LUNG TRANSPLANT Flashcards

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1
Q

What is the predominant reason for lung transplantation?

A

COPD

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2
Q

When is lung transplantation considered?

A

Patient’s risk of mortality is greater than 50% within the next 2 years.

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3
Q

What are some advantages of single-lung transplantation?

A

Shorter extubation time
Less need for cardiopulmonary bypass
Shorter hospitalization

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4
Q

What is the most common complication of single-lung transplantation?

A

Lung hyperinflation

due to graft compression by the hyperinflated native lung.

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5
Q

What is a graft in lung transplantation?

A

The donated lung or transplanted lung

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6
Q

What is the preferred surgical procedure for patients with CF or bronchiectasis?

A

Double-lung transplantation

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7
Q

What are the general indications for lung transplantation?

A

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

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8
Q

What are the types of lung donors?

A

Living donors who may donate part of their lungs

Cadaver donors (Brainstem dead)

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9
Q

What criteria must a donor meet for lung transplantation?

A

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.

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10
Q

What is the recipient selection criteria for lung transplantation?

A

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.

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11
Q

What does maintenance immunosuppression consist of?

A

3C

Corticosteroids

Calcineurin inhibitors (cyclosporin or tacrolimus)

Cell-cycle inhibitor (mycophenolate mofetil or azathioprine)

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12
Q

Lung transplantation is viable option for those with?

A

End stage pulmonary disease without end stage cardiac disease.

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13
Q

This type of lung transplantation is can be done simultaneously.

A

End block

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14
Q

In this type of lung transplantation, the lung is transplanted one after the other.

A

Sequential

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15
Q

Complications post-transplant

A

LIT

Lung hyperinflation

Infection

Transplant rejection

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16
Q

This occurs often within first 3 months after transplantation. In this type of rejection, rapid cell or antibody-driven immune attack the lung allograft. This, however, responds to temporary increase in the potency of immunosuppresion “Augmentation”.

A

Acute rejection

17
Q

This type of rejection is also known as chronic lung allograft dysfunction. Progressive loss of graft function with scarring occurs.

A

Chronic rejection

18
Q

Predisposing factors that leads to chronic rejection

A

HLA
GERD
Concordance with immunosupression
Infection

19
Q

Most common form of chronic rejection

A

Bronchiolitis Obliterans Syndrome (BOS)

  • manage by macrolide antibiotic: Azithromycin
20
Q

Rejection is diagnosed by

A

Trans-bronchial Biopsy