Thoracic Organ Transplantation Flashcards
Primary indication for transplant
terminal cardiopulmonary disease with limited life expectancy
Heart transplantations performed as a result of
- coronary artery disease
- myocardial damage
- cardiomyopathy
what is cardiomyopathy
a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body
1 Lung transplantations performed as a result of
- Emphysema & COPD
- Idiopathic pulmonary fibrosis
Double lung transplant increases survival rate to what
to 65 years old
therefore it is reserved for younger pt
Congenital heart disease
are present at birth and can affect the structure of a baby’s heart and the way it works
NYHA class III–IV despite maximal therapy such as the following
- Medication
- Pacing (CRT)
- Revascularization or valve repair
- Ventricular remodeling procedure
- Recurrent hospitalization for heart failure
- Refractory ischemia and EF <20%
Idiopathic pulmonary fibrosis
a condition in which the lungs become scarred and breathing becomes increasingly difficult
Indications for Lung Transplantation
COPD
Idiopathic pulmonary fibrosis
Cystic fibrosis
Idiopathic pulmonary arterial hypertension
Sarcoidosis
Sarcoidosis
a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body
Idiopathic pulmonary arterial hypertension
a rare disease characterized by elevated pulmonary artery pressure with no apparent cause
Cystic fibrosis
Cystic fibrosis affects the cells that produce mucus, sweat, and digestive juices. It causes these fluids to become thick and sticky. They then plug up tubes, ducts, and passageways.
primary physician who must consider what when thinking of transplant
health status of the patient vs the average time spent on the waiting list
transplant center refferals
If put on waiting list – must re-evaluate every 6 months for status changes
Tests and Procedures before being put on the weight list
Required examination and assessment for transplant candidacy or waitlist placement
lung assessment
cardiac assessment
lab test
bone density scan
Cardiac transplantation Absolute Contraindications
Systemic illness with a life expectancy <2 years despite HT
Physical therapist role in the transplant team
Exercise tolerance test and exercise prescription Musculoskeletal assessment
Cough/mucociliary clearance
PT and lung transplant candidates need to test what
eed to assess efficacy of airway clearance techniques
Primary pulmonary hypertension and exercises
Exercise may be contraindicated in patients with primary pulmonary hypertension as it may aggravate the condition
Factors affecting ranking on the transplant list
tissue match, blood type, length of time on list, immune status, distance between potential recipient and donor
Status 1A HT days
50 days
Status 1B HT days
78 days
Status 2 HT days
309 days
lung transplant 12 and younger are ranked by what
Recipients 12 years or younger are ranked first by ABO blood status
lung transplant older then 12 ranked by what
Other candidates are provided a Lung Allocation Score (LAS)
* score from 0 to 100 and are reassessed every 6 months
training effects in transplantation candidates
Research supports significant training effects in transplantation candidates
Components of rehab for transplant pt include
patient and family education, cardiovascular endurance training, musculoskeletal strength and flexibility training, breathing retraining
Goal of Preoperative Rehabilitation
Goal to improve or prevent deteriorations of candidate’s physical condition, improve exercise tolerance
what guidelines do you use for Preoperative Rehabilitation
hemodynamic guidelines
what is the purpsoe of Left ventricular assist device (LVAD)
is used to “bridge” the
patient to heart transplant leads to improved performance
Preoperative Rehabilitation how much
Most patients are able to participate in exercise 30 to 40 minutes three to five times per week
why use ECMO as a Bridge to Transplant
Some pre–lung transplant patients who must avoid or are failing ventilatory support
what kind of ECMO is used to bridge to transplant
- Venovenous (VV) ECMO is used for respiratory failure
- Venoarterial (VA) ECMO is used for circulatory collapse due to pulmonary hypertension
