Surgical Procedures

Surgical procedures for emphysema are still investigative. They are all very expensive and often not covered by insurance. The great majority of patients cannot be helped by surgery, and no single procedure is ideal for those that can be helped.

Lung and Liver Transplantation

Advanced emphysema is responsible for over half of the lung transplants performed. Three-year survival rates after a lung transplantation are about 60% for patients with either emphysema or AAT deficiencies. Techniques have been developed so that both lungs may be replaced in sequence. The increasingly long waiting time and the extraordinary expense are both significant problems.

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Candidates. The best candidates are under 65 and have good general health aside from lung disease. A lung or liver transplantation may be the only hope for some patients with the inherited disease alpha 1-antitrypsin (AAT) deficiency-related emphysema. AAT is produced in the liver, so a healthy transplanted liver may produce adequate supplies of the protein.

Waiting Time. Unfortunately, up to a third of patients awaiting lung transplantation die before a suitable donor is available. There were 1042 lung transplantation operations in 2002, and as of this report there are nearly 4,000 people waiting for the operation. Not all lung transplant centers, even in major cities like New York, accept Medicare patients. The system is currently operated on a first-come first-served basis (rather than by urgency).

Complications. Drugs that suppress the immune system must be taken life-long after a transplantation to prevent the body from rejecting the transplanted organ. Nevertheless, rejection is the primary cause of late complications and death. The mortality rate from the procedure itself is about 10%.

Lung Volume-Reduction Surgery