Lung Transplants And COPD

Getting a lung transplant is an option for some people living with COPD. So, what exactly does this entail? What are the benefits and risks? Is this a good option for you? If so, how do you begin the process of getting one? Let’s investigate.

What made lung transplants possible?

Lung transplant means part or all of the lungs are removed. They are replaced by donor lungs. The first attempt at lung transplantation was in the early 1900s. It was not very successful. Many more were performed beginning in the 1940s. Some were not very successful. But, the more the procedure was done, the better physicians got.¹

The first human lung transplant was performed in 1963. The patient was a 58-year-old prisoner with severe emphysema. He also had lung cancer. His prognosis looked grim, and he was not expected to live long. So, he was chosen as a good first candidate. By the way, he was well aware of the risks and volunteered.^1,2

The surgery was a success. But, the man died of kidney failure 18 days after the operation. By 1983, 43 similar operations were performed. Many of these surgeries were successful, but all of these patients died due to postoperative complications. Only one of these patients lived ten months.^1,2

But, in each of these attempts, surgeons learned what to do and what not to do. By 1983, a 58-year-old man with pulmonary fibrosis was chosen to be patient number 43. When told of the risks, and that the previous 43 had died after the operation, he said, “It is my privilege to be the 44th patient.” He survived the operation and went on to live another seven years.¹

Today, lung transplants are performed on 2,200 people every year. Cystic fibrosis is the most common reason for transplants in children. Other indications for lung transplantation include pulmonary fibrosis and our disease -- COPD.^2,3

The history of lung transplants and COPD

Severe emphysema is caused by the breakdown of lung tissue. Airways leading to these areas become chronically narrowed. The combination of these effects causes air to become trapped inside their lungs. This is called lung hyperinflation. These bad areas take up space where good lungs would normally expand.

So, space for air exchange is limited. And this creates a feeling of shortness of breath. It may become severe, thereby limiting the ability to stay active. Quality of life is often poor. Life expectancy is often limited.

One treatment option for this is lung transplantation. The first lung transplant on a severe emphysema patient took place in 1970. But, the procedure didn’t become more common until the late 1980s.¹

Today, the procedure is quite common for COPD patients. Outcomes from the procedure have been positive. Breathing becomes easier. Quality of life and life expectancy also increases. So, this is why it remains a viable option for those suffering from severe emphysema/ COPD.¹

But, still, the number of donor lungs remains limited. Plus, the procedure also remains complicated. This has resulted in strict criteria for who qualifies for lung transplantation for severe COPD.

What are the transplant qualifications?

So, who qualifies for this procedure? First, other treatments must have been tried and failed. You have to have tried COPD medicine, avoiding triggers, and physical therapy. Only when these treatments failed should an invasive procedure like lung transplantation be considered.

Other qualifications include:^1,3

• 65 or younger for single lung transplantation
• 60 or younger for double lung transplantation
• Less than 2 years life expectancy
• Good family and psychological support
• No other co-morbidites should exist (i.e. no cancer, pneumonia, heart failure)
• Quit smoking six months prior to the operation
• Participation in a pre-transplant program
• Other qualifications may also apply

There are also other options, such as lung volume reduction surgery and bullectomy. There is also a new procedure just approved by the FDA called endobronchial valve systems. There are also other procedures that show promise for severe COPD. I will discuss all of of these in upcoming posts. And you can always talk to your doctor about them also.

What to make of this information?

Interestingly, COPD patients were considered poor candidates for lung transplantation. Today, COPD is the most common indication for the procedure. In fact, emphysema (including those with genetic COPD) account for nearly 50% of all bilateral lung transplantations and about 33% of double lung transplantations.¹ Today, about 70% of transplantations for COPD are double lung transplants.⁴

There are definitely risks to this complex surgery. But, there is also the hope of better breathing, better quality of life, and increased life expectancy.^1-3 So, if your doctors say you have severe COPD, lung transplantation may be an option worth discussing.