Recipient risk factors and lung transplant outcomes

Vandervest, Katherine; Zamora, Martin R.

doi:10.1097/mot.0b013e32836519ec

Cited by 7 publications

(7 citation statements)

References 37 publications

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“…As a matter of fact, physicians have investigated various measures to further optimize the listing criteria for LTx. Age, weight, FVC% predicted, the amount of oxygen required at rest, and outcomes on hospitalization, intensive care unit (ICU) admission, mechanical ventilation, wedge pressure on catheterization, systolic blood pressure, and psychologic conditions have been shown as predictors of mortality in IPF patients before transplant [29,30,31]. Mechanical support at transplant, history of coronary artery disease at the listing, pCO 2 at transplant are considered as predictors of post-transplant survival in IPF [30].…”

Section: Timing For Transplant: the Las (Lung Allocation System) Imentioning

confidence: 99%

“…Higher LAS scores greater than 46 predict worse post-transplant survival [32]. The beginning of the ‘LAS era’ resulted in an increased number of IPF patients receiving a lung transplant in the United States and in shorter times spent in the wait-list, as compared to the patients in the waiting list belonging the pre-LAS period [31]. Despite the lower median wait-list time to transplant and the higher transplant rate among IPF patients as compared to other pulmonary diseases, Organ Procurement and Transplantation Network (OPTN) have shown that the pre-transplant mortality rate among adult IPF patients wait-listed for a lung transplant remains higher as compared to other pulmonary diseases [33].…”

Section: Timing For Transplant: the Las (Lung Allocation System) Imentioning

confidence: 99%

“…In fibrotic patients, the time in wait-list is relatively long as compared to the rapid functional decline and the few therapeutic options. Advancements in Human Leukocyte Antibody (HLA) testing and the use of extracorporeal membrane oxygenation (ECMO), as a bridge to lung transplantation in carefully selected patients, have improved recipient selection standards in the last years [31]. ECMO allows to retard deconditioning in patients on a waiting list and to reduce preoperative mortality during the waiting time for the organ [44].…”

Section: Management Before Ltxmentioning

confidence: 99%

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Idiopathic Pulmonary Fibrosis and Lung Transplantation: When it is Feasible

et al. 2019

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Despite the availability of antifibrotic therapies, many patients with idiopathic pulmonary fibrosis (IPF) will progress to advanced disease and require lung transplantation. International guidelines for transplant referral and listing of patients with interstitial lung disease are not specific to those with IPF and were published before the widespread use of antifibrotic therapy. In this review, we discussed difficulties in decision-making when dealing with patients with IPF due to the wide variability in clinical course and life expectancy, as well as the acute deterioration associated with exacerbations. Indeed, the ideal timing for referral and listing for lung transplant remains challenging, and the acute deterioration might be influenced after transplant outcomes. Of note, patients with IPF are frequently affected by multimorbidity, thus a screening program for occurring conditions, such as coronary artery disease and pulmonary hypertension, before lung transplant listing is crucial to candidate selection, risk stratification, and optimal outcomes. Among several comorbidities, it is of extreme importance to highlight that the prevalence of lung cancer is increased amongst patients affected by IPF; therefore, candidates’ surveillance is critical to avoid organ allocation to unsuitable patients. For all these reasons, early referral and close longitudinal follow-up for potential lung transplant candidates are widely encouraged.

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Section: Timing For Transplant: the Las (Lung Allocation System) Imentioning

confidence: 99%

Section: Timing For Transplant: the Las (Lung Allocation System) Imentioning

confidence: 99%

Section: Management Before Ltxmentioning

confidence: 99%

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Idiopathic Pulmonary Fibrosis and Lung Transplantation: When it is Feasible

et al. 2019

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“…Because of this and due to the lack of locally available transplant centres and donor organs, patients considered for transplant should be referred early for a transplant eligibility assessment, and then monitored for timing of transplant listing (i.e., addition to waiting list). Experts recommend referral for assessment when FVC <80% predicted, DL CO <40% predicted, any dyspnoea due to lung disease or any oxygen requirement (33). Recent evidence suggest that bilateral lung transplantation is superior to single-lung transplantation in IPF (34,35).…”

Section: Lung Transplantationmentioning

confidence: 99%

Recommendations for the management of idiopathic pulmonary fibrosis in South Africa: a position statement of the South African Thoracic Society

Koegelenberg¹,

Ainslie²,

Dheda³

et al. 2016

J. Thorac. Dis.

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“…Not all patients with severe PAH will be suitable for transplantation, and it is important to bridge those patients who are likely to benefit. Evaluation of patients for lung transplantation is a thorough, multidisciplinary process, which may include evaluation of patient risk factors (age, weight and psychosocial aspects), haemodynamics, laboratory variables and clinical examination [48][49][50]. Conditions that may impact on the likelihood of a patient benefiting from lung transplantation include comorbidities, infection and organ failure [9].…”

Section: Identifying Patients Most Likely To Benefit From Lung Transpmentioning

confidence: 99%

Severe pulmonary arterial hypertension: treatment options and the bridge to transplantation

Corris

Degano

2014

Eur Respir Rev

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Pulmonary arterial hypertension (PAH) is a rare disease leading to right heart failure and death. Prognosis remains poor, particularly for patients with severe disease, i.e. World Health Organization functional class IV. There have been significant improvements in treatment options. Several agents are available that target the three main established PAH disease pathways, and can be combined sequentially or upfront. Strong scientific evidence supports the use of intravenous epoprostenol in severe PAH; however, despite recommendations, many patients do not receive parenteral prostanoids and there is a lack of evidence from randomised clinical trials supporting the value of other PAH medications alone in severe PAH.Lung transplantation is an important option in patients with severe PAH who have not responded sufficiently to therapy, or who have worsened despite maximal treatment. Bridging techniques are available for patients who worsen while awaiting transplantation. The type of bridging technique used depends on various factors including patient illness severity, physician experience and the anticipated waiting time for transplantation. With the aim to facilitate the treatment decision-making process, herein we review the medical treatment options available for patients with severe PAH, and the bridging techniques that may be used to sustain patients awaiting transplantation. @ERSpublications Current options for treatment and bridging to lung transplantation in patients with severe PAH

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Recipient risk factors and lung transplant outcomes

Abstract: Recipient selection criteria continue to evolve because of advances in mechanical bridging to transplant and postoperative management. This review will cover some of the new concepts in lung transplant recipient selection and their potential effect on posttransplant outcomes.

Cited by 7 publications

References 37 publications

Idiopathic Pulmonary Fibrosis and Lung Transplantation: When it is Feasible

Idiopathic Pulmonary Fibrosis and Lung Transplantation: When it is Feasible

Recommendations for the management of idiopathic pulmonary fibrosis in South Africa: a position statement of the South African Thoracic Society

Severe pulmonary arterial hypertension: treatment options and the bridge to transplantation

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