For Lung Transplant Medical Professionals
If you are a physician with a patient who has lung disease, the following guidelines may help you determine whether the patient should be evaluated for transplantation.
Referring Patients for Lung Transplantation
When a patient is referred to the Cedars-Sinai Lung Transplant Center, an initial phone call will be needed to gather medical and insurance information. Following that, a visit will be scheduled for the patient to meet with a pulmonologist, transplant surgeon, transplant coordinator and a finance coordinator for an initial evaluation.
The following are intended to serve as guidelines. Each patient's situations different, the transplant team at Cedars-Sinai Medical Center is always available for consultation. Specific criteria are available for:
The following criteria outline who may be considered for lung transplantation—and who is excluded from consideration.
Inclusion Criteria for Lung Transplantation
Patients may be considered for lung or heart/lung transplantation if they present with end-stage lung disease including the following conditions:
- No response to conventional treatment
- Limited life expectancy (less than two years)
- Severely impaired lifestyle and exercise tolerance, NYHA Class III–IV symptoms
- Oxygen dependence
- Less than 75 years of age for single lung transplants
- Less than 70 years of age for double lung transplants
- Less than 60 years of age for heart/lung transplants
Exclusion Criteria for Lung Transplantation
Patients may not be considered for lung or heart/lung transplantation if they exhibit any of the following:
- Active or recent malignancy within two years of curative treatment without evidence of recurrence (within five years for breast cancer and melanoma)
- Irreversible left-sided heat failure with an ejection fraction of less than 45% may only be a candidate for heart/lung transplantation.
- High dose steroid therapy (more than 40 mg daily) that cannot be tapered or discontinued
- Untreated or uncontrolled psychiatric disorders such as depression and psychosis
- Extrapulmonary end-stage organ disease (multiple-organ transplant may be considered, when appropriate)
- Known active infection or infection with highly resistant pathogens
- History of noncompliance
- Absence of strong social support system
- Poor rehab potential
Relative Exclusion Criteria
The selection committee may use its discretion for the following relative exclusion criteria:
- Ventilator dependency
- Recent smoking history or substance abuse (within six months)
- Severe cachexia and malnourishment (BMI less than 19)
- Morbid obesity (BMI greater than 30)
- Severe extrapulmonary or systemic disorders (i.e. active autoimmune disease, poorly controlled IDDM, coronary artery disease)
- History of pleurodesis or pleural effusion
- Presence of significant esophageal dysfunction
Some of the conditions for which single lung transplant can be considered are:
- Alpha I antitrypsin deficiency
- Bronchiolitis obliterans
- Emphysema
- Eosinophilic granulomatosis
- Occupational lung disease
- Pulmonary fibrosis
- Sarcoidosis
Some of the conditions for which a double lung transplant can be considered are:
- Bilateral pulmonary sepsis
- Bronchiectasis
- Cystic fibrosis
- Eisenmenger's syndrome (with correctable cardiac defects)
- Limited bronchoalveolar cell carcinoma
- Lymphangioleiomyomatosis (lam)
- Primary and secondary pulmonary hypertension
- Select cases of emphysema in patients younger than 60 years old
- Select cases for which a single lung transplant would be considered
If the patient has the following conditions, he or she may be a candidate for a heart and lung transplantation:
- Eisenmenger's with uncorrectable cardiac defects
- Pulmonary hypertension with severe left ventricular dysfunction
- Combined severe end stage heart and lung disease that is not directly related to each other
If the patient has previously had a lung transplant, he or she may be a candidate for another lung transplant, if he or she has:
- Advanced chronic rejection
- Severe primary graft failure
- Airway anastomotic dehisence
Some factors make the possibility of a successful lung or heart and lung transplant unlikely. Other factors are less clear cut. These relative factors tend to make lung transplant less viable.
Absolute Contraindications for Lung Transplantation
A patient is not a candidate for lung transplantation if the following conditions apply:
- Active smoking or substance abuse
- Co-existing failure of organs other than the lungs. (Such a patient may, however, be a candidate for multiple organ transplantation.)
- Current diagnosis of malignancy, including lung cancer; some types of skin cancer may not exclude a patient for consideration
- HIV disease or infection
- Irreversible left heart failure
- Lack of medical insurance
- Inability to walk with a poor potential for improvement through rehabilitation
- Severe connective tissue disease with extensive extrathoracic manifestations
- Severe, untreated psychiatric disorders or a history of medical non-compliance
- Uncorrectable coronary artery disease
Relative Contraindications for Lung Transplantation
The following factors tend to make lung transplantation a less viable option:
- Age greater than 60 for heart-lung transplantation
- Age greater than 70 for bilateral lung
- Age greater than 75 for single lung transplantation
- Bilateral pulmonary sepsis (single lung only)
- Dependence on a ventilator
- Dependence on high doses of steroids (e.g. prednisone at a dose of 20 mg a day or more)
- Active Hepatitis B or C infection with evidence of end-organ liver damage
- Infection with treatment-resistant organisms
- Lack of personal support system
- Malnutrition or obesity. This is gauged as being 20% more or 20% less than an ideal body weight for the patient's height and build.
- Prior thoracic surgery/pleurodesis
- Recent history of malignancy. This means within two years of definitive treatment or within five years of treatment for breast cancer or melanoma.
- Severe osteoporosis
- Presence of significant esophageal dysfunction
- The availability of effective alternative treatment plan
Consultations
For physician-to-physician consultations:
Lung Transplantation Center
Women's Guild Lung Institute
Cedars-Sinai Medical Center
Have Questions or Need Help?
Call us or send a message to the Lung Transplant team. You can also have us call you back at your convenience.