Contraindications for Lung Transplant

Some factors make the possibility of a successful lung or heart and lung transplant unlikely. Other factors are less clear cut. These relative factors tend to make lung transplant less viable.

Absolute Contraindications for Lung Transplantaton

A patient is not a candidate for lung transplantation if the following conditions apply:

  • Active smoking or substance abuse
  • Co-existing failure of organs other than the lungs. (Such a patient may, however, be a candidate for multiple organ transplantation.)
  • Current diagnosis of malignancy, including lung cancer; some types of skin cancer may not exclude a patient for consideration
  • HIV disease or infection
  • Irreversible left heart failure
  • Lack of medical insurance
  • Inability to walk with a poor potential for improvement through rehabilitation
  • Severe connective tissue disease with extensive extrathoracic manifestations
  • Severe, untreated psychiatric disorders or a history of medical non-compliance
  • Uncorrectable coronary artery disease

Relative Contraindications for Lung Transplantation

The following factors tend to make lung transplantation a less viable option:

  • Age greater than 60 for heart-lung transplantation
  • Age greater than 70 for bilateral lung
  • Age greater than 75 for single lung transplantation
  • Bilateral pulmonary sepsis (single lung only)
  • Dependence on a ventilator
  • Dependence on high doses of steroids (e.g. prednisone at a dose of 20 mg a day or more)
  • Active Hepatitis B or C infection with evidence of end-organ liver damage
  • Infection with treatment-resistant organisms
  • Lack of personal support system
  • Malnutrition or obesity. This is gauged as being 20% more or 20% less than an ideal body weight for the patient's height and build.
  • Prior thoracic surgery/pleurodesis
  • Recent history of malignancy. This means within two years of definitive treatment or within five years of treatment for breast cancer or melanoma.
  • Severe osteoporosis
  • Presence of significant esophageal dysfunction
  • The availability of effective alternative treatment plan
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