lung transplantation
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Introduction
In 1998, wait period for lung transplantation was 2 years.
Indications
- severe chronic obstructive pulmonary disease
- history of COPD exacerbation with PaCO2 > 50 mm Hg
- pulmonary hypertension, cor pulmonale despite oxygen therapy
- homogeneously distributed pulmonary emphysema
- end-stage restrictive lung disease
- pulmonary vascular disease (pulmonary hypertension) resistant to medical therapy
- BODE index of 7-10 & at least one or
- history of hospitalization for COPD exacerbation with hypercapnia
- pulmonary hypertension, cor pulmonale or both despite oxygen therapy
- FEV1 < 20% of predicted
- DLCO < 20% of predicted or homegeneous distribution of pulmonary emphysema[1][3]
Contraindications
- significant psychiatric illness
- poor compliance with medical therapy &/or follow-up
- lack of adequate social support
- continued smoking[1][3]
- illicit drugs
- alcohol abuse
- infection with pan-antibiotic-resistant Pseudomonas cepacia
- hepatic or renal disease
- HIV infection
- corticosteroids (> 15 mg prednisone QD)
- mediastinal fibrosis
- patients with malignancy
- bedridden patients
* most transplant centers use 65 years of age as arbitrary cutoff for eligibility[1]
single lung transplantation is not a consideration for patients with cystic fibrosis
- chronic infection with Pseudomonas would quickly colonize & infect the transplanted lung in the presence of the recipients native chronically infected lung
Prior chest tube insertion or pleurodesis is NOT a contraindication.
Laboratory
- screening for hepatitis
- HIV1 serology
Procedure
Donors:
- must be declared brain dead
- have family consent
- no history of chronic respiratory or malignant disease
- < 55 years of age at death
- normal chest X-ray
- adequate oxygenation (PO2 > 300 mm Hg on fiO2 of 1.0)
- free of purulent secretions by fiberoptic bronchoscopy
- HIV negative
- hepatitis serology negative
- blood type compatible
- lung size compatible
Modalities:
- single lung transplant
- generally modality of choice
- simpler procedure
- fewer complications
- bilateral lung transplant
- chronically infected bilateral pulmonary disease
- severe primary heart disease
- heart-lung transplant
- severe primary pulmonary hypertension with secondary end-stage right heart failure
- pulmonary hypertension with noncorrectable Eisenmenger's syndrome
- end-stage pulmonary disease accompanied by cardiac disease
Complications
- postoperative infections
- rejection
- bronchiolitis obliterans
- drug-related toxicity
- post-transplant lymphoproliferative disorders
- lung cancer[2]
Management
- immunosuppression maintained for lifetime
- prognosis:
- single lung transplant
- bilateral lung & heart-lung transplant
- 1 year survival is 60-80%
- 10-12 years survival of transplanted lung?
More general terms
More specific terms
Additional terms
- guidelines for timing initial screening for lung transplantation
- lung volume reduction surgery; lung resection (LVRS)
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17 American College of Physicians, Philadelphia 1998, 2012, 2015
- ↑ 2.0 2.1 Engels EA et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA 2011 Nov 2; 306:1891. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22045767
- ↑ 3.0 3.1 3.2 Kreider M, Kotloff RM. Selection of candidates for lung transplantation. Proc Am Thorac Soc. 2009 Jan 15;6(1):20-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19131527
- ↑ Weill D, Benden C, Corris PA et al A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015 Jan;34(1):1-15. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25085497
- ↑ National Heart, Lung, and Blood Institute (NHLBI) Lung Transplant https://www.nhlbi.nih.gov/health-topics/lung-transplant