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The following factors are carefully considered during the pre-transplant process, since these symptoms or conditions can make a lung transplant inadvisable.

Absolute contraindications

  • Smoking. Patients should not be smoking for at least six months prior to placement on the list for transplantation.
  • Psychiatric disorders and psychosocial problems that are not resolved and will likely negatively impact the patient's outcome
  • Recent drug and/or alcohol abuse
  • Noncompliance with medical care or treatment plans even in the absence of documented psychiatric problems
  • Active malignancy within the past 2 years (except basal cell and squamous cell cancer of the skin) with a 5-year disease free interval for extracapsular renal cell tumors, breast cancer stage 2 or higher, colon cancer staged higher than Dukes A, and melanoma, level III or higher
  • A history of primary or metastatic lung malignancy
  • Ventilator dependency. Patients receiving non-invasive ventilation who meet all other criteria are candidates for lung transplantation.
  • Morbid obesity
  • Disabling arthritis or other condition limiting exercise
  • Progressive neuromuscular disorders
  • Systemic disease such as:
    • Renal (creatinine clearance <50/mls/min)
    • Liver disease (cirrhosis, chronic active, chronic persistent hepatitis, hepatitis B, hepatitis C with advanced or active disease)
    • Insulin-dependent diabetes mellitus, which is not well-controlled or has resulted in any end-organ dysfunction
    • Chronic pancreatitis
    • Active connective tissue disorder

Relative contraindications

  • Coronary artery or other cardiac disease
  • Systemic hypertension that requires more than 2 drugs for adequate control
  • Severe right-sided heart failure
  • Multidrug resistant/pan resistant organism(s)
  • Insulin dependent diabetes mellitus
  • Symptomatic osteoporosis
  • Severe musculoskeletal disease affecting the thorax
  • Poor nutritional status (BMI <17 or >32)
  • Seizure disorder that is not well-controlled
  • Steroid dependency (>20 mg/day)
  • Significant pleural disease/prior chest surgery
  • Colonization with fungi or atypical mycobacteria