Semin Respir Crit Care Med 2010; 31(3): 365-372
DOI: 10.1055/s-0030-1254076
© Thieme Medical Publishers

Lung Transplantation in Advanced COPD: Is it Worth it?

Jamie L. Todd1 , Scott M. Palmer1
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
Further Information

Publication History

Publication Date:
21 May 2010 (online)

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a condition of progressive airflow obstruction occurring primarily as a result of tobacco use that accounts for substantial worldwide morbidity and mortality. Medical therapy, with the exception of oxygen and smoking cessation, does not appreciably alter the natural progression of the disease. In contrast, when performed in carefully selected candidates, lung transplantation can provide substantial benefits in physiology, function, quality of life, and survival. Strict selection criteria limit transplant to highly compliant candidates with advanced disease but preserved functional status who are capable of successfully undergoing the operation. Although either single or bilateral lung transplant may be offered in COPD, recent evidence suggests that bilateral transplant is the preferred operation due to superior long-term outcomes. Regardless of the type of transplant operation, however, all lung transplant recipients are susceptible to numerous complications, including posttransplant infection and rejection. Despite these and other potential complications, advances in medical and surgical management now make lung transplantation a worthwhile therapeutic option in appropriately selected patients. In fact, lung transplant represents the only intervention that can substantially improve long-term outcomes in COPD patients with very advanced disease. Further work to refine recipient selection, improve lung allocation algorithms, and develop better treatments of chronic allograft dysfunction will lead to an even greater benefit to lung transplantation in this ill patient population.

