Surgical therapy for COPD: Lung transplantation

Advanced chronic obstructive pulmonary disease (COPD) is a major cause of morbidity, mortality, and diminished quality of life and no medical therapy is available to restore lung function. Successful lung transplantation can restore lung function for these patients. The first successful lung transplant was performed 15 years ago. In 1997, 942 lung transplants were performed in the United States, with COPD being the most common indication. Appropriate candidates typically have an FEV₁ less than 25% of predicted and no significant concomitant illness. Infection is the most common significant early posttransplant complication and chronic rejection, the most significant long-term complication. Advances in surgical technique and immunosuppression have resulted in a 3-year survival rate of 65% with clear improvements in pulmonary function, exercise capacity, and quality of life. Insufficient donors and inadequate control of chronic rejection remain the major challenges for the future.