Overview of Lung Transplantation and Criteria for Selection of Candidates

Joseph P. Lynch; Rajan Saggar; S. Sam Weigt; David J. Ross; John A. Belperio

doi:10.1055/s-2006-954604

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2006; 27(5): 441-469
DOI: 10.1055/s-2006-954604

Overview of Lung Transplantation and Criteria for Selection of Candidates

Joseph P. Lynch¹ III , Rajan Saggar¹ , S. Sam Weigt¹ , David J. Ross¹ , John A. Belperio¹

¹Division of Pulmonary, Critical Care Medicine, and Hospitalists, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

Abstract

ABSTRACT

Lung or heart-lung transplantation is a viable option for diverse end-stage pulmonary parenchymal or pulmonary vascular disorders. However, mortality associated with lung transplant (LT) is appreciable, with 3 and 5 year survival rates of ~60 and 50%, respectively. Thus LT is reserved for patients with life-threatening disease refractory to medical therapy. Four diagnoses (i.e., chronic obstructive pulmonary disease; idiopathic pulmonary fibrosis; cystic fibrosis; α-1-antitrypsin deficiency emphysema) account for ~80% of LT recipients; diverse interstitial and pulmonary vascular disorders account for the remaining cases. Given the potential morbidity and mortality associated with LT, the decision to refer patients for LT is difficult. Which patients are acceptable candidates for LT? What are the projected benefits of LT? What criteria should be used to estimate mortality with medical therapy alone? Given the uncertainty of waiting time, when should patients be listed for LT? Identifying appropriate candidates for LT and determining when to list for LT is determined by a risk analysis of the likelihood of mortality during the projected waiting period versus the likely mortality following LT. In this review, we discuss the major diseases treated with LT and the appropriate criteria for LT.

KEYWORDS

Lung transplant - chronic obstructive lung disease - emphysema - cystic fibrosis - idiopathic pulmonary fibrosis (IPF) - nonspecific interstitial pneumonia (NSIP) - collagen vascular diseases - pulmonary fibrosis - sarcoidosis - pulmonary arterial hypertension

Full Text

References

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Joseph P Lynch IIIM.D.

The David Geffen School of Medicine at UCLA, Division of Pulmonary, Critical Care Medicine, and Hospitalists

10833 Le Conte Ave., 37-131 CHS, Los Angeles, CA 90095

Email: jplynch@mednet.ucla.edu