Medical Edge Newspaper Column

Lung Transplant May Be Option For Emphysema Sufferer

July 31, 2005
DEAR MAYO CLINIC:
My 58-year-old father was diagnosed with emphysema eight years ago and underwent a double lung volume reduction surgery five years ago. His ability to breathe is declining, and he requires oxygen for basic activities.

According to his doctors, his only option is lung transplantation. Will his previous surgery prevent him for being considered for lung transplantation? Is a double lung transplant necessary? What results can he expect? -- Ontario, Canada

ANSWER:
Your father's problem is common. Emphysema affects over 2 million Americans and is commonly caused by cigarette smoking. In the early stages of emphysema, many symptoms are treatable with medication and exercise. As it progresses, surgery can often help.

The lung volume reduction surgery treats breathlessness. The surgery aims to remove diseased portions of the lungs so that they function better overall. Just as pruning a tree of diseased branches allows the other branches to flourish, lung volume reduction surgery aims to remove the very diseased portions of the lung to allow the healthier portions to function better. The goal is improved breathing, better quality of life and, in some cases, prolonged survival.

As you know from your father, lung volume reduction surgery does not cure emphysema. Instead, it can help preserve breathing and lung function, typically for three to five years. But because emphysema is a progressive disease, the remaining lung tissue continues to deteriorate.

At your father's stage, medications may help improve his symptoms. He may also benefit from a supervised pulmonary rehabilitation program, which uses physical activity to improve lung function. Lung transplantation is another option. Encourage your father to have a lung transplantation evaluation, which assesses overall health status and specific factors related to the lung transplant process. Although his previous lung volume reduction surgery may make a transplant more technically challenging, I don't think it should prevent him from being a candidate.

Emphysema patients may be candidates for single or double lung transplantation, depending on individual characteristics and organ availability. Both options have similar risks and complications; however, patients undergoing double lung transplantation have a slightly higher survival rate over the long term.

Emphysema patients have some of the best rates of survival following transplantation. In Mayo Clinic's overall experience with lung transplantation, the one-year survival rate is around 84 percent while the five-year survival rate is 53 percent. This is slightly higher than national rates reported by the National Organ Transplant Network at 78 percent and 45 percent, respectively.

I would encourage your father and others with severe emphysema to see a lung specialist and talk about lung transplantation as an option to improve breathing and overall quality of life.

-- Stephen D. Cassivi, M.D., Surgical Director of Lung Transplantation, Mayo Clinic, Rochester, Minn.