A patient is usually not considered a candidate for lung transplantation if one or more contraindications is/are present.

Relative Contraindication

Absolute Contraindication


chronic extrapulmonary medical condition that is poorly controlled or associated with target-organ damage

severe extrapulmonary organ dysfunction

multi-organ transplantation

steroid dependent with daily prednisone > 20 mg per day, or equivalent



invasive mechanical ventilation

acute critical illness

noninvasive mechanical ventilation

extensive pleural thickening from prior thoracic surgery or infection



active collagen vascular disease



preoperative colonization of the tracheobronchial tree with multidrug resistant organism (in cystic fibrosis)

active extrapulmonary infection, including HIV, HBV and HCV



inability to walk



poor rehabilitation potential



severe malnutrition (< 70% ideal body weight)



severe obesity (> 130% of ideal body weight)



active or recent cigarette smoking (with preceding 6 months)



severe psychiatric illness



history of noncompliance with medical therapy



drug or alcohol dependence


localized, well-differentiated lung cancers that can be totally resected

active or metastatic cancer; recent history of cancer with high probability of recurrence

squamous or basal cell carcinomas of the skin

> 65 years old for single lung; > 60 for double lung transplant; > 55 for heart-lung transplant



unable to move to transplant center for time required




contraindication to immunosuppression



Extrapulmonary organ dysfunctions include:

(1) severe coronary artery disease with left ventricular dysfunction

(2) right ventricular failure

(3) severe peripheral vascular disease

(4) severe renal disease

(5) severe liver disease

(6) coagulopathy

(7) insulin-dependent diabetes mellitus

(8) active peptic ulcer disease

(9) cerebrovascular disease



• With the availability of HAART therapy HIV infection might be considered a relative contraindication.


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