Cardiopulm - Pulm - Lung Transplants

Front 1

• What are the 4 groups of pt classifications for whom lung txp may be indicated?
  
• Whom is txp contraindicated?

Back 1

• OLD, CF, RLD, and Pulmonary Vascular Disease
  
• Advanced disease of other organs, chest/spinal deformity, CA in prev. 2 years, documented non-adherence, lack of consistent social support, substance abuse/psychiatric conditions, HIV, Hep B/C etc., being sick enough to have been mechanically vented for extended period of time

Front 2

• What is 1-year survival rate s/p lung txp? 5-year?
  
• How are pediatric lung txp recipients determined?
• Adult lung txp recipients?

Back 2

• 86% 1-year; 56% 5-year
  
• Time on list only
• Blood type, body size, then Lung Allocation Score

Front 3

• What does lung allocation score account for?
• What factors predict survival with txp?
• What factors predict mortality w/o txp?

Back 3

• Factors predictive of 1-year survival w/ txp vs. factors predictive of 1-year mortality w/o txp
• FVC, mechanical ventilation status, serum creatinine, Dx
  
• age, DM, BMI, FVC, Pulm BP, 6MWT
  

Front 4

• What factors favor choice of bilateral lung txp vs. unilateral?
  
• What surgical procedure is performed for the txp type?
• What are the 2 types of complication?

Back 4

• Delayed chronic rejection and ↑ survival
  
• Thoracotomy for SLT; Clam-shell incision for BLT
• Infection (leading cause of death) and rejection

Front 5

What are 5 common causes of lung infection s/p txp?

Back 5

1. Exposure of allograft to external environment
2. Blunted cough due to lung denervation
3. ↓'d mucociliary clearance
   
4. Narrowing of bronchial anastomosis
5. Txp of organism with the donor lung

Front 6

What are three common types of rejection?

What are characteristics of each?

Back 6

• Acute antibody-mediated rejection (w/in 72 hr of txp), 1º allograft failure w/ severe ↓ blood O₂
  
• Acute cellular rejection (w/in 1-year of txp; 36% of pts), unapparent except by transbronchial biopsy
  
• Chronic rejection (bronchiolitis obliterans), most common cause of death >1-year post-txp
  

Front 7

What are three classes of immunosuppressant meds? What are SEs of each?

Back 7

• Calcineurin Inhibitors - nephrotoxicity, HTN, tremors 2º neurotoxicity, gastroparesis
  
• Antiproliferative Agents - leukopenia, anemia, thrombocytopenia
  
• Steroids (Prednisone) - hyperglycemia, HTN, weight gain, OP, myopathy, mood disturbance
  

Front 8

How is exercise capacity expected to change s/p lung txp?

Back 8

• 6MWT should double
• 1-2 years s/p lung txp exercise performance remains half of predicted value
• Pts will continue to show ↓ exercise capacity, ↓ sk. muscle function, ↓ bone mineral density