Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Lung transplantation for interstitial lung disease

Siddhartha G. Kapnadak, Ganesh Raghu
European Respiratory Review 2021 30: 210017; DOI: 10.1183/16000617.0017-2021
Siddhartha G. Kapnadak
1Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University of Washington, Seattle, WA, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ganesh Raghu
1Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University of Washington, Seattle, WA, USA
2Dept of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: graghu@uw.edu
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Suggested approach for management of progressive interstitial lung disease (ILD) a) before and b) after lung transplantation (LTx). HRCT: high-resolution computed tomography; CTD: connective tissue disease; GOR: gastro-oesophageal reflux; DLTx: double lung transplantation; SLTx: single lung transplantation; CLAD: chronic lung allograft dysfunction; MDS: myelodysplastic syndrome; EBV: Epstein–Barr virus. #: ILD care should preferably be undertaken by experts in ILD in an experienced centre.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Examples of post-transplant complications in the native fibrotic lung after single lung transplantation (SLTx). a) Images from a 57-year-old male 12 years after left SLTx for familial idiopathic pulmonary fibrosis; i) demonstrates a mycetoma in the native right upper lobe on axial computed tomography images. Bronchoalveolar lavage cultures from the (native) right upper lobe as well as from the (allograft) left upper lobe grew Aspergillus fumigatus. He was treated with prolonged voriconazole, but surveillance imaging showed increasing size of the mycetoma at ii) 13 and iii) 14 years post-transplant, with iv) sagittal imaging also demonstrating several new, smaller mycetomas. b) Images from a 62-year-old male 21 months after left SLTx for rheumatoid arthritis-associated interstitial lung disease. On axial computed tomography, i) demonstrates a small nodule versus focus of scarring superimposed upon underlying fibrosis in the native lung (arrow). ii, iii) Surveillance imaging demonstrated evolution into a clear nodule which increased in size over 5 months (arrows). iv) Positron emission tomography (sagittal image) confirmed a hypermetabolic right upper lobe nodule, along with multiple hypermetabolic lesions in the liver consistent with metastases. Percutaneous biopsy of the lung nodule confirmed adenocarcinoma. The patient died at 29 months post-transplant due to complications from brain metastases.

Tables

  • Figures
  • TABLE 1

    Criteria for referral and listing for lung transplantation in patients with interstitial lung disease (ILD)

    Timing of referral#Timing of listing
    Histopathological UIPHospitalisation for respiratory decline, pneumothorax or acute exacerbation
    Radiographic probable or definite UIP patternDesaturation to <88% on 6MWT or >50 m decline in 6MWD over 6 months
    FVC <80% or DLCO <40% predPulmonary hypertension on right heart catheterisation or echocardiography
    Relative decline in pulmonary function over the past 2 years:
    FVC ≥10% or
    DLCO ≥15% or
    FVC ≥5% with symptomatic or radiographic progression
    Absolute decline in pulmonary function over the past 6 months despite appropriate treatment:
    FVC >10% or
    DLCO >10% or
    FVC >5% with radiographic progression
    Any resting or exertional oxygen requirement
    For inflammatory ILDs, disease progression despite treatment

    Referral or listing should be considered if meeting any one criterion. UIP: usual interstitial pneumonia; FVC: forced vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; 6MWT: 6-min walk test; 6MWD: 6-min walk distance. #: earlier referral is recommended for patients with connective tissue disease or familial idiopathic pulmonary fibrosis to address potential extrapulmonary manifestations. Reproduced and modified from [13] with permission.

    • TABLE 2

      Risk factors for adverse post-transplant outcomes in candidates for lung transplantation

      GeneralHigh or substantially increased riskAbsolute contraindications
      Age 65–70 years
      GFR 40–60 mL·min−1·1.73 m−2
      CAD including prior CABG
      LV ejection fraction 40–50%
      Peripheral vascular disease
      Connective tissue disease
      Severe GOR
      Oesophageal dysmotility
      Bone marrow dysfunction
      Osteoporosis
      BMI 30–34.9 kg·m−2
      BMI 16–17 kg·m−2
      Frailty
      Hypoalbuminaemia
      Poorly controlled diabetes
      Edible marijuana
      Scedosporium apiospermum infection
      HIV with undetectable viral load
      Previous thoracic surgery including pleurodesis
      Mechanical ventilation
      Re-transplantation
      Age >70 years
      Severe CAD requiring CABG at transplant
      LV ejection fraction <40%
      Significant cerebrovascular disease
      Severe oesophageal dysmotility
      Untreatable haematological disorders (bleeding diathesis, thrombophilia, severe bone marrow dysfunction)
      BMI ≥35 kg·m−2
      BMI <16 kg·m−2
      Limited functional status with poor rehabilitation potential
      Psychiatric, psychological or cognitive conditions with potential to interfere with medical adherence
      Unreliable support system
      Lack of understanding of disease and/or transplant despite teaching
      Mycobacterium abscessus infection
      Lomentospora prolificans infection
      Burkholderia cenocepacia or gladioli infection
      Hepatitis B or C infection with detectable viral load and liver fibrosis
      Chest wall or spinal deformity expected to cause restriction after transplant
      Extracorporeal life support
      Re-transplantation for restrictive CLAD, antibody-mediated rejection or within 1 year following initial lung transplant
      Lack of patient willingness or acceptance of transplant
      Malignancy with high risk of death or recurrence
      GFR <40 mL·min−1·1.73 m−2 unless being considered for multi-organ transplant
      Acute coronary syndrome within 30 days (excluding demand ischaemia)
      Stroke within 30 days
      Liver cirrhosis with portal hypertension or synthetic dysfunction unless being considered for multi-organ transplant
      Acute liver failure
      Acute renal failure with rising creatinine or on dialysis and low likelihood of recovery
      Active extrapulmonary infection including septic shock
      Active tuberculosis infection
      HIV infection with detectable viral load
      Severely limited functional status with poor rehabilitation potential
      Progressive cognitive impairment
      Repeated episodes of nonadherence without evidence of improvement
      Active substance use or dependence including current tobacco use, vaping, marijuana smoking or intravenous drug use
      Other severe uncontrolled medical condition expected to limit survival after transplant

