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PULMONOLOGY > Chapter 292 - Lung Transplantation > Flashcards

Chapter 292 - Lung Transplantation Flashcards

1
Q

Most common indications for Lung transplantation in recent years in decreasing order of frequency

A 
IPF (30%)
COPD (27%)
CF (15%)
a1 AT (3%)
IPAH (2.5%)
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2
Q

primary motive for transplantation for many patients

A

QOL

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3
Q

Conditions such as systemic hypertension, diabetes mellitus, gas- troesophageal reflux, and osteoporosis are not unusual, but if uncom- plicated and adequately managed, they do not disqualify patients from transplantation.

A

True

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4
Q

Upper age limit at most centers for Lung Transplant

A

70-75yo

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5
Q

Standard exclusions of Lung Transplant

A
  • HIV infection
  • chronic active hepatitis B or C - uncontrolled or untreatable pulmonary or extrapulmonary infection
  • uncured malignancy
  • active cigarette smoking
  • drug or alcohol dependency
  • irreversible physical deconditioning
  • chronic nonadherence with medical care
  • significant disease of another vital organ (e.g., heart, liver, or kidney)
  • psychiatric or psychosocial situations
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6
Q

If the potential recipient is allosensitized with antibodies to any human leukocyte antigen (HLA), the donor also has to be HLA compatible.

A

True

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7
Q

most lungs are procured from where?

A

deceased donors after brain death

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8
Q

How many percent of brain death organ donors yielding or two lungs suitable for lung transplant

A

only 20%

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9
Q

Patient groups according to the Lung Allocation Score system for LT

A

A - COPD and emphysema
B - IPAH
C - CF
D - IPF

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10
Q

What is the basis of the Lung Allocation Score system

A

risk of death during 1 year on the waiting list and tlikelihood of survival for 1 year after transplantation

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11
Q

Which patient group has the highest LAS score?

A

D

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12
Q

In 2014, 50% of the patients on the waiting list were in group D What is the median waiting time to transplantation?

A

3.7 months

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13
Q

Overall death rate on the wait list

A

10 per 100 waitlist years

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14
Q

death rate on the waitlist for lung transplant by diagnostic group

A

A, 4
B, 11
C, 12
D, 18

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15
Q

Which Transplant procedure is mandatory for Cystic Fibrosis and other forms pdf bronchiectasis?

A

Bilateral transplantation

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16
Q

Which Transplant procedure is obligatory for Eisenmenger syndrome with complex anomalies?

A

Heart-lung transplantation

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17
Q

this interleukin-2 receptor antagonist is the widely used drug for induction therapy

A

Basiliximab

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18
Q

Maintenance immunosuppressive regimen includes which agents?

A

calcineurin inhibitor
purine synthesis antagonist
prednisone

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19
Q

The most commonly used maintenance immunosuppressive regimen for lung transplant recipients

A

Tacrolimus
Mycophenolate
Prednisone

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20
Q

After lung transplantation, if recovery is uncomplicated, lung function rapidly improves and then stabilizes how many months after transplantation?

A

3-6 months

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21
Q

Sustained decline by how much of the spirometric measurement signals a potentially significant problem post lung transplant?

A

≥10–15%

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22
Q

Median survival for Lung transplant recipients

A 
IPF 4.7 years
COPD 5.5 years
IPAH 5.7 years
Sarcoidosis 6.1 years
CF 8.6 years
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23
Q

Long-term survival has been significantly better after bilateral transplantation than after unilateral transplantation for all of the major indications

A

True

24
Q

Median survival for lung transplant recipients by age

A

18–49 years: 7.2 years
50–59 years: 5.5 years
≥60 years: 4.5 years

25
Q

What are the three parameters of the recipients with the lowest survival rates?

A

group D
≥65 years old
had an LAS ≥60

26
Q

Causes of death after lung transplantation during the first 30 days.

A 
graft failure (24%)
infection (19%)
cardiovascular events (11%) technical problems (11%)
27
Q

Causes of death after lung transplantation during the remainder of the first year

A

Infection 37%

Graft failure 17%

28
Q

Causes of death after lung transplantation AFTER the first year

A

bronchiolitis and other forms of late graft failure 40–45%

infection 16–20%.

