LUNG TRANSPLANT Flashcards
What is the predominant reason for lung transplantation?
COPD
When is lung transplantation considered?
Patient’s risk of mortality is greater than 50% within the next 2 years.
What are some advantages of single-lung transplantation?
Shorter extubation time
Less need for cardiopulmonary bypass
Shorter hospitalization
What is the most common complication of single-lung transplantation?
Lung hyperinflation
due to graft compression by the hyperinflated native lung.
What is a graft in lung transplantation?
The donated lung or transplanted lung
What is the preferred surgical procedure for patients with CF or bronchiectasis?
Double-lung transplantation
What are the general indications for lung transplantation?
ALEP
Advanced lung disease (WHO functional class III or IV)
Lung diseases that is progressive and refractory even to maximum medical treatment
Estimated survival chance of <50% in 2 years without transplantation
Patient understanding of risks and responsibilities
What are the types of lung donors?
Living donors who may donate part of their lungs
Cadaver donors (Brainstem dead)
What criteria must a donor meet for lung transplantation?
ANSAP BVAD
Age <65 years
Smoking history <20 pack-years
No significant lung diseases,
Acceptable CXR (Clear)
PaO2/FiO2 > 300 mmHg on PEEP of 5cm H2O
Bronchoscopy (Clear)
Viral studies are negative (HIV, Hepatitis B & C),
ABO matched
Donor-recipient size matching.
What is the recipient selection criteria for lung transplantation?
EASSE
End-stage pulmonary disease with life expectancy < 2 years
Absence of severe extra pulmonary disease
Strong motivation towards the idea of transplantation
Severe functional limitation, but potential for rehabilitation
Excellent psychosocial support.
What does maintenance immunosuppression consist of?
3C
Corticosteroids
Calcineurin inhibitors (cyclosporin or tacrolimus)
Cell-cycle inhibitor (mycophenolate mofetil or azathioprine)
Lung transplantation is viable option for those with?
End stage pulmonary disease without end stage cardiac disease.
This type of lung transplantation is can be done simultaneously.
End block
In this type of lung transplantation, the lung is transplanted one after the other.
Sequential
Complications post-transplant
LIT
Lung hyperinflation
Infection
Transplant rejection