Transplant

Question 1

What is the recommended FEV1 level for LT referral when it is rapidly declining?

Answer 1

FEV1 <50% predicted and rapidly declining (>20% decline within 12 months)

Rapidly declining FEV1 indicates a significant deterioration in lung function.

Question 2

What is one of the additional criterion for lung transplant referral for adults with CF with FEV1 <40%?

Answer 2

FEV1 <40% predicted with markers of shortened survival PLUS:
1) 6-min walk test distance <1,333.33 ft (<400 m), hypoxemia (at rest or exertion), hypercapnia, or pulmonary hypertension.
2) >2 exacerbations per year requiring IV antibiotics or 1 exacerbation requiring PPV
3) Massive hemoptysis or hx bronchial artery embolization
4) Pneumothorax

Markers of shortened survival can include clinical signs or symptoms indicating poor prognosis.

Question 3

What FEV1 level indicates a recommendation for LT referral regardless of other factors?

Answer 3

1) FEV1 <30% predicted
2) Young female

This level reflects severe lung impairment.

Question 4

What BMI and FEV1 criteria suggest LT referral for adults with CF?

Answer 4

BMI <18 and FEV1 <40% predicted

This combination indicates a need for urgent intervention while improving nutritional status.

Question 5

What is CLAD-RAS characterized by?

Answer 5

Upper lobe-predominant fibrotic parenchymal opacities and pleural thickening, sometimes with bronchiectasis

CLAD-RAS can also show a restrictive defect at pulmonary function testing

Question 6

What is a common pulmonary function test result in CLAD-RAS?

Answer 6

Total lung capacity <90% of baseline or a drop of 10% from baseline

This indicates a restrictive defect in lung function

Question 7

True or False: CLAD-RAS is associated with lower lobe fibrotic changes.

Answer 7

False - upper lobe predominant

CLAD-RAS is characterized by upper lobe involvement