Lung Transplantation for Chronic Obstructive Pulmonary Disease: Special Considerations

 

 Buy Article Permissions and Reprints

ABSTRACT

Since the introduction of lung transplantation nearly half a century ago, more procedures have been performed for chronic obstructive pulmonary disease (COPD) than for any other single indication. Because COPD tends to progress slowly and long-term survival is possible even in the advanced stages, the time at which transplantation should be offered remains unclear. Current recommendations rely on use of the BODE index to provide guidance on listing. Although both single lung transplantation (SLT) and bilateral lung transplantation (BLT) are suitable procedures for the COPD population, BLT has become the preferred procedure, particularly for patients under age 60, for whom it appears to offer superior survival and functional benefits. Whether lung transplantation truly extends survival for patients with COPD is uncertain. Preliminary answers have come from use of survivorship models that suggest a subset of COPD patients do derive a survival benefit, and that the size of this subgroup can be enhanced by selecting patients with extremely severe airflow obstruction and preferentially utilizing BLT. Those undergoing SLT are uniquely at risk for complications related to the remaining native lung—bronchogenic carcinoma and progressive hyperinflation—which are fortunately rare.

REFERENCES

• 1 Mannino D M, Homa D M, Akinbami L J, Ford E S, Redd S C. Chronic obstructive pulmonary disease surveillance–United States, 1971–2000.  Respir Care. 2002;  47 1184-1199
  PubMedGoogle Scholar
• 2 Pauwels R A, Buist A S, Calverley P M, Jenkins C R, Hurd S S. GOLD Scientific Committee . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.  Am J Respir Crit Care Med. 2001;  163 1256-1276
  CrossrefPubMedGoogle Scholar
• 3 Christie J D, Edwards L B, Aurora P et al.. The registry of the international society for heart and lung transplantation: twenty-sixth official adult lung and heart-lung transplantation report-2009.  J Heart Lung Transplant. 2009;  28 1031-1049
  CrossrefPubMedGoogle Scholar
• 4 Traver G A, Cline M G, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease: a 15-year follow-up study.  Am Rev Respir Dis. 1979;  119 895-902
  PubMedGoogle Scholar
• 5 Martinez F J, Kotloff R. Prognostication in chronic obstructive pulmonary disease: implications for lung transplantation.  Semin Respir Crit Care Med. 2001;  22 489-498
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 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
  CrossrefPubMedGoogle Scholar
• 7 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 9 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
  CrossrefPubMedGoogle Scholar
• 10 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
  CrossrefPubMedGoogle Scholar
• 11 Meyers B F, Yusen R D, Guthrie T J et al.. Outcome of bilateral lung volume reduction in patients with emphysema potentially eligible for lung transplantation.  J Thorac Cardiovasc Surg. 2001;  122 10-17
  CrossrefPubMedGoogle Scholar
• 12 Senbaklavaci O, Wisser W, Ozpeker C et al.. Successful lung volume reduction surgery brings patients into better condition for later lung transplantation.  Eur J Cardiothorac Surg. 2002;  22 363-367
  CrossrefPubMedGoogle Scholar
• 13 Burns K E, Keenan R J, Grgurich W F, Manzetti J D, Zenati M A. Outcomes of lung volume reduction surgery followed by lung transplantation: a matched cohort study.  Ann Thorac Surg. 2002;  73 1587-1593
  CrossrefPubMedGoogle Scholar
• 14 Bavaria J E, Pochettino A, Kotloff R M et al.. Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg. 1998;  115 9-17, discussion 17–18
  CrossrefPubMedGoogle Scholar
• 15 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
  CrossrefPubMedGoogle Scholar
• 16 Egan T M, Kotloff R M. Pro/Con debate: lung allocation should be based on medical urgency and transplant survival and not on waiting time.  Chest. 2005;  128 407-415
  CrossrefPubMedGoogle Scholar
• 17 McCurry K R, Shearon T H, Edwards L B et al.. Lung transplantation in the United States, 1998–2007.  Am J Transplant. 2009;  9 942-958
  CrossrefPubMedGoogle Scholar
• 18 Stevens P M, Johnson P C, Bell R L, Beall Jr A C, Jenkins D E. Regional ventilation and perfusion after lung transplantation in patients with emphysema.  N Engl J Med. 1970;  282 245-249
  CrossrefPubMedGoogle Scholar
• 19 Levine S M, Anzueto A, Peters J I et al.. Medium term functional results of single-lung transplantation for endstage obstructive lung disease.  Am J Respir Crit Care Med. 1994;  150 398-402
  CrossrefPubMedGoogle Scholar
• 20 Mal H, Andreassian B, Pamela F et al.. Unilateral lung transplantation in end-stage pulmonary emphysema.  Am Rev Respir Dis. 1989;  140 797-802
  CrossrefPubMedGoogle Scholar
• 21 Bavaria J E, Kotloff R, Palevsky H et al.. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg. 1997;  113 520-527, discussion 528
  CrossrefPubMedGoogle Scholar
• 22 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
  CrossrefPubMedGoogle Scholar
