Title : Lung transplantation in COPD patients
Despite Chronic obstructive pulmonary disease (COPD) is still a leading cause of morbidity and mortality in the world, during the last decade interstitial lung disease has overtaken COPD as the most common indication for lung transplantation (LTx)_. Patients with advanced stage of COPD suffer significant debility. For selected group patients with severe COPD, lung transplantation is the final option after considering other therapies like lung volume reduction surgery (LVRS) or bronchoscope lung volume reduction. These two therapies often improve a patient's functional and nutritional status sufficiently, allowing them to become better candidates for LTx. In the most recent transplant era, median survival post-transplant is 6.7 years. In advanced COPD, morbidity, and expected long-term survival can be difficult to quantify leaving the timing of LTx being also difficult to determine for candidate selection. Recently, a multidimensional functional grading system was developed: the BODE index (body mass index [B], degree of airflow obstruction [O], dyspnea [D], and exercise capacity [E] measured via the 6-minute walk test) to give light to precise moment to indicate LTx. A higher BODE index score (measured 0-10) correlates with an increased risk of death, with a score greater than seven associated with an 80% mortality at 4 years. Accordingly, patients with a BODE index greater than seven have been shown to have the greatest survival benefit with LTx. While patients with a BODE index between 5 and 6 have been shown to have a significant improvement in their health-related quality of life after LTx, they do not demonstrate a survival benefit. Bilateral LTx (BLT) is the most common procedure performed and accounts for over two-thirds of lung transplants, leaving Single LTx (SLT) in cases with remarkably high surgical risk or other surgical justifications to avoid bilateral approach. LTx has demonstrated to improve the patient's quality of life, exercise capacity, and overall survival in patients with COPD and other aetiologies of terminal lung disease. After LTx, graft failure is the most common cause of death within the first 30 days. From 30 days to 1 year, infection is the most common cause, and more than 1-year post-transplant, obliterative bronchitis or bronchiolitis obliterans syndrome (BOS)
COPD continues to constitute a high load on medical costs worldwide and has a high prevalence. While there have been multiple advances in the medical and surgical care of advance COPD patients, LTx is a beneficial and proven treatment for those with BODE index higher than seven, despite the many challenges that complicate posttransplant care.