Lung transplants are performed as a means of surgical intervention for a variety of lung diseases including pulmonary fibrosis and pulmonary hypertension. COPD, however, is the most common indication for lung transplantation.
Patients who are less than 65 years old with end-stage COPD in the absence of other significant disease should be considered for lung transplant evaluation and referral. Some programs will consider patients who are older than 65 years, but strict criteria must be met for consideration.
Those who who would reap the highest reward from lung transplantation include patients that demonstrate the following:
- An FEV1 < 20% of the predicted
- Hypercapnia
- Those with associated pulmonary hypertension
- Those whose chance for survival would be greater if they had a lung transplant, than if they did not
Additionally, potential transplant candidates should be able to walk and move about, the appropriate weight, and highly motivated with an adequate support system.
It is interesting to note that previous bullectomy or LVRS is not a contraindication for lung transplantation. These procedures can actually help serve as a bridge to lung transplantation for some patients.
While a lung transplant does not improve survival in COPD patients, benefits from lung transplantation must be looked at in terms of functional and quality-of-life benefit.
To see a step-by-step photo guide to lung transplant surgery, visit the Lung Transplant Image Gallery.
In Conclusion
The burden that COPD places upon a patient can severely impact their quality of life. To those with end-stage COPD that do not respond well to medication, surgical intervention may be an option. Only your primary care provider can determine if you would make a good candidate for this type of surgery.
Sources:
American Lung Association. LVRS Fact Sheet. August, 2005. http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=992745
American Thoracic Society, European Thoracic Society. 2004. Standards for the diagnosis and management of patients with COPD. Version 1.2. 2005. Available at http://www.thoracic.org.
Huang FRCPC, Max MD, Singer, FRCPC, Lianne G. MD. http://www.medscape.com/viewarticle/502203 "Surgical Interventions for COPD". Geriatrics Aging. 2005; 8(3): 40-46.
Fishman A, Martinez F, Naunheim K, Piantadosi S, Wise R, Ries A, et al; "National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema". N Engl J Med 2003;348(21): 2059–2073.
Hosenpud JD, Bennett LE, Keck BM, Edwards EB, Novick RJ. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease. Lancet 1998;351(9095):24–27.
National Emphysema Treatment Trial Research Group. Patients at high risk of death after lung-volume-reduction surgery. N Engl J Med 2001;345(15):1075–1083.
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