Lung Transplantation for Obstructive Lung Diseases

  • Amy L. RigbyEmail author


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.


Lung transplantation Obstructive lung disease 


  1. 1.
    Yusen RD, Edwards LB, Dipchand AI, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-third adult lung and heart-lung transplant report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant. 2016;35(10):1170–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Yusen RD, Edwards LB, Kucheryavaya AY, International Society of Heart and Lung Transplantation, et al. The registry of the International Society for Heart and Lung Transplantation: 31st adult lung and heart-lung transplant report - 2014; focus theme: retransplantation. J Heart Lung Transplant. 2014;33(10):1009–24.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shah RJ, Kotloff RM. Lung transplantation for obstructive lung diseases. Semin Respir Crit Care Med. 2013;34:288–96.CrossRefPubMedGoogle Scholar
  4. 4.
    Lane CR, Tonelli AR. Lung transplantation in chronic obstructive pulmonary disease: patient selection and special considerations. Int J Chron Obstruct Pulmon Dis. 2015;10:2137–46.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Casanova C, de Torres JP, Aguirre-Jaime A, et al. The progression of chronic obstructive pulmonary disease is heterogeneous: the experience of the BODE cohort. Am J Respir Crit Care Med. 2011;184(9):1015.CrossRefPubMedGoogle Scholar
  6. 6.
    Stavem K, Bjørtuft O, Borgan O, Geiran O, Boe J. Lung transplantation in patients with chronic obstructive pulmonary disease in a national cohort is without obvious survival benefit. J Heart Lung Transplant. 2006;25(1):75–84.CrossRefPubMedGoogle Scholar
  7. 7.
    Celli BR. Predictors of mortality in COPD. Respir Med. 2010;104(6):773–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnoea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014 - an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34(1):1–15.CrossRefPubMedGoogle Scholar
  10. 10.
    Lahzami S, Bridevaux PO, Soccal PM, et al. Survival impact of lung transplantation for COPD. Eur Respir J. 2010;36:74–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Soler-Cataluna JJ, Martinez-Garcia MA, Sanchez LS, Tordera MP, Sanchez PR. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir Med. 2009;103:692–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Connors AF Jr, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996;154:959–67.CrossRefPubMedGoogle Scholar
  13. 13.
    Tanash H, Riise G, Hansson L, Nilsson P, Piitulainen E. Survival benefit of lung transplantation in individuals with severe α1-anti-trypsin deficiency (PiZZ) and emphysema. J Heart Lung Transplant. 2011;30(12):1342–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Thabut G, Mornex JF, Pison C, et al. Performance of the BODE index in patients with α1-antitrypsin deficiency-related COPD. Eur Respir J. 2014;44(1):78–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Gulack BC, Ganapathi AM, Speicher PJ, Chery G, Snyder LD, Davis RD, Hartwig MG. Survival after lung transplant in alpha-1-antitrypsin deficiency recipients compared to other forms of chronic obstructive pulmonary disease. J Heart Lung Transplant. 2015;34(4):S243–4.CrossRefGoogle Scholar
  16. 16.
    Taveira-DaSilva AM, Pacheco-Rodriguez G, Moss J. The natural history of lymphangioleiomyomatosis: markers of severity, rate of progression and prognosis. Lymphat Res Biol. 2010;8(1):9–19.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Oprescu N, McCormack FX, Byrnes S, Kinder BW. Clinical predictors of mortality and cause of death in lymphangioleiomyomatosis: a population-based registry. Lung. 2013;191(1):35–42.CrossRefPubMedGoogle Scholar
  18. 18.
    Benden C, Rea F, Behr J, et al. Lung transplantation for lymphangioleiomyomatosis: the European experience. J Heart Lung Transplant. 2009;28(1):1–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Reynaud-Gaubert M, Mornex JF, Mal H, et al. Lung transplantation for lymphangioleiomyomatosis: the French experience. Transplantation. 2008;86(4):515–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Kpodonu J, Massad MG, Chaer RA, et al. The US experience with lung transplantation for pulmonary lymphangioleiomyomatosis. J Heart Lung Transplant. 2005;24(9):1247–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Ussavarungsi K, Hu X, Scott JP, et al. Mayo clinic experience of lung transplantation in lymphangioleiomyomatosis. Respir Med. 2015;109(10):1354–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Suri HS, Yi ES, Nowakowski GS, Vassallo R. Pulmonary Langerhans cell histiocytosis. Orphanet J Rare Dis. 2012;7:16.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Dauriat G, Mal H, Thabut G, et al. Lung transplantation for pulmonary Langerhans cell histiocytosis: a multicenter analysis. Transplantation. 2006;81(5):746–50.CrossRefPubMedGoogle Scholar