REFERENCES

  • 1 Cruz A A, Mantzouranis E, Matricardi P M et al.. Global surveillance, prevention, and control of chronic respiratory diseases: a comprehensive approach. Geneva; World Health Organization 2007 Available at http://www.who.int/gard/publications/GARD_Manual/en/index.html Accessed October, 2009
  • 2 Hardy J D, Webb W R, Dalton Jr M L, Walker Jr G R. Lung homotransplantation in man.  JAMA. 1963;  186 1065-1074
  • 3 Cooper J D, Patterson G A, Grossman R, Maurer J. Double-lung transplant for advanced chronic obstructive lung disease.  Am Rev Respir Dis. 1989;  139 303-307
  • 4 Christie J D, Edwards L B, Aurora P et al.. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult lung and heart/lung transplantation report—2008.  J Heart Lung Transplant. 2008;  27 957-969
  • 5 McCurry K R, Shearon T H, Edwards L B et al.. Lung transplantation in the United States, 1998-2007.  Am J Transplant. 2009;  9(4 Pt 2) 942-958
  • 6 Orens J B, Estenne M, Arcasoy S Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.  J Heart Lung Transplant. 2006;  25 745-755
  • 7 Martinu T, Babyak M A, O'Connell C F INSPIRE Investigators et al. Baseline 6-min walk distance predicts survival in lung transplant candidates.  Am J Transplant. 2008;  8 1498-1505
  • 8 Martinez F J, Foster G, Curtis J L NETT Research Group et al. Predictors of mortality in patients with emphysema and severe airflow obstruction.  Am J Respir Crit Care Med. 2006;  173 1326-1334
  • 9 Celli B R, Cote C G, Marin J M et al.. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 1005-1012
  • 10 Martinez F J, Han M K, Andrei A C National Emphysema Treatment Trial Research Group et al. Longitudinal change in the BODE index predicts mortality in severe emphysema.  Am J Respir Crit Care Med. 2008;  178 491-499
  • 11 Connors Jr A F, Dawson N V, Thomas C et al.. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments).  Am J Respir Crit Care Med. 1996;  154(4 Pt 1) 959-967
  • 12 Nathan S D, Edwards L B, Barnett S D, Ahmad S, Burton N A. Outcomes of COPD lung transplant recipients after lung volume reduction surgery.  Chest. 2004;  126 1569-1574
  • 13 Mora J I, Hadjiliadis D. Lung volume reduction surgery and lung transplantation in chronic obstructive pulmonary disease.  Int J Chron Obstruct Pulmon Dis. 2008;  3 629-635
  • 14 Patel N, DeCamp M, Criner G J. Lung transplantation and lung volume reduction surgery versus transplantation in chronic obstructive pulmonary disease.  Proc Am Thorac Soc. 2008;  5 447-453
  • 15 Fishman A, Martinez F, Naunheim K National Emphysema Treatment Trial Research Group et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema.  N Engl J Med. 2003;  348 2059-2073
  • 16 Arcasoy S M, Kotloff R M. Lung transplantation.  N Engl J Med. 1999;  340 1081-1091
  • 17 Egan T M, Murray S, Bustami R T et al.. Development of the new lung allocation system in the United States.  Am J Transplant. 2006;  6(5 Pt 2) 1212-1227
  • 18 Merlo C A, Weiss E S, Orens J B et al.. Impact of U.S. lung allocation score on survival after lung transplantation.  J Heart Lung Transplant. 2009;  28 769-775
  • 19 Studer S M, Levy R D, McNeil K, Orens J B. Lung transplant outcomes: a review of survival, graft function, physiology, health-related quality of life and cost-effectiveness.  Eur Respir J. 2004;  24 674-685
  • 20 Chan K M, Martinez F J, Chang A C. Nonmedical therapy for chronic obstructive pulmonary disease.  Proc Am Thorac Soc. 2009;  6 137-145
  • 21 Pochettino A, Kotloff R M, Rosengard B R et al.. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: intermediate-term results.  Ann Thorac Surg. 2000;  70 1813-1818 discussion 1818-1819
  • 22 Estenne M, Maurer J R, Boehler A et al.. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria.  J Heart Lung Transplant. 2002;  21 297-310
  • 23 Sharples L D, McNeil K, Stewart S, Wallwork J. Risk factors for bronchiolitis obliterans: a systematic review of recent publications.  J Heart Lung Transplant. 2002;  21 271-281
  • 24 Hadjiliadis D, Davis R D, Palmer S M. Is transplant operation important in determining posttransplant risk of bronchiolitis obliterans syndrome in lung transplant recipients?.  Chest. 2002;  122 1168-1175
  • 25 Hadjiliadis D, Chaparro C, Gutierrez C et al.. Impact of lung transplant operation on bronchiolitis obliterans syndrome in patients with chronic obstructive pulmonary disease.  Am J Transplant. 2006;  6 183-189
  • 26 Rodrigue J R, Baz M A, Kanasky Jr W F, MacNaughton K L. Does lung transplantation improve health-related quality of life? The University of Florida experience.  J Heart Lung Transplant. 2005;  24 755-763
  • 27 Gross C R, Savik K, Bolman III R M, Hertz M I. Long-term health status and quality of life outcomes of lung transplant recipients.  Chest. 1995;  108 1587-1593
  • 28 TenVergert E M, Essink-Bot M L, Geertsma A, van Enckevort P J, de Boer W J, van der Bij W. The effect of lung transplantation on health-related quality of life: a longitudinal study.  Chest. 1998;  113 358-364
  • 29 Anyanwu A C, McGuire A, Rogers C A, Murday A J. Assessment of quality of life in lung transplantation using a simple generic tool.  Thorax. 2001;  56 218-222
  • 30 Kugler C, Fischer S, Gottlieb J et al.. Health-related quality of life in two hundred-eighty lung transplant recipients.  J Heart Lung Transplant. 2005;  24 2262-2268
  • 31 Gerbase M W, Spiliopoulos A, Rochat T, Archinard M, Nicod L P. Health-related quality of life following single or bilateral lung transplantation: a 7-year comparison to functional outcome.  Chest. 2005;  128 1371-1378
  • 32 Snyder L D, Palmer S M. Quality, quantity, or both? Life after lung transplantation.  Chest. 2005;  128 1086-1087
  • 33 Rodrigue J R, Baz M A. Are there sex differences in health-related quality of life after lung transplantation for chronic obstructive pulmonary disease?.  J Heart Lung Transplant. 2006;  25 120-125
  • 34 Vasiliadis H M, Collet J P, Poirier C. Health-related quality-of-life determinants in lung transplantation.  J Heart Lung Transplant. 2006;  25 226-233
  • 35 van Den BERG J W, Geertsma A, van Der BIJ W et al.. Bronchiolitis obliterans syndrome after lung transplantation and health-related quality of life.  Am J Respir Crit Care Med. 2000;  161 1937-1941
  • 36 Titman A, Rogers C A, Bonser R S, Banner N R, Sharples L D. Disease-specific survival benefit of lung transplantation in adults: a national cohort study.  Am J Transplant. 2009;  9 1640-1649
  • 37 Meyer D M, Bennett L E, Novick R J, Hosenpud J D. Single vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points.  J Heart Lung Transplant. 2001;  20 935-41
  • 38 Thabut G, Christie J D, Ravaud P et al.. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data.  Lancet. 2008;  371 744-751
  • 39 Thabut G, Ravaud P, Christie J D et al.. Determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2008;  177 1156-1163
  • 40 Hosenpud J D, Bennett L E, Keck B M, Edwards E B, Novick R J. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease.  Lancet. 1998;  351 24-27
  • 41 Stavem K, Bjørtuft O, Borgan O, Geiran O, Boe J. Lung transplantation in patients with chronic obstructive pulmonary disease in a national cohort is without obvious survival benefit.  J Heart Lung Transplant. 2006;  25 75-84
  • 42 Frost A E, Keller C A, Noon G P, Short H D, Cagle P T. Multiorgan Transplant Group . Outcome of the native lung after single lung transplant.  Chest. 1995;  107 981-984
  • 43 Mal H, Brugière O, Sleiman C et al.. Morbidity and mortality related to the native lung in single lung transplantation for emphysema.  J Heart Lung Transplant. 2000;  19 220-223
  • 44 Weill D, Torres F, Hodges T N, Olmos J J, Zamora M R. Acute native lung hyperinflation is not associated with poor outcomes after single lung transplant for emphysema.  J Heart Lung Transplant. 1999;  18 1080-1087
  • 45 Dickson R P, Davis R D, Rea J B, Palmer S M. High frequency of bronchogenic carcinoma after single-lung transplantation.  J Heart Lung Transplant. 2006;  25 1297-1301
  • 46 Reece T B, Mitchell J D, Zamora M R et al.. Native lung volume reduction surgery relieves functional graft compression after single-lung transplantation for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg. 2008;  135 931-937
  • 47 Nwakanma L U, Simpkins C E, Williams J A et al.. Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database.  J Thorac Cardiovasc Surg. 2007;  133 541-547
  • 48 2008 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1998–2007. Rockville, MD; U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation. 2008 Available at http://www.ustransplant.org/annual_reports/current/Chapter_I_AR_CD.htm?cp=2 Accessed October 2009

Scott M PalmerM.D. 

Division of Pulmonary, Allergy, and Critical Care Medicine

Department of Internal Medicine, Duke University Medical Center, DUMC Box 3876, Durham, NC 27710

Email: Palme002@mc.duke.edu

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