Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation.

In the paper

“The ESC/ERS model also employs the assessment of risk using a multi-parametric comprehensive analysis of clinical variables.(284) Unlike REVEAL, this model avoids use of any non-modifiable criteria, and does not “weight” the variables according to their relative importance.”

What the sources say

• Partly supported

  Section 6.2.4 calls for a multidimensional, comprehensive assessment, and section 6.2.5 says overall assessment should guide decisions when variables fall into different risk categories. The claim that the model avoids any nonmodifiable criteria is too absolute: both sections say age, sex, and other factors not affected by therapy can modify risk. The passages do not explicitly specify whether variables receive numerical weights. (LLM, conf=0.85)

  cites [284] Galiè, 2016, Eur Heart J sourceExperimental — accuracy not yet measured

In the paper

“This trend reflects the expansion of acceptable donors and candidates made possible by clinical and scientific advances. Far fewer absolute contraindications for lung transplant candidacy exist now, compared to the time of publication of prior versions of this document, making the selection of candidates even more complex.”

What the sources say

• Partly supported

  The introduction says advances in technology and medical knowledge prompted updated candidate-selection guidelines, and the Relative contraindications section allows consideration of some candidates previously treated more restrictively. But our copy does not state that lung transplantation expanded worldwide because more donors became acceptable, nor does it explicitly say there are far fewer absolute contraindications than in 1998 or that selection has become more complex for that reason. No page numbers are available in our copy. (LLM, conf=0.83)

  cites [2] Orens, 2006, International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation, J Heart Lung Transplant sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [3] Maurer, 1998, International guidelines for the selection of lung transplant candidates, Transplantation source
• ?Not checked — no full text of the sourcecites [4] Weill, 2015, A consensus document for the selection of lung transplant candidates: 2014–an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation, J Heart Lung Transplant source

In the paper

“Frailty, defined as a generalized vulnerability to stressors resulting from the presence of multiple physiologic deficits, is associated with an increased risk of waitlist and post-transplant mortality.(51–53) However, frailty in lung transplant candidates is often attributable to advanced lung disease and may improve following transplant.”

What the sources say

• Partly supported

  The Results (page unavailable) link frailty measured with FFP-DASI to increased death or delisting among lung-transplant candidates. The Methods (page unavailable) say participants were censored at transplant, so this study does not support the post-transplant mortality claim. The Abstract says no gold-standard frailty measure exists, but the paper does not specifically address using frailty measures for listing decisions. (LLM, conf=0.90)

  cites [51] Baldwin, 2017, Refining low physical activity measurement improves frailty assessment in advanced lung disease and survivors of critical illness, Ann Am Thorac Soc sourceExperimental — accuracy not yet measured
• Supported

  The Discussion states that frailty is associated with both waitlist and post-transplant mortality. It also says further work is needed to identify valid frailty measures before using them in organ allocation; the available passages do not give page numbers. (LLM, conf=0.93)

  cites [52] Singer, 2018, Frailty phenotypes and mortality after lung transplantation: a prospective cohort study, Am J Transplant source
• ?Not checked — no full text of the sourcecites [53] Singer, 2015, Frailty phenotypes, disability, and outcomes in adult candidates for lung transplantation, Am J Respir Crit Care Med source

In the paper

“Despite improved overall outcomes, many individuals with advanced CF lung disease remain at risk of short-term mortality. A 2017 study demonstrated a 10% risk of death each year after reaching an FEV1 < 30%, with many patients dying soon after reaching this threshold.”

What the sources say

• Supported

  The Discussion reports improved survival but an approximately 10% annual probability of death once FEV1 falls below 30% predicted. The Conclusions add that some patients die soon after reaching that threshold, while others live for many years. (LLM, conf=0.92)

  cites [245] Ramos, 2017, Heterogeneity in survival in adult patients with cystic fibrosis with FEV1 < 30% of predicted in the United States, Chest source

In the paper

“Lung transplant candidates must demonstrate abstinence from use of all tobacco and nicotine products (including nicotine replacement therapy) prior to transplant (e.g. with serial nicotine and cotinine screening).(111)”

What the sources say

• Partly supported

  The Introduction says candidates are normally required to be smoke-free before joining a thoracic-transplant waiting list. But the systematic-screening section recommends cotinine testing at post-transplant follow-ups, not serial nicotine and cotinine testing before transplant. The paper also says nicotine replacement therapy can be used in transplant recipients; it does not establish the claimed pre-transplant ban on all nicotine products. (LLM, conf=0.88)

  cites [111] Hofmann, 2018, Smoking resumption after heart or lung transplantation: a systematic review and suggestions for screening and management, J Thorac Dis sourceExperimental — accuracy not yet measured

In the paper

“Non-CF bronchiectasis represents 2.7% of all lung transplants reported to the ISHLT Registry between 1995–2018.”

