Lung Transplant

Question 1

Scar for double transplant

Answer 1

Clamshell thoracotomy

Question 2

Indications for lung transplant

Answer 2

COPD (single)
Cystic fibrosis (double)
Fibrosis (single)
Congenital (double and heart)

Prognosis from double is better

Question 3

What immunosuppression are double lung transplant patients typically taking

Answer 3

Combination of
- tacrolimus
- mycophenolate
- Steroid therapy

Prophylactic abx+aciclovir

Question 4

Complications of lung transplant

Answer 4

Bronchiolitis obliterans (typically terminal)
Bleeding
Bronchial stenosis
Infections
Rejections (acute/ chronic (BOS))
Immunosuppression ADRs (malignancy lymphoproliferative/ skin/ tremor/ renal impairment/ hypercholesterol/ HTN/ steriod side effects/ diabetes)

Question 5

Candidate for lung transplant

Answer 5

1. > 50% risk of death in 2 years without transplant
2. > 80% chance of survival at least 90 days
3. > 80% chance of 5 year survival from general medical perspective

sick enough to need one but well enough to survive if you get one

Question 6

Absolute contraindications for transplant

Answer 6

FATFUCK

Fat - BMI >35
Alcohol/ Addiction/ atherosclerosis
Treatment adherence (poor)
Failure of other organs
Unstable (septic)
Cigarettes/ cancer in last 5 years
Kyphosis (skeletal deformity)

Relative
- >60
- BMI >30/ <17
- Severe OP
- Burkholderia capacia colinisation

Question 7

Timing of referral differs depending on condition. which disorder has the worse prognosis where early referral should be considered

Answer 7

ILD