Lung Transplantation

Question 1

When do you refer to lung transplant for COPD and A1AT?

Answer 1

Question 2

When do you refer to lung transplant for cystic fibrosis?

Answer 2

Question 3

When do you refer to lung transplant for IPF?

Answer 3

Question 4

When do you refer to lung transplant for PAH?

Answer 4

Question 5

Suppurative lung diseases, such as CF and bronchiectasis always require BLT rather than SLT.

Question 6

Colonization with what organism is a relative contraindication to lung transplantation in patients with CF?

Answer 6

Burkholderia cenocepacia

Question 7

What are the major benefits of SLT vs. BLT?

Answer 7

Reduced operative time and complexity.

Reduced ischemic time.

Potentially reduced risk of surgical morbidity in some patients.

Potentially shorter waiting list time.

SLT: shorter ischemia/operative time, possibly shorter waiting list time, and more efficient use of limited organ supply. BLT: improved long-term outcome and life expectancy.

Question 8

Most transplant recipients eventually have at least some degree of chronic kidney disease attributed to the chronic nephrotoxic effects of calcineurin inhibitor therapy.

Question 9

Which immunosuppressive agent is most likely to cause poor wound healing and anastomotic dehiscence?

Answer 9

Sirolimus

Question 10

Which immunosuppressive agents are known to cause thrombotic microangiopathy (TMA)?

Answer 10

Tacrolimus and cyclosporine (calcineurin inhibitors). Neurotoxicity is also common with both agents.

Question 11

Which immunosuppressive agent can cause pancreatitis and cholestatic hepatitis?

Answer 11

Azathioprine

Question 12

If the patient shown in Figure 9-2 has 60% FiO2 with a PaO2 of 90 on posttransplant day 2, does this patient have PGD?

Answer 12

Yes, PGD grade 3

Question 13

Question 14

The most important risk factor for chronic rejection is acute rejection.

Question 15

What is the leading cause of posttransplant mortality after the first year?

Answer 15

Bronchiolitis obliterans syndrome

Question 16

True or False. BOS can be diagnosed with transbronchial biopsies.

Answer 16

False. Unlike AR, transbronchial biopsy has low sensitivity for diagnosing BOS and is used primarily to exclude other diagnoses.

Question 17

CMV is the most common viral infection after lung transplantation.

Question 18

Use of azoles, such as voriconazole, can significantly increase cyclosporine and tacrolimus levels.

Question 19

What is the most important risk factor for CMV infection in posttransplant patients?

Answer 19

Donor seropositivity and recipient seronegativity for CMV

Question 20

What is the first-line therapy for Post transplant lymphoproliferative disorder?

Answer 20

Reduction in immunosuppression

Question 21

The average 5-year survival rate after lung transplant is about 50%.

Answer 21