What are the ISHLT guidelines on selection of lung transplantation candidates with pulmonary vascular diseases?

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:

  • NYHA Functional Class III or IV symptoms during escalating therapy

  • Rapidly progressive disease (assuming weight and rehabilitation concerns not present)

  • Use of parenteral targeted pulmonary arterial hypertension (PAH) therapy regardless of symptoms or NYHA Functional Class

  • Known or suspected pulmonary veno-occlusive disease (PVOD) or pulmonary capillary hemangiomatosis

Timing of transplant listing:

  • NYHA Functional Class III or IV despite a trial of at least 3 months of combination therapy including prostanoids

  • Cardiac index < 2 liters/min/m2

  • Mean right atrial pressure >15 mm Hg

  • 6-minute walk test < 350 m

  • Development of significant hemoptysis, pericardial effusion, or signs of progressive right heart failure 


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