Lung transplantation for COPD/pulmonary emphysema

Geert M. Verleden; Jens Gottlieb

doi:10.1183/16000617.0116-2022

Tables

TABLE 1

Risk factors for poor post-transplant outcomes (reproduced and modified from Leard et al. [3])

Absolute contraindications	Risk factors with high or substantially increased risk	Risk factors
Malignancy with high risk of recurrence or death related to cancer	Age >70 years	Age 65–70 years
Glomerular filtration rate <40 mL·min⁻¹·1.73 m⁻² unless being considered for multi-organ transplant	Severe coronary artery disease that requires coronary artery bypass grafting at transplant	Glomerular filtration rate 40–60 mL·min⁻¹·1.73 m⁻²
Acute coronary syndrome or myocardial infarction within 30 days	Reduced left ventricular ejection fraction <40%	Mild to moderate coronary artery disease
Stroke within 30 days	Significant cerebrovascular disease	Severe coronary artery disease that can be treated via percutaneous coronary intervention prior to transplant
Liver cirrhosis with portal hypertension or synthetic dysfunction unless being considered for multi-organ transplant	Severe oesophageal dysmotility	Patients with prior coronary artery bypass grafting
Acute liver failure	Untreatable haematologic disorders including bleeding diathesis, thrombophilia or severe bone marrow dysfunction	Reduced left ventricular ejection fraction 40–50%
Acute renal failure with rising creatinine or on dialysis and low likelihood of recovery	Body mass index ≥35 kg·m⁻²	Peripheral vascular disease
Septic shock	Body mass index <16 kg·m⁻²	Severe gastro-oesophageal reflux disease
Active extrapulmonary or disseminated infection	Limited functional status with poor potential for post-transplant rehabilitation	Oesophageal dysmotility
Active tuberculosis infection	Psychiatric, psychological or cognitive conditions with potential to interfere with medical adherence without sufficient support systems	Thrombocytopenia, leukopenia or anaemia with high likelihood of persistence after transplant
HIV infection with detectable viral load	Unreliable support system or caregiving plan	Osteoporosis
Limited functional status (e.g. non-ambulatory) with poor potential for post-transplant rehabilitation	Lack of understanding of disease and/or transplant despite teaching	Body mass index 30–34.9 kg·m⁻²
Progressive cognitive impairment	Hepatitis B or C infection with detectable viral load and signs of liver fibrosis	Body mass index 16–17 kg·m⁻²
Repeated episodes of non-adherence without evidence of improvement	Chest wall or spinal deformity expected to cause restriction after transplant	Frailty
Active substance use or dependence including current tobacco use, vaping, marijuana smoking or intravenous drug use	Extracorporeal life support	Hypoalbuminaemia
Other severe uncontrolled medical condition expected to limit survival after transplant	Redo transplant <1 year following initial lung transplant	Poorly controlled diabetes
	Redo transplant for restrictive chronic lung allograft dysfunction	Edible marijuana use
	Redo transplant for antibody mediated rejection	HIV infection with undetectable viral load
		Previous thoracic surgery
		Prior pleurodesis
		Mechanical ventilation
		Redo transplant >1 year for obstructive chronic lung allograft dysfunction

TABLE 2

Selected features associated with 2-year survival derived from patients with COPD

Feature	Frequency	2-year survival	Cohort's median age, years
BODE score >7	82/469 (17%) [10], 139/625(23%) [11]	75% [11], 70% [11]	64 [10], 66 [11]
Resting hypoxaemia (P_O₂ ≤55 mmHg)	81/175 LTx referrals (46%) [12]	50% (COPD) to 70% (α-1 AD) [13]	56 [12], 63–73 [13]
Hypoxaemia on exertion (S_pO₂ <88%) without resting hypoxaemia	33/173 (19% in patient using oxygen) [14]	80% [15, 16]	56 [14], 68 [16]
Home noninvasive ventilation	147/402 LTx referrals(36%) [12]	65% [17, 18]	65 [17], 67 [18]
Exacerbation with hypercapnia	325/4343 (7%) [19, 20]	51% [21], 35% [22], 47% [23]	59 [21], 69 [22], 63 [23], 70 [19, 20]
≥1 exacerbation with hospitalisation	105/304 (34%) [24]	70% [24]	69 [24]
FEV₁ <20%	69/1033 (7%) [25]	80% [25]	63 [25]
Mean pulmonary artery pressure ≥35 mmHg	16/409 (4%) [26], 44/4305 (6%) [27]	70% [26], 58% [27]	54 [26], 59 [27]

BODE: body mass index, obstruction, dyspnoea and exercise capacity score; P_O₂: oxygen tension; S_pO₂: peripheral oxygen saturation; FEV₁: forced expiratory volume in 1 s; LTx: lung transplantation; α-1 AD: α-1 antitrypsin deficiency.