Chronic Obstructive Pulmonary Disease and Lung Transplantation

Abstract

Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

Lung Transplantation as a treatment strategy for Pulmonary Emphysema

“…In the initial year post-LT, the primary causes of death were infection and graft failure. However, in the long term, chronic lung allograft dysfunction (CLAD) emerged as the predominant cause of mortality [53]. Concerning double-lung transplantation (DLT) versus single lung transplantation (SLT), COPD stands out as the primary indication for SLT, with no observed enhancement in long-term survival for DLT [53].…”

“…However, in the long term, chronic lung allograft dysfunction (CLAD) emerged as the predominant cause of mortality [53]. Concerning double-lung transplantation (DLT) versus single lung transplantation (SLT), COPD stands out as the primary indication for SLT, with no observed enhancement in long-term survival for DLT [53]. When comparing lung transplantation in controlled donation after circulatory death (DCD) with donation after brain death (DBD), the one-year survival rates were 97 versus 90%, and at 5-year mark, the rates were 90 versus 61% [38].…”