Professional Statements and Societal Positions Guidelines
International Society for Heart and Lung Transplantation-2006
In 2006, the International Society for Heart and Lung Transplantation published consensus-based guidelines on the selection of lung transplant candidates. The guidelines stated that:
- "Lung transplantation is now a generally accepted therapy for the management of a wide range of severe lung disorders, with evidence supporting the quality of life and survival benefit for lung transplant recipients. However, the number of donor organs available remains far fewer than the number of individuals with end-stage lung disease who might potentially benefit from the procedure. It is of primary importance, therefore, to optimize the use of this resource, such that the selection of individuals who receive a transplant represents those with realistic prospects of favorable long-term outcomes..."
In 2014, these recommendations were updated for pulmonary vascular disease. The Society recommended including a transplant list for Individuals with New York Heart Association class III or IV disease, despite 3 months or more of combination therapy. Additional clinical indications included a cardiac index of less than 2 L/min/m2, a mean right atrial pressure of greater than 15 mm Hg, and a 6-minute walk distance of fewer than 350 meters. Also recommended for transplant listing were individuals with significant hemoptysis, pericardial effusion, or signs of progressive right heart failure. Other common indications for lung transplant include interstitial lung disease, idiopathic pulmonary fibrosis, cystic fibrosis, and COPD.
The 2014 guideline update briefly addressed lung retransplantation with the consensus statement noting that "criteria for candidate selection for lung retransplantation generally mirror the criteria used for selection for initial lung transplantation."
American Thoracic Society et al-2011
Evidence-based recommendations from the American Thoracic Society and 3 international cardiac societies were published in 2011 for the diagnosis and management of individuals with idiopathic fibrosis.For appropriately selected individuals with idiopathic pulmonary fibrosis, the international guideline panel recommended lung transplantation.