title: Lung transplantation in chronic obstructive pulmonary disease: long-term survival, freedom from bronchiolitis obliterans syndrome, and factors influencing outcome.
abstract: OBJECTIVE
  Lung transplantation (LTx) remains the definitive treatment for end-stage lung failure, whereas chronic obstructive pulmonary disease (COPD) represents one of the main diagnoses leading to the indication for a transplant. We sought to assess long-term outcomes after LTx in patients diagnosed with COPD and analyze factors influencing outcome in this frequent patient cohort.
  
  
  METHODS
  Between January 2007 and November 2013, a total of 88 LTx were performed in patients with COPD in our institution. Patients with emphysema associated with alpha1-antitrypsin deficiency were excluded from this observation. The study design was a retrospective review of the prospectively collected data. A large number of pre-, intra-, and postoperative variables were analyzed including long-term survival and freedom from bronchiolitis obliterans syndrome (BOS). Furthermore, impact of different variables on survival was analyzed.
  
  
  RESULTS
  Preoperative donor data indicated a large proportion of marginal donors. While the overall cumulative survival after six yr was 57.4%, the results in terms of BOS-free survival in long-term follow-up were 39.7% after six yr. Patients with COPD were also associated with a low incidence (2.3%) of the need for postoperative extracorporeal life support (ECLS).
  
  
  CONCLUSIONS
  Long-term results after LTx in patients with COPD are acceptable with excellent survival, freedom from BOS, and low use of ECLS postoperatively despite permanently increasing proportion of marginal organs used.
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK; Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors: Mohamed
authors: M
authors: Zeriouh
authors: Prashant N
authors: PN
authors: Mohite
authors: Anton
authors: A
authors: Sabashnikov
authors: Bartlomiej
authors: B
authors: Zych
authors: Nikhil P
authors: NP
authors: Patil
authors: Diana
authors: D
authors: Garcia-Saez
authors: Achim
authors: A
authors: Koch
authors: Ali
authors: A
authors: Ghodsizad
authors: Alexander
authors: A
authors: Weymann
authors: Simona
authors: S
authors: Soresi
authors: Thorsten
authors: T
authors: Wittwer
authors: Yeong-Hoon
authors: YH
authors: Choi
authors: Jens
authors: J
authors: Wippermann
authors: Thorsten
authors: T
authors: Wahlers
authors: Aron-Frederik
authors: AF
authors: Popov
authors: André R
authors: AR
authors: Simon
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: chronic obstructive pulmonary disease; lung transplantation; outcomes