STS E Book - Lung Transplant Flashcards
2014 ISHLT for lung transplant recipient selection criteria?
> 50% of death from lung dz if transplant not performed.
80% likelihood of survival 90 days after txp.
80% likelihood of 5 yr post-txp from medical perspective.
Can lung transplant be offered in pts w/ recent malignancy?
No.
2-year disease-free interval combined with a low predicted risk of cancer recurrence after lung transplantation may be reasonable.
5-yeardisease-free interval is prudent in most cases, particularly for patients with a history of hematologic malignancy, sarcoma, melanoma, or cancers of the lung, breast, bladder, or kidney.
Can lung txp be offered if untreatable significant dysfunction of another major organ exists?
Only if combined organ transplant can be performed.
Can lung txp be performed if uncorrectable atherosclerotic disease w/ end-organ ischemia exists?
No. Has to be amenable to revascularization.
Can a patient with acute sepsis get lung txp?
No. Includes chronic infection with highly virulent or resistant microbes. Includes active TB.
What is the BMI cutoff for lung txp?
35.
Even being overweight (BMI 25) has shown to double rates of severe PGD.
A patient has significant chest wall or spinal deformity expected to cause severe resp restriction after lung transplantation. Can they get lung txp?
Not if it is uncorrectable.
Discuss management of substance abuse/dependence in listing lung txp patients.
In many cases, convincing evidence of risk reduction behaviors, such as meaningful and/or long-term participation in therapy for substance abuse and/or dependence, should be required before offering lung transplantation. Serial blood and urine testing can be used to verify abstinence from substances that are of concern.