Falque L, Gheerbrant H, Saint-Raymond C, Quétant S, Camara B, Briault A, Porcu P, Pirvu A, Durand M, Pison C, Claustre J
Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France.
Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France.
Rev Mal Respir. 2019 Apr;36(4):508-518. doi: 10.1016/j.rmr.2018.03.009. Epub 2019 Apr 19.
In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time.
The main indications for lung transplantation in adults are COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis and pulmonary arterial hypertension (PAH). The specific indications for each underlying disease as well as the general contraindications have been reviewed in 2015 by the ISHLT. For cystic fibrosis, the main factors are forced expiratory volume in one second, 6-MWD, PAH and clinical deterioration characterized by increased frequency of exacerbations; for emphysema progressive disease, the BODE score, hypercapnia and FEV1; for PAH progressive disease or the need of specific intravenous therapy and NYHA classification. Finally, the diagnosis of fibrosing interstitial lung disease is usually a sufficient indication for lung transplantation assessment.
These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.
2015年，国际心肺移植协会（ISHLT）发布了一份关于肺移植受者选择的共识文件。鉴于近期没有法国的相关建议，该指南有助于将肺移植受者转诊至移植中心，并在合适的时间将他们列入肺移植名单。
成人肺移植的主要适应证为慢性阻塞性肺疾病（COPD）和肺气肿、特发性肺纤维化和间质性疾病、囊性纤维化和肺动脉高压（PAH）。ISHLT在2015年对每种基础疾病的具体适应证以及一般禁忌证进行了综述。对于囊性纤维化，主要因素是一秒用力呼气容积、6分钟步行距离（6-MWD）、PAH以及以加重频率增加为特征的临床恶化；对于肺气肿进展性疾病，是BODE指数、高碳酸血症和第一秒用力呼气量（FEV1）；对于PAH进展性疾病或需要特定静脉治疗以及纽约心脏协会（NYHA）分级。最后，纤维化间质性肺疾病的诊断通常是进行肺移植评估的充分指征。
这些接近法国实际做法的新建议有助于临床医生确定将患者转诊至移植中心的合适时间。这对肺移植的预后至关重要。
