Heart and Lung Transplants

Question 1

What are the indications for a heart transplant?

Answer 1

end stage heart disease (hemodynamic compromise, CAD, cardiomyopathy, refractory cardiogenic shock)
NYHA Class III-IV despite maximal therapy
Poor quality of life (intractable angina, refractory arrhythmia, VO2 max less than 10mL/kg/min)
Other: congenital heart dx, cardiac tumors

Question 2

What are the indications for a lung transplant?

Answer 2

COPD
idiopathic pulmonary fibrosis
cystic fibrosis
idiopathic pulmonary arterial hypertension
sarcoidosis

**COPD and idiopathic pulmonary fibrosis and cystic have specific criteria within them to qualify

Question 3

What are absolute contraindications for heart transplants?

Answer 3

systemic illness with life expectancy less than 2 years
AIDS
Lupus
significant obstructive pulmonary disease
fixed pulmonary hypertension

Question 4

What are absolute contraindications for lung transplants?

Answer 4

active malignancy w/in past 2 years
continued abuse of alcohol, tobacco or narcotics
HIV
significant chest wall or spinal deformity
Hep B antigen positivity
Hep C with liver disease
untreatable psychiatric condition
absence of support system

Question 5

What is an alternative to a lung transplant for patients with end-stage pulmonary disease?

Answer 5

lung volume reduction surgery (reduces the size of the lungs in patients with emphysema and decreased lung size help with thoracic distension and chest wall mechanics

Question 6

How long are lungs and hearts able to last before they have to be transplanted?

Answer 6

6 hours only-> so to be a match, has to be able to get to you within that timeframe

Question 7

What heart surgical technique is less commonly done but essentially keeps the old heart and adds in the new heart, piggyback technique?

Answer 7

heterotopic heart

Question 8

What heart transplant technique leaves the recipient node intact and the donor’s SA node operates independently leading to TWO SEPARATE P WAVES on an ECG?

Answer 8

biatrial heart transplant

Question 9

Which heart transplant surgical technique is more frequently used and has separate caval anastomoses sewn together?

Answer 9

bicaval technique

Question 10

T/F, lung transplants are transplanted one lung at a time

Answer 10

true, this decreases the need for cardiopulmonary bypass

Question 11

What are the three stages of immunosuppression?

Answer 11

induction
maintenance therapy
treatment of acute rejection

Question 12

What are the three main risks of having an organ transplant?

Answer 12

transplant issues
immunosuppression
recurrence of the original disease

Question 13

Which type of rejection occurs seconds to minutes after transplant due to pre-formed antibodies (ABO/Rh mismatch) which leads to organ death?

Answer 13

hyperacute rejection

Question 14

Which type of rejection occurs days to years after transplant and is due to cellular and humoral rejection and causes fever and graft tenderness and organ-related issues and is usually reversible?

Answer 14

acute rejection

Question 15

Which type of rejection occurs months to years after transplant (as early as 3 mo) and is slow progressive organ failure?

Answer 15

chronic rejection

Question 16

What is the term that describes when immunocompetent T-cells of donor origin recognize recipient as foreign (new organ attacking body)?

Answer 16

graft vs. host disease

Question 17

t/f, a postoperative heart transplant pt will demonstrate normal response to exercise

Answer 17

false, cardiac denervation occurs and leads to delayed reaction to stimulus of activity (requires adequate warm up and cool down to handle activities, and must use RPE scale)

Question 18

t/f, a pt will need to wear a mask when they leave their room post transplant

Answer 18

true

Question 19

Anyone who has had a live vaccine should not have contact with the patient for at least __ weeks post transplant

Answer 19

6