Lecture 7 - CLAD With Extra Resarch

Question 1

What did Vos R et al provide?

Answer 1

An overview of the clinical effects on Axzithromycin in the setting of BOS after transplant

Question 2

What are the symptoms of BOS?

Answer 2

Cough and dysponea

Question 3

What did Vos R et al conclude?

Answer 3

The acceptance of the dichotomy can improve the understanding of the pathological condition towards BOSe encouring a more accurate diagnosis

Question 4

What is rejection? - American thoracic society

Answer 4

A process where your bodies immune system attacks the transplanted lung recognising it to be different from own tissue

Question 5

What is acute cellular rejection - American thoracic society?

Answer 5

The most common form of rejection - in the first year following the transplant about 30% of patients will have at least one episode of acute rejection.

Question 6

What is acute cellular rejection define as?

Answer 6

The body’s T cells attacking the donor lung directly - American thoracic society

Question 7

What is CLAD - chronic lung allograft dysfunction

Answer 7

Persist inflammation from the immune system over time causing scarring in the lungs - normally happens after 1 year after lung transplant

Question 8

What are the two distinct groups of CLAD? - Byrne D et al

Answer 8

Obstructive chronic lung allograft dysfunction (BOS) and Restrictive CLAD

Question 9

What are the characteristics of CLAD?

Answer 9

Decline in FEV1 and phrenic nerve damage

Question 10

When was the first lung transplant?

Answer 10

1986

Question 11

What is chronic rejection?

Answer 11

T cell and B cell mediated rejection of the non self lung

Question 12

What percent of people that had lung transplant developed CLAD within the first 3 years?

Answer 12

50%

Question 13

What are the proteins after transplant?

Answer 13

Fixed air limitation, FEV1 below 80% = BOS, after a year FEV1 is 40%

Question 14

What are the airways blocked with?

Answer 14

Inflammatory cells and scar tissue

Question 15

What is needed for rejection?

Answer 15

Immunosuppression

Question 16

What happens if you injure the airways?

Answer 16

You will get scar tissue and epithelial damage will remodel the airways

Question 17

What happens in airway remodelling?

Answer 17

Structural changes in the lungs and airways which means airflow will change

Question 18

What are the methods used to diagnose CLAD?

Answer 18

Brush cultures and biopsies

Question 19

What is gastroparesis?

Answer 19

Slowing down of gastric emptying

Question 20

What are people treated with if they have had a lung transplant and are vulnerable to reflux and aspiration?

Answer 20

They are treated with proton pump inhibitors

Question 21

What can aspiration leads to?

Answer 21

Inflammation, epithelial damage and fibrosis

Question 22

What is used as a marker for aspiration?

Answer 22

Pepsin

Question 23

More reflux =

Answer 23

More inflammation

Question 24

What is the lavage like from a lung transplant recipient?

Answer 24

Contains pseudomonas positive - can form a biofilm which is very hard for antibiotics to eradicate. Get antibiotic resistance infection in the lungs

Question 25

What is the link between aspiration and infection of lung allografts? - science direct.com

Answer 25

Following transplantation vagal damage may lead to delayed gastric emptying and distal oesophageal dysmotility, promoting reflux

Question 26

How do proton pump inhibitors reduce gastric acidity? - science direct.com

Answer 26

By irreversibly binding to the hydrogen potassium ATP pump on parietal cell apical membrane. But they don’t prevent fully as pepsin and bile acids are still seen