What the sources say

• ?Could not verify

  The Lung transplantation—Indications section says Table 1 covers transplant indications since January 1995, but the passages available from our copy do not give a figure for non-CF bronchiectasis. Searches for “non-CF bronchiectasis,” “bronchiectasis,” and “2.7%” did not find the claimed proportion; the quoted passages instead discuss other indications and bronchiolitis obliterans syndrome. (LLM, conf=0.70)

  cites [1] Chambers, 2019, The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart–lung transplantation Report—2019; Focus theme: donor and recipient size match, J Heart Lung Transplant sourceExperimental — accuracy not yet measured

In the paper

“Lung transplant for LAM is relatively rare; however, it is associated with better post-transplant survival compared to other advanced lung diseases.(1, 303–307)”

What the sources say

• Partly supported

  The Lung transplantation section (page unavailable) reports that lymphangioleiomyomatosis as an indication for transplantation is favorably associated with survival in a multivariable model. It does not establish that LAM transplantation is relatively rare or recommend bilateral transplantation when organs are available; its favorable association for bilateral transplantation is reported separately, not specifically for LAM. (LLM, conf=0.87)

  cites [1] Chambers, 2019, The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart–lung transplantation Report—2019; Focus theme: donor and recipient size match, J Heart Lung Transplant sourceExperimental — accuracy not yet measured
• Supported

  The Introduction describes LAM as rare and says it accounted for about 1% of heart or lung transplantation indications in an international survey. The Discussion reports that the Japanese LAM recipients had more favorable post-transplant survival than patients transplanted for other indications. The printed citing sentence does not make a claim about bilateral transplantation. (LLM, conf=0.92)

  cites [303] Ando, 2016, Lung Transplantation for lymphangioleiomyomatosis in Japan, PLoS One source
• ?Not checked — no full text of the sourcecites [304] Khawar, 2019, Clinical outcomes and survival following lung transplantation in patients with lymphangioleiomyomatosis, J Heart Lung Transplant source
• ?Not checked — no full text of the sourcecites [305] Baldi, 2017, Experience of lung transplantation in patients with lymphangioleiomyomatosis at a Brazilian reference centre, Lung source
• ?Not checked — no full text of the sourcecites [306] Kurosaki, 2020, Favorable survival even with high disease-specific complication rates in lymphangioleiomyomatosis after lung transplantation-long-term follow-up of a Japanese center, Clin Respir J source
• ?Not checked — no full text of the sourcecites [307] Kpodonu, 2005, The US experience with lung transplantation for pulmonary lymphangioleiomyomatosis, J Heart Lung Transplant source

In the paper

“An updated version of the score, REVEAL 2.0, which incorporates estimated GFR and all-cause hospitalizations within the previous six-months, has emerged as a powerful predictor of mortality and clinical worsening.(285–287) Neither of the REVEAL scores has been validated prospectively.”

What the sources say

• ?Not checked — no full text of the sourcecites [285] Benza, 2019, Predicting survival in patients with pulmonary arterial hypertension: The REVEAL Risk Score Calculator 2.0 and comparison with ESC/ERS-Based risk assessment strategies, Chest source
• ?Could not verify

  The Discussion describes renal insufficiency as a mortality predictor included in the REVEAL risk score, and the Statistical analysis uses that score for adjustment. Our copy does not address REVEAL 2.0’s predictive performance or prospective validation (searched: REVEAL 2.0, clinical worsening, prospective validation). (LLM, conf=0.75)

  cites [286] Chakinala, 2018, Impact of declining renal function on outcomes in pulmonary arterial hypertension: a REVEAL registry analysis, J Heart Lung Transplant sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [287] Frost, 2013, Evaluation of the predictive value of a clinical worsening definition using 2-year outcomes in patients with pulmonary arterial hypertension: a REVEAL Registry analysis, Chest source

In the paper

“Lung volume reduction (LVR), performed by either surgical or bronchoscopic approach, is an option for a subset of COPD patients with advanced emphysema who meet strict selection criteria. These procedures have been associated with improved lung function, exercise capacity, and quality of life.(181–183)”

What the sources say

• Partly supported

  The Scientific Knowledge commentary says lung volume reduction surgery can improve lung function but is limited to eligible patients; the Results report improved lung function and health status after bronchoscopic valve treatment. The Results also say the improvement in exercise capacity was not statistically significant. The claim’s reference to delaying transplant is absent from the verbatim citing sentence and is not established by these passages. (LLM, conf=0.87)

  cites [181] Criner, 2019, Improving lung function in severe heterogenous emphysema with the spiration valve system (EMPROVE). A multicenter, open-label randomized controlled clinical trial, Am J Respir Crit Care Med sourceExperimental — accuracy not yet measured
• Partly supported

