title: Lung transplantation for chronic obstructive pulmonary disease at St Vincent's Hospital.
abstract: BACKGROUND
  Lung transplantation (LTx) offers selected patients with end-stage chronic obstructive pulmonary disease (COPD) an improved quality of life and possibly enhanced survival.
  
  
  OBJECTIVE
  To determine local outcomes of LTx for COPD we analysed 173 consecutive heart-LTx (n = 8), single LTx (SLTx; n = 99) and bilateral LTx (BLTx; n = 66) carried out at a single institution during 1989-2003 for smoking-related emphysema (E) (n = 112) and emphysema related to alpha-1 antitrypsin deficiency (AATD) (n = 61).
  
  
  METHODS
  There were 98 men and 75 women with a mean age of 50 +/- 6 years (standard deviation) (range 32-63 years). Median waiting time was 113 days (interquartile range (IQR) 50-230 days), and median inpatient stay was 13 days (IQR 9-21 days).
  
  
  RESULTS
  Perioperative survival (30 days) was 95% with deaths from sepsis (n = 5), cerebrovascular accident (n = 3) and multiorgan failure (n = 1). Mean follow-up period was 1693 +/- 1302 days (2-4,805 days). The 1-, 5- and 10-year survivals (%) were similar for patients with E and AATD (P = 0.480 log rank) at 86 +/- 5, 57 +/- 7 and 31 +/- 11, respectively, but 1- and 5-year survivals for E were higher after BLTx than after SLTx (97 +/- 2 and 81 +/- 8 vs 85 +/- 4 and 47 +/- 6) (P = 0.015). Pretransplant body mass index, forced expiratory volume in 1 second, forced vital capacity, PaCO(2), PaO(2), six-minute walk distance, home oxygen use, age, sex, cytomegalovirus donor-recipient mismatch, cardiopulmonary bypass use, year of transplant and ischaemic time did not influence survival after LTx. Increasing donor age was a survival risk factor for patients with E but not for those with AATD (hazard ratio 1.043; 95%confidence interval 1.014-1.025).
  
  
  CONCLUSIONS
  Survival after LTx for COPD is similar to survival for other forms of solid organ transplantation, in part reflecting risk factor management.
authors.affiliation: Thoracic Medicine, Cairns Base Hospital, Cairns, Queensland, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Güneş
authors.forename: C L
authors.initials: CL
authors.lastname: Aboyoun
authors.forename: J M
authors.initials: JM
authors.lastname: Morton
authors.forename: M
authors.initials: M
authors.lastname: Plit
authors.forename: M A
authors.initials: MA
authors.lastname: Malouf
authors.forename: A R
authors.initials: AR
authors.lastname: Glanville
mesh_terms: D002423:Cause of Death; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000601:surgery; D011788:Quality of Life; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome