test 8 lung transplants

Question 1

History of Lung Transplantation

Answer 1

 First human lung transplant was done over 35 years ago at the University of Mississippi
 Patient with severe emphysema and carcinoma of L. Bronchus
 Died 18 days later of renal failure

Question 2

1986

Answer 2

 Stanford - First heart-lung transplant

 Toronto – First single lung transplant

Question 3

Wait times for single and double lung transplants

Answer 3

 Wait time for a single lung is more than 24 months, and 36 months for a double lung.

Question 4

Indications for a lung transplant

Answer 4

 Irreversible, progressively disabling, end-stage pulmonary disease
 Usually life expectancy is less than 18 months
 Oxygen dependent
 Exercise intolerance
 Less than 65 years old
 Poor quality of life

Question 5

Evaluation in what areas for lung transplants

Answer 5

 History
 Respiratory exam
 Past medical history
 Family history
 Psychosocial and cultural history

Question 6

Things affecting eligibility for lung transplants

Answer 6

 Osteoporosis
 Musculoskeletal disease
 Use of corticosteroids (>20mg/day)
 Malnutrition
 <70% or >130% ideal body weight
 Substance abuse/ addiction
 Smoking within 4 months of activation on the transplant list
 Psychosocial problems – high risk of poor outcome
 Mechanical ventilation
 Colonization of fungi
 Previous thoracotomy, sternotomy, scarring, etc.

Question 7

Types of Single Lung Transplants

Answer 7

 Right

 Left

Question 8

Types of Double Lung Transplants and other types

Answer 8

 En Bloc (both at the same time)
 Bilateral sequential
 Heart-lung block (heart and lungs together)
 Ex-Vivo Lung Transplant

Question 9

Single Lung Transplant patients have

Answer 9

 COPD/ Emphysema
 Idiopathic Interstitial Pulmonary Fibrosis
 Sarcoidosis
 Eosinophilic Granuloma
 Lymphangiolyomyomatosis
 Primary Pulmonary Hypertension
 Eisenmengers Syndrome with cardiac repair (KNOW THIS)

Question 10

Single lung transplant surgery

Answer 10

 Can be done on either side.
 Left side is easier because IVC and SVC are in the way
 No CPB is necessary – usually
 Depends on patient’s tolerance to unilateral support during cross clamp.
 Posterolateral thoracotomy through bed of excised 5th rib.
 Main PA is encircled and temporarily clamped
 Assess the impact on hemodynamic stability and gas exchange
 If not tolerated, femoral cannulation is used, and patient placed on CPB.

Question 11

Single lung transplant technique

Answer 11

 Usually stay warm
 Native lung is excised
 Left Atrium is clamped
 Pulmonary veins are attached to LA Cuff.
 PA is anastomosed
 End to end anastomosis of the donor and recipient bronchus
 Atrial clamp is removed.

Question 12

Reasons for Bilateral Sequential Double Lung Transplant

Answer 12

 Cystic Fibrosis
 Bronchiectasis
 Emphysema
 Primary Pulmonary Hypertension
 Eisenmenger’s Syndrome with cardiac repair
 Double lung transplant – gives patients a better pulmonary reserve

Question 13

en bloc for double lung transplant

Answer 13

 Used to be done en bloc where each lung was implanted separately through a pleural-pericardial window while on CPB.
 Utilized Clamshell incision
 BIG PAIN from a perfusion standpoint!!
- ON BYPASS

Question 14

Now the more common double lung transplant

Answer 14

• bilateral sequential.
   Like 2 single lung transplants.
   Ventilate the native lung, while the first goes in. Then ventilate the new lung while the second goes in.

Question 15

Ex Vivo Lung Perfusion

Answer 15

 Therapy applied to donor lungs outside the body before transplantation
 Improves organ quality
 Allows lungs that were previously unsuitable for transplantation – safe for transplantation.
 Expands donor pool

Question 16

Ex Vivo Lung Perfusion process

Answer 16

 3-4 hour procedure
 Donor lungs placed inside plastic dome
 Attached to ventilator, pump and filters
 Maintained at normal body temperatures
 Treated with a bloodless solution that contains nutrients, proteins, oxygen
 Reverse lung injury
 Remove excess water
 Once suitable – transplanted into waiting patient

Question 17

Ex Vivo Lung machine have

Answer 17

 Inline perfusate gas monitor
         pH, pO2
 Perfusate management system
         Add perfusate solution into ECC
 Pediatric hardshell reservoir
 Pall Leukocyte filter
 Quadrox iR Integrated
         CardioHelp
 Ventillator
 Heater cooler

Question 18

STEEN Solution – Ex Vivo Lung Perfusate

Answer 18

 Buffered extracellular solution
 Human Serum Albumin for optimal COP
 Dextran 40
 Coat and protect endothelium from leukocytes
 Maintains stable function up to 10 hours at normothermia