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 Johns 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