Flashcards in Lung Transplantation Deck (17):
The "big 4" indications for lung transplant?
End stage COPD.
Median survival after lung transplant?
Does lung transplantation improve survival?
It depends on the indication.
For CF, yes - net benefit after 30 days.
For emphysema, no, there doesn't seem to be a benefit in mortality.
(But mortality =/= quality of life)
Does lung transplant improve quality of life?
Yes... (lecture didn't show data about before vs. after, but people do pretty well afterward)
How does IPF prognosis relate to when you should refer for transplant?
In IPF, you should refer right away - declines in IPF can be precipitous.
Why is a ventilation-perfusion scan useful when evaluating for transplant?
Can help determine if you can do a single lung transplant.
Some absolute contraindications for lung transplant?
After 66th birthday for double-lung, after 71st birthday for single-lung Txp.
Systemic diseases (e.g. scleroderma).
Extremes of weight (BMI < 15 or > 35).
CAD or LV dysfunction.
Other organ failure.
What's the lung allocation score? What is it based upon?
LAS is a measure of how much a patient would be expected to benefit from from transplant, in terms of life expectancy.
(but, given that QoL can improve without increased life expectancy, this may be problematic)
Why might giving a single lung transplant for IPF be tricky?
If the PVR is too high, all the blood flow will go to the new lung... and destroy it.
Most complications of lung transplant have to do with...
Immunosuppression (infections / malignancy) or rejection.
What's the timeframe for primary lung rejection?
What's the problem?
How common a problem is this?
Lungs rejected within 72 hours.
Due to injury from ischemia / reperfusion (due to explant, transport, storage).
This happens in 10-25% of cases.
3 reasons why anastomoses from lung txp have trouble healing?
5 complications that can happen to anastomoses post lung txp?
Dehiscense (stitches unravel).
Infection (esp. aspergillus).
How does chronic rejection of a lung transplant manifest, pathologically speaking?
Typical time to onset?
Bronchiolitis Obliterans Syndrome (BOS).
Onset is in months to years - it's heterogenous.
Histologic appearance of bronchiolitis obliterans syndrome (BOS)?
Airway obstruction due to: Lymphocytic infiltrate, fibrosis, and granulation tissue.
Treatment for post-transplant BOS?
Re-transplantation... which is ethically fraught.