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LUNG TRANSPLANTATION

INDICATION

  • Idiopathic Pulmonary Fibrosis (IPF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cystic Fibrosis
  • Idiopathic Pulmonary Arterial Hypertension
  • Sarcoidosis
  • Lymphangioleyomyomatosis (LAM)

Who Can’t Have a Lung Transplant?

  • A malignancy within the last 2 years, except for non-melanoma skin cancers (a 5-year disease-free interval is preferred)
  • Untreatable dysfunction of another organ system (selected patients with CAD can undergo a lung transplant)
  • Active chronic hepatitis C or B with histological evidence of liver damage
  • Significant chest wall deformities
  • Documented non-adherence to medical therapy or follow up
  • Severe psychiatric illness
  • An unreliable social support system
  • Active substance addiction (tobacco, alcohol, narcotics) or any use within 6 months
  • Class II obesity or higher defined as a body mass index (BMI) exceeding 35 kg/m2

Relative Contraindications: Who might not qualify for a lung transplant?

  • Age > 65 years
  • HIV infection
  • Critical or unstable clinical condition (e.g., shock, mechanical ventilation or extra-corporeal membrane oxygenation)
  • Severely limited functional status poor rehabilitation potential (6 minute walk test with distance < 600 feet)
  • Colonization with highly resistant or highly virulent bacteria, fungi or mycobacteria
  • Class I obesity defined as a body mass index (BMI) between 30-34.9 kg/m2
  • Severe or symptomatic osteoporosis
  • Mechanical ventilation (carefully selected candidates on mechanical ventilation without other acute or chronic organ dysfunction who are able to actively participate in a meaningful rehabilitation program may be successfully transplanted)
  • Other medical conditions that have not resulted in end-stage organ damage, such as diabetes mellitus, systemic hypertension, peptic ulcer disease, or gastro esophageal reflux should be optimally treated before transplantation
  • Patients with coronary artery disease may undergo percutaneous intervention or coronary artery bypass grafting before transplantation

COMPLICATIONS

Reimplantation response

  • coghing of blood
  • shortness of breath

Rejection

  • Shortness of breath
  • Fatigue
  • Dry cough

 Bronchiolitis obliterans syndrome

  • Bronchiolitis obliterans syndrome (BOS) is another form of rejection that typically occurs in the first year after the transplant, but could occur up to a decade later.
  • shortness of breath
  • dry cough
  • wheezing

 Post-transplantation lymphoproliferative disorder

Non-hodgekins lymphoma

 Infection

  • Pneumonia
  • cytomegalovirus infection
  • Aspergillosis

 Long-term use of immunosuppressants

  • Kidney disease
  • Diabetes
  • High blood pressure
  • Osteoporosis
  • Cancers