[When should patients be referred by the physician to the lung transplant team? Patient selection, indications, timing of referral and preparation for lung transplantation].

INTRODUCTION: Lung transplantation (LT) is accepted as a therapeutic option in a wide range of end stage lung diseases, with evidence supporting survival and quality of life benefits in transplant recipients. Appropriate patients who have good chance of survival with transplantation should be identified carefully. STATE OF THE ART: Four diagnoses account for approximately 80% of transplant recipients: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis and alpha-1-antitrypsin deficiency emphysema. The aim of this review is to discuss the selection process of potential candidates and to assist physicians in referring these patients to a transplant team. The decision to refer patients for transplantation is difficult and depends on several parameters such as the results of transplantation, the referring physician's view of survival prospects with actual medical therapy according to the pathology, and also the patient's physical, nutritional and psychological status. The timing of listing patients remains a difficult decision which is imposed by both defined criteria and uncertain events such as the rapid worsening of the lung disease and the likely waiting time. PERSPECTIVES: The optimal modalities for pre-surgical rehabilitation programs and their postoperative impact should be evaluated.
CONCLUSIONS: Careful selection of potential candidates for lung transplantation at the most appropriate time should lead to an improvement of survival of such patients.