Lung transplantation for COPD: one lung, two lungs, or none?

摘要

The history of lung transplantation began with the first unsuccessful attempt in 1963 to transplant one lung to treat chronic obstructive pulmonary disease (COPD). Subsequent attempts and failures led to the widely held belief that unilateral transplantation in COPD was not physiologically possible because of differences in lung compliance and pulmonary-vascular resistance between the transplanted healthy lung and the native emphysematous lung. With this physiological principle in mind, Cooper and colleagues in 1986 used a bilateral transplantation in the first successful treatment of COPD. However, transplantation of one lung was subsequently used to treat emphysema in 1989 in France, thus disproving previous belief about the physiological limitations of unilateral transplantation in COPD. Over the next two decades, both unilateral and bilateral transplantation in COPD were shown to improve pulmonary functions, exercise capacity, and quality of life. Whether lung transplantation actually improves survival is debated. Whereas Hosenpud and colleagues8 found a survival benefit in patients with cystic fibrosis and interstitial pulmonary fibrosis treated with lung transplantation, this was not the case in patients with emphysema.