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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 Cover

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

Open Access
|May 2026

Figures & Tables

Figure 1.

Study flow chart. PRISMA, preferred reporting items for systematic reviews and meta-analyses.

Figure 2.

Meta-analysis of mortality-associated prognostic factors: recipient age (increase of 1 year) (A), donor white race (B), diabetes mellitus (C), and ECMO support (D).

Figure 3.

Meta-analysis of mortality-associated prognostic factors: male gender (A), BMI (B), SLT type (C), FVC (D), FEV1 (E), donor age (F), mean arterial pressure (G), oxygen requirement (H) and steroid use (I). BMI, body mass index; SLT, single lung transplant.

Figure 4.

Forest plot of 1-year (A), 2-year (B), 3-year (C), 4-year (D), 5-year (E), 10-year (F) SR in post lung transplantation COPD patients. COPD, chronic obstructive pulmonary disease; CI, confidence intervals; SR, survival rates.

Figure 5.

Forest plot of 1-year (A), 5-year (B) SR in post-SLT and 1-year (C), 5-year (D) SR in post BLT COPD patients. BLT, bilateral lung transplant; SLT, single lung transplant; SR, survival rates.

Figure 6.

Forest plot of 1-year (A), 5-year (B) BOS-free SR in post-SLT COPD and 1-year (C), 5-year (D) BOS-free SR in post-BLT COPD patients. BOS, bronchiolitis obliterans syndrome; BLT, bilateral lung transplant; COPD, chronic obstructive pulmonary disease; SLT, single lung transplant; SR, survival rates.

6MWT evaluation after lung transplantation in COPD patients_

Author, Year6MWT (m)Evaluation time
Latos, 2020158.07Pre-transplant
377.61At 1 months
424.26At 3 months
457.25At 6 months
430.70At 12 months
501.54At 18 months
440.92At 24 months

