Criterios principais na Indicacao do Transplante na UPMC

Recipient Selection Guidelines
University of Pittsburgh Lung Transplantation Program

Indications

1) Pulmonary parenchymal or vascular disease with:
i) severe functional limitations despite maximal surgical and medical therapy
ii) anticipated limited survival

Relative Contraindications

1) Symptomatic osteoporosis refractory to therapy
2) Systemic disease with end organ damage other than the lung that might affect long-term outcome
3) Persistent poor nutritional status (despite program intervention) with evidence of low visceral protein stores (low albumin and/or prealbumin) and weight <70% of ideal body weight
4) Obesity – body mass index > 30 despite program intervention
5) Unresolvable psychosocial issues – documented noncompliance with medical care, inadequate social support structure
6) Invasive mechanical ventilation (assessed on a case by case basis)
7) Severe musculoskeletal disease affecting the thorax
8) Persistent positive smear for mycobacterium despite therapy
9) Severe deconditioning despite program intervention
10) 6-minute walk < 600 feet with diagnosis of COPD, cystic fibrosis or IPF
11) Prior chest surgery resulting in severe pleural adherence/thickening
12) Mediastinal fibrosis

Absolute Contraindications

1) Infection with HIV
2) Dysfunction of major organs other than the lung:
i) creatinine clearance < 40 ml/min
ii) left ventricular dysfunction (LVEF < 30%) (consider HLT)
iii) significant untreatable coronary artery disease (may consider HLT)
iv) progressive neuromuscular disease
3) Hepatitis B antigen positivity
4) Hepatitis C with either histologic evidence of liver disease or positive PCR indicitating presence of hepatitis C DNA
5) Active malignancy
i) within the last two years with the exception of basal cell and squamous cell carcinoma of the skin
ii) within the last five years for extracapsular renal tumor, breast cancer stage 2 or higher, colon cancer stage Duke’s B or higher and melanoma level III or higher
6) Substance addiction/use within 6 months (tobacco, alcohol or other drugs)
7) Presence of psychosis