  The Introduction and Conclusion (pages not provided) describe surgical and bronchoscopic lung volume reduction as options for carefully selected patients with severe emphysema. The Discussion reports improvements in lung function, exercise capacity, and quality of life. The copy does not say these treatments delay transplantation; that point also does not appear in the verbatim citing sentence. (LLM, conf=0.85)

  cites [182] Criner, 2018, A multicenter randomized controlled trial of Zephyr Endobronchial valve treatment in heterogeneous emphysema (LIBERATE), Am J Respir Crit Care Med sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion (p. 2071) reports that lung-volume-reduction surgery increased the chance of improved exercise capacity, lung function, and quality of life, with benefits varying by patient subgroup. The Methods (page not supplied) describe surgical approaches, not bronchoscopic reduction, so this paper does not support the sentence’s extension to both approaches. The citing sentence does not make a transplant-delay claim; the Treatment section reports transplant counts but does not establish that surgery delayed transplantation. (LLM, conf=0.87)

  cites [183] Fishman, 2003, A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema, N Engl J Med sourceExperimental — accuracy not yet measured

In the paper

“The BODE index [BMI, airflow limitation (forced expiratory volume in one second), dyspnea and 6-min walk distance], which has been externally validated in at least 13 additional cohorts following the original derivation. The BODE index has been cited as the prognostic model of choice by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and it formed the basis for listing recommendations in the 2014 ISHLT candidate selection guidelines. (4, 166–168)”

What the sources say

• ?Not checked — no full text of the sourcecites [4] Weill, 2015, A consensus document for the selection of lung transplant candidates: 2014–an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation, J Heart Lung Transplant source
• ?Not checked — no full text of the sourcecites [166] Celli, 2004, The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease, N Engl J Med source
• Partly supported

  The external validation studies section reports that BODE was externally validated in 13 cohorts. The Principal findings in context section says GOLD uses BODE in clinical decision-making for lung transplantation, but our copy does not say that BODE formed the basis of the 2014 ISHLT listing recommendations. (LLM, conf=0.88)

  cites [167] Bellou, 2019, Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal, BMJ sourceExperimental — accuracy not yet measured
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [168] Disease GIfCOL: Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2020 Report. 2020.

In the paper

“Thoracic malignancy is a rare indication for lung transplant, accounting for only 0.1% of all lung transplants performed between 1995– 2018.(1) Notably, there is an absence of current data describing outcomes of patients transplanted for thoracic malignancy, likely reflecting the abandonment of this practice in many lung transplant centers.”

What the sources say

• ?Could not verify

  The Lung transplantation—Indications section (page unavailable) points to a table of transplant indications but does not state a thoracic-malignancy count or the claimed 0.1% for 1995–2018. Searches for thoracic malignancy and that percentage also found no passage about a lack of outcomes data or centers abandoning the practice. The citation is attached to the first sentence; the latter explanation appears to be the citing authors’ own statement. (LLM, conf=0.70)

  cites [1] Chambers, 2019, The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart–lung transplantation Report—2019; Focus theme: donor and recipient size match, J Heart Lung Transplant sourceExperimental — accuracy not yet measured

In the paper

“Determining transplant timing is difficult due to the wide range of etiologies and demographics. Two non-CF bronchiectasis severity assessment tools were developed from the overall population (not limited to those with advanced lung disease): the FACED score [FEV1, Age, Chronic Pseudomonas aeruginosa, Extension to 1–2 lobes, Dyspnea by modified Medical Research Council scale] and the bronchiectasis severity index (BSI), which adds BMI and exacerbation frequency.”

What the sources say

• Supported

  The citation is attached to the FACED score, not to the preceding statement about transplant timing or the subsequent description of BSI. The Design section describes a broad non-CF bronchiectasis cohort, and the Multivariate analysis section identifies the five FACED components used to predict five-year mortality. No page numbers are available in our copy. (LLM, conf=0.91)

  cites [272] Martinez-Garcia, 2014, Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score, Eur Respir J source
• Partly supported

  The Abstract and Discussion describe the BSI as a prognostic severity tool for non-CF bronchiectasis, derived and validated in cohorts spanning a wide range of disease severity. The Results identify low BMI and frequent exacerbations among its predictors. The paper does not address transplant timing or describe the FACED score, so those parts of the attributed claim are unsupported. (LLM, conf=0.86)

  cites [273] Chalmers, 2014, The bronchiectasis severity index. An international derivation and validation study, Am J Respir Crit Care Med sourceExperimental — accuracy not yet measured

