[Lung transplantation in pulmonary hypertension].

Medical therapy for pulmonary hypertension is very limited and surgical interventions can only be performed in cases with acute or chronic pulmonary embolism. Secondary pulmonary hypertension of other origin (Eisenmengers' Syndrome) as well as primary pulmonary hypertension can only be treated with lung transplantation. In selected cases, three different techniques are available, heart-lung transplantation (HLTx), single, and double lung transplantation (SLTx; DLTx). The indication for any of these operations has to be made on an individual basis, and the degree of pulmonary hypertension and right ventricular failure have to be encountered. Also, correctability of the underlying congenital disorder in Eisenmenger Syndromes has to be taken into account. In principle, combined heart-lung transplantation will allow for the best results. Due to the restricted number of donor organs, SLTx and DLTx are performed in increasing numbers. SLTx for pulmonary hypertension, however, is characterized by a high number of early (reperfusion injury) and late complications (ventilation-perfusion-mismatch). Following lung transplantation in pulmonary hypertension, 1- and 5-year survival rates of 70 and 60% can be expected, respectively. Which type of transplantation will ultimately prove to be the best therapy for pulmonary hypertension has not yet been defined.