Fast Five Quiz: Idiopathic Pulmonary Fibrosis Treatment

Guy W. Soo Hoo, MD, MPH

Disclosures

June 17, 2019

Unless significant contraindications exist, lung transplantation should be considered for patients with end-stage disease who meet selection criteria. Lung transplant is considered for patients with IPF whose DLCO is less than 40%, functional vital capacity is less than 80% of the predicted values, and oxygen saturation at rest is less than 89%. Unfortunately, as many patients die while awaiting transplantation, clinicians should discuss palliative care and end-of-life planning with patients whose DLCO is less than 50%.

Although some patients experiencing AE-IPF may require mechanical ventilation, it does not make patients eligible for referral for lung transplant.

Although CT chest scan may demonstrate worsening fibrosis, the result does not make patients eligible for referral for lung transplant. Additional criteria need to be considered, and CT scans are not the sole determinants for referral for lung transplant. It is important to consider physiologic measures, as the increased fibrosis may be relatively focal and mild, and may not result in any clinically significant impairment.

Interstitial fibrosis is an independent risk factor for lung cancer, but the interval appearance of a lung cancer does not represent a criterion for lung transplantation. Any cancer, and specifically lung cancer, represents an exclusion criterion for lung transplantation even if the lung cancer can be completely treated with surgical resection.

For more information on lung transplantation in IPF, read here.

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