Thoracic Organ Transplantation

Question 1

Types of cardiopulmonary transplants:

Answer 1

heart
heart-lung
lung

Question 2

Candidate for heart transplant:

Answer 2

majority due to CAD, myocardial damage, cardiomyopathy

Question 3

Majority of lung transplant due to:

Answer 3

emphysema

Question 4

Majority of repeat transplant due to:

Answer 4

failure/rejection

Question 5

Indications for heart transplant:

Answer 5

end stage heart disease
CAD
cardiomyopathy
congenital heart disease

Question 6

Indications for lung transplant:

Answer 6

Chronic obstructive pulmonary disease 
BODE index of 7-10 and any of the following:
hx of hypercapnia
pulmonary hypertension
cor pulmonale
FEV1 of 20%

Question 7

Indications for repeated transplant:

Answer 7

severe acute rejection
transplant CAD
graft failure
intractable airway problems
brochiolitis obliterans

Question 8

Absolute contraindications for cardiac transplant:

Answer 8

systemic illness with left expectancy less than 2 years
active/recent solid organ or blood malignancy within 5 years
AIDS
Lupus, sacroid, amyloidosis
fixed pulmonary hypertension
pulmonary artery systolic pressure greater than 60mmHg

Question 9

Relative contraindications for cardiac transplant:

Answer 9

age over 72
active infections
active peptic ulcer disease
severe diabetes w/organ damage
server peripheral vascular or cerebrovascular disease 
ABI less than 0.7

Question 10

Absolute contraindications for lung transplant:

Answer 10

active malignancy within last 2 years
Alcohol or narcotic abuse
HIV
Hep B and C
compliance
absence of support
chest wall or spinal deformity

Question 11

Relative contraindication for lung transplant:

Answer 11

symptomatic osteoporosis
65 or older
poor rehab potential
Obesity

Question 12

Factors affecting UNOS ranking:

Answer 12

tissue match, blood type, length of time on list, immune status, distance between potential recipient and donor

Question 13

1A status for adults:

Answer 13

Has one of the following:
total artificial heart
intraaortic balloon pump
extracorporeal membran oxygenator

Question 14

1A status for children:

Answer 14

mechanical ventilator
mechanical assist device
extracorporeal membrane oxygenation
balloon pump
congenital/acquired heart disease
life expectancy less than 14 days w/out transplant

Question 15

1A (re-certified every 7 days) status for adults:

Answer 15

continuous infusion of single high dose IV inotrope or multiple IV inotropes and required continuous hemodynamic monitoring of left ventricular filling pressure

Question 16

1A (only 30 days)

Answer 16

One of following:
lVAD
RVAD
BiVAD

Question 17

1A (every 14 days)

Answer 17

mechanical and circulatory support and device elated complications

Question 18

1B for adults

Answer 18

LVAD or RVAD
BiVAD
continuous infusion of intravenous inotropes

Question 19

1B for children

Answer 19

infusion of low dose single inotrope

6 months or younger

Question 20

2

Answer 20

Does not met higher criteria but suitable for transplant

Question 21

Inactive

Answer 21

Temporarily unsuitable for transplant

Question 22

Components of lung allocation score:

Answer 22

DOB
height and weight
lung diagnosis
functional status
diabetes
assisted ventilation
supplemental O2
MAP
6 minute walk distance

Question 23

Pulmonary Rehab recommendation:

Answer 23

minimum of 20 sessions three times/week or two times/week plus home
high intensity when possible
interval training
UE and LE training
endurance and strength
inspiratory muscle training

Question 24

Goal of preoperative rehab:

Answer 24

improve or prevent deteriorations of candidate’s physical condition
Endurance activities – limited to minimal levels of exertion or ADLs
30-40 min, 3-5x/wk

Question 25

Why Alternative Therapies

Transplant Unsuitability

Answer 25

Did not meet criteria for organ system failure
Contraindications limits potential for success
Dec overall benefits for the pt
Pt opted for more conservative surgical or medical management

Question 26

Alternatives for Lung Transplant:

LVRS – Lung Volume Reduction Surgery

Answer 26

20-30% of volume of each lung is removed

Goal improve thoracic distention & chest wall mechanics

Question 27

Alternatives for Lung Transplant:

Noninvasive ventilation or BiPAP

Answer 27

Tightly fitting nasal mask

Deliver positive airway pressure during inspiration & exhalation

Question 28

Who is noninvasive ventilation or BiPAP indicated for?

Answer 28

pts with signs of respiratory failure despite max drug & O2 therapy

Question 29

Alternative Therapies to Heart Transplant

Answer 29

VAD
Home IV pharmacological mangement
cardiomyoplasty

Question 30

Most common VAD until transplant?

Answer 30

LVAD

Question 31

Harvest of Donor Lungs

Answer 31

Pulmonary veins are detached from heart with cuff of left atrium
Pulmonary arteries are transected
Lungs removed en bloc, divided into separate right and left lungs

Question 32

Heterotopic heart transplantation (HHT) – “piggyback”

Answer 32

Pt heart is not removed

Donor heart is connected via R/L atria

Question 33

Orthotopic/biatrial technique

Answer 33

Recipient’s SA node is left intact,
Donor & recipient’s atrial cuffs are sewn together
2 P-waves on ECG

Question 34

Signs and Symptoms of acute rejection:

Answer 34

low grade fever
increase in resting BP
hypotension with activity
myalgia
fatigue
decrease exercise tolerance
ventricular dyshythmias