Our Summary

This research paper discusses guidelines introduced in 2015 by the International Society for Heart and Lung Transplantation (ISHLT) for deciding who should be considered for a lung transplant. These guidelines are particularly useful for French doctors who don’t have recent domestic recommendations to follow.

The study outlines the main reasons why adults may require a lung transplant. These include chronic obstructive pulmonary disease (COPD) and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis, and pulmonary arterial hypertension (PAH).

For each of these diseases, there are specific factors that doctors look at to decide if a patient should be considered for a lung transplant. For example, for cystic fibrosis, doctors look at the patient’s forced expiratory volume (how much air a person can exhale during a forced breath), how far they can walk in six minutes, whether they have PAH, and how often their symptoms get worse. For emphysema, doctors consider the progress of the disease, the BODE score (a measure of how severe the disease is), levels of carbon dioxide in the blood, and forced expiratory volume. For PAH, they look at disease progress, the need for specific intravenous therapy, and the New York Heart Association classification (which grades the severity of heart failure). In cases of fibrosing interstitial lung disease, usually just having the diagnosis is enough for a lung transplant assessment.

The paper concludes that these guidelines, which align closely with French medical practices, are useful for helping doctors decide when to refer patients to transplant centers. This is crucial for improving the chances of a successful lung transplant.

FAQs

  1. What are the main indications for lung transplantation in adults according to the ISHLT?
  2. What are the specific indications for lung transplantation for diseases like cystic fibrosis, emphysema, and pulmonary arterial hypertension (PAH)?
  3. How do the 2015 ISHLT guidelines assist clinicians in determining the right time for patient referral to transplantation centers?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung transplant is to follow a healthy lifestyle, including quitting smoking, maintaining a healthy weight, and staying physically active. These lifestyle choices can help improve overall lung health and increase the success of the transplant surgery. Additionally, it’s important for patients to adhere to their medication regimen, attend all follow-up appointments, and communicate any changes in symptoms or concerns with their medical team.

Suitable For

Patients who are typically recommended for lung transplant include those with COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis, and pulmonary arterial hypertension. Specific indications for each underlying disease, such as forced expiratory volume, 6-minute walk distance, pulmonary arterial hypertension, and clinical deterioration, are important factors in determining eligibility for lung transplantation. Patients with progressive disease, significant functional impairment, or the need for specific therapies may also be considered for lung transplantation. Ultimately, the decision to recommend lung transplant is based on the individual patient’s overall health status and prognosis.

Timeline

Before lung transplant:

  • Patients with end-stage lung disease undergo a thorough evaluation by a transplant team to determine if they are suitable candidates for lung transplantation.
  • The main indications for lung transplantation include COPD and emphysema, idiopathic pulmonary fibrosis, cystic fibrosis, and pulmonary arterial hypertension.
  • Specific criteria for each underlying disease, such as forced expiratory volume, 6-minute walk distance, and clinical deterioration, are taken into consideration.
  • Patients may undergo various tests and evaluations, such as lung function tests, exercise testing, imaging studies, and psychological evaluations.
  • Once deemed eligible, patients are placed on the waiting list for a suitable donor organ.

After lung transplant:

  • Patients undergo the lung transplant surgery, which involves removing the diseased lung(s) and replacing it with a healthy donor lung.
  • Following surgery, patients are closely monitored in the intensive care unit for any complications.
  • Patients will then transition to a regular hospital room for further recovery and monitoring.
  • Rehabilitation and physical therapy may be initiated to help patients regain strength and lung function.
  • Patients will need to take immunosuppressive medications for the rest of their lives to prevent rejection of the donor organ.
  • Regular follow-up appointments and monitoring will be necessary to ensure the success of the transplant and address any potential complications.

What to Ask Your Doctor

  1. What are the specific indications for lung transplantation based on my underlying lung disease?
  2. What are the general contraindications for lung transplantation that I should be aware of?
  3. How will my candidacy for lung transplantation be evaluated and determined?
  4. What is the expected timeline for the transplant evaluation process?
  5. What are the potential risks and complications associated with lung transplantation?
  6. How long is the average wait time for a lung transplant?
  7. What is the success rate of lung transplant procedures at your institution?
  8. What is the expected recovery process like after a lung transplant?
  9. What kind of follow-up care and monitoring will be necessary after the transplant?
  10. Are there any lifestyle changes or restrictions I should be aware of post-transplant?

Reference

Authors: Falque L, Gheerbrant H, Saint-Raymond C, Quétant S, Camara B, Briault A, Porcu P, Pirvu A, Durand M, Pison C, Claustre J; groupe coopératif COhort of Lung Transplantation - COLT. Journal: Rev Mal Respir. 2019 Apr;36(4):508-518. doi: 10.1016/j.rmr.2018.03.009. Epub 2019 Apr 19. PMID: 31006579