Lung transplantation in chronic obstructive pulmonary disease: patient selection and special considerations.
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity. Lung transplantation is one of the few treatments available for end-stage COPD with the potential to improve survival and quality of life. The selection of candidates and timing of listing present challenges, as COPD tends to progress fairly slowly, and survival after lung transplantation remains limited. Though the natural course of COPD is difficult to predict, the use of assessments of functional status and multivariable indices such as the BODE index can help identify which patients with COPD are at increased risk for mortality, and hence which are more likely to benefit from lung transplantation. Patients with COPD can undergo either single or bilateral lung transplantation. Although many studies suggest better long-term survival with bilateral lung transplant, especially in younger patients, this continues to be debated, and definitive recommendations about this cannot be made. Patients may be more susceptible to particular complications of transplant for COPD, including native lung hyperinflation, and development of lung cancer.
Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
C Randall
CR
Lane
Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Adriano R
AR
Tonelli
D006801:Humans; D016040:Lung Transplantation / Q000379:methods / Q000523:psychology; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011788:Quality of Life; D012720:Severity of Illness Index
alpha-1 antitrypsin deficiency; emphysema; mortality; outcomes; prognosis; pulmonary hypertension