Lung transplant Flashcards
Patients with what diseases are likely to get lung transplants?
COPD
CF
ILD
Pulmonary hypertension
Covid 19
Describe the window required for a patient to receive a lung transplant
Has to have enough function to benefit from a transplant
Discuss how a patients reaction to treatments affects their chance to receive a transplant
Patients whose disease progresses despite optimization of their treatment indicating that despite treatment their condition will continue to degrade
In order to receive a lung transplant, COPD patients cannot be a candidate for what?
They cannot be a candidate for endoscopic or lung volume reduction surgery
What PaCO2 and/or PaO2 is needed for a COPD patient to be considered for lung transplantation?
PaCO2 > 50 mmHg
PaO2 < 60 mmHg
What FEV1 should a COPD patient have in order to be considered for a lung transplant?
FEV1 < 25% predicted
What should a COPD patients BODE index be in order to be considered for lung transplantation?
5-6
Indicates a 57% chance of surviving 4 years
What does the BODE index predict?
4 year survival
What are the components of the BODE index?
Body mass index
Airflow obstruction
Dyspnea
Exercise capacity
What PaCO2 and PaO2 would a patient with CF have to have in order to qualify for lung transplant?
PaCO2 > 50 mmHg
PaO2 < 55 mmHg
What kind of FEV1 would a patient with cystic fibrosis have in order to qualify for a lung transplant?
FEV1 of 30% or rapid decline in FEV1 despite optimal therapy
What result on a 6 minute walk test would qualify a CF patient for a lung transplant?
< 400 m
What clinical syndromes would increase a CF patients chance of recieving a lung transplant?
Acute respiratory failure requiring NIV
Increasing antimicrobial resistance with poor clinical recovery from exacerbations
Pneumothoraces
Life threatening hemoptysis
What FVC and/or DLCO are required for an ILD patient to receive a lung transplant?
FVC < 80 %
DLCO < 40% of predicted
What age and condition disqualifies a patient for lung transplant?
Age greater than 60
In need of multi-organ transplant
What are contraindications for lung transplant?
Malignancy in the past 2 years
Untreateable advanced dysfunction of another major organ system
What are other clinical features required for a patient with ILD to receive a lung transplant?
Dyspnea or functional limitation due to lung disease
Supplemental oxygen requirement
What about CAD would disqualify a patient from a lung transplant?
Uncorrected atherosclerotic disease
With or suspected end organ ischemia or dysfunction
CAD not amenable to revascularization
Evidence of what infection is a contraindication for lung transplant?
Evidence of active myobacterium tuberculosis
What psychiatric conditions or mental attitudes could be considered a contraindication for lung transplant?
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
What chest wall or spinal characteristics can be a contraindication for lung transplant?
Significant chest wall/spinal deformity that can cause restriction
Excessive obesity or malnutrition
What are human leukocytes antigens
Proteins that are found on most cells of the body that the immune system identifies and uses to distinguish self vs not self
What role do human leukocyte antigens play in organ transplants?
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
Describe the match run system
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
Who is the local organ procurement organization?
Finger lakes donor recovery network
What is the purpose of the lung composite allocation score?
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
What are the 5 categories that determine the ordering of potential lung recipients in a match run?
Prioritizing medically urgent candidates
Improving post transplant outcomes
Reducing biological disadvantages
Promoting patient access
Promoting efficient management of the organ placement system
What are the two methods for determining death preceeding a lung donation
Determination of neurologic death
Donation after circulatory determination of death
Why are the medical team and the team responsible for obtaining permission for organ harvest
For piece of mind of the family
To insure that death has not been engineered for organ harvest
How are patients monitored for primary graft dysfunction?
Their P/F ratio is calculated and they are monitored for pulmonary infiltrates
What grade on the Pulmonary graft dysfunction test is correlated with an increased chance of 90 day mortality?
PGD of 3
What are 4 risks that are followed particularly closely following a lung transplant?
Infection
Hypoxia
Aspiration
Thromboembolism
