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

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

The natural history of various interstitial diseases is quite variable. Idiopathic pulmonary fibrosis, of the usual interstitial variant, which is the second most frequent disease for which lung transplantation is performed, has a median survival of approximately 2.5 to 3.5 years from the time of diagnosis. Dismal survival rates of these patients on waiting lists indicate that these patients should have early referrals for transplantation evaluation.

ISHLT criteria for timing of referral in patients with interstitial lung disease are as follows [16] :

  • Evidence of usual interstitial pneumonitis or fibrosing nonspecific interstitial pneumonitis, regardless of lung function

  • Forced vital capacity (FVC) <80% predicted or diffusing capacity of lung for carbon monoxide (DLCO) <40% predicted

  • Any dyspnea or functional limitation attributable to lung disease

  • Any oxygen requirement, even if only during exertion

  • For inflammatory interstitial lung disease (ILD), failure to improve dyspnea, oxygen requirement, and/or lung function after a clinically indicated trial of medical therapy

ISHLT criteria for timing of listing for transplantation in patients with interstitial lung disease are as follows [16] :

  • Decline in FVC ≥10% during 6 months of follow-up 

  • Decline in DLCO ≥15% during 6 months of follow-up

  • Desaturation to <88% or distance 50 m decline in 6-minute-walk distance over a 6-month period

  • Pulmonary hypertension on right heart catheterization or 2-dimensional echocardiography

  • Hospitalization because of respiratory decline, pneumothorax, or acute exacerbation

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