Lung transplantation for chronic obstructive pulmonary disease at St Vincent's Hospital

Background: Lung transplantation (LTx) offers selected patients with end‐stage chronic obstructive pulmonary disease (COPD) an improved quality of life and possibly enhanced survival. Aim: To determine local outcomes of LTx for COPD we analysed 173 consecutive heart–LTx (n = 8), single LTx (SLTx; n = 99) and bilateral LTx (BLTx; n = 66) carried out at a single institution during 1989–2003 for smoking‐related emphysema (E) (n = 112) and emphysema related to α‐1 antitrypsin deficiency (AATD) (n = 61). Methods: There were 98 men and 75 women with a mean age of 50 ± 6 years (standard deviation) (range 32–63 years). Median waiting time was 113 days (interquartile range (IQR) 50–230 days), and median inpatient stay was 13 days (IQR 9–21 days). Results: Perioperative survival (30 days) was 95% with deaths from sepsis (n = 5), cerebrovascular accident (n = 3) and multiorgan failure (n = 1). Mean follow‐up period was 1693 ± 1302 days (2–4805 days). The 1‐, 5‐ and 10‐year survivals (%) were similar for patients with E and AATD (P = 0.480 log rank) at 86 ± 5, 57 ± 7 and 31 ± 11, respectively, but 1‐ and 5‐year survivals for E were higher after BLTx than after SLTx (97 ± 2 and 81 ± 8 vs 85 ± 4 and 47 ± 6) (P = 0.015). Pretransplant body mass index, forced expiratory volume in 1 second, forced vital capacity, PaCO2, PaO2, six‐minute walk distance, home oxygen use, age, sex, cytomegalovirus donor–recipient mismatch, cardiopulmonary bypass use, year of transplant and ischaemic time did not influence survival after LTx. Increasing donor age was a survival risk factor for patients with E but not for those with AATD (hazard ratio 1.043; 95%confidence interval 1.014–1.025). Conclusion: Survival after LTx for COPD is similar to survival for other forms of solid organ transplantation, in part reflecting risk factor management.