TGH Lung Transplant Referral Guide

The guidelines established by the International Society of Heart and Lung Transplantation for referrals has been adopted by our program at Tampa General Hospital. If you should have a specific question about a particular case, a lung transplant physician is available by phone 24 hours at day at 1-800-505-7769 or 813-844-7137.

A downloadable pdf version of indications for transplant is available.

Referral Guidelines

A patient is:

  • Physiologic age <70 (for all types of lung transplant)
  • Life Expectancy <24 Months
  • Absence of significant systemic disease or infection
  • Within 20% of ideal body weight
  • Rehabiliation potential
  • Abstinence from smoking >6 months
  • Cancer free survival >5 years

Contraindications:

  • HIV infection
  • Liver cirrhosis or active hepatitis B
  • Active malignancy within the past 2-5 years
  • Bone Marrow Failure

Relative Contraindications:

  • Symptomatic Osteoporosis
  • Severe musculoskeletal disease affecting the thorax
  • Inability to comply with complex medication regimen
  • History of medical non-compliance
  • Colonization with pan-resistant organisms
  • Invasive mechanical ventilation

Referral Criteria

COPD

  • BODE Index exceeding 5
  • FEV1 < 35% or PaCO2 > 55 or Resting Hypoxemia
  • Pulmonary Hypertension or Cor Pulmonale
  • Deteriorating Clinical Course

Cystic Fibrosis

  • FEV1 < 30%
  • Rapid declining FEV1
  • PaO2 <50 or PaCO2 > 55
  • Weight Loss
  • Massive hemoptysis
  • Refractory or recurrent pneumothorax
  • Frequent hospitalizations

Lymphangioleiomyomatosis (LAM)

  • NYHA Functional Class III or IV
  • Hypoxemia at rest
  • Severe impairment in lung function and exercise (VO2 <50% predicted)

Pulmonary Fibrosis (UIP/NSIP)

  • Refer at the time of diagnosis (radiographic or histologic presence)
  • FVC <70% = 2 year survival of 50%
  • FVC <60% = 2 year survival of 20%
  • DLCO <50%
  • Hypoxemia
  • Poor peformance status
  • Desaturation on exercise

Primary Pulmonary Hypertension

  • NYHA Functional Class III or IV, Irrespective of Ongoing therapy
  • Low (<350 meter) or declining 6 MWT
  • Cardiac index < 2 L per min/M2
  • Right Atrial Pressure >15 mmHg
  • Poor survival without treatment (eg epoprostenol)

Sarcoidosis

  • NYHA Functional Class III or IV
  • Hypoxemia at rest
  • Pulmonary Hypertension
  • Right Atrial Pressure >15mmHg

More information: Lung Transplant Referral Process