Mortality-associated prognostic factors, survival rates, lung functions and complications in post-transplant chronic obstructive pulmonary disease patients: A systematic review and meta-analysis

Hana Khairina Putri Faisal; Ahmad Fadhil Ilham; Hanna Lianti Afladhia; Agus Dwi Susanto; Prasenohadi; Mia Elhidsi; Susan Hendriarini Mety; Faisal Yunus

doi:10.2478/pneum-2026-0007

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Mortality-associated prognostic factors, survival rates, lung functions and complications in post-transplant chronic obstructive pulmonary disease patients: A systematic review and meta-analysis

Pneumologia

Volume 75 (2026): Issue 1 (January 2026)

By: Hana Khairina Putri Faisal, Ahmad Fadhil Ilham, Hanna Lianti Afladhia, Agus Dwi Susanto, Prasenohadi, Mia Elhidsi, Susan Hendriarini Mety and Faisal Yunus

Open Access

|May 2026

Abstract

English:

Background

Chronic obstructive pulmonary disease (COPD) remains a significant global health burden. Due to limited donor organs, it is essential to implement rigorous selection criteria for lung transplantation candidates to maximise survival outcomes.

Methods

This study is a systematic review and meta-analysis of mortality-associated prognostic factors, survival rates (SR), lung function and complications among COPD patients who underwent lung transplantation. We follow preferred reporting items for systematic reviews and meta-analyses 2020 guidelines and register this review in PROSPERO (CRD42024617160). Eligibility criteria guided article selection through Medline, Scopus, ProQuest, Central and manual searches. Study quality was assessed using the Newcastle–Ottawa scale (NOS). Data were extracted and analysed, including performing meta-analysis for relevant outcomes.

Results

Our analysis identified prognostic factors associated with post-transplant mortality, including increased age per year (HR: 1.03, 95% CI: 1.02–1.03; I² = 0%), diabetes mellitus (HR: 1.38, 95% CI: 1.22–1.57; I² = 0%), ECMO support (HR: 3.58, 95% CI: 1.95–6.57; I² = 5%) and white donor race (HR: 0.81, 95% CI: 0.74–0.89; I² = 0%). Other significant factors included previous lung surgery, non-alpha-1 antitrypsin deficiency, induction agent type, continuous mechanical ventilation, 6-min walk distance and pulmonary hypertension. Lung transplantation significantly improves survival in COPD patients, with pooled SR of 79.8% (95% CI: 69.2%–87.4%) at 1 year and 55.3% (95% CI: 47.3%–63.1%) at 5 years. Lung function also showed marked improvement. Reported complications included infections, metabolic complications, rejection and bronchiolitis obliterans syndrome.

Conclusions

This systematic review identifies the key prognostic factors associated with mortality in post-transplant COPD patients, as well as post-transplant SR, lung function improvements and common complications.

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Articles in this issue

DOI: https://doi.org/10.2478/pneum-2026-0007 | Journal eISSN: 2247-059X | Journal ISSN: 2067-2993

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Language: English

Page range: 44 - 57

Published on: May 11, 2026

Published by: Romanian Society of Pneumology

In partnership with: Paradigm Publishing Services

Publication frequency: Volume open

Keywords:

Chronic obstructive pulmonary disease,

lung transplantation,

Related subjects:

Clinical medicine, other,

Internal medicine,

Pneumology

© 2026 Hana Khairina Putri Faisal, Ahmad Fadhil Ilham, Hanna Lianti Afladhia, Agus Dwi Susanto, Prasenohadi, Mia Elhidsi, Susan Hendriarini Mety, Faisal Yunus, published by Romanian Society of Pneumology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 75 (2026): Issue 1 (January 2026)