Lung Transplants to Treat COPD

Understanding the Goals and Criteria for Selection

In 2019, there were 2,759 lung transplants performed in the United States, and over 75% of candidates who received one were on the waiting list for less than 90 days. If you are getting ready to receive a lung transplant or are on the waiting list, you may have mixed feelings about what comes next, especially if you are unsure when you will receive the call that it's time for your operation.

While the one-year survival rate after receiving a lung transplant is about 88.8%, it is still the lowest survival rate out of any other type of organ transplant. Receiving a lung transplant can have a positive impact on your quality of life for years to come, but it's still very important to weigh the risks involved.

Chest X-Ray

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Benefits of Lung Transplant Surgery

People living with chronic obstructive pulmonary disease (COPD) face a number of symptoms that can make everyday life more difficult to manage. By the time a person reaches stage 4 COPD, they may have exhausted all other therapeutic or surgical options available. At that point, lung transplantation is considered by many to be the preferred treatment option.

Between the years 1995 and 2018, there were 19,152 lung transplants performed on people with emphysema, and 2,969 lung transplants performed on people with AAT deficiency. On average, people who received a double lung transplant survived 7.8 years after their operation, whereas the average for those who received a single lung transplant was 4.8 years.

Surgical success rates increased by 31% between 2005 and 2017 alone and survival outcomes are consistently improving. 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 continues to improve.

  • Between 80% and 90% of persons undergoing a transplant survive the first year.
  • Successful lung transplantation is associated with drastic improvements in lung function and exercise capacity. Some individuals report having no physical limitations after their operation.
  • Significant improvements in overall wellness and bodily pain, as well as mental health and vitality, have also been reported.

The BODE Index is a tool used by healthcare professionals to predict the likelihood that a person with COPD will survive. The assessment is often used as criteria for determining whether or not a person with COPD is an eligible candidate for lung transplantation.

Selection of Lung Transplant Candidates

Generally speaking, a person is considered a candidate for a lung transplant if they have a life expectancy of two years or less. They may also be placed on the waiting list if they meet at least one of the following criteria:

  • Their BODE Index score is seven or higher, indicating they have an 80% risk of dying within four years.
  • They have moderate to severe pulmonary hypertension (high blood pressure in the lungs).
  • They have had at least three flare-ups of COPD in the past year and have a high carbon dioxide level in their blood.
  • Their breathing tests revealed severe COPD or they had a forced expiratory volume (FEV1) that was less than 20%.

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.

You may not be eligible to receive a lung transplant if you have a recent history of cancer, liver disease, or heart attack; a chronic infection such as HIV or hepatitis B; morbid obesity; or a pattern of substance abuse.

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 immunosuppressive 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

Frequently Asked Questions

What is the long-term survival rate for lung transplant recipients?

Adult lung transplant recipients have an average one-year survival rate of 85% and five-year survival rate of 59%.

How often are lung transplants rejected?

The most common type of rejection is called acute rejection, which happens within a year of getting a lung transplant, and it occurs in approximately one-third of lung transplant recipients. Chronic rejection, referred to as chronic lung allograft dysfunction, may also occur. Most lung transplant recipients will experience chronic rejection over time, which results in damage and eventual dysfunction of the transplant.

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. In the end, you are one of the most important factors in determining your long-term success.

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