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Indications for Transplant

                                                                                  Lung Transplantation: Version 7.0

Indications for Lung Transplantation
The International Society for Heart and Lung Transplantation emphasizes the complexity of the decisions around selecting potential lung recipients and that early referral of patients with disease amenable to transplantation is important in improving outcomes. Aggressive management of these patients can prevent the commonly encountered deconditioning of patients with pulmonary disease. These patients do less well and often the costs of the transplant episode are higher than patients who receive adequate pulmonary rehabilitation pre-operatively.

Typically, evaluation and listing of candidates is indicated for patients with progressive and irreversible chronic lung disease who are expected to live no more than two years, have severe exercise intolerance, poor quality of life related to the ESLD, are < 65 years of age (although age alone should not be a contraindication) and typically are dependent on oxygen. Other general characteristics needing consideration are the nutritional status, psycho-social status, freedom from recent (less than 2 years) malignancy with low chance of recurrence, with a 5-year disease-free interval prudent in most cases, overall functional status, and freedom from major uncorrectable medical conditions.

In general, adult patients should be considered for lung transplantation if they meet the following general criteria: [2]
        • Untreatable chronic, end-stage pulmonary disease of any etiology
        • High (>50%) risk of death from lung disease within 2 years if lung
           transplantation is not performed
        • High (>80%) likelihood of surviving at least 90 days after lung
        • High (>80%) likelihood of 5-year post-transplant survival from a general
           medical perspective provided that there is adequate graft function

There are different disease specific indications for the four major categories of disease leading to end-stage pulmonary disease.  These are listed below.  Different centers have differing policies on some of the criteria, but all rely on guidelines published by the ISHLT in 1998, revised 2006, and further updated in 2014. These are endorsed by all major professional societies in the US and Europe involved in lung and heart-lung transplantation. Visit the full ISHLT document for candidate selection here.

1 White-Williams C. “Lung Transplantation.” Organ Transplantation 2002 17 June 2002.
2 Orens JB, Estenne M, Arcasoy S,  et al. International guidelines for the selection of lung transplant candidates: 2006 update – a concensus report from the pulmonary scientific council of the International Society for Heart and Lung Transplantation  J Heart Lung Transplant. 2006;25:745-755