Another option for people with COPD is lung transplantation. According to the most recent data available, more than 1,900 lung transplants were performed for a variety of conditions in 2014 in the United States. For emphysema, the procedure can involve either a single lung (unilateral transplant) or both lungs (bilateral transplant).
Who is a lung transplant candidate?
Because donor lungs are scarce and transplants are risky, potential candidates for transplantation must undergo extensive evaluation. Successful candidates must meet disease-specific criteria for severe (end-stage) lung disease, yet be able to survive the wait for one or both donor lungs, as well as endure the rigors of the operation itself and the postoperative period.
Changes to the rules for organ allocation have reduced waiting times for lung transplants in people who are seriously ill. Also, international guidelines have established an upper age limit of 65 years for unilateral and bilateral transplants. A number of medical centers, however, have performed lung transplants in people exceeding this age limit.
Guidelines from the International Society for Heart & Lung Transplantation note that while older patients are less likely to survive than younger patients because they often have a number of coexisting illnesses, advanced age alone in an otherwise acceptable candidate with few other health problems does not necessarily imply a less successful result.
Lung transplants cannot be performed in people with major disease in other organs, including cancer (other than basal or squamous cell skin cancers) diagnosed within the past two years, positive tests for hepatitis B antigen, or hepatitis C infection with liver disease. Lung transplantation may not be suitable for people who are obese or have severe osteoporosis.
After a lung transplant
People who undergo lung transplantation are required to take medications for the rest of their life to suppress the immune system and prevent it from rejecting the transplanted lung(s). After successful transplantation, patients may experience some limitations in exercise tolerance, but usually not enough to interfere with normal daily activities or to reduce quality of life.
The five-year survival rate after lung transplantation in general is approximately 51 percent. The survival rate is highest in those who receive lung transplants for underlying emphysema, as opposed to other conditions, and lowest in those treated for idiopathic pulmonary fibrosis (progressive scarring of the lungs for which the cause is unknown) or pulmonary hypertension.
While lung transplants can provide improvement in quality of life and survival for properly selected candidates, there are numerous shortcomings associated with this treatment. As mentioned above, after transplantation, potent lifelong immunosuppressive medications are required to prevent the body from rejecting the lung.
These medications can be toxic to the liver and kidneys, cause hypertension (high blood pressure) and hair growth, and increase the risk of infections. Rejection of a transplanted lung comes in two forms: acute rejection and chronic rejection. Acute rejection occurs most commonly during the first year after transplantation and can cause fever, shortness of breath, and a reduction in lung function. Acute rejection is usually easy to treat with increased immune suppressive drugs.
Chronic rejection is the most common cause of death long-term after a lung transplant. The pathologic hallmark of chronic rejection is bronchiolitis obliterans, a condition in which the bronchioles become blocked. Chronic rejection typically develops after the first year following transplantation and causes progressive loss of lung function, shortness of breath, cough, and potentially death. Unfortunately, there is no effective therapy for chronic rejection.
(Originally published Jul. 11, 2016; updated Feb. 24, 2017)