respiratory
COPD

Lung transplants: 8 things we have learned from the WA experience


Although the first lung transplant in Australia was done in 1986, patients in WA had to wait almost two decades before transplantatation started in the state in 2004. Since then, 115 lung transplants have been performed, and Professor Bill Musk and other WA lung specialists have now summarised their experience in a paper in the Internal Medicine Journal.

  1. Rates continue to trend upwards, with 20 lung transplants performed in 2015.
  2. Interstitial lung disease (mostly idiopathic pulmonary fibrosis) is the most common indication for lung transplantation (30.4%), followed by cystic fibrosis (27.8%) and COPD (22.6%).
  3. Reflecting the rise in COPD and ILD, the average age of transplant recipients is increasing, with half the transplant recipients over 50 and 10% between 60 and 65.
  4. Waitlist times for transplantation range from a few weeks to more than three years, with a median of four months. Waitlist times are shortest for patients in the AB blood group and longest for those in the O group. Short stature is also associated with longer waitlist times.
  5. Outcome data compare well with international data, with survival rates of 89% at three months, 80% at one year, 65% at three years and 54% at five years.
  6. Chronic lung allograft dysfunction (CLAD) is the leading cause of late mortality, affecting over half of patients over five years.
  7. Donor shortages are an ongoing issue. Mismatches in donor-recipient lung capacity due to the limited donor pool are managed by trimming donor lungs intra-operatively by lobectomy.
  8. Rural patients who require a lung transplant have to move to the capital city during the transplant period, but may have long term follow up via telehealth in collaboration with a local medical practitioner.