Who and When to Transplant: What Has Changed?

  • Isuru N. S. Seneviratne
  • Peter Hopkins


Lung transplantation needs to be considered in all patients with advance lung disease, who, despite maximal therapy continue to deteriorate. Rates of lung transplantation have increased significantly over the last 10 years with Chronic Obstructive pulmonary disease, Idiopathic pulmonary fibrosis and Cystic Fibrosis being the main indications.

Through experience and research, it is now apparent that the underlying severity of the lung condition should not be the sole factor that determines the need for lung transplantation and a holistic approach to health incorporating aspects such as nutrition, function status, frailty and social supports needs to be evaluated and optimised to ensure positive outcomes post transplantation.

In addition to general indications for lung transplantation, disease specific indications have been developed and specific considerations within these disease cohorts need to be evaluated prior to, and after transplantation.

Lastly, advances in medical technologies and therapeutics have allowed patients whom in the past may not have been suitable for lung transplantation, to progress down the transplantation pathway and have similar favourable outcomes compared to traditional candidates. To this, with improvements in overall health status of post-transplant patients we are seeing enhanced survival rates and a steady increase in patient presenting for repeat lung transplant.


Indications Exclusion Retransplantation Nutrition Malignancy Infection Frailty 


  1. 1.
    Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34(1):1–15. [cited 2017 Oct 30]. Scholar
  2. 2.
    Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb SB, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-second official adult lung and heart-lung transplantation report—2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34(10):1264–77. [cited 2017 Oct 30]. Scholar
  3. 3.
    International Society for Heart and Lung Transplantation. Registries - heart/lung registries > slides.
  4. 4.
    Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005–12. [cited 2017 Oct 30]. Scholar
  5. 5.
    Madill J, Gutierrez C, Grossman J, Allard J, Chan C, Hutcheon M, et al. Nutritional assessment of the lung transplant patient: body mass index as a predictor of 90-day mortality following transplantation. J Heart Lung Transplant. 2001;20(3):288–96. [cited 2017 Nov 5]. Scholar
  6. 6.
    Lederer DJ, Wilt JS, D’Ovidio F, Bacchetta MD, Shah L, Ravichandran S, et al. Obesity and underweight are associated with an increased risk of death after lung transplantation. Am J Respir Crit Care Med. 2009;180(9):887–95. [cited 2017 Nov 5]. Scholar
  7. 7.
    Snell GI, Bennetts K, Bartolo J, Levvey B, Griffiths A, Williams T, et al. Body mass index as a predictor of survival in adults with cystic fibrosis referred for lung transplantation. J Heart Lung Transplant. 1998;17(11):1097–103. [cited 2017 Nov 5]. Scholar
  8. 8.
    Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41. [cited 2017 Nov 5]. Scholar
  9. 9.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. [cited 2017 Nov 5]. Scholar
  10. 10.
    Singer JP, Katz PP, Dean MY, Chen J, Su B, Kern R, et al. Frailty Is common in lung transplant candidates and associated with poorer health-related quality of life. J Hear Lung Transplant. 2013;32(4):S43. [cited 2017 Nov 5]. Scholar
  11. 11.
    Lederer DJ, Sonett JR, Philip NA, Larkin M, Peterson ER, Desai A, et al. Frailty and early mortality after lung transplantation: preliminary results. J Heart Lung Transplant. 2013;32(4):S119–20. [cited 2017 Nov 5]. Scholar
  12. 12.
    Wilson ME, Vakil AP, Kandel P, Undavalli C, Dunlay SM, Kennedy CC. Pretransplant frailty is associated with decreased survival after lung transplantation. J Hear Lung Transplant. 2016;35(2):173–8. [cited 2017 Nov 5]. Scholar
  13. 13.
    Tuppin MP, Paratz JD, Chang AT, Seale HE, Walsh JR, Kermeeen FD, et al. Predictive utility of the 6-minute walk distance on survival in patients awaiting lung transplantation. J Heart Lung Transplant. 2008;27(7):729–34. [cited 2017 Oct 30]. Scholar
  14. 14.
    Martinu T, Babyak MA, O’Connell CF, Carney RM, Trulock EP, Davis RD, et al. Baseline 6-min walk distance predicts survival in lung transplant candidates. Am J Transplant. 2008;8(7):1498–505. [cited 2017 Nov 5]. Scholar
  15. 15.
    Mistiaen WP. Heart transplantation in patients with previous malignancy. An overview. Acta Cardiol. 2015;70(2):123–30. [cited 2017 Nov 24]. Scholar
  16. 16.
