Lung Transplantation for COPD

Chronic obstructive pulmonary disease (COPD) is one of the most relevant diseases worldwide from an epidemiological standpoint and can lead to end-stage respiratory failure. Patients with COPD and irreversible organ damage can benefit from lung transplantation (LTX). This population constitutes to date the largest cohort of lung transplant recipients. The indications for lung transplantation in COPD have been extensively explored in the medical literature but considerable debate exists on the best timing of LTX, in consideration of the difficulty of predicting the actual survival benefit of transplantation. COPD candidates for lung transplantation often display several comorbidities that can derive from cigarette smoking and that should be carefully assessed before LTX, because they can have a significant impact on postoperative outcomes. Lung transplantation for COPD can be performed both as a double or single lung transplant. Both options carry risks and benefits that must be outweighed at the time of candidates’ selection. Postoperatively, patients who underwent lung transplantation for COPD enjoy favorable outcome figures in terms of quality and quantity of life, although the hurdle of chronic rejection is still having a significant impact on long-term outcome. Due to the features of the baseline disease, there are specific postoperative issues such as infections, malignancies, and native lung hyperinflation that should be carefully monitored and addressed.