Risk factors for adverse post-transplant outcomes in candidates for lung transplantation
| General | High or substantially increased risk | Absolute 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.