Lung Transplantation in COPD: Risks and Benefits

Dr. Surana presented a case of a woman who had previously received a single R lung transplant for severe COPD in 2000. She presented with progressive SOB found to have a large L sided pleural effusion with cytology resulting positive for lung adenocarcinoma on serial thoracenteses.

Dr. Surana reviewed the outcomes related to single vs. double lung transplants by age, which suggests that double lung transplants in a young person have improved survival at 5 and 10 years relative to single lung transplants and in people over the age of 50:

 Todd JL, Palmer SM, Semin Respir Crit Care Med, 2010

Todd JL, Palmer SM, Semin Respir Crit Care Med, 2010

Complications of lung transplant stem from chronic immunosuppression including infection, HTN, DM2, CKD, and inreased risk of malignancy. Chronic allograft dysfunction is more common in lung transplantation than in other solid organ transplants and manifests as the Bronchiolitis Obliterans Syndrome with a 50% incidence within 5 years post transplant. (1)

As is true for other populations with chronic immunosuppression, patients with lung transplantation have a higher incidence of malignancy relative to the general population. Highest excess risks were for non-Hodgkin lymphoma (20.8−66.7), skin cancer (20.3−35.2), lung (11.7−31.2), liver (3.6−51.6), and colorectal cancer (6.1−19.5). (2)

Some general take home points from Dr. Surana's presentation:

  • COPD is the most common indication for lung transplantation
  • Bilateral lung transplants offer superior outcomes compared to single lung transplants
  • Chronic allograft rejection is more common in lung transplants compared to other solid organ transplants
  • Patients undergoing lung transplant for COPD are at an increased risk for secondary malignancy

References:

  1. Todd JL, Palmer SM. Lung transplantation in advanced COPD: is it worth it?. Semin Respir Crit Care Med. 2010;31(3):365-72.
  2. Ekström M, Riise GC, Tanash HA. Risk of cancer after lung transplantation for COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:2841-2847.