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DOI: 10.1055/a-2563-3691
Indikationsspektrum zur Lungentransplantation – Weiterentwicklungen seit den letzten ISHLT-Empfehlungen
Indications for Lung Transplantation – Updates Since the Last ISHLT Recommendations
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.
Publikationsverlauf
Eingereicht: 22. Januar 2025
Angenommen nach Revision: 17. März 2025
Artikel online veröffentlicht:
15. Mai 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/).
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