Indications/Contraindications

Who Can Have a Lung Transplant?

Indications: Who needs a lung transplant?

Lung transplants are indicated for patients with End Stage Lung Disease for which maximal medical therapy is ineffective or there is no proven therapy. These include patients with the following diseases or conditions:

  • Idiopathic Pulmonary Fibrosis (IPF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cystic Fibrosis
  • Idiopathic Pulmonary Arterial Hypertension
  • Sarcoidosis
  • Lymphangioleyomyomatosis (LAM)

Who Can’t Have a Lung Transplant?

Absolute Contraindications: Who isn’t a candidate for a lung transplant?

You shouldn’t have a lung transplant if you have the following:

  • A malignancy within the last 2 years, except for non-melanoma skin cancers (a 5-year disease-free interval is preferred)
  • Untreatable dysfunction of another organ system (selected patients with CAD can undergo a lung transplant)
  • Active chronic hepatitis C or B with histological evidence of liver damage
  • Significant chest wall deformities
  • Documented non-adherence to medical therapy or follow up
  • Severe psychiatric illness
  • An unreliable social support system
  • Active substance addiction (tobacco, alcohol, narcotics) or any use within 6 months
  • Class II obesity or higher defined as a body mass index (BMI) exceeding 35 kg/m2

Relative Contraindications: Who might not qualify for a lung transplant?

The following criteria may preclude you from being able to have a lung transplant:

  • Age > 65 years
  • HIV infection
  • Critical or unstable clinical condition (e.g., shock, mechanical ventilation or extra-corporeal membrane oxygenation)
  • Severely limited functional status poor rehabilitation potential (6 minute walk test with distance < 600 feet)
  • Colonization with highly resistant or highly virulent bacteria, fungi or mycobacteria
  • Class I obesity defined as a body mass index (BMI) between 30-34.9 kg/m2
  • Severe or symptomatic osteoporosis
  • Mechanical ventilation (carefully selected candidates on mechanical ventilation without other acute or chronic organ dysfunction who are able to actively participate in a meaningful rehabilitation program may be successfully transplanted)
  • Other medical conditions that have not resulted in end-stage organ damage, such as diabetes mellitus, systemic hypertension, peptic ulcer disease, or gastro esophageal reflux should be optimally treated before transplantation
  • Patients with coronary artery disease may undergo percutaneous intervention or coronary artery bypass grafting before transplantation.

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