Lung volume reduction surgery and lung transplantation in chronic obstructive pulmonary disease

Mora, Jorge; Hadjiliadis, Denis

doi:10.2147/copd.s4306

Cited by 11 publications

(9 citation statements)

References 53 publications

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“…It has been shown to improve the QoL and exercise capacity; however, survival benefit has not been shown consistently. [418] The accepted indications for lung transplantation include a BODE index of 7-10 with an FEV 1 < 20% predicted, or a DL CO < 20% and homogenous emphysema or corpulmonale. [78]…”

Section: Introductionmentioning

confidence: 99%

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

et al. 2013

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Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

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Section: Introductionmentioning

confidence: 99%

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

et al. 2013

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“…Their inclusion criteria in terms of patient candidacy for LVRS are still valid and with the knowledge about the patient outcome an algorithm was suggested to decide between LVRS and LuTX (1). Briefly, LVRS should be considered for patients with an upper-lobe predominant emphysema, an FEV 1 between 45% and 20% of the predicted value and a DLCO not less than 20% as those patients will have a significant advantage in exercise capacity and dyspnea related quality of life (10). Findings of the NETT trial have been reproduced in a study of the STS database (11) and in the Canadian Lung Volume Reduction Surgery (CLVRS) trial (12).…”

Section: Patient Selection For Lvrsmentioning

confidence: 99%

Lung volume reduction followed by lung transplantation—considerations on selection criteria and outcome

Slama¹,

Taube²,

Kamler³

et al. 2018

J. Thorac. Dis

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Lung transplantation (LuTX) and lung volume reduction (LVR), either surgical (LVRS: lung volume reduction surgery) or endoscopic (ELVR: endoscopic lung volume reduction), are established therapies in the treatment of end-stage chronic obstructive pulmonary disease (COPD) patients. Careful patient selection is crucial for each intervention. If these techniques are sequentially applied there is a paucity of available data and individual center experiences vary depending on details in selection criteria and operative technique. This review aims to summarize the published data with a focus on LuTX after LVRS. This review covers patient selection for LuTX and LVR, technical considerations, limitations and outcomes. Published literature was identified by systematic search on Medline and appropriate papers were reviewed. Seven case reports/series, 7 comparative observational studies and one multicenter database analysis incorporating a total of 284 patients with LuTX and LVR were evaluated. Prior LVR can significantly affect intraoperative and postoperative risks after subsequent LuTX. Careful patient selection and timing and the choice of appropriate techniques such as minimal invasive LVRS and using ECMO as extracorporeal support during LuTX if required can minimize those risks, ultimately leading to very good postoperative outcomes in terms of lung function and survival. LVRS has the potential to delay listing and to bridge patients to LuTX by improving their physical condition while on the waiting list. After single lung transplantation (SLuTX) contralateral LVRS can counteract the deleterious effects of native lung hyperinflation (NLH). LVR and LuTX are adjunct therapies in the treatment of end-stage COPD. The combination of both can safely be considered in selected patients.

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“…12 LVRS has been demonstrated to significantly improve FEV 1 and total lung capacity, while reducing residual volume and reoptimizing diaphragmatic function in selected patients with predominantly upper lobe disease. 13,14 Although there are no head-to-head trials evaluating superiority of either LVRS or lung transplantation in patients with COPD, the National Emphysema Treatment Trial identified a subset of high-risk patients with a considerable increase in mortality with LVRS as compared with standard medical therapy. 15 This population includes those with an FEV 1 of 20% of predicted or less and either homogeneous emphysema on chest computed tomography (CT) or a diffusing capacity of carbon monoxide of 20% of predicted or less.…”

Section: Candidate Selectionmentioning

confidence: 99%

“…Additionally, LVRS has not been demonstrated to reduce pulmonary artery pressures; thus patients with significant secondary pulmonary hypertension should be considered preferentially for lung transplantation. 13 COPD AND LUNG ALLOCATION The lung, perhaps more so than any other organ, is fragile, making it easily susceptible to damage and poorly tolerant of prolonged ischemic times. Together these factors reduce the percentage of donor lungs suitable for transplantation, thus severely limiting the donor organ pool and increasing time to transplantation for those on the waiting list.…”

Section: Candidate Selectionmentioning

confidence: 99%

Lung Transplantation in Advanced COPD: Is it Worth it?

Todd¹,

Palmer²

2010

Semin Respir Crit Care Med

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Chronic obstructive pulmonary disease (COPD) is a condition of progressive airflow obstruction occurring primarily as a result of tobacco use that accounts for substantial worldwide morbidity and mortality. Medical therapy, with the exception of oxygen and smoking cessation, does not appreciably alter the natural progression of the disease. In contrast, when performed in carefully selected candidates, lung transplantation can provide substantial benefits in physiology, function, quality of life, and survival. Strict selection criteria limit transplant to highly compliant candidates with advanced disease, but preserved functional status, who are capable of successfully undergoing the operation. Although either single or bilateral lung transplant may be offered in COPD, recent evidence suggests that bilateral transplant is the preferred operation due to superior long-term outcomes. Regardless of the type of transplant operation, however, all lung transplant recipients are susceptible to numerous complications including post-transplant infection and rejection. Despite these and other potential complications, advances in medical and surgical management now make lung transplantation a worthwhile therapeutic option in appropriately selected patients. In fact, lung transplant represents the only intervention that can substantially improve long-term outcomes in COPD patients with very advanced disease. Further work to refine recipient selection, improve lung allocation algorithms, and develop better treatments of chronic allograft dysfunction will lead to an even greater benefit to lung transplantation in this ill patient population.

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Lung volume reduction surgery and lung transplantation in chronic obstructive pulmonary disease

Cited by 11 publications

References 53 publications

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

Lung volume reduction followed by lung transplantation—considerations on selection criteria and outcome

Lung Transplantation in Advanced COPD: Is it Worth it?

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