      GFR: glomerular filtration rate; CAD: coronary artery disease; CABG: coronary artery bypass grafting; LV: left ventricular; GOR: gastro-oesophageal reflux; BMI: body mass index; CLAD: chronic lung allograft dysfunction. Reproduced and modified from [13] with permission.

      • TABLE 3

        Common risk factors for adverse post-lung transplant outcomes in candidates with interstitial lung disease

        Advanced age
        Overweight status
        Telomere biology disorders
        Prior thoracic surgery
        Limited functional status, deconditioning, frailty
        Gastro-oesophageal reflux
        High-risk atherosclerotic disease
        Connective tissue disease manifestations
        Corticosteroids, other immunosuppressants
        Acute exacerbations
        Active mechanical ventilation
      • TABLE 4

        Morbidity rates in survivors at 5 years after lung transplantation for interstitial lung disease

        Idiopathic interstitial pneumonia % of survivors with listed diagnosisOther interstitial lung diseases % of survivors with listed diagnosis
        Hypertension79.580.0
        Creatinine >2.5 mg·dL−135.834.4
        Chronic dialysis or renal transplant2.72.7
        Hyperlipidaemia63.457.1
        Diabetes37.733.2

        Data from the International Society for Heart and Lung Transplantation 2016 registry [143].

        PreviousNext
        Back to top
        View this article with LENS
        Vol 30 Issue 161 Table of Contents
        European Respiratory Review: 30 (161)
        • Table of Contents
        • Index by author
        Email

        Thank you for your interest in spreading the word on European Respiratory Society .

        NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

        Enter multiple addresses on separate lines or separate them with commas.
        Lung transplantation for interstitial lung disease
        (Your Name) has sent you a message from European Respiratory Society
        (Your Name) thought you would like to see the European Respiratory Society web site.
        CAPTCHA
        This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
        Print
        Citation Tools
        Lung transplantation for interstitial lung disease
        Siddhartha G. Kapnadak, Ganesh Raghu
        European Respiratory Review Sep 2021, 30 (161) 210017; DOI: 10.1183/16000617.0017-2021

        Citation Manager Formats

        • BibTeX
        • Bookends
        • EasyBib
        • EndNote (tagged)
        • EndNote 8 (xml)
        • Medlars
        • Mendeley
        • Papers
        • RefWorks Tagged
        • Ref Manager
        • RIS
        • Zotero

        Share
        Lung transplantation for interstitial lung disease
        Siddhartha G. Kapnadak, Ganesh Raghu
        European Respiratory Review Sep 2021, 30 (161) 210017; DOI: 10.1183/16000617.0017-2021
        del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
        Full Text (PDF)

        Jump To

        • Article
          • Abstract
          • Abstract
          • Introduction
          • Consideration and timing of LTx in patients with ILD
          • Unique risk factors and consideration for LTx in candidates with ILD
          • Management while being considered or after listing for LTx
          • Single versus double LTx for ILD
          • Outcomes and considerations after LTx for ILD
          • Conclusions
          • Future directions
          • Footnotes
          • References
        • Figures & Data
        • Info & Metrics
        • PDF

        Subjects

        • Interstitial and orphan lung disease
        • Tweet Widget
        • Facebook Like
        • Google Plus One

        More in this TOC Section

        • Role of air pollutants in airway epithelial barrier dysfunction
        • E-cigarettes and nicotine abstinence
        • Lung imaging in cystic fibrosis
        Show more Review

        Related Articles

        Navigate

        • Home
        • Current issue
        • Archive

        About the ERR

        • Journal information
        • Editorial board
        • Press
        • Permissions and reprints
        • Advertising
        • Sponsorship

        The European Respiratory Society

        • Society home
        • myERS
        • Privacy policy
        • Accessibility

        ERS publications

        • European Respiratory Journal
        • ERJ Open Research
        • European Respiratory Review
        • Breathe
        • ERS books online
        • ERS Bookshop

        Help

        • Feedback

        For authors

        • Instructions for authors
        • Publication ethics and malpractice
        • Submit a manuscript

        For readers

        • Alerts
        • Subjects
        • RSS

        Subscriptions

        • Accessing the ERS publications

        Contact us

        European Respiratory Society
        442 Glossop Road
        Sheffield S10 2PX
        United Kingdom
        Tel: +44 114 2672860
        Email: journals@ersnet.org

        ISSN

        Print ISSN: 0905-9180
        Online ISSN: 1600-0617

        Copyright © 2023 by the European Respiratory Society