Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation

Debbie Rybak, Michael B. Fallon, Michael J. Krowka, Robert S. Brown, Jenna Reinen, Linda Stadheim, Dorothy Faulk, Carrie Nielsen, Nadine Al-Naamani, Karl Roberts, Steven Zacks, Ted Perry, James Trotter, Steven M. Kawut, Jeffrey Okun, Daniel Rabinowitz, Evelyn M. Horn, Lori Rosenthal, Sonja Olsen, Vijay ShahRussell Wiesner, J. Stevenson Bynon, Devin Eckhoff, Harpreet Singh, Rajasekhar Tanikella, Raymond L. Benza, Keith Wille, Lisa Forman, David Badesch, Roshan Shrestha, Darren B. Taichman, Vivek Ahya, Harold Palevsky, Rajender Reddy, Neil Kaplowitz, James Knowles

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Chronic obstructive pulmonary disease (COPD) may cause significant symptoms and have an impact on survival. Smoking is an important risk factor for COPD and is common in candidates for liver transplantation; however, the risk factors for and outcomes of COPD in this population are unknown. We performed a prospective cohort study of 373 patients being evaluated for liver transplantation at 7 academic centers in the United States. COPD was characterized by expiratory airflow obstruction and defined as follows: prebronchodilator forced expiratory volume in 1 second/forced vital capacity < 0.70. Patients completed the Liver Disease Quality of Life Questionnaire 1.0, which included the Short Form-36. The mean age of the study sample was 53 ± 9 years, and 234 (63%) were male. Sixty-seven patients (18%, 95% confidence interval 14%-22%) had COPD, and 224 (60%) had a history of smoking. Eighty percent of patients with airflow obstruction did not previously carry a diagnosis of COPD, and 27% were still actively smoking. Older age and any smoking (odds ratio = 3.74, 95% confidence interval 1.94-7.23, P < 0.001) were independent risk factors for COPD. Patients with COPD had worse New York Heart Association functional class and lower physical component summary scores on the 36-Item Short Form but had short-term survival similar to that of patients without COPD. In conclusion, COPD is common and often undiagnosed in candidates for liver transplantation. Older age and smoking are significant risk factors of COPD, which has adverse consequences on functional status and quality of life in these patients.

Original languageEnglish (US)
Pages (from-to)1357-1365
Number of pages9
JournalLiver Transplantation
Issue number9
StatePublished - Sep 2008

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation


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