• 23 Sundaresan R S, Shiraishi Y, Trulock E P et al.. Single or bilateral lung transplantation for emphysema?.  J Thorac Cardiovasc Surg. 1996;  112 1485-1494, discussion 1494–1495
  CrossrefPubMedGoogle Scholar
• 24 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;  20 935-941
  CrossrefPubMedGoogle Scholar
• 25 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
  CrossrefPubMedGoogle Scholar
• 26 Gaissert H A, Trulock E P, Cooper J D, Sundaresan R S, Patterson G A. Comparison of early functional results after volume reduction or lung transplantation for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg. 1996;  111 296-306, discussion 306–307
  CrossrefPubMedGoogle Scholar
• 27 Bossenbroek L, ten Hacken N H, van der Bij W, Verschuuren E A, Koëter G H, de Greef M H. Cross-sectional assessment of daily physical activity in chronic obstructive pulmonary disease lung transplant patients.  J Heart Lung Transplant. 2009;  28 149-155
  CrossrefPubMedGoogle Scholar
• 28 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
  CrossrefPubMedGoogle Scholar
• 29 Levy R D, Ernst P, Levine S M et al.. Exercise performance after lung transplantation.  J Heart Lung Transplant. 1993;  12 27-33
  PubMedGoogle Scholar
• 30 Williams T J, Patterson G A, McClean P A, Zamel N, Maurer J R. Maximal exercise testing in single and double lung transplant recipients.  Am Rev Respir Dis. 1992;  145 101-105
  CrossrefPubMedGoogle Scholar
• 31 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
  CrossrefPubMedGoogle Scholar
• 32 De Meester J, Smits J M, Persijn G G, Haverich A. Listing for lung transplantation: life expectancy and transplant effect, stratified by type of end-stage lung disease, the Eurotransplant experience.  J Heart Lung Transplant. 2001;  20 518-524
  CrossrefPubMedGoogle Scholar
• 33 Charman S C, Sharples L D, McNeil K D, Wallwork J. Assessment of survival benefit after lung transplantation by patient diagnosis.  J Heart Lung Transplant. 2002;  21 226-232
  CrossrefPubMedGoogle Scholar
• 34 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;  15 1156-1163
  PubMedGoogle Scholar
• 35 King M B, Campbell E J, Gray B H, Hertz M I. The proteinase-antiproteinase balance in alpha-1-proteinase inhibitor-deficient lung transplant recipients.  Am J Respir Crit Care Med. 1994;  149 966-971
  CrossrefPubMedGoogle Scholar
• 36 Meyer K C, Nunley D R, Dauber J H et al.. Neutrophils, unopposed neutrophil elastase, and alpha1-antiprotease defenses following human lung transplantation.  Am J Respir Crit Care Med. 2001;  164 97-102
  CrossrefPubMedGoogle Scholar
• 37 Mal H, Guignabert C, Thabut G et al.. Recurrence of pulmonary emphysema in an alpha-1 proteinase inhibitor-deficient lung transplant recipient.  Am J Respir Crit Care Med. 2004;  170 811-814
  CrossrefPubMedGoogle Scholar
• 38 Strange C, Stoller J K, Sandhaus R A, Dickson R, Turino G. Results of a survey of patients with alpha-1 antitrypsin deficiency.  Respiration. 2006;  73 185-190
  PubMedGoogle Scholar
• 39 Arcasoy S M, Hersh C, Christie J D et al.. Bronchogenic carcinoma complicating lung transplantation.  J Heart Lung Transplant. 2001;  20 1044-1053
  CrossrefPubMedGoogle Scholar
• 40 de Perrot M, Chernenko S, Waddell T K et al.. Role of lung transplantation in the treatment of bronchogenic carcinomas for patients with end-stage pulmonary disease.  J Clin Oncol. 2004;  22 4351-4356
  CrossrefPubMedGoogle Scholar
• 41 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
  CrossrefPubMedGoogle Scholar
• 42 Minai O A, Shah S, Mazzone P et al.. Bronchogenic carcinoma after lung transplantation: characteristics and outcomes.  J Thorac Oncol. 2008;  3 1404-1409
  CrossrefPubMedGoogle Scholar
• 43 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
  CrossrefPubMedGoogle Scholar
• 44 Yonan N A, el-Gamel A, Egan J, Kakadellis J, Rahman A, Deiraniya A K. Single lung transplantation for emphysema: predictors for native lung hyperinflation.  J Heart Lung Transplant. 1998;  17 192-201
  PubMedGoogle Scholar
• 45 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
  CrossrefPubMedGoogle Scholar
• 46 Anderson M B, Kriett J M, Kapelanski D P, Perricone A, Smith C M, Jamieson S W. Volume reduction surgery in the native lung after single lung transplantation for emphysema.  J Heart Lung Transplant. 1997;  16 752-757
  PubMedGoogle Scholar
• 47 Venuta F, De Giacomo T, Rendina E A et al.. Thoracoscopic volume reduction of the native lung after single lung transplantation for emphysema.  Am J Respir Crit Care Med. 1998;  157 292-293
  PubMedGoogle Scholar
• 48 Crespo M M, Johnson B A, McCurry K R, Landreneau R J, Sciurba F C. Use of endobronchial valves for native lung hyperinflation associated with respiratory failure in a single-lung transplant recipient for emphysema.  Chest. 2007;  131 214-216
  CrossrefPubMedGoogle Scholar
• 49 Schulman L L, O'Hair D P, Cantu E, McGregor C, Ginsberg M E. Salvage by volume reduction of chronic allograft rejection in emphysema.  J Heart Lung Transplant. 1999;  18 107-112
  CrossrefPubMedGoogle Scholar

Robert M KotloffM.D. 

Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center

3400 Spruce St., Philadelphia, PA 19104

Email: kotloffr@uphs.upenn.edu