Lung transplant

Question 1

Patients with what diseases are likely to get lung transplants?

Answer 1

COPD
CF
ILD
Pulmonary hypertension
Covid 19

Question 2

Describe the window required for a patient to receive a lung transplant

Answer 2

Has to have enough function to benefit from a transplant

Question 3

Discuss how a patients reaction to treatments affects their chance to receive a transplant

Answer 3

Patients whose disease progresses despite optimization of their treatment indicating that despite treatment their condition will continue to degrade

Question 4

In order to receive a lung transplant, COPD patients cannot be a candidate for what?

Answer 4

They cannot be a candidate for endoscopic or lung volume reduction surgery

Question 5

What PaCO2 and/or PaO2 is needed for a COPD patient to be considered for lung transplantation?

Answer 5

PaCO2 > 50 mmHg
PaO2 < 60 mmHg

Question 6

What FEV1 should a COPD patient have in order to be considered for a lung transplant?

Answer 6

FEV1 < 25% predicted

Question 7

What should a COPD patients BODE index be in order to be considered for lung transplantation?

Answer 7

5-6
Indicates a 57% chance of surviving 4 years

Question 8

What does the BODE index predict?

Answer 8

4 year survival

Question 9

What are the components of the BODE index?

Answer 9

Body mass index
Airflow obstruction
Dyspnea
Exercise capacity

Question 10

What PaCO2 and PaO2 would a patient with CF have to have in order to qualify for lung transplant?

Answer 10

PaCO2 > 50 mmHg
PaO2 < 55 mmHg

Question 10

What kind of FEV1 would a patient with cystic fibrosis have in order to qualify for a lung transplant?

Answer 10

FEV1 of 30% or rapid decline in FEV1 despite optimal therapy

Question 11

What result on a 6 minute walk test would qualify a CF patient for a lung transplant?

Answer 11

< 400 m

Question 11

What clinical syndromes would increase a CF patients chance of recieving a lung transplant?

Answer 11

Acute respiratory failure requiring NIV
Increasing antimicrobial resistance with poor clinical recovery from exacerbations
Pneumothoraces
Life threatening hemoptysis

Question 12

What FVC and/or DLCO are required for an ILD patient to receive a lung transplant?

Answer 12

FVC < 80 %
DLCO < 40% of predicted

Question 13

What age and condition disqualifies a patient for lung transplant?

Answer 13

Age greater than 60
In need of multi-organ transplant

Question 13

What are contraindications for lung transplant?

Answer 13

Malignancy in the past 2 years
Untreateable advanced dysfunction of another major organ system

Question 14

What are other clinical features required for a patient with ILD to receive a lung transplant?

Answer 14

Dyspnea or functional limitation due to lung disease
Supplemental oxygen requirement

Question 15

What about CAD would disqualify a patient from a lung transplant?

Answer 15

Uncorrected atherosclerotic disease
With or suspected end organ ischemia or dysfunction
CAD not amenable to revascularization

Question 16

Evidence of what infection is a contraindication for lung transplant?

Answer 16

Evidence of active myobacterium tuberculosis

Question 17

What psychiatric conditions or mental attitudes could be considered a contraindication for lung transplant?

Answer 17

Psychiatric or psychological conditions that would result in the inability to cooperate with medical team or adhere to complex therapy
History of non-compliance with medical therapies

Question 18

What chest wall or spinal characteristics can be a contraindication for lung transplant?

Answer 18

Significant chest wall/spinal deformity that can cause restriction
Excessive obesity or malnutrition

Question 19

What are human leukocytes antigens

Answer 19

Proteins that are found on most cells of the body that the immune system identifies and uses to distinguish self vs not self

Question 20

What role do human leukocyte antigens play in organ transplants?

Answer 20

Blood samples are drawn from donor and recipient and analyzed for HLA types
The degree of mismatch is calculated to determine whether or not the host will reject the to donor tissue or whether or not immunosupressive therapy will be required

Question 20

Describe the match run system

Answer 20

An ordered list of transplant candidates is used to contact potential recipients and if the offer is declined they move on to the next available recipient

Question 20

Who is the local organ procurement organization?

Answer 20

Finger lakes donor recovery network

Question 21

What is the purpose of the lung composite allocation score?

Answer 21

The purpose of the score is to optimize lung allocations to appropriate candidates in an appropriate window
Balances prediction of waitlist survival with predictions of post transplant survival

Question 22

What are the 5 categories that determine the ordering of potential lung recipients in a match run?

Answer 22

Prioritizing medically urgent candidates
Improving post transplant outcomes
Reducing biological disadvantages
Promoting patient access
Promoting efficient management of the organ placement system

Question 23

What are the two methods for determining death preceeding a lung donation

Answer 23

Determination of neurologic death
Donation after circulatory determination of death

Question 24

Why are the medical team and the team responsible for obtaining permission for organ harvest

Answer 24

For piece of mind of the family
To insure that death has not been engineered for organ harvest

Question 25

How are patients monitored for primary graft dysfunction?

Answer 25

Their P/F ratio is calculated and they are monitored for pulmonary infiltrates

Question 26

What grade on the Pulmonary graft dysfunction test is correlated with an increased chance of 90 day mortality?

Answer 26

PGD of 3

Question 27

What are 4 risks that are followed particularly closely following a lung transplant?

Answer 27

Infection
Hypoxia
Aspiration
Thromboembolism