What are the criteria for lung transplantation in a patient with Chronic Obstructive Pulmonary Disease (COPD) in the United Kingdom (UK)?

From the Guidelines

The criteria for lung transplantation in a patient with Chronic Obstructive Pulmonary Disease (COPD) in the UK 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, as outlined in the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1. To be considered for lung transplantation, patients with COPD must meet specific requirements, including:

• A BODE index score indicating severe disease
• Significant hypercapnia or hypoxemia
• Severe airflow obstruction, as indicated by an FEV1 less than 25% predicted
• Inability to benefit from other treatments, such as endoscopic or surgical lung volume reduction Patients must also be assessed for their overall suitability for transplantation, taking into account factors such as age, comorbidities, nutritional status, and psychological stability 1. The decision to proceed with lung transplantation is complex and requires careful consideration of the potential benefits and risks, as well as the availability of donor lungs.
• The BODE index is a key factor in determining suitability for transplantation, with a score of 5 to 6 indicating severe disease and a score greater than 7 indicating very severe disease 1.
• Other factors, such as pulmonary hypertension and history of severe exacerbations, may also be taken into account when assessing a patient's suitability for transplantation 1. It is essential to prioritize the most recent and highest-quality evidence when making decisions about lung transplantation, as outlined in the 2017 report 1.

From the Research

Criteria for Lung Transplantation in COPD Patients

The criteria for lung transplantation in patients with Chronic Obstructive Pulmonary Disease (COPD) in the United Kingdom (UK) involve several factors, including:

• Severity of lung disease, with a low forced expiratory volume in 1 second (FEV1) being a common reason for referral to a lung transplant center 2, 3
• Patient comorbidities, such as secondary pulmonary hypertension 2
• Age and overall health of the patient 2, 4
• Balance between individual and community benefit 2
• Functional status and multivariable indices, such as the BODE index, to help identify patients at increased risk for mortality 5
• Presence of progressing disease despite maximal medical therapy, with referral to a lung transplant center considered in the presence of:
  • FEV1 < 25% predicted in the absence of exacerbation 3
  • Hypoxia (PaO2 < 60 mm Hg/8 kPa) 3
  • Hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) 3
  • Satisfactory general clinical condition 3

Patient Selection and Transplant Listing

Patient selection and transplant listing involve careful consideration of various factors, including:

• Assessment of functional status and multivariable indices 5
• Evaluation of patient comorbidities and overall health 2, 4
• Discussion of potential benefits and critical issues of bilateral and single lung transplantation 2, 5
• Consideration of donor-to-recipient organ size-matching 2

Special Considerations

Special considerations for COPD patients undergoing lung transplantation include:

• Native lung hyperinflation 5
• Development of lung cancer 5
• Infection and graft failure in the first year post-transplant 3
• Chronic graft rejection, currently referred to as chronic lung allograft dysfunction, as a leading cause of death beyond the first year post-transplant 3