LUNG TRANSPLANT

Question 1

What is the predominant reason for lung transplantation?

Answer 1

COPD

Question 2

When is lung transplantation considered?

Answer 2

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

Question 3

What are some advantages of single-lung transplantation?

Answer 3

Shorter extubation time
Less need for cardiopulmonary bypass
Shorter hospitalization

Question 4

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

Answer 4

Lung hyperinflation

due to graft compression by the hyperinflated native lung.

Question 5

What is a graft in lung transplantation?

Answer 5

The donated lung or transplanted lung

Question 6

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

Answer 6

Double-lung transplantation

Question 7

What are the general indications for lung transplantation?

Answer 7

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

Question 8

What are the types of lung donors?

Answer 8

Living donors who may donate part of their lungs

Cadaver donors (Brainstem dead)

Question 9

What criteria must a donor meet for lung transplantation?

Answer 9

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.

Question 10

What is the recipient selection criteria for lung transplantation?

Answer 10

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.

Question 11

What does maintenance immunosuppression consist of?

Answer 11

3C

Corticosteroids

Calcineurin inhibitors (cyclosporin or tacrolimus)

Cell-cycle inhibitor (mycophenolate mofetil or azathioprine)

Question 12

Lung transplantation is viable option for those with?

Answer 12

End stage pulmonary disease without end stage cardiac disease.

Question 13

This type of lung transplantation is can be done simultaneously.

Answer 13

End block

Question 14

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

Answer 14

Sequential

Question 15

Complications post-transplant

Answer 15

LIT

Lung hyperinflation

Infection

Transplant rejection

Question 16

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”.

Answer 16

Acute rejection

Question 17

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

Answer 17

Chronic rejection

Question 18

Predisposing factors that leads to chronic rejection

Answer 18

HLA
GERD
Concordance with immunosupression
Infection

Question 19

Most common form of chronic rejection

Answer 19

Bronchiolitis Obliterans Syndrome (BOS)

• manage by macrolide antibiotic: Azithromycin

Question 20

Rejection is diagnosed by

Answer 20

Trans-bronchial Biopsy