Update: Organspende und -präservation

Zusammenfassung

In den letzten Jahren konnten wir eine atemberaubende Entwicklung in der Organspende und Präservation von Spenderlungen miterleben. Besondere Gamechanger dabei waren:
1. Die normothermische Ex-vivo-Lungenperfusion (EVLP): eine transformative Innovation in der Lungentransplantation. Sie ermöglicht nicht nur eine Erweiterung des Spenderpools durch Rekonditionierung marginaler Lungen, sondern auch eine Verbesserung der Transplantationsergebnisse durch optimierte Bewertung und Behandlung vor der Implantation. Mit weiteren technologischen Fortschritten und einer breiteren klinischen Akzeptanz könnte EVLP in naher Zukunft zum Standardverfahren in der Lungentransplantation werden.
2. Die Organspende nach Kreislaufstillstand: eine essenzielle Strategie, um den Mangel an transplantierbaren Lungen zu bekämpfen. Trotz logistischer Herausforderungen und ethischer Überlegungen zeigt sie vergleichbare klinische Ergebnisse wie die traditionelle Spende nach Hirntod. Mit fortschreitender Forschung und technologischen Innovationen könnten diese Spender in Zukunft eine noch größere Rolle in der Lungentransplantation spielen.
3. Die kontrollierte hypothermische Lagerung bei 10 °C: Sie bietet eine verlängerte Lagerungszeit, reduziert kälteinduzierte Schäden und verbessert die Flexibilität bei der Planung von Transplantationen. Mit fortschreitender Forschung könnte diese Methode vor allem die heutige strenge Logistik der Lungentransplantation revolutionieren, in dem diese Eingriffe semielektiv in das Tagesoperationsprogramm einfließen können.
Mit einem besonderen Fokus auf diese Innovationen versuchen wir, den aktuellen Wissensstand über Lungenspender und Spenderlungen zusammenzufassen.

Abstract

In recent years, we have witnessed remarkable progress in organ donation and the preservation of donor lungs. Several transformative innovations have been particularly influential:
1. Normothermic ex vivo lung perfusion (EVLP): EVLP is a groundbreaking advancement in lung transplantation. This technology not only enables expansion of the donor pool by reconditioning marginal lungs, but also improves transplantation outcomes, through optimised assessment and therapeutic intervention prior to implantation. Lungs considered high-risk or initially unsuitable for transplantation can be evaluated and, in many cases, rehabilitated using EVLP, resulting in post-transplant outcomes comparable to those of conventionally selected lungs. With ongoing technological advancements and increasing clinical acceptance, EVLP could soon become the standard of care in lung transplantation.
2. Donation after circulatory death (DCD): DCD has emerged as an essential strategy to address the shortage of transplantable lungs. Despite logistical challenges and ethical considerations, transplantation outcomes using DCD lungs are comparable to those achieved with traditional donation after brain death. As research and technology continue to advance, DCD donors are expected to play an increasingly significant role in lung transplantation.
3. Controlled hypothermic preservation at 10 °C: Controlled hypothermic storage at 10 °C offers extended preservation times, reduces cold-induced injury, and enhances flexibility in transplant scheduling. This method has the potential to revolutionise the currently rigid logistics of lung transplantation, allowing semi-elective procedures to be integrated into daily surgical programs as research progresses.
With a particular focus on these innovations, we aim to summarise the current state of knowledge regarding lung donors and donor lung preservation.

Schlüsselwörter

Transplantation - Transplantationschirurgie - Thoraxchirurgie - Organtransplantation

Keywords

transplantation - transplantation surgery - thoracic surgery - organ transplantation

Publication History

Received: 04 March 2025

Accepted after revision: 04 September 2025

Article published online:
29 October 2025

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