Table 4.

Guidelines for timing of referral for potential lung transplantation

Referral to a transplant center (all patients with ILD)* Impaired lung function - FVC <80% predicted - DLCO <40% predicted Any dyspnea or functional limitation due to lung disease Any requirement for supplemental oxygen (even if only required during exertion) Failure to improve dyspnea, reduce/eliminate requirement for supplemental oxygen, and/or improve lung function with a clinically indicated trial of medical therapy if inflammatory ILD is present

Referral to a transplant center (all patients with PVD)* NYHA Functional Class III or IV symptoms despite escalating therapy Rapidly progressive disease (rule out body weight or rehabilitation concerns) Use of parenteral targeted vasoactive therapy regardless of symptoms or NYHA Functional Class

Suggested timing of referral to a transplant center for patients with sarcoidosis Dyspnea or functional limitation due to lung disease Significantly impaired lung function (e.g. FVC <80% predicted, DLCO <40% predicted) Requirement for use of supplemental oxygen Evidence of SAPH NYHA Functional Class III or IV symptoms Rapidly progressive disease Lack of response to clinically indicated pharmacologic therapies Life-threatening complications of suppurative bronchiectasis (e.g. episode of respiratory failure requiring non-invasive ventilation, poor clinical recovery from exacerbations and/or increasing antibiotic resistance, pneumothorax, life-threatening hemoptysis)