Transplant

Question 1

Single vs double vs heart lung

Answer 1

Single Copd or Ild

Bilateral 80%

Heart lung
Eisenmengers
LHF with lung disease

Question 2

COPD Ix

Answer 2

Bode 5-7
Increase PA pressure
Low FEV1 <20
TLCO <20
Hypoxia on 10L
PH<7.3
PH despite LTOT

Question 3

IPF Ix

Answer 3

Fev1 falls 10% 6m
DLCO falls 15% 6m
DLCO <40%
Desat on 6WT
Sats < 88% on 8L
Po2<8 on 5L

Urgent
Po2 less than 8 despite 10L
Refractory RHf despite medication

Question 4

CF Ix

Answer 4

Chronic Resp failure
Hospitalisation inc ITU
FEV1 <30%
PTX
Haemoptysis
PH<7.3 optimised on NIV
LTOT or NIV Resp failure
<20 rapid deterioration

Urgent
on 10L po2 less than 7.5 and pco2 more than 6.5 on NIV
Refractory RHF
Haemoptysis despite embolisation
Ph less than 7.3 despite embolisation

Question 5

Pulmonary hypertension Ix

Answer 5

Class 3-4 on max medical therapy
Worsening RHF
RAP more than 20
CI <2
6wt less than 350m

Urgent
RHF despite optimal treatment
RAP more than 20 and CI less than 2 despite IV for 3m
Needs IV ionotropes

Question 6

Absolute contra indications

Answer 6

BMI >35
Solid organ tumour 5y
Advanced organ dysfunction
Chest wall disease
Substance addiction
Poor social support

Question 7

Relative contra indications

Answer 7

Age over 65
BMI <17 or 30-35
Egfr <50
Poorly controlled dam
End organ damage
Pleural disease
Lung cavity with aspergilloma
1 vessel cad
Steroids more than 15mg
Pleural disease
HIV, Aspergillus, hepatitis
Burkholdeira
M Abscessus
Osteoporosis
Ventilation

Question 8

Immune suppression

Answer 8

Steroids
MMF
Cyclosporine

Question 9

Early complication

Answer 9

Primary Graft dysfunction or ischaemic repercussion
72 hours
Pulmonary infiltrates, hypoxia, alveolar damage
OP on box
Diuresis, protective ventilation, ecmo
60% mortality

Infection
CMV
Fungal aspergillus

Question 10

Early

Answer 10

Rejection
3w to 1y
T cell mediated reacting to donor HLA
Loss of function
Malaise fever cough
Cxr infiltrates
Neutrophils BAL or lymph
IV methylpred, plasma and rATG
CX BO

Anastomotic stenosis
Weeks to months
Wheeze /recurrent cap
Lung function notching
Stent vs balloon dilation
Dehiscence rare needs urgent tx

Question 11

Late complication

Answer 11

Chronic lung allograft dysfunction
BO or restrictive allograft syndrome
Fev1 decline to less than 89%
Look for infection inc pseud
HRCT air trapping
Modify iss
40% mortality

Restrictive
UL fibrosis
Worse prognosis than BO

PTLD eg NHL
First year
Reduce iss p, antiviral EBV and Ritux

Infection MTB

Recurrence disease

Question 12

Infection

Answer 12

Bacterial
Early or late
Gram negative eg pseud or capholdeira

CMV

Aspergillus
2m middle
Affects airways

Question 13

Medium survival

Answer 13

Single 5y
Double 7y

Question 14

Causes tx

Answer 14

Copd 30%
Ild 25%
Cf 6%
Ipah 3%
CTD 1%

Question 15

Bronchiectasis Ix

Answer 15

Fev1 < 30%
Ptx
Haemoptysis
O2 dependent
Raised co2

Question 16

Survival

Answer 16

1 year 84%
5 year 55%

Question 17

Super urgent

Answer 17

ILA
ECMO

Question 18

Urgent

Answer 18

Po2 less than 7.5 on 10L
Pco2 more than 6.5 on NIV
PH <7.3
Refractory RHf

Question 19

CMV negative gets cmv positive lung

Answer 19

Valganciclovir

Question 20

Nodule post tx

Answer 20

PTLD
Infection pseud nocardia or aspergillus
Disease recurrence
Cancer