Download PDF
Semin Respir Crit Care Med 2013; 34(03): 288-296
DOI: 10.1055/s-0033-1348468
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lung Transplantation for Obstructive Lung Diseases

Rupal J. Shah
1   Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
,
Robert M. Kotloff
2   Section of Advanced Lung Disease and Lung Transplantation, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
02 July 2013 (online)

    Permissions and Reprints

Abstract

Chronic obstructive pulmonary disease (COPD) represents one of the most common indications for lung transplantation, accounting for approximately one third of all procedures performed worldwide to date. Despite this extensive experience, questions remain about the appropriate timing of transplantation in the natural history of COPD, the optimal procedure to perform, and the survival benefit achieved. Less commonly encountered obstructive lung disorders for which transplantation is occasionally performed include emphysema due to α-1-antitrypsin deficiency, lymphangioleiomyomatosis, and Langerhans cell histiocytosis. Like COPD, the application of transplantation to these rare disorders also poses several questions. This article explores issues that arise when lung transplantation is utilized for treatment of both common and uncommon obstructive lung disorders.

Keywords

lung transplantation - chronic obstructive pulmonary disease - α-1-antitrypsin deficiency - lymphangioleiomyomatosis - Langerhans cell histiocytosis
 

  • References

  • 1 Christie JD, Edwards LB, Kucheryavaya AY , et al; International Society of Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant 2012; 31 (10) 1073-1086
    CrossrefPubMedSearch in Google Scholar
  • 2 Vestbo J, Edwards LD, Scanlon PD , et al; ECLIPSE Investigators. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med 2011; 365 (13) 1184-1192
    CrossrefPubMedSearch in Google Scholar
  • 3 Nishimura M, Makita H, Nagai K , et al; Hokkaido COPD Cohort Study Investigators. Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012; 185 (1) 44-52
    CrossrefPubMedSearch in Google Scholar
  • 4 Martinez FJ, Kotloff R. Prognostication in chronic obstructive pulmonary disease: implications for lung transplantation. Semin Respir Crit Care Med 2001; 22 (5) 489-498
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Traver GA, Cline MG, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease: a 15-year follow-up study. Am Rev Respir Dis 1979; 119 (6) 895-902
    PubMedSearch in Google Scholar
  • 6 Celli BR, Cote CG, Marin JM , et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350 (10) 1005-1012
    CrossrefPubMedSearch in Google Scholar
  • 7 Martinez FJ, Han MK, Andrei AC , et al; National Emphysema Treatment Trial Research Group. Longitudinal change in the BODE index predicts mortality in severe emphysema. Am J Respir Crit Care Med 2008; 178 (5) 491-499
    CrossrefPubMedSearch in Google Scholar
  • 8 Orens JB, Estenne M, Arcasoy S , et al; Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006; 25 (7) 745-755
    CrossrefPubMedSearch in Google Scholar
  • 9 Egan TM, Kotloff RM. Pro/Con debate: lung allocation should be based on medical urgency and transplant survival and not on waiting time. Chest 2005; 128 (1) 407-415
    CrossrefPubMedSearch in Google Scholar
  • 10 Yusen RD, Shearon TH, Qian Y , et al. Lung transplantation in the United States, 1999-2008. Am J Transplant 2010; 10 (4 Pt 2) 1047-1068
    CrossrefPubMedSearch in Google Scholar
  • 11 McCurry KR, Shearon TH, Edwards LB , et al. Lung transplantation in the United States, 1998-2007. Am J Transplant 2009; 9 (4 Pt 2) 942-958
    CrossrefPubMedSearch in Google Scholar
  • 12 Fishman A, Martinez F, Naunheim K , et al; National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003; 348 (21) 2059-2073
    CrossrefPubMedSearch in Google Scholar
  • 13 Meyers BF, Yusen RD, Guthrie TJ , et al. Outcome of bilateral lung volume reduction in patients with emphysema potentially eligible for lung transplantation. J Thorac Cardiovasc Surg 2001; 122 (1) 10-17
    CrossrefPubMedSearch in Google Scholar
