Table 3.

Contraindications to lung transplantation

Absolute Recent history of malignancy (2-year disease-free interval if low risk of recurrence; 5-year interval for higher risk; risk be remain too high for some cancers beyond 5 years) Severely limited functional capacity with poor rehabilitation potential Significant dysfunction of other major organ systems (unless multiple combined organ transplantation is feasible) Acute medical instability (e.g. acute myocardial infarction, sepsis, hepatic failure) Uncorrectable bleeding diathesis Significant, uncorrected atherosclerotic disease with suspected/confirmed dysfunction (or ischemia or significant coronary artery disease that cannot be revascularized) Chronic infection with highly virulent and/or antibiotic-resistant microbes with poor control pre-transplant Active infection with Mycobacterium tuberculosis Chest wall or spinal deformity that would cause severe ventilator restriction post-transplant Body mass index (BMI) ≥35 kg/m2 (Class II/III obesity) Non-adherence to recommended medical therapies Psychiatric/psychologic conditions causing inability to cooperate with health care team interactions and/or adherence to complex medical therapies Lack of an adequate and/or reliable social support system Substance abuse or dependence (must demonstrate meaningful/persistent risk reduction behaviors and verified abstinence from substances of concern (e.g. tobacco, alcohol, marijuana, or other illicit substances))

Relative Age >65 years if other relative contraindications are present of physiologic reserve is significantly impaired Malnutrition if progressive or severe Osteoporosis if severe, symptomatic BMI 30.0-34.9 kg/m2 (Class I obesity, especially if truncal/central obesity) Extensive prior thoracic surgery (e.g. lung resection) Receiving mechanical ventilation Receiving extracorporeal life support Hepatitis B and/or C infection Human immunodeficiency virus infection Colonization/infection with highly virulent and/or antibiotic-resistant bacteria or fungi Significant atherosclerotic disease burden Other significant medical conditions (e.g. diabetes mellitus, systemic hypertension, gastroesophageal reflux) that have not caused advanced organ system damage (especially if not optimally treated/controlled)