In the paper

“Inhaled cannabis use must be ceased prior to lung transplant.(115–119)”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [115] 2017
• ?Not checked — no full text of the sourcecites [116] Marks, 1996, Successfully treated invasive pulmonary aspergillosis associated with smoking marijuana in a renal transplant recipient, Transplantation source
• ?Not checked — no full text of the sourcecites [117] Hamadeh, 1988, Fatal aspergillosis associated with smoking contaminated marijuana, in a marrow transplant recipient, Chest source
• ?Not checked — no full text of the sourcecites [118] Levi, 2019, Marijuana use in transplantation: a call for clarity, Clin Transplant source
• ?Could not verify

  The Introduction says the paper addresses workplace cannabinoid testing, and the Conclusions discuss testing for workplace impairment. Searches for lung transplantation and pre-transplant cessation found no passage addressing whether inhaled cannabis must be stopped before a lung transplant. (LLM, conf=0.78)

  cites [119] Kulig, 2017, Interpretation of workplace tests for cannabinoids, J Med Toxicol sourceExperimental — accuracy not yet measured

In the paper

“Idiopathic pulmonary fibrosis (IPF), the prototype of fibrotic ILDs, carries a prognosis of 3–5 years survival after diagnosis when untreated. Two anti-fibrotic medications (nintedanib and pirfenidone) have been shown to reduce the rate of forced vital capacity (FVC) decline and slow disease progression in patients with a definite usual interstitial pneumonia (UIP) pattern and with a probable UIP pattern on high resolution CT (HRCT).(191–193)”

What the sources say

• ?Not checked — no full text of the sourcecites [191] King, 2014, A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis, New Eng J Med source
• Partly supported

  The Abstract reports that nintedanib reduced FVC decline in patients with IPF, consistent with slower disease progression. The passages in our copy do not establish the claimed 3–5-year untreated survival, a benefit from pirfenidone, or efficacy specifically in both definite and probable UIP patterns. (LLM, conf=0.88)

  cites [192] Richeldi, 2014, Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis, New Eng J Med sourceExperimental — accuracy not yet measured
• Partly supported

  The Results (page not supplied) show that nintedanib reduced FVC decline in both diagnostic subgroups; the Discussion describes a similar treatment effect in patients with possible UIP and traction bronchiectasis. The cited paper does not establish the claimed 3–5-year untreated survival or an effect of pirfenidone in these subgroups. (LLM, conf=0.88)

  cites [193] Raghu, 2017, Effect of nintedanib in subgroups of idiopathic pulmonary fibrosis by diagnostic criteria, Am J Respir Crit Care Med sourceExperimental — accuracy not yet measured

In the paper

“A full evaluation includes assessment of lung disease severity, anatomy, nutritional status, degree of frailty, presence and severity of comorbidities, psychosocial circumstances, and health-related behaviors that impact recovery and long-term survival.”

In the paper

“The fundamental ethical principles of “utility”, “justice”, and “respect for persons” (see Table 1) must therefore, provide the framework for candidate selection and organ allocation systems.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [5] Beauchamp, 2012
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [6] Ethical Principles in the Allocation of Human Organs. Organ Procurement and Transplant Network. Accessed August 12, 2021. https://optn.transplant.hrsa.gov/resources/ethics/ethical-principles-in-the-allocation-of-human-organs/

In the paper

“In patients with concurrent emphysema, a decline in FVC is a less reliable parameter to detect progression of fibrosis, and other markers such as progression of disease on CT scan or DLCO, or development of secondary pulmonary hypertension, may be more useful.”

In the paper

“It is essential to account for medical comorbidities, psychosocial factors, and potential for rehabilitation in the evaluation of transplant candidates.”

In the paper

“In areas where there was paucity of evidence, the statements reflect consensus reached by the committee with an a priori threshold of >80% agreement on consensus statements.”

In the paper

“Literature searches performed in early 2020 reviewed all pertinent articles, focusing on newer peer reviewed research available since publication of the 2014 consensus document.(4) During review of the document additional pertinent newly published articles were included, but a comprehensive review of literature was not repeated.”

What the sources say

• ?Not checked — no full text of the sourcecites [4] Weill, 2015, A consensus document for the selection of lung transplant candidates: 2014–an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation, J Heart Lung Transplant source

In the paper

“when making recommendations about allocating a scare resource, survival benefit is prioritized based on the ethical framework described in this document.”

In the paper

“This document is intended to express a consensus of the membership of the International Society for Heart and Lung Transplantation (ISHLT) to provide guidance for timely referral, assessment, optimization, and listing of potential lung transplant candidates.”

In the paper

“Our recommendations have the explicit goal of maximizing long-term survival in order to provide net survival gains for society as a whole.”

In the paper

“These include non-adherence to medical treatment, progressive cognitive impairment, and active substance use (Table 2).”

In the paper

“Prognostic models that can be used to determine the appropriate timing of listing for lung transplant for COPD patients are inherently imprecise as survival is highly variable even among patients with advanced disease. In general, multidimensional models have proven to be more robust predictors of mortality than single parameters.”