Lung Transplantation for Chronic Obstructive Pulmonary Disease: Special Considerations

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.

KEYWORDS

Lung transplantation - chronic obstructive pulmonary disease - outcomes

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
• 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
• 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
• 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
• 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
• 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
• 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
• 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 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 29 Levy R D, Ernst P, Levine S M et al.. Exercise performance after lung transplantation.  J Heart Lung Transplant. 1993;  12 27-33
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 39 Arcasoy S M, Hersh C, Christie J D et al.. Bronchogenic carcinoma complicating lung transplantation.  J Heart Lung Transplant. 2001;  20 1044-1053
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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