    Beaty CA, George TJ, Kilic A, Conte JV, Shah AS. Pre-transplant malignancy: an analysis of outcomes after thoracic organ transplantation. J Heart Lung Transplant. 2013;32(2):202–11. [cited 2017 Nov 24]. Scholar
  17. 17.
    Olland A, Falcoz P, Canuet M, Massard G. Should we perform bilateral-lung or heart – lung transplantation for patients with pulmonary hypertension? Interact Cardiovasc Thorac Surg. 2017;17(1):166–70.CrossRefGoogle Scholar
  18. 18.
    Burns KE, Keenan RJ, Grgurich WF, Manzetti JD, Zenati MA. Outcomes of lung volume reduction surgery followed by lung transplantation: a matched cohort study. Ann Thorac Surg. 2002;73(5):1587–93. [cited 2017 Nov 3]. Scholar
  19. 19.
    Senbaklavaci O, Wisser W, özpeker C, Marta G, Jaksch P, Wolner E, et al. Successful lung volume reduction surgery brings patients into better condition for later lung transplantation. Eur J Cardiothorac Surg. 2002;22(3):363–7. [cited 2017 Nov 3]. Scholar
  20. 20.
    Nathan SD, Edwards LB, Barnett SD, Ahmad S, Burton NA. Outcomes of COPD lung transplant recipients after lung volume reduction surgery. Chest. 2004;126(5):1569–74. [cited 2017 Nov 3]. Scholar
  21. 21.
    Shitrit D, Fink G, Sahar G, Eidelman L, Saute M, Kramer MR. Successful lung transplantation following lung volume reduction surgery. Thorac Cardiovasc Surg. 2003;51(5):274–6. [cited 2017 Nov 3]. Scholar
  22. 22.
    Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, 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(6):788–824. [cited 2017 Nov 3]. Scholar
  23. 23.
    King TE, Bradford WZ, Castro-Bernardini S, Fagan EA, Glaspole I, Glassberg MK, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med. 2014;370(22):2083–92. [cited 2017 Nov 3]. Scholar
  24. 24.
    Richeldi L, Du Bois RM, Raghu G, Azuma A, Brown KK, Costabel U, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med. 2014;370(22):2071–82. [cited 2017 Nov 3]. Scholar
  25. 25.
    Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Dobbels F, 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(10):1073–86. [cited 2017 Nov 4]. Scholar
  26. 26.
    Mason DP, Brizzio ME, Alster JM, McNeill AM, Murthy SC, Budev MM, et al. Lung transplantation for idiopathic pulmonary fibrosis. Ann Thorac Surg. 2007;84(4):1121–8. [cited 2017 Nov 4]. Scholar
  27. 27.
    Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med. 1986;314(18):1140–5. [cited 2017 Nov 4]. Scholar
  28. 28.
    Neurohr C, Huppmann P, Thum D, Leuschner W, von Wulffen W, Meis T, et al. Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis. Transpl Int. 2010;23(9):887–96. [cited 2017 Nov 4]. Scholar
  29. 29.
    Force SD, Kilgo P, Neujahr DC, Pelaez A, Pickens A, Fernandez FG, et al. Bilateral lung transplantation offers better long-term survival, compared with single-lung transplantation, for younger patients with idiopathic pulmonary fibrosis. Ann Thorac Surg. 2011;91(1):244–9. [cited 2017 Nov 4]. Scholar
  30. 30.
    Cong Y-S, Wright WE, Shay JW. Human telomerase and its regulation. Microbiol Mol Biol Rev. 2002;66(3):407–25. [cited 2017 Nov 4]. Scholar
  31. 31.
    Borie R, Kannengiesser C, Hirschi S, Le Pavec J, Mal H, Bergot E, et al. Severe hematologic complications after lung transplantation in patients with telomerase complex mutations. J Heart Lung Transplant. 2015;34(4):538–46. [cited 2017 Nov 4]. Scholar
  32. 32.
    Silhan LL, Shah PD, Chambers DC, Snyder LD, Riise GC, Wagner CL, et al. Lung transplantation in telomerase mutation carriers with pulmonary fibrosis. Eur Respir J. 2014;44(1):178–87. [cited 2017 Nov 4]. Scholar
  33. 33.
    Chalermskulrat W, Sood N, Neuringer IP, Hecker TM, Chang L, Rivera MP, et al. Non-tuberculous mycobacteria in end stage cystic fibrosis: implications for lung transplantation. Thorax. 2006;61(6):507–13. [cited 2017 Nov 4]. Scholar
  34. 34.
    Mahenthiralingam E, Vandamme P, Campbell ME, Henry DA, Gravelle AM, Wong LTK, et al. Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans. Clin Infect Dis. 2001;33(9):1469–75. [cited 2017 Nov 4]. Scholar
  35. 35.
    De Soyza A, Archer L, Wardle J, Parry G, Dark JH, Gould K, et al. Pulmonary transplantation for cystic fibrosis: pre-transplant recipient characteristics in patients dying of peri-operative sepsis. J Heart Lung Transplant. 2003;22(7):764–9. [cited 2017 Nov 4]. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Isuru N. S. Seneviratne
    • 1
    • 2
  • Peter Hopkins
    • 1
    • 2
  1. 1.Queensland Lung Transplant ServiceThe Prince Charles HospitalBrisbaneAustralia
  2. 2.Queensland HealthBrisbaneAustralia

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