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Editorials |

Referral for Lung Transplantation: A Moving Target

Omar A. Minai, MD, FCCP; Marie M. Budev, DO, MPH
Author and Funding Information

Affiliations: Cleveland, OH
 ,  Drs. Minai and Budev are associated with the Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation.

Correspondence to: Omar A. Minai, MD, FCCP, Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH 44195; e-mail: minaio@ccf.org



Chest. 2005;127(3):705-707. doi:10.1378/chest.127.3.705
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Successful human lung transplantation has evolved significantly since 1963, when the first lung transplant recipients lived only a few days after transplantation. Changes in surgical techniques and advances in immunosuppressive therapy have been credited with the advancing lung transplantation, making it an invaluable tool for the management of advanced respiratory diseases.1 This is apparent by the growing number of transplants performed each year and by the increase in the number of patients listed for transplantation. A gross disparity exists, however, between the number of potential recipients and the number of donor organs available, resulting in many patients dying while on the waiting list.23 Due to long wait times, transplant physicians are no longer just faced with trying to improve survival after transplantation, but are now facing the challenge of improving a patient’s chances of survival while on the waiting list for transplantation. As a further challenge, the natural history of various advanced lung diseases vary and are somewhat unpredictable. This is especially true of diseases for which we do not have adequate prognostic scales, unlike cystic fibrosis or idiopathic pulmonary fibrosis.45 As a result, predicting survival in specific advanced pulmonary diseases is one of the major issues confounding referral for transplantation. As waiting list times appear to be increasing from 24 months to a median of 46 months, questions are now being raised regarding the appropriate disease-specific time for referral to ensure maximum survival before and after transplantation.3

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