19. Lung transplantation Flashcards
What is the aim of lung transplantation?
Lung transplantation may be the only intervention that can prolong survival and improve quality of life for those patients with advanced, end-stage lung disease.
What are the indications for lung transplantation?
High (>50%) risk of death due to lung disease within 2 years if lung transplantation is not performed. Main causes include idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), chronic obstructive lung disease (COPD), and idiopathic arterial hypertension (iPAH).
What are the less frequent causes of lung transplantation?
- bronchiectasis,
- chronic thromboembolism with pulmonary hypertension,
- interstitial lung disease (e.g. sarcoidosis),
- Eisenmenger syndrome.
What are the absolute contraindications of lung transplantation? (9)
- malignancy (5 years),
- severe systemic comorbidity (coronary disease, renal function)
- septicemia,
- uncontrolled infection
- HIV,
- grade II/III obesity,
- psychiatric disorder,
- non-compliance,
- addiction (smoking, drug).
What are the donor and recipient match requirements for lung transplantation?
Size matching, main blood group matching, and no HLA match.
What are some pre-transplantation checkups required for lung transplantation?
- ECG,
- serology (HIV, hepatitis, treponema)
- chest CT and lung scintigraphy,
- HLA phenotyping,
- PET-CT to exclude occult tumors (age >40 years).
What are the surveillance controls required after lung transplantation?
- In the first 3 months every week: lung function, CXR, ECG, laboratory chemistry, immunosuppressive drug serum level, CMV antigenic.
- Bronchoscopy, lavage for microbiology, transbronchial biopsy at week 2, 4, 8 and at 3, 6, 12 month.
- Chest CT at every 6 month, after every year.
- Bronchoscopy needed when progression in lung function or new radiologic sign is observed.
Why is immunosuppression needed after lung transplantation?
To avoid graft rejection, but not so much that the patient becomes immunocompromised and susceptible to infections.
What is the mechanism of action of induction treatment in lung transplant patients?
- Inhibition of lymphocyte migration to the donor lung
- peripheral immunotolerance,
- inhibition of reactive T-lymphocytes,
- decrease of T-cell number.
What drugs are used for induction treatment in lung transplants?
- ATG (anti-thymocyte globulin)
- CD52 monoclonal antibody
- IL-2 blocker (daclizumab)
What is the traditional triple drug combination used in maintenance therapy for lung transplant patients?
Calcineurin inhibitor (tacrolimus, cyclosporin), antimetabolite (mycophenolate), and steroid.
When are mTOR inhibitors used in lung transplant patients?
In case of post-transplant malignancy.
What is the purpose of inhalation of amphotericin B in lung transplant patients?
To prevent colonization of Aspergillus species.
What is the purpose of trimethoprim/sulfamethoxazole (TMP-SMX) in lung transplant patients?
To prevent pneumocystis jirovecii infection.
When is valganciclovir used in lung transplant patients?
In high-risk patients against CMV infection for 3 months.
