Lung Transplant Patient Selection Criteria
Indications
- Bilateral Lung Transplant
- Cystic fibrosis
- Bronchiectasis
- Pulmonary hypertension
- Emphysema
- Pulmonary fibrosis (idoiopathic or secondary to scleroderma or other disease states)
- Single Lung Transplant
- Emphysema
- Pulmonary fibrosis (idoiopathic or secondary to scleroderma or other disease states)
- Heart/Lung Transplant
- Same as SLT and BLT with:
- Poor left ventricular function or irreversible right ventricle function
- Surgically irreparable congenital heart defects
- Same as SLT and BLT with:
Contraindications
Absolute Contraindications
Absolute contraindications for adults and children include, but may not be limited to:
- Age appropriateness
- 65 years of age for single lung (must be evaluated before 63rd birthday)
- 65 years of age for double lung transplant
- 55 years of age for heart/lung transplant
- Active smoker (less than 6 months since quitting)
- Active substance abuse
- Chronic mechanical ventilation (unless tolerating 3 hours of physical therapy/day and is free of bacterial colonization)
- Previous lung transplant (rare exceptions for Johns Hopkins Hospital primary transplant patients)
- Severe Diffuse Coronary artery disease (especially with poor EF)
- End-stage renal disease (creatinine clearance < 40 mg/min)
- End-stage liver disease
- Bone marrow dysfunction
- HIV
- Severe local or systemic infection
- Severe neurologic deficits
- Untreatable psychiatric
Relative Contraindications
Relative contraindications for adults and children include, but may not be limited to:
- Morbid obesity (BMI>30)
- Severe malnutrition/cachexia
- Chronic prednisone use > 20 mg / day
- Symptomatic osteoporosis
- Psychiatric / social problems (including non-compliance)
- Financial problems (no prescription coverage)
- Previous thoracic surgery / procedure
- Lack of family or social support
- Cancer in the last 5 years except localized skin (never melanoma)
- Colonization with resistant organisms