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Flashcards in Lung Transplantation Deck (17):
0

The "big 4" indications for lung transplant?

End stage COPD.
IPF.
CF.
Pulmonary HTN.

1

Median survival after lung transplant?

5 years.

2

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)

3

Does lung transplant improve quality of life?

Yes... (lecture didn't show data about before vs. after, but people do pretty well afterward)

4

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.

5

Why is a ventilation-perfusion scan useful when evaluating for transplant?

Can help determine if you can do a single lung transplant.

6

Some absolute contraindications for lung transplant?

After 66th birthday for double-lung, after 71st birthday for single-lung Txp.
Lung infection.
Systemic diseases (e.g. scleroderma).
Extremes of weight (BMI < 15 or > 35).
CAD or LV dysfunction.
Other organ failure.

7

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)

8

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.

9

Most complications of lung transplant have to do with...

Immunosuppression (infections / malignancy) or rejection.

10

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.

11

3 reasons why anastomoses from lung txp have trouble healing?

Steroids.
Ischemic time.
Hypotension.

12

5 complications that can happen to anastomoses post lung txp?

Dehiscense (stitches unravel).
Malacia. (softening)
Stenosis.
Granulation.
Infection (esp. aspergillus).

13

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.

14

Histologic appearance of bronchiolitis obliterans syndrome (BOS)?

Airway obstruction due to: Lymphocytic infiltrate, fibrosis, and granulation tissue.

15

Treatment for post-transplant BOS?

Re-transplantation... which is ethically fraught.

16

Ex-vivo lung perfusion is cool.

Yeah, and it even seems to work well.