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Home O: Optimise function O9. Surgery O9.3 Lung Transplantation

O9.3 Lung Transplantation

Lung transplantation is indicated for selected patients with chronic end stage lung disease who are failing maximal medical therapy. However a survival benefit has not been demonstrated in emphysema. For most patients, transplantation is a palliative rather than a curative treatment. The International Society for Heart and Lung Transplantation has listed a number of contraindications. (Orens et al., 2006) The absolute contraindications include malignancy and untreatable advanced dysfunction of another major organ system. Relative contraindications include age older than 65 years, severely limited functional status and other medical conditions that have not resulted in end stage organ damage. The consensus guidelines (Orens et al., 2006) recommend transplantation be considered in COPD patients with:

  • BODE index of 7 – 10 or at least one of the following:
  • History of hospitalisation for exacerbations associated with acute hypercapnia
  • Pulmonary hypertension or cor pulmonale or both, despite oxygen therapy
  • FEV1 < 20% and either DLCO < 20% or homogeneous emphysema (Fishman et al., 2003)

The experience of one Australian lung transplantation centre has recently been reviewed. (Gunes et al., 2006) Over a 14 year period, 173 single lung, bilateral lung and heart lung transplants were performed for COPD. Perioperative survival (30 days) was 95% with deaths from infection, cerebrovascular accidents and multiorgan failure. The one, five and ten year survival rates were similar for patients with smoking related emphysema and a1 antitrypsin deficiency at 86%, 57% and 31% respectively. Survival in smoking related emphysema was better following bilateral than single lung transplantation. The commonest cause of late mortality was chronic rejection manifest as the bronchiolitis obliterans syndrome. Overall survival was comparable to international experience and similar to other forms of solid organ transplantation.

 

COPD-X Plan - Version 2.36 - December 2013