Lungentransplantation: Indikationen, Langzeitergebnisse und die besondere Bedeutung der Nachsorge

Lung transplantation has been established as an appropriate ultimate treatment strategy in end-stage lung disease, when all conventional therapeutic options have been exhausted. A successful transplantation should result in an improved quality of life as well as an increase in life-expectancy for certain diseases (cystic fibrosis, pulmonary fibrosis and pulmonary hypertension). There is still a critical need regarding the number of available donor organs. Presently, one out of six patients dies on the waiting list. In order to identify suitable candidates for transplantation a number of criteria require consideration. These include the exact etiology of the pulmonary or cardiac disease, but also patient age, physical mobility, nutritional and muscular status as well as a comprehensive assessment to exclude significant extra-pulmonary co-morbidities. Complications arising after transplantation occur because of general perioperative risks, but also as a result of specific issues such as acute or chronic graft rejection, airway stenoses, infections of the newly immunosuppressed patient as well as a complete spectrum of secondary extra-pulmonary conditions. Comprehensive follow-up care in lung transplantation patients remains a vital issue. Analyses have shown a relevant improvement in long-term outcome, when follow-up care is delivered in cooperation with an established large volume transplant centre.