Absolute contraindications Candidates with these conditions are considered too high risk to achieve successful outcomes post-lung transplantation | 1) Lack of patient willingness for transplant |
2) Malignancy with high risk of recurrence or death related to cancer |
3) Glomerular filtration rate <40 mL·min−1 per 1.73 m2 unless being considered for multi-organ transplant |
4) Acute coronary syndrome or myocardial infarction within 30 days (excluding demand ischaemia) |
5) Stroke within 30 days |
6) Liver cirrhosis with portal hypertension or synthetic dysfunction unless being considered for multi-organ transplant |
7) Acute liver failure |
8) Acute renal failure with rising creatinine or on dialysis and low likelihood of recovery |
9) Septic shock |
10) Active extrapulmonary or disseminated infection |
11) Active tuberculosis infection |
12) HIV infection with detectable viral load |
13) Limited functional status (e.g. non-ambulatory) with poor potential for post-transplant rehabilitation |
14) Progressive cognitive impairment |
15) Repeated episodes of non-adherence without evidence of improvement (note: for paediatric patients this is not an absolute contraindication and ongoing assessment of non-adherence should occur as they progress through different developmental stages) |
16) Active substance use or dependence including current tobacco use, vaping, marijuana smoking, or i.v. drug use |
17) Other severe uncontrolled medical condition expected to limit survival after transplant |
Risk factors with high or substantially increased risk | 1) Age >70 years |
2) Severe coronary artery disease that requires coronary artery bypass grafting at transplant |
3) Reduced left ventricular ejection fraction <40% |
4) Significant cerebrovascular disease |
5) Severe oesophageal dysmotility |
6) Untreatable haematological disorders including bleeding diathesis, thrombophilia, or severe bone marrow dysfunction |
7) BMI >35 kg·m−2 |
8) BMI <16 kg·m−2 |
9) Limited functional status with potential for post-transplant rehabilitation |
10) Psychiatric, psychological or cognitive conditions with potential to interfere with medical adherence without sufficient support systems |
11) Unreliable support system or caregiving plan |
12) Lack of understanding of disease and/or transplant despite teaching |
13) Mycobacterium abscessus infection |
14) Lomentospora prolificans infection |
15) Burkholderia cenocepacia or Burkholderia gladioli infection |
16) Hepatitis B or C infection with detectable viral load and liver fibrosis |
17) Chest wall or spinal deformity expected to cause restriction after transplant |
18) Extracorporeal life support |
19) Retransplant |
Risk factors Risk factors with unfavourable implications for short- and/or long-term outcomes after lung transplant While acceptable for lung transplant programmes to consider patients with these risk factors, multiple risk factors together may increase risk for adverse post-lung transplant outcomes | 1) Age 65–70 years |
2) Glomerular filtration rate 40–60 mL·min−1 per 1.73 m2 |
3) Mild-to-moderate coronary artery disease |
4) Severe coronary artery disease that can be revascularised via percutaneous coronary intervention prior to transplant |
5) Patients with prior coronary artery bypass grafting |
6) Reduced left ventricular ejection fraction 40–50% |
7) Peripheral vascular disease |
8) Connective tissue diseases (scleroderma, lupus, inflammatory myopathies) |
9) Severe gastro-oesophageal reflux disease |
10) Oesophageal dysmotility |
11) Thrombocytopenia, leukopenia, or anaemia with high likelihood of persistence after transplant |
12) Osteoporosis |
13) BMI 30–34.9 kg·m−2 |
14) BMI 16–17 kg·m−2 |
15) Frailty |
16) Hypoalbuminaemia |
17) Diabetes that is poorly controlled |
18) Edible marijuana use |
19) Scedosporium apiospermum infection |
20) HIV infection with undetectable viral load |
21) Previous thoracic surgery |
22) Prior pleurodesis |
23) Mechanical ventilation |
24) Retransplant >1 year for obstructive CLAD |