lecture 6? airway injury following lung transplantation Flashcards
1
Q
how does survival change after lung transplant?
A
- less early mortality
- long term survival is around 7 years after transplant
2
Q
why does survival after lung transplant decline faster?
A
- constantly exposed to environment
- vulnerable to pathogens inhaled etc.
3
Q
what is chronic lung allograft dysfunction (CLAD)?
A
- narrowing of bronchiolar lumen by fibrous tissue
- chronic rejection
4
Q
how many recipients develop CLAD within 3 years?
A
- 50%
- no improvements over last decade despite improving medicines
5
Q
how does FEV1 change after transplant?
A
- shows overall deterioration
- fixed airflow limitation
6
Q
what does this decreasing FEV1 after transplant lead to?
A
- bronchiolitis obliterans syndrome
7
Q
what is brochiolitis obliterans syndrome?
A
- chronic lung allograft dysfunction
- affects majority of lung transplant recipients
8
Q
what are the characteristics of BOS?
A
- dyspnea (shortness of breath)
- persistent progressive cough
- wheezing
- fatigue
9
Q
what pathology underlies BOS?
A
- obliterative bronchiolitis (inflammatory cell fibrosis)
- blockage of airways so no air flow to lungs
10
Q
how does the response to injury lead to BOS?
A
- rejection due to aspiration/ infection
- neutrophil production to protect
- epithelial damage occurs
- causes airway remodelling
- fixed airway obstruction
11
Q
what is airway remodelling?
A
- change in structure and airflow of the lungs
12
Q
what methods are used to diagnose and test for BOS?
A
- flexible fibrotic bronchoscopy
- bronchioalveolar lavage
13
Q
what is a biopsy?
A
- small amount of tissue taken for analysis and diagnosis
14
Q
what is a bronchialveolar lavage?
A
- minimally invasive procedure
- tests for lung disease
- bronchoscope passed through mouth or nose
- measured amount of fluid collected for examination
15
Q
what does aspiration of reflux cause?
A
- pneumonia