Indications for referring a patient for lung transplant include one or more of the following:
(1) FEV1 postbronchodilator <= 30% of predicted
(2) resting hypoxia (PO2 < 55-60 mm Hg on room air)
(3) hypercapnia (PaCO2 > 50 mm Hg on room air)
(4) FEV1 > 30% of predicted with worsening clinical course (unintended weight loss, increasing frequency and severity of exacerbations, rapidly deteriorating lung function, massive hemoptysis)
(5) FEV1 > 30% of predicted in a female < 18 years of age
where:
• Females less than 18 years of age tend to have a worse prognosis and so should be considered for early referral.
Indications for heart-lung transplantation: cor pulmonale
Contraindications to transplantation:
(1) colonization with antibiotic resistant Pseudomonas species or Burkholderia cepacia
(2) pulmonary aspergilloma
(3) pulmonary mycobacteria
(4) general contraindication for lung transplantation
