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.