Skip to main content

Advertisement

Log in

Update to the guidelines for selection of lung-transplant candidates

  • Lung Transplant (M Zamora, Section Editor)
  • Published:
Current Respiratory Care Reports Aims and scope Submit manuscript

Abstract

Lung transplantation (LT) for treatment for end stage lung disease is becoming increasingly available, and can improve survival and quality of life for some patients. Because of limited availability of donor organs and because of limited post-transplant survival of recipients, appropriate selection of candidates is invariably important. Since the revision of the 2006 international guidelines for selection of lung-transplant recipients, new literature has continued to improve our understanding of the effect of non-pulmonary comorbidities on disease-specific prognosis. By applying this new understanding to evaluation of potential lung-transplant recipients, we can best ensure optimum allocation of the limited resource of donor organs to recipients that are most likely to benefit from LT. This article will review the most recent literature on lung transplant candidate selection to provide an updated framework for optimum allocation of this limited resource.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Shah PD, Orens JB. Guidelines for the selection of lung-transplant candidates. Curr Opin Organ Transplant. 2012;17:467–73.

    Article  PubMed  Google Scholar 

  2. Russo MJ, Worku B, Iribarne A, et al. Does lung allocation score maximize survival benefit from lung transplantation? J Thorac Cardiovasc Surg. 2011;141:1270–7.

    Article  PubMed  Google Scholar 

  3. Yusen RD. Survival and quality of life of patients undergoing lung transplant. Clin Chest Med. 2011;32:253–64.

    Article  PubMed  Google Scholar 

  4. Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: thirtieth adult lung and heart-lung transplant report–2013; focus theme: age. J Heart Lung Transplant. 2013;32:965–78.

    Article  PubMed  Google Scholar 

  5. Halpern SD. Turning wrong into right: the 2013 lung allocation controversy. Ann Intern Med. 2013;159:358–9.

    Article  PubMed  Google Scholar 

  6. Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update–a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006;25:745–55.

    Article  PubMed  Google Scholar 

  7. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788–824.

    Article  PubMed  Google Scholar 

  8. Yusen RD, Shearon TH, Qian Y, et al. Lung transplantation in the United States, 1999–2008. Am J Tranplant: Off J Am Soc Transplant Am Soc Transplant Surg. 2010;10:1047–68.

    Article  CAS  Google Scholar 

  9. George TJ, Arnaoutakis GJ, Shah AS. Lung transplant in idiopathic pulmonary fibrosis. Arch Surg. 2011;146:1204–9.

    Article  PubMed  Google Scholar 

  10. Nathan SD, Shlobin OA, Weir N, et al. Long-term course and prognosis of idiopathic pulmonary fibrosis in the new millennium. Chest. 2011;140:221–9.

    Article  PubMed  Google Scholar 

  11. Ley B, Collard HR, King Jr TE. Clinical course and prediction of survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;183:431–40.

    Article  PubMed  Google Scholar 

  12. Ley B, Ryerson CJ, Vittinghoff E, et al. A multidimensional index and staging system for idiopathic pulmonary fibrosis. Ann Intern Med. 2012;156:684–91.

    Article  PubMed  Google Scholar 

  13. Ryerson CJ, Vittinghoff E, Ley B, et al. Predicting survival across chronic interstitial lung disease: The ILD-GAP model. Chest 2014;145:723-8.

  14. Richeldi L, Costabel U, Selman M, et al. Efficacy of a tyrosine kinase inhibitor in idiopathic pulmonary fibrosis. N Engl J Med. 2011;365:1079–87.

    Article  CAS  PubMed  Google Scholar 

  15. Noble PW, Albera C, Bradford WZ, et al. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet. 2011;377:1760–9.

    Article  CAS  PubMed  Google Scholar 

  16. Datta A, Scotton CJ, Chambers RC. Novel therapeutic approaches for pulmonary fibrosis. Br J Pharmacol. 2011;163:141–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Idiopathic Pulmonary Fibrosis Clinical Research N, Raghu G, Anstrom KJ, King Jr TE, Lasky JA, Martinez FJ. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med. 2012;366:1968–77.

    Article  CAS  PubMed  Google Scholar 

  18. The Idiopathic Pulmonary Fibrosis Clinical Research Network. Randomized Trial of Acetylcysteine in Idiopathic Pulmonary Fibrosis. N Eng J Med. 2014;370:2093-101

  19. Armanios MY, Chen JJ, Cogan JD, et al. Telomerase mutations in families with idiopathic pulmonary fibrosis. N Engl J Med. 2007;356:1317–26.

