The changing face of lung transplant candidates

PURPOSE OF REVIEW: Lung transplant remains the ultimate life-saving therapy for people with progressive end-stage lung disease. It is important to highlight the evolution of the field in the United States, as its development has had varying impacts on the different lung transplant candidate groups. This review seeks to synthesize current evidence on the evolution of transplantation across various patient groups, reflecting advances in medical therapies, the implementation of the new composite allocation score (CAS) and trends in lung transplant candidate groups over the years. RECENT FINDINGS: The proportion of waitlisted candidate with chronic obstructive pulmonary disease (COPD, group A) and cystic fibrosis (group C) has declined, reflecting the impact of novel therapeutics and advanced procedural interventions. In contrast, restrictive lung disease patients (group D) now account for most lung transplant recipients, which is likely reflective of our increased use of extracorporeal membrane oxygen (ECMO) for bridging and transplant centers expanded eligibility. Pulmonary hypertension patients (group B) continue to face high waitlist mortality despite the change to the new allocation scoring system. SUMMARY: Advancements in medical therapies and the new composite allocation scoring system has altered both the timing and outcomes for various transplant candidate groups. It is important that we continue to study these findings to optimize patient outcomes and organ allocation.