Characteristics of included studies

No.AuthorLocationStudy designEnrollment periodParticipants (n)AgeDetails on populationDetails on transplantationDetails on outcome assessed
1Bennett et al. (18).United StatesRetrospective cohortJanuary 1992–December 20123084Mean: 57.52 years (SD: 7.32)COPD patients, excluding those with α-1 antitrypsin deficiencySLT (n = 206 + 4408), BLT (n = 30 + 2848)Post-transplant SR
2Cano et al. (19).SpainRetrospective cohortOctober 1993–November 200763Mean: 53 years (Range:25–65)Severe COPD requiring transplantationSLT (n = 28), BLT (n = 35)Surgical and long-term complications; post-transplant survival rates
3Crawford et al. (20).United StatesRetrospective cohortMay 2005–December 20143554Mean single transplant: 62 years (SD: 5) Mean double transplant: 60 years (SD: 6)COPDSLT (n = 1358), BLT (n = 2196)Post-transplant SR and prognostic factors of mortality
4De Miguel-Diez et al. (21).SpainRetrospective cohort2001–20152896Mean 55.41 years (SD: 8.6)ICD9 codes for COPD; focus on advanced COPDSLT (36.78%), BLT (61.47%), non-specified (1.75%)Complications, in-hospital mortality risk factors
5De Miguel-Diez et al. (22).SpainRetrospective cohortJanuary 2016–December 2020704Mean 58.07 (SD: 7.73)ICD-10 code for COPDSLT (31.68%), BLT (68.32%)Complications, lung transplant rejection, in-hospital mortality risk factors
6De Pablo et al. (17).SpainRetrospective cohortFebruary 1993–November 199774Mean SLT: 48 (SD: 7)Mean BLT: 46 (SD: 7)COPD: clinical-radiological diagnosis of emphysema (including due to alpha-1-antitrypsin) or chronic bronchitisSLT (n = 30), BLT (n = 44)Post-transplant SR, lung function
7Duffy et al. (23).United StatesRetrospective cohortMay 2001–June 20143405Mean agent-induced group: 60.7 (SD: 6.3), Mean non-induced group: 60.4 (SD: 6.0)COPDReceiving induction (n = 1761), not receiving induction (n = 1146)Prognostic factors of mortality
8Gaissert et al. (24).United StatesRetrospective cohortMarch 1989–April 199464Mean SLT: 55Mean BLT: 49COPD patients, excluding those with α-1 antitrypsin deficiencySLT (n = 39), BLT (0 = 25)Post-transplant survival rate and lung function
9Güneş et al. (25).AustraliaRetrospective cohort1989–2003173Mean 50 (SD: 6)Emphysema (n = 112) and AATD (n = 61)SLT (n = 99), BLT (n = 66), HLT (n = 8)Post-transplant SR, post-transplant SR
10Hadjiliadis et al. (26).United States and CanadaRetrospective cohortJanuary 1983–December 2000221Mean SLT: 55.3 (SD: 8.0)Mean BLT: 53.0 (SD: 7.8)COPD and AATDSLT(n = 118), BLT(n = 103)Post-transplant SR, freedom from BOS
11Hayes et al. (27).United StatesRetrospective cohortMay 2005–September 20133105Mean 59.6 (SD: 6.2)COPD with severe pulmonary hypertensionSLT (40%), BLT (60%)Post-transplant survival and prognostic factors of mortality
12Lahzami et al. (28).SwitzerlandRetrospective cohort1993–200754Mean 55 (SD: 6)Non-AATD related COPDSLT (35%), BLT (65%)Post-transplant SR
13Latos et al. (15).PolandRetrospective cohort2006–201840Not specifiedEnd-stage COPD as per ISHLT guidelinesSLT (42.5%), BLT (57.5%)Post-transplant SR, lung function improvement (FEV1 and FVC), 6MWT results
14Mutyala et al. (29).United StatesRetrospective cohortFebruary 2012–March 2020186Mean SLT: 65.3 (SD: 5.9)Mean BLT: 63.2 (SD: 7.1)COPDSLT (n = 115), BLT (n = 71)Prognostic factors of mortality
15Navarro et al. (13, 14).SpainRetrospective cohort1991–2008107Mean: 52.58 (SD: 8.05)COPD and AATDSLT (n = 31), BLT (n = 76)Post-transplant SR, surgical complications, BOS status, lung function test
16Nunley et al. (30).United StatesRetrospective and prospective cohortNot specified17Mean: 57 (SD: 6.11)COPD (emphysema/chronic bronchitis) and AATD with history of smokingAll patients underwent SLT.Post-transplant SR
17Singh et al. (31).United StatesRetrospective cohortMay 2005–June 20102025Median 60 years (IQR 56-64)COPD patients, excluding those with α-1 antitrypsin deficiencySLT (44.4%), BLT (55.6%)1-year post-transplant mortality, prognostic factors of mortality
18Stavern et al. (32).NorwayRetrospective cohort1990–June 2003219Mean 49 (SD: 10)COPD/emphysema, including AATDSLT (n = 70), and BLT (n = 56)Prognostic factors of mortality ≤90 and >90 days after transplantation
19Tanash et al. (33).SwedenRetrospective cohort1990–2012342Median 55 (Range:32–70)COPD, analysed AATD and non-AATD subgroupsSLT (71 %)Prognostic factors of mortality, median survival
20Thabut et al. (34).United StatesRetrospective cohort1987–20045873Mean: 56 (7.1)COPD/emphysema (including AATD)SLT (72.2%)Prognostic factors of mortality, median survival
21Türkkan et al. (16).TurkeyRetrospective cohortMarch 2013–January 202334Median 57 (Range:34–69)COPDSLT (n = 3), BLT (n = 30)Post-transplant clinical results
22Zeriouh et al. (35).UK, GermanyRetrospective cohortJanuary 2007–November 201388Mean 54.3 (SD: 6.8)COPD, emphysema, exclusion of alpha-1-antitrypsinSLT (n = 12), BLT (n = 76)Cumulative survival; freedom from BOS survival

PaO2 and PCO2 evaluation after lung transplantation in COPD patients

Author, YearPaO2 (mmHg)PaCO2 (mmHg)Evaluation time
De pablo, 199950 ± 751 ± 10Pre-transplant
79 ± 9*39 ± 4*At 3 months
79 ± 10*39 ± 4*At 6 months
81 ± 11*38 ± 4*At 12 months
DOI: https://doi.org/10.2478/pneum-2026-0007 | Journal eISSN: 2247-059X | Journal ISSN: 2067-2993
Language: English
Page range: 44 - 57
Published on: May 11, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: Volume open

© 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.