Home Non-invasive Ventilation and Telemonitoring as a Bridge to Lung Transplantation: A Narrative

Patients with advanced lung disease may experience progressive respiratory failure, recurrent exacerbations and loss of functional capacity while awaiting lung transplantation. Home non-invasive ventilation (NIV) can support selected patients with chronic ventilatory failure, particularly those with persistent hypercapnia, while telemonitoring may help clinicians identify problems with adherence, mask leak and ventilator performance between scheduled reviews. This narrative review discusses the physiological basis, indications, practical delivery and potential role of combining domiciliary NIV with remote monitoring during the pre-transplant period. Evidence from chronic hypercapnic chronic obstructive pulmonary disease (COPD) supports the use of appropriately targeted long-term NIV in selected patients, and studies of tele-assistance suggest that structured remote follow-up can reduce healthcare utilisation in some chronic respiratory populations. Home initiation and remote review may also improve access for patients who live far from specialist centres. However, evidence directly evaluating this combined strategy in lung transplant candidates is sparse. It is therefore not established that home NIV plus telemonitoring independently improves wait-list survival, transplant rates or post-transplant outcomes. The approach should be regarded as an individualized supportive-care pathway rather than a proven transplant- bridging intervention. Successful implementation requires transplant-team coordination, patient education, predefined escalation pathways, attention to data privacy and regular assessment of symptoms, gas exchange and functional status. Prospective transplant-specific studies are needed to determine clinical effectiveness, safety and cost-effectiveness.