Who and When to Transplant: What Has Changed?

Abstract

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.