From the Guidelines
Yes, a person with Chronic Obstructive Pulmonary Disease (COPD) can get a lung transplant, as it is the most common indication for lung transplantation, accounting for 35% of lung transplants 1. Lung transplantation is actually one of the treatment options for end-stage COPD when other treatments have failed to improve quality of life and lung function. Candidates for lung transplantation must meet specific criteria, including having severe disease despite optimal medical therapy, no significant comorbidities that would increase surgical risk, good nutritional status, and psychological stability. The evaluation process is comprehensive and includes pulmonary function tests, cardiac evaluation, and screening for infections. Not all COPD patients will qualify, as factors like advanced age (typically over 65-70), active smoking, severe obesity, or other organ dysfunction may exclude someone from transplantation. Some key criteria for referral for lung transplantation include a BODE index of 5 to 6, P CO2 greater than 50 mm Hg or 6.6 kPa and/or Pa O2 less than 60 mm Hg or 8 kPa, and FEV1 less than 25% predicted 1. The procedure involves replacing one or both diseased lungs with healthy donor lungs, with bilateral lung transplantation being a better option than single lung transplantation for better long-term outcomes, at least among patients younger than 60 years 1. After transplantation, patients require lifelong immunosuppressive medications to prevent rejection. While lung transplantation can significantly improve quality of life and survival for selected COPD patients, it carries risks including rejection, infection, and complications from immunosuppression. Key considerations for listing for lung transplantation include a BODE index greater than 7, FEV1 less than 15 to 20% predicted, three or more severe exacerbations during the preceding year, one severe exacerbation with acute hypercapnic respiratory failure, or moderate to severe pulmonary hypertension 1.
From the Research
Eligibility for Lung Transplant
- A person with Chronic Obstructive Pulmonary Disease (COPD) can be considered for a lung transplant, as it is a viable option for patients with end-stage COPD 2, 3, 4, 5, 6.
- The decision to refer a COPD patient for a lung transplant should be based on the severity of the disease, with factors such as forced expiratory volume in 1 second (FEV1) < 25% predicted, hypoxia, and hypercapnia being considered 2.
Selection Criteria
- The selection of candidates for lung transplant involves assessing the patient's functional status and using multivariable indices such as the BODE index to identify those at increased risk for mortality 4, 5.
- Patients with COPD can undergo either single or bilateral lung transplantation, although the choice of procedure remains debated 4, 5.
Post-Transplant Complications
- Post-transplant complications for COPD patients include infection, graft failure, chronic graft rejection, and malignancy 2, 3, 6.
- Native lung hyperinflation and development of lung cancer are also potential complications for COPD patients undergoing lung transplantation 4, 5.
Outcomes
- Lung transplantation can improve survival and quality of life for patients with end-stage COPD, although survival after lung transplantation remains limited 2, 3, 4, 5, 6.
- The median survival for COPD recipients is approximately 6.0 years, with chronic graft rejection being a leading cause of death beyond the first year post-transplant 2.