6533b82afe1ef96bd128b682

RESEARCH PRODUCT

Lung Transplantation

subject

description

For patients with terminal lung conditions such chronic obstructive lung disease (COPD), lung transplantation (LuTx) offers treatment to improve quality of life and additionally, in those with certain other diseases—e.g., cystic fibrosis (CF), idiopathic pulmonary fibrosis (IPF), and pulmonary arterial hypertension (PAH)—to prolong life (1, 2, e1). It is used at the point when, despite treatment by all available conservative methods, the patient’s quality of life will be clearly impaired or life shortened if transplantation does not take place (3, 4, e2). At present, there are four main surgical options when performing a lung transplantation (5, e3, e4). These are: Unilateral (single lung) transplantation (SLuTx) Bilateral (double lung) transplantation (DLuTx) Combined heart–lung transplantation (HLuTx) Transplantation of individual pulmonary lobes from living donors. The last of these options is practiced in only a few centers in the world, and at present is burdened with the weight, not only of non-negligible risks for two healthy living donors, but also of an agglomeration of associated ethical difficulties, and for this reason it will not be discussed further in this article (e5). Analysis of data from the relevant registries show that lung transplantations have been continually on the rise over the past 5 years, despite a reduction in numbers of willing donors. Worldwide, the increase is estimated at 30% (International Society for Heart and Lung Transplantation, ISHLT), while in Germany the figure is 19% (German Foundation for Organ Transplantation, DSO [Deutsche Stiftung Organtransplantation]). According to data from the ISHLT, 3519 lung transplantations were carried out worldwide in 2010, 298 of them in Germany (6, 7, e6). For 2012, the DSO recorded 357 organ transplantations (7). It is against the background of this positive development that the present article has been written to give an up-to-date overview of the topic of lung transplantation, and to answer questions on the key components of the therapy: recipient selection, contraindications, waiting lists, organ allocation procedures, surgical procedure, postoperative immune suppression, aftercare, early and late complications, rehabilitation, and recent long-term results (eFigure). eFigure Interaction between components of treatment and current clinical practice in lung transplantation.