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Palliative Care in der Lungentransplantation

Palliative care in the setting of lung transplantation

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Hintergrund

Die erste Lungentransplantation (LTx) wurde bereits 1963 von James Hardy durchgeführt. Nach nun mehr als 50 Jahren sind weltweit über 32.000 Lungentransplantationen erfolgt. Damit ist die LTx für selektionierte Patienten mit fortgeschrittener Lungenkrankheit im Endstadium ein anerkanntes Verfahren. Die häufigsten zu einer LTx führenden Krankheitsentitäten sind Lungenfibrose, zystische Fibrose (CF), pulmonalarterielle Hypertonie (PAH) und COPD.

Fragestellung

Transplantations- und Palliativmedizin haben auf den ersten Blick gegensätzliche Ansätze, nämlich kurativ versus palliativ. Es stellt sich daher die Frage, ob sich Palliative Care in ein Lungentransplantationsprogramm integrieren und ein Nutzen vor und nach LTx für den Patienten, die Angehörigen und die Behandelnden erzielen lässt.

Implementierung von Palliative Care in die Transplantationsmedizin

Durch den kurativen Ansatz bei der LTx sind palliativmedizinische Konzepte bisher nur selten etabliert. Ein systematisches Vorgehen zur Integration der Palliative Care in das Lungentransplantationsprogramm existiert bis heute nicht, da noch immer klar definierte Kriterien fehlen. Im Vordergrund der Konsultation des Palliativteams zur Unterstützung der Behandlung von lungentransplantierten Patienten stehen u. a. folgende Anforderungen: End-of-life-Diskussion, Unterstützung der Familie, Schmerz- und Symptommanagement, psychologische Themen und Planung der Versorgung.

Schlussfolgerung

Palliative Care lässt sich sinnvoll in die Transplantationsmedizin integrieren. Sie kann in den Phasen vor und nach LTx einen wichtigen Platz in der Versorgung der Patienten einnehmen und Maßnahmen zur Unterstützung des Patienten und der Angehörigen beisteuern.

Abstract

Background

The first lung transplantation was performed in 1963 by James Hardy. After more than 50 years over 32,000 lung transplantations have been carried out worldwide and it is therefore an accepted procedure for selected patients in end stage advanced lung disease. The most common disease entities leading to lung transplantation are pulmonary fibrosis, cystic fibrosis (CF), primary pulmonary hypertension (PPH) and chronic obstructive pulmonary disease (COPD).

Objective

At first glance transplantation medicine and palliative care have opposite approaches, namely curative versus palliative. For this reason the question arises whether palliative care can be integrated into lung transplantation programs and achieve benefits before and after lung transplantation for patients, their families and care givers.

Implementation of palliative care into transplantation medicine

Because of the curative approach in lung transplantation, palliative care concepts have rarely been established. A systematic approach for the integration of palliative care into lung transplantation programs does not currently exist and a prerequisite would be clearly defined criteria, which have not yet been established. The focus of consultation of palliative teams to support the treatment of lung transplantation patients are end of life discussions, family support, pain and symptom management, psychological issues and planning of care.

Conclusion

Palliative care can be usefully integrated into transplantation medicine. In the phases before and after lung transplantation palliative care can fulfil an important role in the care of patients and thereby contribute measures to support patients and their families.

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Authors and Affiliations

  1. Sektion Mukoviszidose, Christiane Herzog-Zentrum, Erwachsenen-Mukoviszidose, Endoskopie und Lungentransplantation, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    C. Schwarz

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  1. C. Schwarz
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Correspondence to C. Schwarz.

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Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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O. Karg, Gauting

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Schwarz, C. Palliative Care in der Lungentransplantation. Pneumologe 13, 113–117 (2016). https://doi.org/10.1007/s10405-015-0019-9

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