  • 14 Senbaklavaci O, Wisser W, Ozpeker C , et al. Successful lung volume reduction surgery brings patients into better condition for later lung transplantation. Eur J Cardiothorac Surg 2002; 22 (3) 363-367
    CrossrefPubMedSearch in Google Scholar
  • 15 Burns KE, Keenan RJ, Grgurich WF, Manzetti JD, Zenati MA. Outcomes of lung volume reduction surgery followed by lung transplantation: a matched cohort study. Ann Thorac Surg 2002; 73 (5) 1587-1593
    CrossrefPubMedSearch in Google Scholar
  • 16 Bavaria JE, Pochettino A, Kotloff RM , et al. Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1998; 115 (1) 9-17 , discussion 17–18
    CrossrefPubMedSearch in Google Scholar
  • 17 Stevens PM, Johnson PC, Bell RL, Beall Jr AC, Jenkins DE. Regional ventilation and perfusion after lung transplantation in patients with emphysema. N Engl J Med 1970; 282 (5) 245-249
    CrossrefPubMedSearch in Google Scholar
  • 18 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
    CrossrefPubMedSearch in Google Scholar
  • 19 Mal H, Andreassian B, Pamela F , et al. Unilateral lung transplantation in end-stage pulmonary emphysema. Am Rev Respir Dis 1989; 140 (3) 797-802
    CrossrefPubMedSearch in Google Scholar
  • 20 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) 520-527 , discussion 528
    CrossrefPubMedSearch in Google Scholar
  • 21 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) 1813-1818 , discussion 1818–1819
    CrossrefPubMedSearch in Google Scholar
  • 22 Sundaresan RS, Shiraishi Y, Trulock EP , et al. Single or bilateral lung transplantation for emphysema?. J Thorac Cardiovasc Surg 1996; 112 (6) 1485-1494 , discussion 1494–1495
    CrossrefPubMedSearch in Google Scholar
  • 23 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) 935-941
    CrossrefPubMedSearch in Google Scholar
  • 24 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) 744-751
    CrossrefPubMedSearch in Google Scholar
  • 25 Gaissert HA, Trulock EP, Cooper JD, Sundaresan 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 , discussion 306–307
    CrossrefPubMedSearch in Google Scholar
  • 26 Bossenbroek L, ten Hacken NH, van der Bij W, Verschuuren EA, Koëter GH, de Greef MH. Cross-sectional assessment of daily physical activity in chronic obstructive pulmonary disease lung transplant patients. J Heart Lung Transplant 2009; 28 (2) 149-155
    CrossrefPubMedSearch in Google Scholar
  • 27 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) 1371-1378
    CrossrefPubMedSearch in Google Scholar
  • 28 Levy RD, Ernst P, Levine SM , et al. Exercise performance after lung transplantation. J Heart Lung Transplant 1993; 12 (1 Pt 1) 27-33
    PubMedSearch in Google Scholar
  • 29 Williams TJ, Patterson GA, McClean PA, Zamel N, Maurer JR. Maximal exercise testing in single and double lung transplant recipients. Am Rev Respir Dis 1992; 145 (1) 101-105
    CrossrefPubMedSearch in Google Scholar
  • 30 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) 1168-1175
    CrossrefPubMedSearch in Google Scholar
  • 31 Burton CM, Iversen M, Mortensen J , et al. Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder?. J Heart Lung Transplant 2007; 26 (11) 1127-1134
    CrossrefPubMedSearch in Google Scholar
  • 32 Munson JC, Christie JD, Halpern SD. The societal impact of single versus bilateral lung transplantation for chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2011; 184 (11) 1282-1288
    CrossrefPubMedSearch in Google Scholar
  • 33 Arcasoy SM, Hersh C, Christie JD , et al. Bronchogenic carcinoma complicating lung transplantation. J Heart Lung Transplant 2001; 20 (10) 1044-1053
    CrossrefPubMedSearch in Google Scholar
  • 34 de Perrot M, Chernenko S, Waddell TK , et al. Role of lung transplantation in the treatment of bronchogenic carcinomas for patients with end-stage pulmonary disease. J Clin Oncol 2004; 22 (21) 4351-4356
    CrossrefPubMedSearch in Google Scholar
  • 35 Dickson RP, Davis RD, Rea JB, Palmer SM. High frequency of bronchogenic carcinoma after single-lung transplantation. J Heart Lung Transplant 2006; 25 (11) 1297-1301
