Lung Transplantation for Chronic Obstructive Pulmonary Disease: Special Considerations

Joshua Diamond; Robert M Kotloff

doi:10.1055/s-0030-1249108

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2010; 31(2): 115-122
DOI: 10.1055/s-0030-1249108

Lung Transplantation for Chronic Obstructive Pulmonary Disease: Special Considerations

Joshua Diamond¹ , Robert M. Kotloff¹

¹Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Abstract

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

Full Text

References

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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