    Article  CAS  PubMed  Google Scholar 

  20. Nathan SD, Shlobin OA, Ahmad S, Burton NA, Barnett SD, Edwards E. Comparison of wait times and mortality for idiopathic pulmonary fibrosis patients listed for single or bilateral lung transplantation. J Heart Lung Transplant. 2010;29:1165–71.

    Article  PubMed  Google Scholar 

  21. Sottile PD, Iturbe D, Katsumoto TR, et al. Outcomes in systemic sclerosis-related lung disease after lung transplantation. Transplantation. 2013;95:975–80.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yazdani A, Singer LG, Strand V, Gelber AC, Williams L, Mittoo S. Survival and quality of life in rheumatoid-arthritis-interstitial lung disease after lung transplantation. J Heart Lung Transplant 2014;In Press.

  23. Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008;371:744–51.

    Article  PubMed  Google Scholar 

  24. Connors Jr AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996;154:959–67.

    Article  PubMed  Google Scholar 

  25. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–12.

    Article  CAS  PubMed  Google Scholar 

  26. Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J. 2008;32:1371–85.

    Article  CAS  PubMed  Google Scholar 

  27. Oswald-Mammosser M, Weitzenblum E, Quoix E, et al. Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure. Chest. 1995;107:1193–8.

    Article  CAS  PubMed  Google Scholar 

  28. Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348:2059–73.

    Article  PubMed  Google Scholar 

  29. Marin JM, Alfageme I, Almagro P, et al. Multicomponent indices to predict survival in COPD: the COCOMICS study. Eur Respir J. 2013;42:323–32.

    Article  PubMed  Google Scholar 

  30. Eskander A, Waddell TK, Faughnan ME, Chowdhury N, Singer LG. BODE index and quality of life in advanced chronic obstructive pulmonary disease before and after lung transplantation. J Heart Lung Transplant. 2011;30:1334–41.

    Article  PubMed  Google Scholar 

  31. Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant. 2012;31:1073–86.

    Article  PubMed  Google Scholar 

  32. Munson JC, Christie JD, Halpern SD. The societal impact of single versus bilateral lung transplantation for chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2011;184:1282–8.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Foundation CF. 2012 Annual report. 2012.

  34. Ramsey BW, Davies J, McElvaney NG, et al. A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. N Engl J Med. 2011;365:1663–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Doershuk CF, Stern RC. Timing of referral for lung transplantation for cystic fibrosis: overemphasis on FEV1 may adversely affect overall survival. Chest. 1999;115:782–7.

    Article  CAS  PubMed  Google Scholar 

  36. Thabut G, Christie JD, Mal H, et al. Survival benefit of lung transplant for cystic fibrosis since lung allocation score implementation. Am J Respir Crit Care Med. 2013;187:1335–40.

    Article  PubMed  Google Scholar 

  37. Belkin RA, Henig NR, Singer LG, et al. Risk factors for death of patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med. 2006;173:659–66.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Liou TG, Alder FR, Huang D. Use of lung transplantation survival models to refine patient selection in cystic fibrosis. Am J Respir Crit Care Med. 2005;171:1053–9.

    Article  PubMed  Google Scholar 

  39. Kerem E, Reisman J, Corey M, Canny GJ, Levison H. Prediction of mortality in patients with cystic fibrosis. N Engl J Med. 1992;326:1187–91.

    Article  CAS  PubMed  Google Scholar 

  40. Murray S, Charbeneau J, Marshall BC, LiPuma JJ. Impact of burkholderia infection on lung transplantation in cystic fibrosis. Am J Respir Crit Care Med. 2008;178:363–71.

    Article  PubMed  Google Scholar 

  41. De Soyza A, Meachery G, Hester KL, et al. Lung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: a single-center experience. J Heart Lung Transplant. 2010;29:1395–404.

    Article  PubMed  Google Scholar 

  42. Lobo LJ, Chang LC, Esther Jr CR, Gilligan PH, Tulu Z, Noone PG. Lung transplant outcomes in cystic fibrosis patients with pre-operative Mycobacterium abscessus respiratory infections. Clin Transplant. 2013;27:523–9.

    Article  PubMed  Google Scholar 

  43. Belle-van Meerkerk G, van de Graaf EA, Kwakkel-van Erp JM, et al. Diabetes before and after lung transplantation in patients with cystic fibrosis and other lung diseases. Diabet Med : J Br Diabet Assoc. 2012;29:e159–62.

    Article  CAS  Google Scholar 

  44. Benza RL, Miller DP, Barst RJ, Badesch DB, Frost AE, McGoon MD. An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry. Chest. 2012;142:448–56.

