Transplant Flashcards
When to refer COPD patients for transplant evaluation?
FEV1 < 25%
When to refer PAH patients for transplant evaluation?
NYHA III-IV, rapid progression, use of parenteral meds
When to refer CF patients for transplant evaluation?
FEV1 < 30%, or rapidly declining
- NTM, DM, or B Cepacia complex
- 6MWT < 400m, or PH.
Timeline of early vs late airway complications after transplant? What are the complications?
- <8 weeks: dehiscence
- >8 weeks: stenosis, bronchomalacia
Biggest risk factor for developing chronic lung allograft dysfunction?
History of acute cellular rejection
Biggest risk factor for developing acute cellular rejection of lung?
Decreased immunosuppression
First sign of acute cellular rejection of the lung?
FEV1 decrease by 10% from baseline.
TBBx of acute cellular rejection of the lung?
Perivascular lymphocytic infiltrate
2 major phenotypes of CLAD (Chronic Lung Allograft Dysfunction)?
- BOA: Bronchiolitis Obliterans Syndrome
- RAS: Restrictive Allograft Syndrome
Treatment of CLAD (Chronic Lung Allograft Dysfunction)?
- Avoid sustained, high steroids
- Azithromycin
- Fundoplication for GERD
- Total lymphoid irradiation
- Extracorporeal photophoresis
- Monteleukast
- Re-transplant
Major cause for PTLD (post-Transplant Lymphoproliferative disorder)?
-HSV, VAV, EBV
PPx for (CMV) after lung transplant?
valgancyclovir
Treatment for PTLD (Post-Transplant Lymphoproliferative Disorder)?
Decrease immunosuppression, Rituxan, CHOP, Surgery/XRT
Major toxicity of calcineurin-inhibitors used post lung transplant?
CKD
Name 2 calcineurin hibitoris used post-lung transplant.
Tacrolimus, cyclosporin
Name the DNA synthetase inhibitor used post lung transplant.
MMF
Name the mTOR inhibitor used post lung transplant. What patient population is it good for?
Sirolimus. For patients w/ renal disease.
What transplant consideration is important for CF?
Always a double lung transplant.
Major toxicity of valgancyclovir used long-term (post lung transplant)?
Pancytopenias.
What interaction do azoles and calcineurin hibitors have?
Increase calcineurin inhibitor levels.
-Azole is a CYP inhibitor
