Transplant

Question 1

What is the criteria for transplant in COPD?

Answer 1

stopped smoking for >6months
FEV1<20% despite maximal medical therapy
PR complete
increasing exacs with raised CO2
PHTN
BODE >7

Question 2

What is the criteria for transplant in CF?

Answer 2

FEV1 <30% or rapid decline
exac requiring ITU
PTX. with advanced disease
Haemoptysis- not controlled by embolisation
increasing exacs

Question 3

What is the criteria for transplant in IPF?

Answer 3

> 10% drop in FVC within 6months
DLCO <40% or drop by 15% in 6months
drop to <88% sats during min walk
rapid decline

Question 4

What is the criteria for transplant in PAH?

Answer 4

deterioration to or presentation of WHO III/IV
decline of 6 min walk to <350m
refractory RHF
requirement for continuous IV inotropes

Question 5

absolute CIs in transplant?

Answer 5

solid organ malignancy in last 5 yrs - excludes BCC and SqCC of skin
BMI >35
untreated advanced dysfunction of other organ- eg CAD not amenable to CABG/PCI or LVSD
unstable critical condition
significant spinal/chest wall deformity
substance addiction
non-adherence
uncontrolled MH
inconsitent/absent social support

Question 6

Relevant CIs in transplant?

Answer 6

> 60years old
limited functional status
Colonisation with Burkholderia cenocepacia
chronic infection
BMI >30 or <17
osteoporosis >2SD
limited CAD (PCI? CABG with transplant?)
CKD eGFR <50
poorly controlled DM
prednisolone >15mg/day
extensive pleural disease
high burden of lung disease with aspergilloma
HIV- generally uncontrolled

Question 7

In chronic GvHD, what is the rate of lung disease post allograft?

Answer 7

20%. Main issue to progression to bronchiolitis obliterans