The Complete Guide to Lung Transplants for COPD

Learn whether you qualify for a lung transplant and what it involves

Chest X-Ray
Chest X-Ray. Getty Images / Handout / Getty Images

Lung transplants are possible treatments for people with chronic obstructive pulmonary disease (COPD) who are in the very advanced stages of the disease and who meet very specific criteria.

If you are an individual with COPD who has tried every avenue of treatment, both medically and surgically, and your condition continues to deteriorate, you may be eligible to receive a lung transplant.

Benefits of Lung Transplants for COPD

Lung transplants have been shown to improve quality of life and the ability to perform physical activities related to muscle strength.

Medical research indicates that a double lung transplant seems to help more than a single lung transplant.

While lung transplants do not, as of yet, increase long-term survival in COPD, short-term survival continues to improve. In fact, in a 2005 survey of patients who had single-lung transplants, the National Heart, Lung and Blood Institute reports that:

  • more than 82% of patients survive the first year after a transplant
  • approximately 60% survive three years after a transplant
  • more than 43% survive five years after a transplant

Another recent study found that survival following lung transplant is better for those whose COPD is not related to cigarette smoking.

As surgical procedures and technology improve, perhaps one day, long-term survival will be possible for people with COPD who receive lung transplants.

Who Qualifies for a Lung Transplant?

To be referred by your doctor for a possible lung transplant, you should:

  • be less than 65 years of age (although some programs will consider older patients)
  • have an FEV1 of less than 20% predicted (although some programs accept an FEV1 that is higher, depending upon the circumstances)
  • have chronic hypercapnia and a lowered Pa02 as measured by arterial blood gases
  • have secondary pulmonary hypertension
  • have a BODE Index score of > 7 (the BODE Index, which is based on your lung test values, predicts your chances of survival in four years)

In addition, to qualify for a lung transplant, you need to have a greater chance of survival with a lung transplant than without one. Since lung transplantation is a procedure with considerable risks, including the risk of dying from the surgery itself, doctors won't perform it unless you're also at considerable risk of dying without it.

Potential transplant patients should also be ambulatory, not be overweight or underweight, be highly motivated and have an excellent support system.

What if I've Had Previous Lung Surgery?

Having had previous lung surgery such as lung volume reduction surgery (LVRS) or bullectomy, does not disqualify you from having a lung transplant. In some patients, prior lung surgery can actually work in their favor.

Complications of Lung Transplant

Apart from the possibility of death during the operation, complications of lung transplants include:

Risk Factors for Complications After Lung Transplant

There are many factors that may contribute to a poor outcome in lung transplant surgeries, including smoking, poor baseline health, increased age, obesity and the severity of your disease. Your doctor will review these risk factors with you very carefully, to make sure that the benefits of the surgery outweigh the risks.

To see a step-by-step photo guide to lung transplant surgery, visit the Lung Transplant Image Gallery.

Sources:

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010. Available from: http://www.goldcopd.org.

Merlo, Christian A; Orens, Jonathan B. Selection of candidates for lung transplantation. Current Opinion in Organ Transplantation: October 2007. Volume 12. Issue 5. pages 479-484.

National Heart, Lung and Blood Institute. What are the Risks of Lung Transplants? Dec. 2008.

Tanash HA et al. Survival benefit of lung transplantation for chronic obstructive pulmonary disease in Sweden. The Annals of Thoracic Surgery. 2014 Dec;98(6):1930-5.

Cerón Navarro J et al. Functional outcomes after lung transplant in chronic obstructive pulmonary disease. Archevos de Bronconeumologia. 2015 Mar;51(3):109-14.

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