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Lung Transplant Patient Selection Criteria

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Am I a Candidate for a Lung Transplant?

Lung Transplant surgeon Ashish Shah, MD talks lung transplant eligibility, diseases that may lead to one (cystic fibrosis, emphysema, lung cancer) and patients' average age.

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Indications

  • Bilateral Lung Transplant
    • Cystic fibrosis
    • Bronchiectasis
    • Pulmonary hypertension
    • Emphysema
    • Pulmonary fibrosis (idoiopathic or secondary to scleroderma or other disease states)
  • Single Lung Transplant
    • Emphysema
    • Pulmonary fibrosis (idoiopathic or secondary to scleroderma or other disease states)
  • Heart/Lung Transplant
    • Same as SLT and BLT with:
      • Poor left ventricular function or irreversible right ventricle function
      • Surgically irreparable congenital heart defects

Contraindications

Absolute Contraindications

Absolute contraindications for adults and children include, but may not be limited to:

  • Age appropriateness
    • 65 years of age for single lung (must be evaluated before 63rd birthday)
    • 65 years of age for double lung transplant
    • 55 years of age for heart/lung transplant
  • Active smoker (less than 6 months since quitting)
  • Active substance abuse
  • Chronic mechanical ventilation (unless tolerating 3 hours of physical therapy/day and is free of bacterial colonization)
  • Previous lung transplant (rare exceptions for John Hopkins Hospital primary transplant patients)
  • Severe Diffuse Coronary artery disease (especially with poor EF)
  • End-stage renal disease (creatinine clearance < 40 mg/min)
  • End-stage liver disease
  • Bone marrow dysfunction
  • HIV
  • Severe local or systemic infection
  • Severe neurologic deficits
  • Untreatable psychiatric

Relative Contraindications

Relative contraindications for adults and children include, but may not be limited to:

  • Morbid obesity (BMI>30)
  • Severe malnutrition/cachexia
  • Chronic prednisone use > 20 mg / day
  • Symptomatic osteoporosis
  • Psychiatric / social problems (including non-compliance)
  • Financial problems (no prescription coverage)
  • Previous thoracic surgery / procedure
  • Lack of family or social support
  • Cancer in the last 5 years except localized skin (never melanoma)
  • Colonization with resistant organisms

Contact us for more information on lung transplants at Johns Hopkins.

 

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