Lung Transplantation Flashcards
Common underlying conditions for lung transplantation
Resource: Oxford Resp Med Handbook
COPD
IPF
CF
𝛂1AT
PAH
Sarcoidosis
LAM
PLCH
Bronchiectasis
Indications for lung transplantation
Transplantation to be considered in
1) progressive & advanced lung disease,
2) who are deteriorating,
3) despite maximal therapy,
4) with poor QoL,
5) and/or having predicted 2y survival <50%
6) Candidates should still be able to walk, with no significant untreatable cardiac, renal or hepatic impairment, and
7) completed Pulm Rehab
Indications for lung transplantation in COPD & obstructive lung disease
1) FEV1<20% and DLCO <20% or homogenous emphysema
2) Hx of admission for T2RF and worsening hypoxia
3) Pulm HTN or cor pulmonale
4) BODE score >7
Indications for lung transplantation in IPF
Any:
1) DLCO <40% with clinical deterioration
2) Fall in DLCO ≥15% over 6m
3) Fall in FVC ≥10% over 6m
4) SpO2 <88% on 6MWT
Indications for lung transplantation in PAH
1) WHO functional class III or IV despite rx
2) Worsening RHF
3) Declining 6MWT <350m despite med therapy
Contraindications for lung transplantation
Absolute:
1) Severe, untreatable extrapulm organ dysfunction (inc renal, hepatic & cardiac disease)
2) Solid organ or haem malignancy within 5y
3) Unstable critical condition (e.g. sepsis, shock)
4) Severe untreatble psy illness
5) BMI>35
6) Active or recent substance addiction (cig, ETOH, drug)
7) Non-adherence
8) lack of social support
Relative:
1) Age>60
2) Chronic condition with terminal organ damage
3) Severe osteoporosis
4) Poor rehab potential
5) IMV
6) Previous MAC which was treated
7) Aspergilloma with extensive cavitation
8) Chronic infection (HIV, hep B/C)
Ix prior to referral for lung transplantation
1) full pulmonary function tests
2) tests of exercise performance (e.g. 6MWt),
3) sputum microbiology,
4) ECG
5) echo,
6) HRCT
7) blood group,
8) LFT
9) viral serology (human immunodeficiency virus (hIV), cytomegalovirus (CMV), hepatitis B and C),
10) 24 h creatinine clearance
11) stress echo and coronary angiography for some
Mx of pt on lung transplant waiting list
1) Maintenance of nutrition
2) Avoidance of obesity
3) Maintenance of mobility, continuing exercise, and rehabilitation
4) Monitoring comorbid disease: heart, kidney, liver, bones.
5) Optimize treatment of diabetes, systemic hypertension, osteoporosis, peptic
ulcer disease, gastro-oesophageal reflux, and sinus disease
6) Psychological and social support
7) Symptom control: palliative care input is often required and should be considered in parallel with active treatment for patients on a transplant
waiting list
8) Prompt treatment of exacerbations * early NIV, if indicated
9) Avoiding intubation, if possible.
Surgical approach to lung transplantation
Single lung
Bilateral sequential
Heart-lung
Living lobar transplant
Complications of lung transplantation
Early:
1) Graft dysfunction
2) Acute cellular rejection
3) Airway complications
4) Infection
5) Immunosupp drug complications
6) VTE, arrhythmia
Late:
1) Chronic lung allograft dysfunction
2) Bronchiolitis Obliterans Syndrome
3) Recurrence of primary disease
4) Malignancy
Organ donation campaign in Malaysia
1) The Organ Donation Awareness Week is from Sept 7-13
2) The National Transplant Resource Center (NTRC) is a department within Hospital Kuala Lumpur. We are responsible for the implementation of organ donation program. As a national referral center, we coordinate organ donation process, provide training for donor coordinators as well as conduct promotional and awareness activities.
3) According to National Fatwa Council, organ and tissue donation for transplantation is allowed permissible
4) Benefits of being a donor while alive:
- Free first class ward subject to availability
- Exemption from ward charges inc for Ix, surgical procedures, and follow-ups
