Lecture 7 - CLAD With Extra Resarch Flashcards
What did Vos R et al provide?
An overview of the clinical effects on Axzithromycin in the setting of BOS after transplant
What are the symptoms of BOS?
Cough and dysponea
What did Vos R et al conclude?
The acceptance of the dichotomy can improve the understanding of the pathological condition towards BOSe encouring a more accurate diagnosis
What is rejection? - American thoracic society
A process where your bodies immune system attacks the transplanted lung recognising it to be different from own tissue
What is acute cellular rejection - American thoracic society?
The most common form of rejection - in the first year following the transplant about 30% of patients will have at least one episode of acute rejection.
What is acute cellular rejection define as?
The body’s T cells attacking the donor lung directly - American thoracic society
What is CLAD - chronic lung allograft dysfunction
Persist inflammation from the immune system over time causing scarring in the lungs - normally happens after 1 year after lung transplant
What are the two distinct groups of CLAD? - Byrne D et al
Obstructive chronic lung allograft dysfunction (BOS) and Restrictive CLAD
What are the characteristics of CLAD?
Decline in FEV1 and phrenic nerve damage
When was the first lung transplant?
1986
What is chronic rejection?
T cell and B cell mediated rejection of the non self lung
What percent of people that had lung transplant developed CLAD within the first 3 years?
50%
What are the proteins after transplant?
Fixed air limitation, FEV1 below 80% = BOS, after a year FEV1 is 40%
What are the airways blocked with?
Inflammatory cells and scar tissue
What is needed for rejection?
Immunosuppression
What happens if you injure the airways?
You will get scar tissue and epithelial damage will remodel the airways
What happens in airway remodelling?
Structural changes in the lungs and airways which means airflow will change
What are the methods used to diagnose CLAD?
Brush cultures and biopsies
What is gastroparesis?
Slowing down of gastric emptying
What are people treated with if they have had a lung transplant and are vulnerable to reflux and aspiration?
They are treated with proton pump inhibitors
What can aspiration leads to?
Inflammation, epithelial damage and fibrosis
What is used as a marker for aspiration?
Pepsin
More reflux =
More inflammation
What is the lavage like from a lung transplant recipient?
Contains pseudomonas positive - can form a biofilm which is very hard for antibiotics to eradicate. Get antibiotic resistance infection in the lungs
What is the link between aspiration and infection of lung allografts? - science direct.com
Following transplantation vagal damage may lead to delayed gastric emptying and distal oesophageal dysmotility, promoting reflux
How do proton pump inhibitors reduce gastric acidity? - science direct.com
By irreversibly binding to the hydrogen potassium ATP pump on parietal cell apical membrane. But they don’t prevent fully as pepsin and bile acids are still seen
