Referral to a lung transplant center is recommended at or before any of the following milestones are reached: |
Patients ≥18 years |
FEV1 <50% predicted and rapidly declining (eg, >20% relative decline in FEV1 within 12 months) |
FEV1 <40% predicted and*: - Any of the following markers of shortened survival:
- >2 exacerbations per year requiring intravenous antibiotics
- Massive hemoptysis (>240 mL) requiring intensive care unit admission or bronchial artery embolization
- Pneumothorax
- BMI <18 (while working to improve nutritional status)
|
FEV1 <30% predicted |
Patients <18 years |
FEV1 <50% predicted and rapidly declining (eg, >20% relative decline in FEV1 within 12 months) |
FEV1 <50% predicted with any marker of shortened survival listed above or malnutrition (BMI <10th percentile, while working to improve nutritional status) |
FEV1 <40% predicted* |
All patients |
Any of the following, regardless of FEV1: - 6-minute walk test <400 meters
- Hypoxemia (SpO2 <88% or PaO2 <55 mmHg, at rest or with exertion)
- Hypercarbia (PaCO2 >50 mmHg, confirmed on arterial blood gas)
- Pulmonary artery systolic pressure >50 mmHg on echocardiogram or evidence of right ventricular dysfunction in the absence of tricuspid regurgitant jet
- Any exacerbation requiring positive pressure ventilation
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Other factors that warrant earlier consideration for transplant referral, even when other thresholds have not been met |
Female sex, especially those who are younger |
Short stature (height <162 cm)¶ |
Liver cirrhosis or chronic kidney disease (may require consideration of multiple organ transplantation and may affect timing or choice of transplant center) |