    CrossrefPubMedSearch in Google Scholar
  • 36 Minai OA, Shah S, Mazzone P , et al. Bronchogenic carcinoma after lung transplantation: characteristics and outcomes. J Thorac Oncol 2008; 3 (12) 1404-1409
    CrossrefPubMedSearch in Google Scholar
  • 37 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) 1080-1087
    CrossrefPubMedSearch in Google Scholar
  • 38 Yonan NA, el-Gamel A, Egan J, Kakadellis J, Rahman A, Deiraniya AK. Single lung transplantation for emphysema: predictors for native lung hyperinflation. J Heart Lung Transplant 1998; 17 (2) 192-201
    PubMedSearch in Google Scholar
  • 39 Gavazzeni V, Iapichino G, Mascheroni D , et al. Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema. Chest 1993; 103 (1) 96-100
    CrossrefPubMedSearch in Google Scholar
  • 40 Reece TB, Mitchell JD, Zamora MR , et al. Native lung volume reduction surgery relieves functional graft compression after single-lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 2008; 135 (4) 931-937
    CrossrefPubMedSearch in Google Scholar
  • 41 Anderson MB, Kriett JM, Kapelanski DP, Perricone A, Smith CM, Jamieson SW. Volume reduction surgery in the native lung after single lung transplantation for emphysema. J Heart Lung Transplant 1997; 16 (7) 752-757
    PubMedSearch in Google Scholar
  • 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 1997; 156: 292-293
    CrossrefPubMedSearch in Google Scholar
  • 43 Crespo MM, Johnson BA, McCurry KR, Landreneau RJ, Sciurba FC. Use of endobronchial valves for native lung hyperinflation associated with respiratory failure in a single-lung transplant recipient for emphysema. Chest 2007; 131 (1) 214-216
    CrossrefPubMedSearch in Google Scholar
  • 44 Hosenpud JD, Bennett LE, Keck BM, Edwards EB, Novick RJ. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease. Lancet 1998; 351 (9095) 24-27
    CrossrefPubMedSearch in Google Scholar
  • 45 De Meester J, Smits JM, Persijn GG, Haverich A. Listing for lung transplantation: life expectancy and transplant effect, stratified by type of end-stage lung disease, the Eurotransplant experience. J Heart Lung Transplant 2001; 20 (5) 518-524
    CrossrefPubMedSearch in Google Scholar
  • 46 Charman SC, Sharples LD, McNeil KD, Wallwork J. Assessment of survival benefit after lung transplantation by patient diagnosis. J Heart Lung Transplant 2002; 21 (2) 226-232
    CrossrefPubMedSearch in Google Scholar
  • 47 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
    CrossrefPubMedSearch in Google Scholar
  • 48 Titman A, Rogers CA, Bonser RS, Banner NR, Sharples LD. Disease-specific survival benefit of lung transplantation in adults: a national cohort study. Am J Transplant 2009; 9 (7) 1640-1649
    CrossrefPubMedSearch in Google Scholar
  • 49 Thabut G, Ravaud P, Christie J , et al. Determinants of the survival benefit of lung transplantation in COPD patients. Am J Respir Crit Care Med 2008; 177 (10) 1156-1163
    CrossrefPubMedSearch in Google Scholar
  • 50 Lahzami S, Bridevaux PO, Soccal PM , et al. Survival impact of lung transplantation for COPD. Eur Respir J 2010; 36 (1) 74-80
    CrossrefPubMedSearch in Google Scholar
  • 51 King MB, Campbell EJ, Gray BH, Hertz MI. The proteinase-antiproteinase balance in alpha-1-proteinase inhibitor-deficient lung transplant recipients. Am J Respir Crit Care Med 1994; 149 (4 Pt 1) 966-971
    CrossrefPubMedSearch in Google Scholar
  • 52 Meyer KC, Nunley DR, Dauber JH , et al. Neutrophils, unopposed neutrophil elastase, and alpha1-antiprotease defenses following human lung transplantation. Am J Respir Crit Care Med 2001; 164 (1) 97-102
    CrossrefPubMedSearch in Google Scholar
  • 53 Mal H, Guignabert C, Thabut G , et al. Recurrence of pulmonary emphysema in an alpha-1 proteinase inhibitor-deficient lung transplant recipient. Am J Respir Crit Care Med 2004; 170 (7) 811-814
    CrossrefPubMedSearch in Google Scholar
  • 54 Strange C, Stoller JK, Sandhaus RA, Dickson R, Turino G. Results of a survey of patients with alpha-1 antitrypsin deficiency. Respiration 2006; 73 (2) 185-190
    PubMedSearch in Google Scholar
