Lung Transplantation for Obstructive Lung Diseases

Abstract

Lung transplantation is commonly performed for obstructive lung diseases—most commonly chronic obstructive pulmonary disease (COPD)—and this presents unique challenges. Unlike the fibrotic conditions, obstructive lung diseases may have a more indolent course, and so timing of listing and transplantation becomes increasingly relevant. Given the variable natural history and progression of COPD, the use of functional assessments and use of multivariate tools such as the BODE index may assist in identification of those individuals most likely to derive benefit from undergoing lung transplantation. Additionally, the possibility of single lung transplantation should be explored, with the potential for increased utility (by providing organs for two recipients) to be weighed against potential post-transplant complications, namely native lung hyperinflation and malignancy in the native lung. A survival benefit from bilateral lung transplantation for COPD continues to be debated. Compared with lung transplantation for other indications, survival in the cohort of obstructive lung diseases is comparable, and in the early post-operative period compares favourably.