Summary
Background: (Heart-)Lung transplantation has become an accepted surgical therapy for selected patients suffering from a variety of (cardio-)pulmonary diseases.
Methods: The objective of this paper is to give an overview on the international knowledge, trends and results of lung transplantation, including the experience with 72 lung and heart-lung transplantations at the University Hospital of Leuven, Belgium is described.
Results: According to the International Registry for Heart and Lung Transplantation, the number of lung and heart-lung transplantations has plateaued over the last few years. Donor age in both types of transplants is still increasing with less suitable donor organs available. Therefore, alternative treatment modalities such as lung volume reduction surgery for patients suffering from emphysema and pulmonary tromboendarterectomy for patients with pulmonary hypertension secondary to chronic pulmonary emboli, are now receiving renewed interest. Overall 5-year survival following pulmonary transplantation is close to 40%. Morbidity of chronic immunosuppression and late graft failure from chronic rejection presenting as bronchiolitis obliterans syndrome remain the major drawbacks of this surgical treatment.
Conclusions: A greater donor supply is necessary until xenotransplantation becomes a practical reality. Future efforts to improve the results of lung transplantation should be directed towards both a better control of immune response of the allograft and an effective treatment for bronchiolitis obliterans.
Zusammenfassung
Grundlagen: Die (Herz-)Lungentransplantation ist heute eine allgemein anerkannte Form der chirurgischen Behandlung vieler kardiopulmonaler Erkrankungen.
Methodik: Anhand einer Übersicht mit Einbeziehen der Erfahrung des Universitätskrankenhauses Leuven (Belgien) mit 72 Lungen- und Herz-Lungentransplantationen werden der aktuelle Stand der internationalen Kenntnisse, die Trends und Resultate der Lungentransplantation dargestellt.
Ergebnisse: Laut Bericht des „International Registry for Heart and Lung Transplantation“ hat die Zahl der Lungen- und Herz-Lungen-Transplantationen in den letzten Jahren ein Plateau erreicht. Das Alter der Spender in beiden Transplantationstypen steigt, die Zahl der brauchbaren Organe sinkt. Alternative Behandlungsverfahren gewinnen an Bedeutung: Patienten mit Emphysem werden einer Lungenvolumenreduktionschirurgie, Patienten mit pulmonalem Bluthochdruck nach Lungenembolie einer pulmonalen Thrombendarterektomie zugeführt. Die 5-Jahres-Überlebensrate nach Lungentransplantation erreicht knapp 40%. Die Morbidität der chronischen Immunsuppression und der späte Organverlust wegen chronischer Organabstoßung, die sich als Bronchiolitis-obliterans-Syndrom präsentiert, bleiben das Hauptproblem dieser chirurgischen Behandlung.
Schlußfolgerungen: Ein größeres Spenderaufkommen ist so lange notwendig, bis die Xenotransplantation zu einer praktischen Realität wird. Zukünftige Bemühungen zur Verbesserung der Resultate der Lungentransplantation sollten sich der besseren Kontrolle der Immunenreaktion auf das Allotransplantat sowie der effektiven Behandlung der Bronchiolitis obliterans widmen.
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van Raemdonck, D., Verleden, G., Vanhaecke, J. et al. The current status of lung transplantation. Acta Chir Austriaca 31, 292–301 (1999). https://doi.org/10.1007/BF02619929
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DOI: https://doi.org/10.1007/BF02619929