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Lung transplantation: General guidelines for recipient selection

INTRODUCTION

The most common indications for lung transplantation are advanced chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), emphysema due to alpha-1 antitrypsin deficiency, and idiopathic pulmonary arterial hypertension (IPAH) (figure 1) [1]. These account for approximately 85 percent of all procedures performed worldwide. The remaining 15 percent consist of a variety of diagnoses that span the spectrum of end-stage lung disease from sarcoidosis to lymphangioleiomyomatosis (LAM) to pulmonary Langerhans' cell histiocytosis [2-7].

The indications and general guidelines for recipient selection will be presented here. An overview of lung transplantation, the international guidelines for recipient selection, disease-specific indications, and choice of procedure are presented separately. (See "Lung transplantation: An overview" and "Lung transplantation: Disease-based choice of procedure".)

GENERAL GUIDELINES

Lung transplantation should be considered for patients with advanced lung disease whose clinical status has progressively declined despite maximal medical or surgical therapy. Candidates are usually symptomatic during activities of daily living and have a limited expected survival over the next two years [8-10]. In addition, the ideal candidate should be free of significant other organ dysfunction and extrapulmonary manifestations of a systemic disease. Guidelines for recipient selection have been developed by the American Thoracic Society and the International Society of Heart and Lung Transplantation and include [11,12]:

  • Appropriate age (see 'Recipient age' below)
  • Clinically and physiologically severe disease
  • Ineffective or unavailable medical therapy
  • Limited life expectancy due to lung disease
  • Acceptable nutritional status, usually 80 to 120 percent of ideal body weight or body mass index (BMI) less than 30 kg per m2
  • Satisfactory psychosocial profile and support system
  • Adequate financial coverage for the procedure and postoperative care

Recipient age — Because older recipients have a significantly shorter survival than younger ones [1], age older than 65 is considered a relative contraindication for lung transplantation [12]:

               

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Literature review current through: Sep 2014. | This topic last updated: Oct 15, 2013.
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