What are the ISHLT criteria for referral and listing for lung transplantation in patients with COPD?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

The ISHLT criteria for timing of referral for lung transplantation in patients with COPD are as follows [16] :

  • Disease is progressive, despite treatment including medication, pulmonary rehabilitation, and oxygen therapy.

  • Patient is not a candidate for endoscopic or surgical lung volume reduction surgery (LVRS); simultaneous referral of patients with COPD for both lung transplant and LVRS evaluation is appropriate.

  • BODE index >5

  • Partial pressure of carbon dioxide (PaCO2 >50 mm Hg and/or partial pressure of oxygen (PaO2) <60 mm Hg 

  • FEV1 <25% predicted.

The ISHLT recommends listing COPD patients for transplantation when they meet one or more of the following criteria:

  • BODE index ≥7

  • Forced expiratory volume in 1 second (FEV1) <15% to 20% of predicted

  • Three or more severe exacerbations during the preceding year.

  • One severe exacerbation with acute hypercapnic respiratory failure.

  • Moderate to severe pulmonary hypertension.


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