Selecting lung transplant candidates: where do current guidelines fall short?

Abstract

In 2010, 1770 lung transplant procedures were performed in the USA, yet 2469 new candidates were added to the waiting list the same year. The shortage of suitable donor lungs requires that transplant professionals select patients for lung transplantation only if they are likely to sustain a survival benefit from the procedure. However, 20% of lung transplant recipients die within the first year of transplantation, suggesting that we are failing to identify those at high risk for severe early complications. In this perspective, we review the current guidelines for the selection of lung transplant candidates, which are based largely on expert opinion and small case series. We also propose the study of new extrapulmonary factors, such as frailty and sarcopenia, that might help improve the prediction of complications and early death after lung transplantation, leading to an improved candidate selection process.

Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients

“…Obesity and decreased body weight, which are defined using BMI, have been considered relative contraindications for LTx (23,24). In previous studies, obesity (BMI greater than 30 kg/m 2 ) was considered a relative contraindication to LTx (25), and these patients had a marked decrease in post-transplantation survival rate (26).…”

Predicting 6-Minute Walking Distance in Recipients of Lung Transplantation: Longitudinal Study of 108 Patients

“…Frailty, in turn, is proposed as a factor that should be considered in the screening process as it reflects muscle mass (sarcopenia), the immune process, and inflammatory responses. 38 Overall, it is not likely that grip strength training would increase walking distance since grip strength appears to be reflective of an underlying general construct.…”

Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation

“…Decisions to initiate ECMO in a potential transplant candidate should be done with an aim toward optimizing overall success as organ shortage continues to be the limiting factor in transplantation. 1,2 With an aging patient population pursuing LTx, 22 we designed this study to investigate age-related factors regarding the use of ECMO before LTx.…”

“…A major obstacle in LTx remains to be the imbalance between donor organ demand and organ availability. 1,2 Due to high mortality for patients awaiting organs, clinical interests have centered on strategies to extend the life of potential lung transplant candidates through various methods of mechanical support during times of acute clinical deterioration.…”