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Indikationen und Ergebnisse der Lungentransplantation bei idiopathischer Lungenfibrose

Indications and results of lung transplantation for idiopathic pulmonary fibrosis

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die Lungentransplantation (LTx) ist eine etablierte Therapieoption für Patienten im Endstadium verschiedener nichtmaligner Lungenkrankheiten. Derzeit beträgt die weltweite Aktivität ca. 3500 Prozeduren pro Jahr. Leider führt die Verknappung von Spenderorganen dazu, dass etwa jeder sechste Patient in den westlichen Ländern vor Verfügbarkeit eines Spenderorgans auf der Warteliste verstirbt. Die häufigsten zugrundeliegenden klinischen Indikationen sind Emphysem, Lungenfibrose, und Mukoviszidose. Weltweit hatten in der letzten veröffentlichen Analyse des internationalen Registers 23% aller Empfänger die Diagnose einer idiopathischen Lungenfibrose (IPF). In erfahrenen Zentren werden die Kandidaten zur Lungentransplantation nach krankheitsspezifischen Kriterien unter dem Aspekt der Prognoseverbesserung nach Ausschluss von Kontraindikationen ausgewählt. Allerdings gibt es mehrere Herausforderungen für die LTx. Der Erfolg der Lungentransplantation wird begrenzt durch den Mangel an Spenderorganen. Im Vergleich zu anderen Formen der Organtransplantation sind die Langzeitüberlebensraten noch unterlegen. Dennoch bietet die LTx einen Überlebensvorteil bei sorgfältig ausgewählten Patienten vor allem mit interstitiellen Lungenkrankheiten und besonders der IPF.

Abstract

Lung transplantation is an established therapy option for patients with various end stages of pulmonary diseases and presently the worldwide frequency is about 3,500 procedures per year. Unfortunately, the shortage of donor organs leads to approximately every sixth patient in western countries dying before a donor organ is available. The most frequent underlying clinical indications are emphysema, pulmonary fibrosis and cystic fibrosis. In a recent analysis 23 % of all recipients worldwide had a diagnosis of idiopathic pulmonary fibrosis. In experienced centers, candidates for transplantation are chosen according to disease-specific factors under prognostic aspects after excluding contraindications. However, there are several challenges for lung transplantation. The number of lung transplantations performed is limited by the supply of donor organs and the long-term survival rates are still inferior compared to other forms of solid organ transplantation. Nevertheless, lung transplantation offers a survival benefit in carefully selected patients with interstitial lung diseases, especially with idiopathic pulmonary fibrosis.

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Interessenkonflikt

Jens Gottlieb erhielt Honorare für Vorträge und/oder Beratertätigkeit von Boehringer, Gilead, MSD, Nycomed, InterMune, Novartis, Astellas, Pfizer, Roche und Forschungsförderung durch Alnylam, Astellas, Roche, Novartis.

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  1. Klinik für Pneumologie OE6870, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Gottlieb

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Gottlieb, J. Indikationen und Ergebnisse der Lungentransplantation bei idiopathischer Lungenfibrose . Pneumologe 10, 112–119 (2013). https://doi.org/10.1007/s10405-012-0609-8

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