Selecting lung transplant candidates: where do current guidelines fall short?

Abstract

In 2010, 1770 lung transplant procedures were performed in the USA, yet 2469 new candidates were added to the waiting list the same year. The shortage of suitable donor lungs requires that transplant professionals select patients for lung transplantation only if they are likely to sustain a survival benefit from the procedure. However, 20% of lung transplant recipients die within the first year of transplantation, suggesting that we are failing to identify those at high risk for severe early complications. In this perspective, we review the current guidelines for the selection of lung transplant candidates, which are based largely on expert opinion and small case series. We also propose the study of new extrapulmonary factors, such as frailty and sarcopenia, that might help improve the prediction of complications and early death after lung transplantation, leading to an improved candidate selection process.

Keywords::

• chronic obstructive pulmonary disease
• frailty
• interstitial lung disease
• lung transplantation
• obesity
• pulmonary arterial hypertension
• sarcopenia

Financial & competing interests disclosure

DJ Lederer is a steering committee member for the ASCEND trial of pirfenidone for idiopathic pulmonary fibrosis sponsored by Intermune, is coinvestigator in clinical trials for idiopathic pulmonary fibrosis sponsored by Gilead and Boehringer-Ingelheim and has served on advisory boards for Gilead in 2010 and 2011. DJ Lederer was supported by NIH grant numbers K23 HL086714 and R01 HL103676. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

ECMO: Extracorporeal membrane oxygenation; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Adapted with permission from [4].

Data taken from the Organ Procurement and Transplantation Network.

BODE: BMI, airflow obstruction, dyspnea and exercise capacity; DLCO: Diffusing capacity of carbon monoxide; FEV₁: Forced expiratory volume in 1 s; FVC: Forced vital capacity; IPF: Idiopathic pulmonary fibrosis; NSIP: Nonspecific interstitial pneumonia; NYHA: New York Heart Association; PaCO₂: Arterial partial pressure of carbon dioxide; VO₂: Oxygen uptake.

Adapted from [4].