Emphysema is the most common indication for lung transplantation. Recipients include
younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD)
and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We
analyzed the results of our single-institution series of lung transplants for emphysema
to identify outcome differences and factors predicting mortality and morbidity in
these two groups.
A retrospective analysis was undertaken of the 306 consecutive lung transplants for
emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up
was complete and averaged 3.7 years.
The mean age of AAD recipients (49 +/- 6 years) was less than those with COPD (55
+/- 6 years; p < 0.001). Hospital mortality was 6.2%, with no difference between COPD
and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital
mortality during the most recent 6 years was significantly lower (3.9% vs 9.5%, p
= 0.044). Five-year survival was 58.6% +/- 3.5%, with no difference between COPD (56.8%
+/- 4.4%) and AAD (60.5% +/- 5.8%). Five-year survival was better with bilateral-lung
transplants (66.7% +/- 4.0%) than with single-lung transplants (44.9% +/- 6.0%, p
< 0.005). Independent predictors of mortality by Cox analysis were single lung transplantation
(relative hazard = 1.98, p < 0.001), and need for cardiopulmonary bypass during the
transplant (relative hazard = 1.84, p = 0.038).
AAD recipients, despite a younger age, do not achieve significantly superior survival
results than those with COPD. Bilateral lung transplantation for emphysema results
in better long-term survival. Accumulated experience and modifications in perioperative
care over our 13-year series may explain recently improved early and long-term survival.