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Timing of Referral


                                                                                  Lung Transplantation: Version 7.0

Guidelines for Timing of a Referral for Evaluation
 

Nonbronchiectatic Diseases (COPD, others):
        • Forced expiratory volume in 1 second (FEV1) < 25% of the predicted
          value
        • paCO2 ≥ 55 mm Hg
        • paO2 < 55-60 mm Hg
        • Elevated pulmonary artery pressures (secondary pulmonary hypertension)
        • Clinical course - rapid rate of decline in FEV1 or life-threatening
          exacerbations

Bronchiectatic diseases (CF, others):
        • FEV1 ≤ 30% of predicted value or rapid respiratory deterioration
          with FEV1 > 30%
        • paCO2 > 50 mm Hg
        • paO2 < 55 mm Hg
        • Increasing frequency and severity of exacerbations
        • Young female patient who deteriorates rapidly

Interstitial Lung Disease (idiopathic pulmonary fibrosis, others):
        • Symptomatic, progressive disease with failure to respond to optimal
          medical treatment
        • Vital capacity < 60% to 65% of predicted value
        • Diffusing capacity of the lung for carbon monoxide (DLCO) < 50%
          to 60% of predicted value
        • Resting hypoxemia with PaO2 < 55 mm Hg
        • Rapid progression of IPF warrants early referral

Pulmonary Hypertension
        • NYHA functional class III or IV
        • Mean right atrial pressure of greater than 10 mm Hg
        • Mean pulmonary arterial pressure of greater than 50 mm Hg
        • Cardiac index of less than 2.5 L/min/m2
        • Failure of therapy with long-term prostacyclin infusion