TABLE 2

Risk factors for lung transplantation

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

BMI: body mass index; CLAD: chronic lung allograft dysfunction. Reproduced and modified from [65].