[When should the pulmonologist consider lung transplantation? Criteria for referral and transplantation in COPD and idiopathic pulmonary fibrosis].
BACKGROUND
The definition of the optimal timing of referral for lung transplantation in cases of chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis remains a difficult question.


BACKGROUND
The decision is based on the balance between the risk of death associated with the transplant procedure on one hand and, on the other, the risk of death associated with the natural course of the disease and/or the severity of the disability. It is not surprising, therefore, that the selection criteria take into account the main prognostic factors identified in both diseases. Recommendations for the selection criteria based on these prognostic indices have been published recently by a panel of international experts. In case of chronic obstructive pulmonary disease, the main indication for lung transplantation worldwide, the decision is not simple. The course of the individual patient is not easy to determine as, on an individual basis, some patients have a prolonged survival. In the case of idiopathic pulmonary fibrosis, the survival benefit provided by lung transplantation is well documented and it is therefore recommended to refer the patient to a transplantation centre once the diagnosis is established. This evaluation for lung transplantation does not prevent the subsequent inclusion of the patients in therapeutic protocols.


CONCLUSIONS
International guidelines assist the pulmonologist to define the optimal moment of referral but these guidelines are not absolute and therefore, in case of doubt, physicians should not hesitate to refer the patient to a transplant centre.
Mal
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H
Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, Paris, France. herve.mal@bch.aphp.fr
Thabut
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G
Evrard
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P