What are the ISHLT absolute contraindications for lung transplantation?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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According to the International Society for Heart and Lung Transplantation, the absolute contraindications are as follows [16] :

  • Malignancy in the last 2 years, with the exception of non-melanoma localized skin cancer that has been treated appropriately (a 5-y disease-free interval is prudent)

  • Untreatable advanced dysfunction of another major organ system unless combined organ transplantation can be performed

  • Atherosclerotic disease with suspected or confirmed end-organ ischemia or dysfunction and/or coronary artery disease not amenable to revascularization

  • Acute medical instability such as acute sepsis, myocardial infarction, and liver failure

  • Uncorrectable bleeding diathesis

  • Chronic infection with highly virulent and/or resistant microbes that are poorly controlled pre-transplant

  • Active Mycobacterium tuberculosis infection

  • Significant chest wall or spinal deformity expected to cause severe restriction after transplantation

  • Class II-III obesity (body mass index ≥35.0 kg/m2)

  • History of repeated or prolonged episodes of non-adherence to medical therapy that are perceived to increase the risk of non-adherence after transplantation
  • Psychiatric conditions associated with the inability to cooperate with the medical/allied health care team and/or adhere with complex medical therapy

  • Absence of an adequate or reliable social support system

  • Severely limited functional status with poor rehabilitation potential

  • Substance abuse or dependence; meaningful and/or long-term participation in therapy should be required before offering lung transplantation; serial blood and urine testing can be used to verify abstinence from substances of concern

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