29
Q

FACTORS associated with an increased risk of death in the first year AFTER transplantation

A
  • Hospitalized during transplantation
  • supported by mechanical ventilation
  • extracorporeal membrane oxygenation
  • dialysis at the time of transplantation
  • undergoing retransplantation
30
Q

Mortality risk have been higher at centers with an annual volume below?

A

below 30 transplants/year

31
Q

T/F

After bilateral transplantation, pulmonary function tests are typically normal.

A

True

32
Q

The average length of stay after bilateral transplantation in the United States days

A

29.5 days

33
Q

Rehospitalization rate in the first year after transplntation is higher than any other solid organ transplant except intestine.

A

True

34
Q

Complication of Lung transplantation presenting with diffuse pulmonary infiltrates and hypoxemia within 72 h of transplantation

A

Primary graft dysfunction

35
Q

Severity of Primary graft dysfunction based on PF ration

A

Grade 1: >300
Grade 2: 200-300
Grade 3: <200

36
Q

Complication of Lung transplant caused by T lymphocyte inter- actions with donor alloantigens, mainly in the major histocompatibility

A

Acute Cellular rejection

37
Q

Incidence of acute cellular rejection is highest when?

A

6-12 months after transplant

38
Q

Diagnosis of ACR after transplantation is confirmed how?

A

transbronchial biopsies showing lymphocytic infiltrates around arterioles or bronchioles

39
Q

At what grade of ACR is treatment started regardless of the clinical situation

A

≥A2

40
Q

Lung transplantation complication occurring when lung function never reaches expected values due to early complications or when there is a sustained decrement in lung function below previously normal baseline measurements

A

Chronic Lung Allograft Dysfunction

41
Q

CLAD must persist how many weeks before diagnosis is entertained?

A

≥3 weeks

42
Q

2 types of CLAD

A

Bronchiolitis obliterates syndrome

Restrictive Allograft Syndrome

43
Q

Severity of BOS

)is cat- egorized by the decrement in FEV1 from the average of the two best posttransplant values

A

20–35%, stage 1; 35–50%, stage 2; >50%, stage 3

44
Q

Median survival after onset of BOS

A

3-4 years

45
Q

Median survival of RAS

A

1.5 years

46
Q

Which CLAD

FEV1 <80% Air trapping is usually present with minimal, if any, infiltrates

A

BOS

47
Q

Which CLAD

FEV 1 <80%
TLC <90%

A

RAS

48
Q

Which CLAD

Infiltrates are usually present
± air trapping
± bronchiectasis

A

RAS

49
Q

Criteria for Humoral/Antibody mediated rejection

A
  1. graft dysfunction
  2. serologic detection of donor-specific antibodies,
  3. pathologic pattern of graft injury with evidence of antibody deposition
50
Q

2 most common organisms in bronchitis with BOS

A

pseudomonas aeruginosa

MRSA

51
Q

Most common complication of lung transplantation related to the side effect of the immunosuppressive drugs

A

Hypertension

52
Q

Referral for Evaluation for COPD

A

Progressive Sx
FEV1 <25%
PaO2 <60 or PaCO2 >50
BODE 5-6

53
Q

Listing for transplantation for COPD

A
  • BODE ≥7
  • FEV1 <15–20%
  • Moderate to severe pulmonary hypertension
  • 3 or more severe exacerbations in preceding year
  • One severe exacerbation with acute hypercapnic respiratory failure
54
Q

Referral for evaluation for IPF

A
  • Pathologic or radiographic evidence of UIP or NSIP
  • FVC <80% or DLCO <40%
  • Dyspnea or functional limitation
  • Any oxygen requirement (rest or exercise)
55
Q

Listing for transplantation for IPF

A
  • Decrement in FVC ≥10% or in DLCO >15% during 6 months of follow-up
  • Pulmonary hypertension
  • Desaturation to SpO2 <88% during 6-min walk test
  • 6-min walk test distance <250 m or decrement >50 m over 6 months
  • Hospitalization for acute exacerbation

PULMONOLOGY (10 decks)

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