Surgical Procedures

Surgical Procedures

Surgical procedures for emphysema are still investigative. They are all very expensive and often not covered by insurance. The great majority of patients cannot be helped by surgery, and no single procedure is ideal for those that can be helped.

Lung and Liver Transplantation

Advanced emphysema is responsible for over half of the lung transplants performed. Three-year survival rates after lung transplantation are about 60% for patients with either emphysema or AAT deficiencies. Techniques have been developed so that both lungs may be replaced in sequence. The increasingly long waiting time and the extraordinary expense are both significant problems.

Candidates. The best candidates are under 65 and have good general health aside from lung disease. A lung or liver transplantation may be the only hope for some patients with the alpha 1-antitrypsin (AAT) deficiency-related emphysema. AAT is produced in the liver, so a healthy transplanted liver may produce adequate supplies of this enzyme.

Waiting Time. Unfortunately, up to a third of patients awaiting lung transplantation die before a suitable donor is available. There were 1,042 lung transplantation operations in 2002, and as of this nearly 4,000 people are waiting for the operation. Not all lung transplant centers, even in major cities like New York, accept Medicare. Starting in 2005, the United Network for Organ Sharing (UNOS) is assigning lungs for transplants based on an allocation score, rather than time spent on the waiting list. The allocation score takes into account the length of time a patient is likely to survive before and after transplant. This policy applies to transplant candidates aged 12 or older.

Complications. Transplant patients must take drugs that suppress the immune system to prevent the body from rejecting the transplanted organ. Nevertheless, rejection is the primary cause of late complications and death. The mortality rate from the procedure itself is about 10%.

Lung Volume-Reduction Surgery

Lung volume-reduction surgeries (LVRS) remove over 30% of severely diseased lung tissue, and the remaining parts of the lung are joined together. Improvement in breathing after surgery appears to be largely due to the following factors:

• An improvement in the lung and chest wall's ability to spring back during breathing
• Improvement in function of the muscles, such as the diaphragm, involved with breathing