  24. 24.
    ISHLT transplant registry quarterly reports. 30 Dec 2016.Google Scholar
  25. 25.
    Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008;371(9614):744–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Trulock EP. Lung transplantation for COPD. Chest. 1998;113:269S–76S.CrossRefPubMedGoogle Scholar
  27. 27.
    Bavaria JE, Kotloff R, Palevsky H, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg. 1997;113(3):520–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Levine SM, Anzueto A, Peters JI, et al. Medium term functional results of single-lung transplantation for endstage obstructive lung disease. Am J Respir Crit Care Med. 1994;150(2):398–402.CrossRefPubMedGoogle Scholar
  29. 29.
    Malk H, Andreassian B, Pamela F, et al. Unilateral lung transplantation in end-stage pulmonary emphysema. Am Rev Respir Dis. 1989;140(3):797–802.CrossRefGoogle Scholar
  30. 30.
    Meyer DM, Bennett LE, Novick RJ, Hosenpud JD. Single vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points. J Heart Lung Transplant. 2001;20(9):935–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Nwakanma LU, Simpkins CE, Williams JA, et al. Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database. J Thorac Cardiovasc Surg. 2007;133(2):541–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Gerbase MW, Spiliopoulos A, Rochat T, Archinard M, Nicod LP. Health-related quality of life following single or bilateral lung transplantation: a 7-year comparison to functional outcome. Chest. 2005;128(3):1371–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Gaissert HA, Trulock EP, Cooper JD, Sunaresan RS, Patterson GA. Comparison of early functional results after volume reduction or lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg. 1996;111(2):296–306.CrossRefPubMedGoogle Scholar
  34. 34.
    Sundaresan RS, Shiraishi Y, Trulock EP, et al. Single or bilateral lung transplantation for emphysema? J Thorac Cardiovasc Surg. 1996;112(6):1485–94.CrossRefPubMedGoogle Scholar
  35. 35.
    Weill D, Torres F, Hodges TN, Olmos JJ, Zamora MR. Acute native lung hyperinflation is not associated with poor outcomes after single lung transplant for emphysema. J Heart Lung Transplant. 1999;18(11):1080–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Pochettino A, Kotloff RM, Rosengard BR, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: intermediate term results. Ann Thorac Surg. 2000;70(6):1813–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Hadjiliadis D, Davis RD, Palmer SM. Is transplant operation important in determining posttransplant risk of bronchiolitis obliterans syndrome in lung transplant recipients? Chest. 2002;122(4):1168–75.CrossRefPubMedGoogle Scholar
  38. 38.
    Mal H, Brugiere O, Sleiman C, et al. Morbidity and mortality related to the native lung in single lung transplantation for emphysema. J Heart Lung Transplant. 2000;19(2):220–3.CrossRefPubMedGoogle Scholar
  39. 39.
    Horvath J, Dummer S, Loyd J, Walker B, Merril WH, Frist WH. Infection in the transplanted and native lung after single lung transplantation. Chest. 1993;104:681–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Angles R, Tenorio L, Roman A, Soler J, Rochera M, de Latorre FJ. Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome. Transpl Int. 2005;17:810–4.CrossRefPubMedGoogle Scholar
  41. 41.
    Ahya VN, Kawut SM. Noninfectious pulmonary complications after lung transplantation. Clin Chest Med. 2005;26(4):613–22.CrossRefPubMedGoogle Scholar
  42. 42.
    Venuta F, de Giacomo T, Rendina EA, et al. Thoracoscopic volume reduction of the native lung after single lung transplantation for emphysema. Am J Respir Crit Care Med. 1998;157(1):292–3.CrossRefPubMedGoogle Scholar
  43. 43.
    Dickson RP, Davis RD, Rea JB, Palmer SM. High frequency of bronchogenic carcinoma after single-lung transplantation. J Heart Lung Transplant. 2006;25:1297–301.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    King CS, Khandar S, Burton N, et al. Native lung complications in single-lung transplant recipients and the role of pneumonectomy. J Heart Lung Transplant. 2009;28(8):851–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Yserbyt J, Verleden GM, Dupont LJ, et al. Bronchial carcinoma after lung transplantation: a single-center experience. J Heart Lung Transplant. 2012;31:585–90.CrossRefPubMedGoogle Scholar
  46. 46.
    Arcasoy SM, Hersh C, Christie JD, et al. Bronchogenic carcinoma complicating lung transplantation. J Heart Lung Transplant. 2001;20(10):1044–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Lung Transplant Unit, St. Vincent’s Hospital, SydneyDarlinghurstAustralia

Personalised recommendations