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
BMI 30–34.9 kg·m−2
BMI 16–17 kg·m−2
Poorly controlled diabetes
Edible marijuana
Scedosporium apiospermum infection
HIV with undetectable viral load
Previous thoracic surgery including pleurodesis
Mechanical ventilation
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.