Risk factors for poor post-transplant outcomes (reproduced and modified from Leard et al. [3])

Absolute contraindicationsRisk factors with high or substantially increased riskRisk factors
Malignancy with high risk of recurrence or death related to cancerAge >70 yearsAge 65–70 years
Glomerular filtration rate <40 mL·min−1·1.73 m−2 unless being considered for multi-organ transplantSevere coronary artery disease that requires coronary artery bypass grafting at transplantGlomerular filtration rate 40–60 mL·min−1·1.73 m−2
Acute coronary syndrome or myocardial infarction within 30 daysReduced left ventricular ejection fraction <40%Mild to moderate coronary artery disease
Stroke within 30 daysSignificant cerebrovascular diseaseSevere 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 transplantSevere oesophageal dysmotilityPatients with prior coronary artery bypass grafting
Acute liver failureUntreatable haematologic disorders including bleeding diathesis, thrombophilia or severe bone marrow dysfunctionReduced left ventricular ejection fraction 40–50%
Acute renal failure with rising creatinine or on dialysis and low likelihood of recoveryBody mass index ≥35 kg·m−2Peripheral vascular disease
Septic shockBody mass index <16 kg·m−2Severe gastro-oesophageal reflux disease
Active extrapulmonary or disseminated infectionLimited functional status with poor potential for post-transplant rehabilitationOesophageal dysmotility
Active tuberculosis infectionPsychiatric, psychological or cognitive conditions with potential to interfere with medical adherence without sufficient support systemsThrombocytopenia, leukopenia or anaemia with high likelihood of persistence after transplant
HIV infection with detectable viral loadUnreliable support system or caregiving planOsteoporosis
Limited functional status (e.g. non-ambulatory) with poor potential for post-transplant rehabilitationLack of understanding of disease and/or transplant despite teachingBody mass index 30–34.9 kg·m−2
Progressive cognitive impairmentHepatitis B or C infection with detectable viral load and signs of liver fibrosisBody mass index 16–17 kg·m−2
Repeated episodes of non-adherence without evidence of improvementChest wall or spinal deformity expected to cause restriction after transplantFrailty
Active substance use or dependence including current tobacco use, vaping, marijuana smoking or intravenous drug useExtracorporeal life supportHypoalbuminaemia
Other severe uncontrolled medical condition expected to limit survival after transplantRedo transplant <1 year following initial lung transplantPoorly controlled diabetes
Redo transplant for restrictive chronic lung allograft dysfunctionEdible marijuana use
Redo transplant for antibody mediated rejectionHIV infection with undetectable viral load
Previous thoracic surgery
Prior pleurodesis
Mechanical ventilation
Redo transplant >1 year for obstructive chronic lung allograft dysfunction