What are the ISHLT guidelines on selection of lung transplantation candidates with interstitial lung disease?

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:

  • Evidence of usual interstitial pneumonitis (UIP) or fibrosing non-specific interstitial pneumonitis (NSIP), regardless of lung function.

  • FVC < 80% predicted or 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.

Timing of listing:

  • 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 < 250 m on 6-minute-walk test or >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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