  • 55 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
    CrossrefPubMedSearch in Google Scholar
  • 56 Benden C, Rea F, Behr J , et al. Lung transplantation for lymphangioleiomyomatosis: the European experience. J Heart Lung Transplant 2009; 28 (1) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 57 Kpodonu J, Massad MG, Chaer RA , et al. The US experience with lung transplantation for pulmonary lymphangioleiomyomatosis. J Heart Lung Transplant 2005; 24 (9) 1247-1253
    CrossrefPubMedSearch in Google Scholar
  • 58 Boehler A, Speich R, Russi EW, Weder W. Lung transplantation for lymphangioleiomyomatosis. N Engl J Med 1996; 335 (17) 1275-1280
    CrossrefPubMedSearch in Google Scholar
  • 59 Pechet TT, Meyers BF, Guthrie TJ , et al. Lung transplantation for lymphangioleiomyomatosis. J Heart Lung Transplant 2004; 23 (3) 301-308
    CrossrefPubMedSearch in Google Scholar
  • 60 Reynaud-Gaubert M, Mornex JF, Mal H , et al. Lung transplantation for lymphangioleiomyomatosis: the French experience. Transplantation 2008; 86 (4) 515-520
    PubMedSearch in Google Scholar
  • 61 Machuca TN, Losso MJ, Camargo SM , et al. Lung transplantation for lymphangioleiomyomatosis: single-center Brazilian experience with no chylothorax. Transplant Proc 2011; 43 (1) 236-238
    CrossrefPubMedSearch in Google Scholar
  • 62 Groetzner J, Kur F, Spelsberg F , et al; Munich Lung Transplant Group. Airway anastomosis complications in de novo lung transplantation with sirolimus-based immunosuppression. J Heart Lung Transplant 2004; 23 (5) 632-638
    CrossrefPubMedSearch in Google Scholar
  • 63 King-Biggs MB, Dunitz JM, Park SJ, Kay Savik S, Hertz MI. Airway anastomotic dehiscence associated with use of sirolimus immediately after lung transplantation. Transplantation 2003; 75 (9) 1437-1443
    CrossrefPubMedSearch in Google Scholar
  • 64 Bittmann I, Rolf B, Amann G, Löhrs U. Recurrence of lymphangioleiomyomatosis after single lung transplantation: new insights into pathogenesis. Hum Pathol 2003; 34 (1) 95-98
    CrossrefPubMedSearch in Google Scholar
  • 65 Karbowniczek M, Astrinidis A, Balsara BR , et al. Recurrent lymphangiomyomatosis after transplantation: genetic analyses reveal a metastatic mechanism. Am J Respir Crit Care Med 2003; 167 (7) 976-982
    CrossrefPubMedSearch in Google Scholar
  • 66 Ohara T, Oto T, Miyoshi K , et al. Sirolimus ameliorated post lung transplant chylothorax in lymphangioleiomyomatosis. Ann Thorac Surg 2008; 86 (6) e7-e8
    CrossrefPubMedSearch in Google Scholar
  • 67 Chen F, Bando T, Fukuse T , et al. Recurrent lymphangioleiomyomatosis after living-donor lobar lung transplantation. Transplant Proc 2006; 38 (9) 3151-3153
    CrossrefPubMedSearch in Google Scholar
  • 68 Shigemura N, Kawamura T, Minami M , et al. Successful factor XIII administration for persistent chylothorax after lung transplantation for lymphangioleiomyomatosis. Ann Thorac Surg 2009; 88 (3) 1003-1006
    CrossrefPubMedSearch in Google Scholar
  • 69 Bhorade S, Ahya VN, Baz MA , et al. Comparison of sirolimus with azathioprine in a tacrolimus-based immunosuppressive regimen in lung transplantation. Am J Respir Crit Care Med 2011; 183 (3) 379-387
    CrossrefPubMedSearch in Google Scholar
  • 70 Vassallo R, Ryu JH, Colby TV, Hartman T, Limper AH. Pulmonary Langerhans-cell histiocytosis. N Engl J Med 2000; 342 (26) 1969-1978
    CrossrefPubMedSearch in Google Scholar
  • 71 Dauriat G, Mal H, Thabut G , et al. Lung transplantation for pulmonary Langerhans cell histiocytosis: a multicenter analysis. Transplantation 2006; 81 (5) 746-750
    CrossrefPubMedSearch in Google Scholar
  • 72 Le Pavec J, Lorillon G, Jaïs X , et al. Pulmonary Langerhans cell histiocytosis-associated pulmonary hypertension: clinical characteristics and impact of pulmonary arterial hypertension therapies. Chest 2012; 142 (5) 1150-1157
    CrossrefPubMedSearch in Google Scholar
  • 73 Vassallo R, Ryu JH, Schroeder DR, Decker PA, Limper AH. Clinical outcomes of pulmonary Langerhans-cell histiocytosis in adults. N Engl J Med 2002; 346 (7) 484-490
    CrossrefPubMedSearch in Google Scholar