Transplant

Question 1

When to refer COPD patients for transplant evaluation?

Answer 1

FEV1 < 25%

Question 2

When to refer PAH patients for transplant evaluation?

Answer 2

NYHA III-IV, rapid progression, use of parenteral meds

Question 3

When to refer CF patients for transplant evaluation?

Answer 3

FEV1 < 30%, or rapidly declining

• NTM, DM, or B Cepacia complex
• 6MWT < 400m, or PH.

Question 4

Timeline of early vs late airway complications after transplant? What are the complications?

Answer 4

• <8 weeks: dehiscence

- >8 weeks: stenosis, bronchomalacia

Question 5

Biggest risk factor for developing chronic lung allograft dysfunction?

Answer 5

History of acute cellular rejection

Question 6

Biggest risk factor for developing acute cellular rejection of lung?

Answer 6

Decreased immunosuppression

Question 7

First sign of acute cellular rejection of the lung?

Answer 7

FEV1 decrease by 10% from baseline.

Question 8

TBBx of acute cellular rejection of the lung?

Answer 8

Perivascular lymphocytic infiltrate

Question 9

2 major phenotypes of CLAD (Chronic Lung Allograft Dysfunction)?

Answer 9

• BOA: Bronchiolitis Obliterans Syndrome

- RAS: Restrictive Allograft Syndrome

Question 10

Treatment of CLAD (Chronic Lung Allograft Dysfunction)?

Answer 10

• Avoid sustained, high steroids
• Azithromycin
• Fundoplication for GERD
• Total lymphoid irradiation
• Extracorporeal photophoresis
• Monteleukast
• Re-transplant

Question 11

Major cause for PTLD (post-Transplant Lymphoproliferative disorder)?

Answer 11

-HSV, VAV, EBV

Question 12

PPx for (CMV) after lung transplant?

Answer 12

valgancyclovir

Question 13

Treatment for PTLD (Post-Transplant Lymphoproliferative Disorder)?

Answer 13

Decrease immunosuppression, Rituxan, CHOP, Surgery/XRT

Question 14

Major toxicity of calcineurin-inhibitors used post lung transplant?

Answer 14

CKD

Question 15

Name 2 calcineurin hibitoris used post-lung transplant.

Answer 15

Tacrolimus, cyclosporin

Question 16

Name the DNA synthetase inhibitor used post lung transplant.

Answer 16

MMF

Question 17

Name the mTOR inhibitor used post lung transplant. What patient population is it good for?

Answer 17

Sirolimus. For patients w/ renal disease.

Question 18

What transplant consideration is important for CF?

Answer 18

Always a double lung transplant.

Question 19

Major toxicity of valgancyclovir used long-term (post lung transplant)?

Answer 19

Pancytopenias.

Question 20

What interaction do azoles and calcineurin hibitors have?

Answer 20

Increase calcineurin inhibitor levels.

-Azole is a CYP inhibitor