[Lung and heart-lung transplantation: indications, complications and prognosis]

Lung- and heart-lung transplantation has become a serious therapeutic option for terminally ill patients with chronic pulmonary failure. Due to the still rather high risk of acute rejection, severe pulmonary or systemic infection, and the relatively demanding postoperative care, this treatment can only be considered for patients where inspite exhausted conservative options for therapy quality of life and prognosis are not acceptable. Not only due to lack of donors single-lung transplantation has developed to be the favorite treatment for patients with interstitial lung disease (idiopathic, sarcoidosis, asbestosis etc.) and even for pulmonary hypertension unless irreversible damage to the myocardium is present. Double-lung transplantation is the treatment of choice for patients with emphysema and cystic fibrosis. Heart-lung transplantation is mainly limited to patients with a high degree of right ventricular or valve dysfunction as in Eisenmenger-Syndrome. Midterm clinical results have evolved to be very satisfactory while on the longterm basis chronic transplant dysfunction not responding to any kind of therapy causes a lot of concern. One- and two-year survival rates are 85 and 82% resp. in our program and thus are in the same range as those after heart transplantation.