A patient with primary pulmonary hypertension or other pulmonary vascular disease may be a candidate for lung transplant if certain poor prognostic factors are present.
Criteria for considering a patient with pulmonary vascular disease for lung transplantation:
(1) functional Class III or IV NYHA
(2) mean pulmonary artery pressure >= 55 mm Hg (Smith); >= 50 mm Hg (Trulock)
(3) mean right atrial pressure >= 10 mm Hg (Smith); > 15 mm Hg (Arcasoy)
(4) cardiac index < 4.0 liters per minute per square meter BSA (Smith); <= 2.5 liters per minute per square meter BSA (Trulock); < 2 liters per minute per square meter BSA (Argasoy)
(5) failure to respond to vasodilator drugs and medical management
where:
• Smith feels that a patient should be listed for transplant before end-stage disease develops because of the delay in getting the transplant and better survival after transplantation.
Criteria for considering a patient for heart-lung transplantation:
(1) cardiac index < 1.5 liters per minute per square meter BSA
(2) mixed venous oxygen saturation < 63%
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