Lung or heart-lung transplantation is an option for patients who have respiratory insufficiency or failure and who remain at risk of death despite optimal medical treatment.
The most common indications for lung transplantation are
COPD
Idiopathic pulmonary fibrosis
Cystic fibrosis
Alpha-1 antitrypsin deficiency
Primary pulmonary hypertension
Less common indications include other interstitial lung disorders (eg, sarcoidosis), bronchiectasis, and congenital heart disease.
Single and double lung procedures are equally appropriate for most lung disorders without cardiac involvement; the exception is chronic diffuse infection (eg, bronchiectasis), for which double lung transplantation is best.
Indications for heart-lung transplantation are
Eisenmenger syndrome
Any lung disorder with severe ventricular dysfunction likely to be irreversible
Cor pulmonale often reverses after lung transplantation alone and is therefore rarely an indication for heart-lung transplantation; however, sometimes a heart-lung transplantation is necessary.
Relative contraindications include age (single lung recipients must be lt; 65; double lung recipients, lt; 60; and heart-lung recipients, lt; 55), current cigarette smoking, previous thoracic surgery, and, for some cystic fibrosis patients and at some medical centers, lung infection with resistant strains of Burkholderia cepacia, which greatly increases mortality risk.
Single and double lung procedures are about equally common and are at least 8 times more common than heart-lung transplantation.