Referral Criteria for Lung Transplantation

Chronic Obstructive Pulmonary Disease (COPD)

• Hospitalization for exacerbation associated with acute hypercapnia (PCO2 exceeding 50 mm Hg)

• Pulmonary hypertension or cor pulmonale, despite oxygen therapy

• FEV1 of less than 20 percent predicted

• DLCO of less than 20 percent predicted

Idiopathic pulmonary fibrosis or non-specific interstitial pneumonia

• Histologic evidence of UIP or fibrotic NSIP, irrespective of vital capacity

• Radiographic evidence of UIP by honey-combing on HRCT, irrespective of vital capacity

• A 10 percent decrement in FVC within six (6) months

• Exercise desaturation to less than 88 percent

• DLCO of less than 40 percent predicted

Cystic fibrosis or other bronchiectasis

• FEV1below 30 percent predicted or rapid decline in FEV1

• Exacerbation of pulmonary disease requiring ICU stay

• Increasing frequency of exacerbations

• Refractory and/or recurrent pneumothorax

• Recurrent hemoptysis not controlled by embolization

• Oxygen-dependent respiratory failure, hypercarbia +/- cor pulmonale

Pulmonary arterial hypertension

• NYHA functional class III or IV, irrespective of ongoing therapy

• Rapidly progressive disease

• Cardiac index of less than 2 liters/min/m2

• Right atrial pressure exceeding 15 mm Hg

• Sarcoidosis, lymphangioleiomyomatosis, and langerhans cell histiocytosis

• NYHA functional class III or IV with resting hypoxemia or cor pulmonale

NOTE: To be used only as a guide, as individual circumstances may vary. To discuss your patient's condition or to learn more about our program, contact a University of Louisville transplant physician.

Links

• International Society for Heart and Lung Transplantation

• Lung Transplant Considerations for the Community Pulmonologist