CHEST Guidelines-Lung-Transplantation

Lung-Transplantation_chest

Pdf Summary

The criteria for referral and selection of lung transplant candidates have evolved significantly in the past two decades, shifting towards more evidence-based strategies. This evolution is partly due to analyses of large datasets that allow reassessment of existing beliefs. Historically, the lack of comprehensive studies has meant reliance on expert opinion, as noted by the International Society for Heart and Lung Transplantation (ISHLT). However, two new studies based on U.S. data have provided new insights.<br /><br />One study by Ramos et al. challenges the perceived contraindication related to low body mass index (BMI) in cystic fibrosis (CF) patients, traditionally excluding those with a BMI of less than 17 kg/m². Their analysis reveals that CF patients with low BMI have survival outcomes similar to those with chronic obstructive pulmonary disease (COPD), suggesting BMI should not be a standalone exclusion criterion. This highlights the need for nuanced understanding, especially as new CF treatments like elexacaftor/tezacaftor/ivacaftor show promise in improving patient outcomes.<br /><br />Another study by Lehr et al. examines the impact of age on lung transplant outcomes, using data from 2006 to 2015. It identifies older age as a risk for decreased survival, yet also notes younger patients experience poorer outcomes compared to middle-aged patients due to more severe illness and social determinants. These findings underscore the need for careful consideration of age in transplant decisions.<br /><br />Both studies contribute significantly to the lung transplant field by refining candidate selection criteria and emphasizing the importance of leveraging registry data to inform practice. They push forward the conversation on fair and effective organ allocation, accounting for diverse factors influencing patient outcomes.

Keywords

lung transplant

candidate selection

evidence-based strategies

cystic fibrosis

body mass index

chronic obstructive pulmonary disease

age impact

registry data

organ allocation

patient outcomes