From the Guidelines
Lung transplantation is indicated for patients with end-stage lung disease, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and other conditions, who have exhausted all other medical and surgical treatment options and meet specific criteria, such as an FEV1 less than 20% predicted in COPD patients, as stated in the American Journal of Respiratory and Critical Care Medicine 1. The primary indications for lung transplantation include:
- Chronic obstructive pulmonary disease (COPD)
- Idiopathic pulmonary fibrosis (IPF)
- Cystic fibrosis (CF)
- Pulmonary arterial hypertension
- Alpha-1 antitrypsin deficiency Patients are typically considered for lung transplantation when they have a life expectancy of less than 2-3 years without transplantation, deteriorating quality of life despite maximal medical therapy, and no contraindications to transplantation, as suggested by the American Thoracic Society/European Respiratory Society statement 1. Specific criteria for lung transplantation include:
- FEV1 less than 20% predicted in COPD patients
- Rapid decline in lung function for IPF patients (with DLCO <40% predicted)
- FEV1 <30% predicted with rapid deterioration in CF patients
- Pulmonary hypertension patients with WHO functional class III or IV symptoms despite optimal medical therapy (including prostanoids, endothelin receptor antagonists, and phosphodiesterase inhibitors) The decision to proceed with lung transplantation should be based on individualized assessment of the patient's suitability, taking into account their overall health status, rehabilitation potential, and absence of significant comorbidities that would compromise post-transplant outcomes, as recommended by the American Journal of Respiratory and Critical Care Medicine 1.
From the Research
Indications for Lung Transplant
The indications for lung transplant include various end-stage lung diseases, such as:
- Chronic obstructive pulmonary disease (COPD) 2, 3
- Pulmonary fibrosis 3, 4
- Cystic fibrosis 4
- Pulmonary arterial hypertension 4
- Emphysema 4
Selection Criteria
The selection criteria for lung transplant candidates include:
- Age 5, 4
- Degree of mobility 4
- Nutritional and muscular condition 4
- Concurrent extrapulmonary disease 5, 4
- Underlying pulmonary or cardiopulmonary disease 4
- Likelihood of posttransplant success 6
Timing and Evaluation
The timing of lung transplant evaluation is crucial, and most programs favor initiating the process early and proactively 6. A comprehensive, multidisciplinary evaluation is used to:
- Elucidate disease prognosis 6
- Identify risk factors for poor posttransplant outcomes 6
- Determine optimal timing for transplant 6
Transplant Options
The transplant options for lung disease include: