CrossrefPubMedSearch in Google Scholar
  • 6 Doucette KE, Halloran K, Kapasi A. et al. Outcomes of Lung Transplantation in Recipients With Hepatitis C Virus Infection. Am J Transplant 2016; 16: 2445-2452
    CrossrefPubMedSearch in Google Scholar
  • 7 Donohue JK, Chan EG, Clifford S. et al. Lung transplantation in HIV seropositive recipients: An analysis of the UNOS registry. Clin Transplant 2024; 38: e15246
    CrossrefPubMedSearch in Google Scholar
  • 8 Rouzaud C, Berastegui C, Picard C. et al. Lung transplantation in HIV-positive patients: a European retrospective cohort study. Eur Respir J 2022; 60: 2200189
    CrossrefPubMedSearch in Google Scholar
  • 9 Al-Adra DP, Hammel L, Roberts J. et al. Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement. Am J Transplant 2021; 21: 460-474
    CrossrefPubMedSearch in Google Scholar
  • 10 Meyer J, Shtraichman O, Zur A. et al. Long-Term Outcomes of Lung Transplantation in the Elderly: An Analysis Using the UNOS Database. J Heart Lung Transpl 2024; 43(4 Suppl.): S309
    PubMedSearch in Google Scholar
  • 11 Panchal NN, Chen J, Trinh BN. et al. Lung Transplantation in the Elderly – When is Old Too Old?. Am J Transplant 2023; 23(6 Suppl. 1): S1028-S1029
    PubMedSearch in Google Scholar
  • 12 Slama A, Ceulemans LJ, Hedderich C. et al. Lung Volume Reduction Followed by Lung Transplantation in Emphysema-A Multicenter Matched Analysis. Transpl Int 2022; 35: 10048
    CrossrefPubMedSearch in Google Scholar
  • 13 Begic M, Schwarz S, Boehm P. et al. Lung Transplant in Patients with Suspicious Lung Nodules: A Single-Center Retrospective Data Analysis. J Heart Lung Transpl 2023; 42(4 Suppl.): S148
    PubMedSearch in Google Scholar
  • 14 Lang C, Ritschl V, Augustin F. et al. Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study. Eur Respir J 2022; 60: 2102404
    CrossrefPubMedSearch in Google Scholar
  • 15 Frick AE, Gan CT, Vos R. et al. Lung transplantation for acute respiratory distress syndrome: A multicenter experience. Am J Transplant 2022; 22: 144-153
    CrossrefPubMedSearch in Google Scholar
  • 16 Lehr CJ, Dasenbrook EC. The changing landscape of cystic fibrosis and lung transplant. Curr Opin Pulm Med 2024; 30: 631-632
    CrossrefPubMedSearch in Google Scholar
  • 17 Sertic F, Han J, Diagne D. et al. Not All Septal Defects Are Equal: Outcomes of Bilateral Lung Transplant With Cardiac Defect Repair vs Combined Heart-Lung Transplant in Patients With Eisenmenger Syndrome in the United States. Chest 2020; 158: 2097-2106
    CrossrefPubMedSearch in Google Scholar
  • 18 Kearney K, Bart N, Khush K. Survival outcomes in patients with Eisenmenger syndrome after heart-lung or bilateral sequential lung transplantation. Eur Heart J 2019; 40 (Suppl. 1) ehz745.1079
    CrossrefPubMedSearch in Google Scholar
  • 19 Kolaitis NA, Chen H, Calabrese DR. et al. The Lung Allocation Score Remains Inequitable for Patients with Pulmonary Arterial Hypertension, Even after the 2015 Revision. Am J Resp Crit Care 2023; 207: 300-311
    CrossrefPubMedSearch in Google Scholar
  • 20 Anand SC, Furqan M, Tonelli AR. et al. Sotatercept: A New Era in Pulmonary Arterial Hypertension. Cardiol Rev 2025;
    CrossrefPubMedSearch in Google Scholar
  • 21 Valapour M, Lehr CJ, Wey A. et al. Expected effect of the lung Composite Allocation Score system on US lung transplantation. Am J Transplant 2022; 22: 2971-2980
    CrossrefPubMedSearch in Google Scholar
  • 22 Harhay MO, Cherikh W, Toll AE. et al. Epidemiology, Risk Factors, and Outcomes of Lung Retransplantation: An Analysis of the International Society for Heart and Lung Transplantation (ISHLT) Registry. J Heart Lung Transpl 2022; 41: 1468-1486
    CrossrefPubMedSearch in Google Scholar