Lung Transplants to Treat COPD

Understanding the Goals and Criteria for Selection

Lung transplants are commonly used for persons with end-stage chronic obstructive pulmonary disease (COPD) who meet specific criteria. The disease is classified as end-stage when flare-ups and breathing problems have become potentially life-threatening, and every other avenue of treatment, both medical and surgical, have been exhausted.

All told, around 2,000 lung transplants are performed each year in the United States, according to statistics from the Scientific Registry of Transplant Recipients in Minneapolis.

Chest X-Ray
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Benefits of Lung Transplant Surgery

Lung transplants can significantly improve the quality of life and restore many of the physical functions long denied persons living with stage 4 COPD. In terms of options, current research suggests that a bilateral lung transplant (the replacement of both lungs) is typically more beneficial in the long term compared to a single-lung transplant.

While lung transplants do not, as of yet, increase the long-term survival rates in people with COPD, the quality and span of short-term survival continue to improve. According to the research:

  • Between 80 percent and 90 percent of persons undergoing a transplant survive the first year.
  • Between 41 percent and 52 percent survive for five or more years.

Moreover, 66.7 percent of people with a bilateral transplant are able to live five years or more compared to only 44.9 percent of those with a single-lung transplant.

Selection of Lung Transplant Candidates

Generally speaking, a person is considered a candidate for a lung transplant if he or she has a life expectancy of two years or less. Moreover, an age limit of 65 is typically advised for a single-lung transplant and 60 years for a bilateral transplant. Statistics have shown little benefit in either the survival time or quality of life for persons older than this.

Other criteria include:

  • Having an FEV1 of less than 20 percent
  • Experiencing chronic hypercapnia (excessive carbon dioxide) and reduced blood oxygen levels
  • Experiencing secondary pulmonary hypertension
  • Having a BODE Index score of under seven (indicating a shortened life expectancy)

There may be some leeway in these numbers, based on a review of the individual case. Selection would also involve an assessment of whether the person is ambulatory, has a strong support system, and is motivated to undergo physical therapy, exercise, smoking cessation, and other lifestyle changes leading up to and following surgery.

Persons with a previous lung surgery, such as a lung volume reduction surgery (LVRS) or a bullectomy, may also qualify if they are able to meet the criteria.

Post-Surgical Complications

There is no underplaying the fact that a lung transplant is a major procedure that carries a significant risk of complications, including death. They can either be respiratory-related or non-respiratory-related.

Respiratory-related complications are those that directly affect the lungs and may include:

  • Ischemia-reperfusion injury (damage caused when blood returns to tissue after a period of oxygen deprivation)
  • Bronchiolitis obliterans (respiratory obstruction due to acute inflammation)
  • Tracheal malacia (collapsed windpipe)
  • Atelectasis (collapsed lung)
  • Pneumonia

By contrast, non-respiratory-related complications are those affecting other organs or related to the immune suppressive drugs used to prevent organ rejection. While organ rejection is the most immediate concern following transplant surgery, others can include:

  • Infection
  • Lymphoproliferative disease (caused when too many white blood cells, called lymphocytes, are produced in persons with a compromised immune system)
  • Lymphoma (cancer of the immune system)
  • Systemic hypertension
  • Kidney failure
  • Post-transplant diabetes

A Word From Verywell

While lung transplants are always considered a last resort, advances in technology and post-surgical care have led to greater rates of success than ever before.

With that being said, the utmost care needs to be taken to ensure that you not only comprehend the benefits of treatment but understand the challenges you can face for the weeks, months, and years following the surgery.

The risks can be high. All told, around 50 percent of persons receiving a lung transplant from an unrelated donor will experience chronic rejection (characterized by the progressive loss of organ function over the course of years).

The improvement of these rates depends largely on the management of complications. This means that you, as the patient, need to be fully committed to taking every step needed to improve your overall health. In the end, you are one of the most important factors in determining your long-term success.

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  1. Valapour M, Skeans MA, Smith JM, et al. OPTN/SRTR 2015 Annual Data Report: Lung. Am J Transplant. 2017;17 Suppl 1:357-424. doi:10.1111/ajt.14129

  2. Aziz F, Penupolu S, Xu X, He J. Lung transplant in end-staged chronic obstructive pulmonary disease (COPD) patients: a concise reviewJ Thorac Dis. 2010;2(2):111–116.