Lung Transplant

Question 1

2014 ISHLT for recipient selection criteria?

Answer 1

> 50% of death from lung dz if transplant not performed.
80% likelihood of survival 90 days after txp.
80% likelihood of 5 yr post-txp from medical perspective.

Question 2

Can lung transplant be offered in pts w/ recent malignancy?

Answer 2

No. A 2-year disease-free interval combined with a low predicted risk of cancer recurrence after lung transplantation may be reasonable.
5-year disease-free interval is prudent in most cases, particularly for patients with a history of hematologic malignancy, sarcoma, melanoma, or cancers of the lung, breast, bladder, or kidney.

Question 3

Can lung txp be offered if untreatable significant dysfunction of another major organ exists?

Answer 3

Only if combined organ transplant can be performed.

Question 4

Can lung txp be performed if uncorrectable atherosclerotic disease w/ end-organ ischemia exists?

Answer 4

No. Has to be amenable to revascularization.

Question 5

Can a patient with acute sepsis get lung txp?

Answer 5

No. Includes chronic infection with highly virulent or resistant microbes. Includes active TB.

Question 6

What is the BMI cutoff for lung txp?

Answer 6

35.

Even being overweight (BMI 25) has shown to double rates of severe PGD.

Question 7

A patient has significant chest wall or spinal deformity expected to cause severe resp restriction after lung transplantation. Can they get lung txp?

Answer 7

Not if it is uncorrectable.

Question 8

Discuss management of substance abuse/dependence in listing lung txp patients.

Answer 8

In many cases, convincing evidence of risk reduction behaviors, such as meaningful and/or long-term participation in therapy for substance abuse and/or dependence, should be required before offering lung transplantation. Serial blood and urine testing can be used to verify abstinence from substances that are of concern.