Informing patient choices: Morbidity and mortality 4 years after lung transplantation for COPD

PURPOSE: Severe COPD is one of the main indications for lung transplantation (LTX) with documented improvements in physiology, survival and quality of life. The aim of our study was to catalogue significant morbidities that developed within 4 years of LTX in order to inform patient discussions regarding likely outcomes after LTX. METHODS: Retrospective single center study of 46 consecutive patients who underwent LTX for COPD 1st January 2009- 31st December 2011. Transplant assessment data were used to calculate BODE index score. Post-operative, 1 year and 4 year morbidity data were collected from patient files. RESULTS: 34 patients had a BODE index ≥ 7. Mean age was 54.9 (39-66). Survival at 1 year was 93.5% (43/46) and at 4 years 71.7% (33/46). 6/12 patients ≥ 60 years old at transplant were deceased at 4 years but only 1 death occurred in 10 patients with alpha-1 anti-trypsin deficiency. Post-operatively, 45.7% (21/46) were discharged from acute hospital bed within 14 days; 82.6% within 30 days (38/46; and 17.4% (8/46) had length of stay beyond 30 days (range 8-178 days). 4 patients required ECMO postoperatively. At 4 years among survivors, 54.5% maintained BOS 0 or 0-P lung function (18/33); 10.9% BOS I; 10.9% BOS II; 10.9% BOS III. 41.3% (19/46) received treatment for antibody mediated rejection. 23.9% (11/46) had documented pulmonary embolism. 13.0% (6/46) required Nissen's fundoplication for GORD and 57.6% (19/33) of patients alive at 4 years were on ≥ 3 classes of medications for GORD or had surgery. 1 patient required permanent hemodialysis; 23 developed stage 3 chronic kidney disease (CKD) at 1 year; 5 progressed to stage 4 CKD at 4 years. 15.2% (5/33) developed insulin dependent diabetes (DM) with a further 4 on oral hypoglycaemics (12.1%) at 4 years. Mean pill burden was 26 tablets (15-41) daily at 4 years. 12 patients took > 30 tablets. CONCLUSIONS: LTX for COPD confers an excellent 4 year survival advantage. Significant morbidities at 4 years include pulmonary embolism, GORD, stage 4 CKD, DM and a significant daily tablet burden.