Lung transplantation for chronic obstructive pulmonary disease patients: an overview

To provide an overview of current indications for lung transplantation (LTx) in COPD patients, to describe the different transplantation options, to compare the outcome of COPD and alpha1-antitrypsin deficiency (AATD) patients versus non-AATD COPD patients and to discuss the possible complications, also specifically related to COPD, AATD patients and the transplantation procedure.

Some 30-50% of all lung LTx worldwide are performed in COPD patients, with the majority being operated via double lung transplantation (DLTx). Unilateral lung transplantation (SLTx) remains an option, depending on the donor availability and the center's experience. The mean survival after LTx for COPD remains somewhat lower compared to other underlying diseases, especially after SLTx, which may lead to specific complications such as native lung hyperinflation and development of a native lung cancer.

LTx for end-stage COPD remains an accepted treatment modality in selected patients, which increases the QOL and the survival. The global 5-year survival is around 60%; somewhat better for AATD, compared to non-AATD COPD and after DLTx compared to SLTx. The best procedure of choice remains a matter for further discussion, although most centers prefer to perform DLTx, certainly in patients with underlying AATD.