What are the ISHLT guidelines on selection of lung transplantation candidates 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

Timing of referral:

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

  • Patient is not a candidate for endoscopic or surgical LVRS. Simultaneous referral of patients with COPD for both lung transplant and LVRS evaluation is appropriate.

  • BODE index >5

  • Paco2 >50 mm Hg and/or Pao2 < 60 mm Hg 

  • FEV1 < 25% predicted.

Timing of listing (presence of one criterion is sufficient):

  • BODE index ≥7.

  • FEV1 < 15% to 20% 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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