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Lung transplantation for COPD/pulmonary emphysema.

Geert M Verleden1, Jens Gottlieb2,3

  • 1Department of Respiratory Diseases, Lung Transplantation Unit, University Hospital Gasthuisberg, Leuven, Belgium geert.verleden@uzleuven.be.

European Respiratory Review : an Official Journal of the European Respiratory Society
|March 22, 2023
PubMed
Summary
This summary is machine-generated.

Lung transplantation is a vital option for end-stage COPD and alpha-1 antitrypsin deficiency emphysema when other treatments fail. While improving life expectancy and quality of life, complications like chronic lung allograft dysfunction impact long-term survival.

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Area of Science:

  • Pulmonology
  • Transplant Surgery
  • Immunology

Background:

  • Chronic Obstructive Pulmonary Disease (COPD) and alpha-1 antitrypsin deficiency emphysema are leading causes for lung transplantation.
  • Lung transplantation is considered when all other therapeutic options, including rehabilitation and ventilation, are exhausted or not feasible.
  • Strict selection criteria and contraindications, coupled with donor lung shortages, limit transplant eligibility for many end-stage patients.

Purpose of the Study:

  • To review the indications, procedures, outcomes, and complications of lung transplantation for COPD and alpha-1 antitrypsin deficiency emphysema.

Main Methods:

  • Review of current literature and clinical practice regarding lung transplantation for COPD and alpha-1 antitrypsin deficiency emphysema.
  • Analysis of patient selection criteria, surgical approaches (single vs. double lung transplant), and post-transplant outcomes.
  • Examination of major complications, including solid organ cancer and chronic lung allograft dysfunction.

Main Results:

  • Lung transplantation significantly improves life expectancy and health-related quality of life in eligible COPD patients.
  • Double lung transplantation may offer slightly better outcomes compared to single lung transplantation.
  • Chronic lung allograft dysfunction affects up to 50% of patients within 5 years, significantly impacting long-term survival due to limited treatment options.

Conclusions:

  • Lung transplantation offers a critical lifeline for select COPD patients, enhancing survival and quality of life.
  • Managing post-transplant complications, particularly chronic lung allograft dysfunction, is crucial for long-term success.
  • Ongoing donor shortages necessitate careful patient selection and optimization of transplant strategies.