Tables
- TABLE 1
Risk factors for poor post-transplant outcomes (reproduced and modified from Leard et al. [3])
Absolute contraindications Risk factors with high or substantially increased risk Risk factors Malignancy with high risk of recurrence or death related to cancer Age >70 years Age 65–70 years Glomerular filtration rate <40 mL·min−1·1.73 m−2 unless being considered for multi-organ transplant Severe coronary artery disease that requires coronary artery bypass grafting at transplant Glomerular filtration rate 40–60 mL·min−1·1.73 m−2 Acute coronary syndrome or myocardial infarction within 30 days Reduced left ventricular ejection fraction <40% Mild to moderate coronary artery disease Stroke within 30 days Significant cerebrovascular disease Severe coronary artery disease that can be treated via percutaneous coronary intervention prior to transplant Liver cirrhosis with portal hypertension or synthetic dysfunction unless being considered for multi-organ transplant Severe oesophageal dysmotility Patients with prior coronary artery bypass grafting Acute liver failure Untreatable haematologic disorders including bleeding diathesis, thrombophilia or severe bone marrow dysfunction Reduced left ventricular ejection fraction 40–50% Acute renal failure with rising creatinine or on dialysis and low likelihood of recovery Body mass index ≥35 kg·m−2 Peripheral vascular disease Septic shock Body mass index <16 kg·m−2 Severe gastro-oesophageal reflux disease Active extrapulmonary or disseminated infection Limited functional status with poor potential for post-transplant rehabilitation Oesophageal dysmotility Active tuberculosis infection Psychiatric, psychological or cognitive conditions with potential to interfere with medical adherence without sufficient support systems Thrombocytopenia, leukopenia or anaemia with high likelihood of persistence after transplant HIV infection with detectable viral load Unreliable support system or caregiving plan Osteoporosis Limited functional status (e.g. non-ambulatory) with poor potential for post-transplant rehabilitation Lack of understanding of disease and/or transplant despite teaching Body mass index 30–34.9 kg·m−2 Progressive cognitive impairment Hepatitis B or C infection with detectable viral load and signs of liver fibrosis Body mass index 16–17 kg·m−2 Repeated episodes of non-adherence without evidence of improvement Chest wall or spinal deformity expected to cause restriction after transplant Frailty Active substance use or dependence including current tobacco use, vaping, marijuana smoking or intravenous drug use Extracorporeal life support Hypoalbuminaemia Other severe uncontrolled medical condition expected to limit survival after transplant Redo transplant <1 year following initial lung transplant Poorly controlled diabetes Redo transplant for restrictive chronic lung allograft dysfunction Edible marijuana use Redo transplant for antibody mediated rejection HIV infection with undetectable viral load Previous thoracic surgery Prior pleurodesis Mechanical ventilation Redo transplant >1 year for obstructive chronic lung allograft dysfunction - TABLE 2
Selected features associated with 2-year survival derived from patients with COPD
Feature Frequency 2-year survival Cohort's median age, years BODE score >7 82/469 (17%) [10],
139/625(23%) [11]75% [11], 70% [11] 64 [10], 66 [11] Resting hypoxaemia (PO2 ≤55 mmHg) 81/175 LTx referrals (46%) [12] 50% (COPD) to 70% (α-1 AD) [13] 56 [12], 63–73 [13] Hypoxaemia on exertion (SpO2 <88%) without resting hypoxaemia 33/173 (19% in patient using oxygen) [14] 80% [15, 16] 56 [14], 68 [16] Home noninvasive ventilation 147/402 LTx referrals(36%) [12] 65% [17, 18] 65 [17], 67 [18] Exacerbation with hypercapnia 325/4343 (7%) [19, 20] 51% [21], 35% [22], 47% [23] 59 [21], 69 [22], 63 [23], 70 [19, 20] ≥1 exacerbation with hospitalisation 105/304 (34%) [24] 70% [24] 69 [24] FEV1 <20% 69/1033 (7%) [25] 80% [25] 63 [25] Mean pulmonary artery pressure ≥35 mmHg 16/409 (4%) [26],
44/4305 (6%) [27]70% [26], 58% [27] 54 [26], 59 [27] BODE: body mass index, obstruction, dyspnoea and exercise capacity score; PO2: oxygen tension; SpO2: peripheral oxygen saturation; FEV1: forced expiratory volume in 1 s; LTx: lung transplantation; α-1 AD: α-1 antitrypsin deficiency.