Professional Statements and Societal Positions Guidelines
International Society for Heart and Lung Transplantation 2021
Initial Transplant
In 2021, the International Society for Heart and Lung Transplantation published updated consensus-based guidelines on the selection of lung transplant candidates. The guidelines states that:
'Lung transplantation should be considered for adults with chronic, end-stage lung disease who meet all the following general criteria:
High (greater than 50 percent) risk of death from lung disease within two (2) years if lung transplantation is not performed.
High (greater than 80 percent) likelihood of five (5)-year post-transplant survival from a general medical perspective provided that there is adequate graft function.'
The guideline also notes risk factors to be considered in the evaluation of transplant candidates, along with pediatric and disease-specific considerations.
Retransplant
The 2021 guideline update briefly addressed lung retransplantation, with the consensus statement noting that 'The outcomes after re-transplants are inferior compared to first lung transplants, particularly if the retransplant is done within the first year after the original transplant or for individuals with restrictive allograft syndrome (RAS) [...] In the pre-transplant evaluation of such individuals, particular emphasis should be focused on understanding the possible reasons for the graft failure, such as alloimmunization, poor adherence, gastroesophageal reflux, or repeated infections'.
American Thoracic Society et al-2011
Evidence-based recommendations from the American Thoracic Society and three (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.
An update to this document was published in 2015 in which the committee did not make a recommendation regarding single versus bilateral lung transplantation in individuals with idiopathic fibrosis. The committee stated that 'it is unclear whether single or bilateral lung transplantation is preferential for long-term outcomes'.
In 2014, the American Thoracic Society published guidelines on the management of bronchiolitis obliterans syndrome in lung transplant recipients in conjunction with the International Society for Heart and Lung Transplantation and the European Respiratory Society. The guideline recommends referral to a transplant surgeon to be evaluated for retransplantation for end-stage bronchial obliterans syndrome that is refractory to other therapies
