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Lung Transplant COPD — RACP Adult Medicine MCQ

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EasyRespiratoryLung Transplant COPDRACP Adult Medicine

A 45-year-old man with severe COPD (FEV₁ 20%, DLCO 25%) and alpha-1 antitrypsin deficiency has progressive disease despite optimal medical therapy, augmentation therapy, and pulmonary rehabilitation. He has no other significant comorbidities. His BMI is 22. He has no active infections. What is the most appropriate next consideration?

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Correct answer: D — Lung transplant assessment

End-stage COPD (FEV₁ <25%, DLCO <25%) failing all medical therapies in a young patient with no contraindications warrants lung transplant assessment. General referral criteria: BODE index 7-10, FEV₁ <25%, frequent exacerbations with ICU admissions, PH (PASP >35), or declining FEV₁ despite optimal therapy. Bilateral sequential lung transplant is standard for COPD/AAT deficiency. 5-year survival post-lung transplant ~55%. Concomitant palliative care approach alongside transplant assessment.

Reference: ISHLT – 2024 – Lung Transplant Selection; TSANZ 2024