Lung transplantation for chronic obstructive pulmonary disease

Area of Science:

• Pulmonary Medicine
• Thoracic Surgery
• Transplantation Immunology

Background:

• Emphysema is a leading cause of death and the primary indication for lung transplantation globally.
• Advances in surgical techniques, organ preservation, and immunosuppression have improved long-term survival post-transplant.
• Inadequate organ supply and chronic rejection remain significant challenges limiting transplantation for many patients.

Purpose of the Study:

• To review current data on recipient and donor selection for emphysema lung transplantation.
• To discuss the choice between single versus bilateral lung transplantation.
• To highlight the role and impact of lung volume reduction surgery (LVRS) in managing end-stage emphysema, including its combination with transplantation.

Main Methods:

• Review of recent literature and clinical data pertaining to lung transplantation for emphysema.
• Analysis of outcomes associated with different transplant procedures (single vs. bilateral).
• Evaluation of the integration of lung volume reduction surgery with lung transplantation.

Main Results:

• Bilateral lung transplantation is often favored for potentially superior functional results and long-term survival.
• Lung volume reduction surgery has altered decision-making for emphysema transplantation.
• Combining lung transplantation with synchronous lung volume reduction surgery is explored for its rationale and outcomes.

Conclusions:

• Lung transplantation offers improved survival for end-stage emphysema, but limitations persist.
• Lung volume reduction surgery presents a viable alternative and adjunct to transplantation.
• Synchronous lung volume reduction surgery and lung transplantation may offer enhanced benefits for select emphysema patients.