title: Selecting lung transplant candidates: where do current guidelines fall short?
abstract: In 2010, 1770 lung transplant procedures were performed in the USA, yet 2469 new candidates were added to the waiting list the same year. The shortage of suitable donor lungs requires that transplant professionals select patients for lung transplantation only if they are likely to sustain a survival benefit from the procedure. However, 20% of lung transplant recipients die within the first year of transplantation, suggesting that we are failing to identify those at high risk for severe early complications. In this perspective, we review the current guidelines for the selection of lung transplant candidates, which are based largely on expert opinion and small case series. We also propose the study of new extrapulmonary factors, such as frailty and sarcopenia, that might help improve the prediction of complications and early death after lung transplantation, leading to an improved candidate selection process.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Hook
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
mesh_terms: D019317:Evidence-Based Medicine; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D014481:United States