Contraindications for Transplantation
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/panresistant 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
