Lung Transplant

Question 1

What are the indications for a double lung transplantation?

Answer 1

Cystic fibrosis
Bronchiectasis
Pulmonary hypertension

Question 2

What are the indications for a single lung transplantation?

Answer 2

COPD, pulmonary fibrosis

Question 3

What are the indications for lung transplant?

Answer 3

Cardiopulmonary
1. Pulmonary hypertension
2. Eisenmenger’s syndrome (heart and lung transplant)

Chronic lung condition
3. Restriction lung disease - ILD
4. Obstructive lung disease - COPD, AAT
5. Suppurative - bronchiectasis, cystic fibrosis
6. Sarcoidosis

Question 4

What are the contraindications for lung transplant?

Answer 4

1. Disease specific guidelines
2. Old age
3. Presence of concomitant disease significantly shortening life expectancy
4. Contraindications to surgery/GA
5. Active smoker, alcoholic
6. Poor social support

Question 5

What are the complications of lung transplant?

Answer 5

1. Rejection
   - Acute: lymphocytic inflammation
   - Chronic: alloimmune inflammatory and non-alloimmune fibroproliferative, bronchiolitis obliterans
2. Graft dysfunction - reperfusion oedema in 1st week
3. Airway complications - dehiscence, stenosis, bronchomalacia
4. Infection - CMV, aspergillus, pneumonia

Question 6

How do you manage patient post-lung transplant?

Answer 6

1. Multidisciplinary approach, regular follow up, transplant coordinator
2. ISTs - CNI, purine synthesis antagonist, steroids
3. CMV and PCP prophylaxis