    Article  PubMed  Google Scholar 

  45. Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. 2010;122:164–72.

    Article  PubMed  Google Scholar 

  46. Gomberg-Maitland M, Glassner-Kolmin C, Watson S, et al. Survival in pulmonary arterial hypertension patients awaiting lung transplantation. J Heart Lung Transplant. 2013;32:1179–86.

    Article  PubMed  Google Scholar 

  47. Chen H, Shiboski SC, Golden JA, et al. Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension. Am J Respir Crit Care Med. 2009;180:468–74.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Christie JD, Kotloff RM, Pochettino A, et al. Clinical risk factors for primary graft failure following lung transplantation. Chest. 2003;124:1232–41.

    Article  PubMed  Google Scholar 

  49. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153–65.

    Article  CAS  PubMed  Google Scholar 

  50. Shah L. Lung transplantation in sarcoidosis. Sem Respir crit Care Medicine. 2007;28:134–40.

    Article  Google Scholar 

  51. Pandya CM, Soubani AO. Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update. Clin Transplant. 2010;24:291–306.

    Article  PubMed  Google Scholar 

  52. Holm AM, Riise GC, Hansson L, et al. Lung transplantation for bronchiolitis obliterans syndrome after allo-SCT. Bone Marrow Transplant. 2013;48:703–7.

    Article  CAS  PubMed  Google Scholar 

  53. Vogl UM, Nagayama K, Bojic M, et al. Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a single-center experience. Transplantation. 2013;95:623–8.

    Article  PubMed  Google Scholar 

  54. Wendt A, Adhoute X, Castellani P, et al. Chronic hepatitis C: future treatment. Clin Pharmacol: Adv Appl. 2014;6:1–17.

    Google Scholar 

  55. Kowdley KV, Lawitz E, Poordad F, et al. Phase 2b trial of interferon-free therapy for hepatitis C virus genotype 1. N Engl J Med. 2014;370:222–32.

    Article  CAS  PubMed  Google Scholar 

  56. Sulkowski MS, Gardiner DF, Rodriguez-Torres M, et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. 2014;370:211–21.

    Article  CAS  PubMed  Google Scholar 

  57. George TJ, Beaty CA, Kilic A, Shah PD, Merlo CA, Shah AS. Outcomes and temporal trends among high-risk patients after lung transplantation in the United States. J Heart Lung Transplant. 2012;31:1182–91.

    Article  PubMed  Google Scholar 

  58. Jackson A, Cropper J, Pye R, Junius F, Malouf M, Glanville A. Use of extracorporeal membrane oxygenation as a bridge to primary lung transplant: 3 consecutive, successful cases and a review of the literature. J Heart Lung Transplant. 2008;27:348–52.

    Article  PubMed  Google Scholar 

  59. Fischer S, Hoeper MM, Tomaszek S, et al. Bridge to lung transplantation with the extracorporeal membrane ventilator Novalung in the veno-venous mode: the initial Hannover experience. ASAIO J. 2007;53:168–70.

    Article  PubMed  Google Scholar 

  60. Fuehner T, Kuehn C, Hadem J, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185:763–8.

    Article  PubMed  Google Scholar 

  61. Weiss ES, Merlo CA, Shah AS. Impact of advanced age in lung transplantation: an analysis of United Network for Organ Sharing data. J Am Coll Surg. 2009;208:400–9.

    Article  PubMed  Google Scholar 

  62. Lederer DJ, Wilt JS, D'Ovidio F, et al. Obesity and underweight are associated with an increased risk of death after lung transplantation. Am J Respir Crit Care Med. 2009;180:887–95.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Lederer DJ, Kawut SM, Wickersham N, et al. Obesity and primary graft dysfunction after lung transplantation: the Lung Transplant Outcomes Group Obesity Study. Am J Respir Crit Care Med. 2011;184:1055–61.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Baldwin MR, Arcasoy SM, Shah A, et al. Hypoalbuminemia and early mortality after lung transplantation: a cohort study. Am J Tranplant: Off J Am Soc Transplant Am Soc Transplant Surg. 2012;12:1256–67.

    Article  CAS  Google Scholar 

Download references

Compliance with ethics guidelines

Conflicts of interest

Leann L. Silhan and Jonathan B. Orens declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by either of the authors.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Leann L. Silhan or Jonathan B. Orens.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Silhan, L.L., Orens, J.B. Update to the guidelines for selection of lung-transplant candidates. Curr Respir Care Rep 3, 103–111 (2014). https://doi.org/10.1007/s13665-014-0078-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13665-014-0078-0

Keywords

Navigation