Rheumatologic Considerations in Lung Transplant Candidates

Evaluating lung transplant candidates with underlying systemic autoimmune rheumatic diseases is challenging due to a wide spectrum of extrapulmonary manifestations, leading to variable practice among centers. This article aims to define autoimmune disease activity and treatment failure, discuss post-transplant complications of pre-transplant immunosuppression, propose criteria for timely lung transplant referral, and discuss management of rheumatologic manifestations after lung transplant. The guidelines and rheumatological considerations in lung transplant candidates remain unclear, with poorly understood effects of autoimmune disease on lung transplant outcomes and acceptance criteria for these risks. In this review, we will discuss the important gray areas in the rheumatological considerations for lung transplant candidates, specifically addressing diagnostic uncertainty and therapeutic dilemmas involved, as well as the need for standardization protocols among lung transplant centers on rheumatological evaluation and considerations.