Lung Transplant Flashcards
List 8 Contraindications to lung transplant
- Non operable organ failure, athlersclerotic disease not amenable to revascularization
- Active TB
- untreated HIV
- Active Cancer or less than 2 years
- Uncontrolled psychiatric disease
- uncontrolled substance abuse, active smoking
- Limited functional status unable to participate in rehabilitation program
- absent or inadequate social support
Good answers, Uncorrectable bleeding diasthesis, BMI >35, Hx of Non-adherance, chest wall deformity leading to restriction post transplant
List 5 indications for Lung transplant listing in COPD
- BODE score of 7-10 (18% 4 year survival)
- FEV1 <15%
- 3 severe exacerbations in the last year
- Hypercardbic resp failure
- Moderate to severe PH
List 4 indications for Transplant referral in COPD
- BODE 5-6 (57% 4 year survival)
- PaCO2 >50 or PaO2 <60
- FEV1 <25%
- Progressive dsiease despite rehab, O2, medications
* must not be a LVRS candidate
Name the components of the BODE index
B - BMI (>21, <21)
O - obstruction ( FEv1 >65, 50-64, 36-49,<35)
D- Dyspnea MMRC level
E- exercise capacity (6MWD), >350m or <149
Name 6 relative contraindications to lung transplant
- BMI <18 or malnutrition
- BMI >30
- Age >65
- Colonization with highly resistant organism
- severe osteoporosis
- limited functional status
* other answers previous thoracic surgery
What are the predictors of early death post lung transplant
Age >65
Bleeding during surgery, need 20U
Prolonged CP bypass
Pleurodesis
In what situations is ECLS (ecmo) not recommended as a bridge to transplant
Septic shock
Multi organ failure
HIT
advanced age
obesity
List 3 referral and 3 listing criteria for transplant for ILD
Referral
- UIP or fibrosing NSIP at dx
- FVC <80%, DLCO <40 - rapidly progressive disease
- Hypoxic
listing
- PH
- Hospitalized with resp decline, AE
- Pneumothorax
Others: Decline in FVC >10% over 6m
2. Decline in DLCO >15% in 6 months
List 8 criteria for lung transplant referral in CF/ NCF bronchiectasis
- Fev1 < 30%, or rapid decline
- Pulmonary hypertension
- 6mWD <400m
- Exacerbations associated with NIV
- Pneumothorax
- Life threatening hemoptysis,
- Worsening nutritional status
- Increasing frequency of exacerbations
List 5 criteria for lung transplant listing in CF
- Chronic resp failure
- Long term NIV
- Pulm hypertention
- Freq hospitalizations
- rapid lung functional decline
*who class 4-5 symptoms
List factors that increase mortality in CF lung transplant recipients
NTM/ MAC
Burkolderia cenocepacia
Malnutrition
List 3 referral and 3 listing criteria for Pulmonary arterial hypertention
- NYHA 3 not responding to therapy
- rapidly progressive disease
- Use of riociguat or any IV therapy
listing
- Progressive symptoms unresponsive to >3 months combo
- therapy CI<2
- . RAP >15
Others : 6MWD <350; Hemoptysis
In which diseases does lung transplant confer a survival benefit?
CF, IPF, IPAH
Name 6 acute complications post lung transplant
- Primary graft dysfunction (ischemia -reperfusion)
- Myocardial infarction
- Intra-operative hemorrhage
- Phrenic nerve injury
- Venous thromboembolism
- complications of CP bypass such as cerebral ischemia
*others: Acute allograft rejection, native lung hyperinflation in single lung transplant ; airway complications
List 6 long term complications post DLTX
- Chronic lung allograft dysfunction
- Chronic rejection
- Infection
- Lung cancer, skin cancer
- recurrence of primary disease
- PTLD
* medication adverse effects - CKD, osteoporosis, PRES
