Aktuelle Aspekte der Lungentransplantation

Zusammenfassung

Seit der ersten Lungentransplantation im Jahr 1963 ist diese Operation zu einer erfolgreichen und etablierten Therapie für Patienten mit Lungenversagen geworden. Obwohl die Sterblichkeitsraten im Vergleich zu anderen Organtransplantationen höher sind, wurden dank Verbesserungen in den Bereichen Technik, Organkonservierung, Immunsuppression und Antibiotika sowie diagnostischer Mittel und Therapie gegen Abstoßung bemerkenswerte Fortschritte erzielt.

Abstract

Since 1963, the lung transplantation has become a successful and established therapy for patients with lung failure. Even though mortality is higher than with other solid organ transplantations, remarkable progress has been made due to improved techniques, improved conservation, immunosuppression and antibiotics as well as diagnostic tools and therapy for rejection. The survival for lung transplantation is good. The survival rate after 3 months is 88%, after 1 year 79% and after 3, 5, and 10 years 64%, 53%, and 31%, respectively. But chronic rejection, presenting as chronic lung allograft dysfunction, is still a major problem after lung transplantation. An overview of indications and contraindications, surgical techniques and results is given in this article.

Kernaussagen

• Aktuelle Aspekte der Lungentransplantation werden beschrieben.

• Seit 1963 hat sich die Lungentransplantation zu einer erfolgreichen und anerkannten Therapie für Patienten entwickelt.

• Auch wenn die Langzeitergebnisse der Lungentransplantation noch hinter den Ergebnissen anderer Organe zurückliegen, so haben sich sowohl Überleben als auch die Lebensqualität nach der Transplantation durch verbesserte Operationstechniken und Organkonservierung, durch optimierte Immunsuppression und antibiotische Therapiekonzepte und besonders durch die Diagnostik und Therapie von Abstoßungsprozessen deutlich gesteigert.

• Die Überlebensraten nach Lungentransplantation liegen für die ersten 3 Monate bei 89% und für das erste Jahr bei 83%. Nach 3 Jahren beträgt die Überlebensrate 68%, nach 5 Jahren 61% und nach 10 Jahren 36%. Dennoch ist die chronische Abstoßung in ihrer Form als Chronic Lung Allograft Dysfunction (CLAD) das größte Problem.

• Die Akquise von Spenderorganen ist nach wie vor problematisch. Bei nur einem Viertel aller Organspender in Deutschland können die Lungen erfolgreich transplantiert werden. Auch neuere Verfahren zur Verbesserung marginaler Spenderorgane (ex vivo Lung Perfusion EVLP) haben die Situation nicht wesentlich verändert.

Schlüsselwörter

Lungenversagen - Lungentransplantation - Organtransplantation - Organspende - Hirntod

Key words

lung transplantation - brain death - lung failure - organ transplantation - organ donor

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