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LUNG TRANSPLANT
Dr.Ahmed Sayeed.MD,MRCP(UK)
ABSOLUTE
CONTRAINDICATIONS
 Severe extra pulmonary organ
dysfunctions
 Active cancer
 Severe psychiatric illness
 Infe...
INDICATIONS FOR ADULT LUNG
TRANSPLANTS BY YEAR
COPD
 BODE index >5
 Hypertension or cor
pulmonale
 FEv1 <20%
CYSTIC FIBROSIS
 Fev1 < 30%
 H/O ITU admission
 Respiratory failure/PAH
 Severe recurrent hemoptysis
 Refractory or r...
IPF
1.If Possible all patients
2.TLCO < 40%
3.Desaturation <88% on
6MWT
4.Honey combing on HRCT
IPAH
 NYHA class III
 Rapidly progressive disease
 6MWT < 350m
 Mean Right atrial pressure >15 mmHg
 Cardiac index <2...
PART 1 POST
TRANSPLANT
SURVIVAL
MEASURE:
1. FVC (Group B, D)
2. PCW pressure ≥20 (Group D)
3. Continuous mechanical ventil...
PART 2
WAITING
LIST
URGENCY
MEASURE:
1. Forced vital capacity (FVC)
2. Pulmonary artery systolic pressure (Group A, C, D)*...
CLASSIFICATION OF TRANSPLANT CANDIDATES
Group A: COPD, alpha-1-antitrypsin, emphysema,
lymphangioleiomyomatosis, bronchiec...
EVALUATION AND TREATMENT OF
ACUTE LUNG TRANSPLANT REJECTION
●Acute cellular rejection
●Humoral rejection
●Hyperacute rejec...
RISK FACTORS FOR ACUTE
REJECTION
●Human leukocyte antigens (HLA)
mismatching
●Genetic factors
●Immunosuppression regimen
●...
CLINICAL MANIFESTATIONS
BACTERIAL INFECTIONS FOLLOWING
LUNG TRANSPLANTATION
BACTERIAL INFECTIONS FOLLOWING LUNG TRANSPLANTATION
The high level of immunosuppression required to prevent rejection
●Adv...
BACTERIAL INFECTIONS FOLLOWING
LUNG TRANSPLANTATION
 Pneumonia, particularly bacterial pneumonia, is the
most common type...
VIRAL INFECTIONS
 CMV pneumonitis
 Increases risk of bacterial and
fungal superinfection
 Ganciclovir prohylaxis is
pro...
FUNGAL INFECTION
 Aspergillus colonization
 Peak after 2 month
REFERENCES
 Uptodate
 Oxford text book of
respiratory medicine
THANK YOU
Lun g transplant indications and complications
Lun g transplant indications and complications
Lun g transplant indications and complications
Lun g transplant indications and complications
Lun g transplant indications and complications
Lun g transplant indications and complications
Lun g transplant indications and complications
Lun g transplant indications and complications
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Lun g transplant indications and complications

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Lun g transplant indications and complications

  1. 1. LUNG TRANSPLANT Dr.Ahmed Sayeed.MD,MRCP(UK)
  2. 2. ABSOLUTE CONTRAINDICATIONS  Severe extra pulmonary organ dysfunctions  Active cancer  Severe psychiatric illness  Infection like HIV  Active or recent substance abuse
  3. 3. INDICATIONS FOR ADULT LUNG TRANSPLANTS BY YEAR
  4. 4. COPD  BODE index >5  Hypertension or cor pulmonale  FEv1 <20%
  5. 5. CYSTIC FIBROSIS  Fev1 < 30%  H/O ITU admission  Respiratory failure/PAH  Severe recurrent hemoptysis  Refractory or recurrent pneumothorax
  6. 6. IPF 1.If Possible all patients 2.TLCO < 40% 3.Desaturation <88% on 6MWT 4.Honey combing on HRCT
  7. 7. IPAH  NYHA class III  Rapidly progressive disease  6MWT < 350m  Mean Right atrial pressure >15 mmHg  Cardiac index <2 L/M2
  8. 8. PART 1 POST TRANSPLANT SURVIVAL MEASURE: 1. FVC (Group B, D) 2. PCW pressure ≥20 (Group D) 3. Continuous mechanical ventilation 4. Age 5. Serum creatinine 6. Functional Status (NYHA class) 7. Diagnosis
  9. 9. PART 2 WAITING LIST URGENCY MEASURE: 1. Forced vital capacity (FVC) 2. Pulmonary artery systolic pressure (Group A, C, D)* 3. Pulmonary artery mean pressure 4. Pulmonary capillary wedge pressure 5. Supplemental O2 required at rest (Group A, C, D)* 6. Age 7. Body mass index (BMI) 8. Diabetes 9. Functional status 10. Six-minute walk distance 11. Continuous mechanical ventilation 12. Diagnosis 13. pCO2¶
  10. 10. CLASSIFICATION OF TRANSPLANT CANDIDATES Group A: COPD, alpha-1-antitrypsin, emphysema, lymphangioleiomyomatosis, bronchiectasis, sarcoidosis with a mean PA pressure ≤30 mmHg. Group B: Pulmonary hypertension (IPAH, Eisenmenger's syndrome) Group C: Cystic fibrosis, immunodeficiency disorders . Group D: IPF, other causes of pulmonary fibrosis, sarcoidosis with PA >30 mmHg, obliterative bronchiolitis (non-retransplant).
  11. 11. EVALUATION AND TREATMENT OF ACUTE LUNG TRANSPLANT REJECTION ●Acute cellular rejection ●Humoral rejection ●Hyperacute rejection ●Chronic lung transplant rejection
  12. 12. RISK FACTORS FOR ACUTE REJECTION ●Human leukocyte antigens (HLA) mismatching ●Genetic factors ●Immunosuppression regimen ●Age ●Vitamin D deficiency
  13. 13. CLINICAL MANIFESTATIONS
  14. 14. BACTERIAL INFECTIONS FOLLOWING LUNG TRANSPLANTATION
  15. 15. BACTERIAL INFECTIONS FOLLOWING LUNG TRANSPLANTATION The high level of immunosuppression required to prevent rejection ●Adverse effects of transplantation on local pulmonary host defenses (loss of lymphatics, reduced mucociliary clearance, decreased cough) ●Constant environmental contact allowing pathogens direct access into the allograft RISK OF INFECTION
  16. 16. BACTERIAL INFECTIONS FOLLOWING LUNG TRANSPLANTATION  Pneumonia, particularly bacterial pneumonia, is the most common type of infection in lung transplant recipients,  Bloodstream,  Pleural space, and  Wound infections are also common
  17. 17. VIRAL INFECTIONS  CMV pneumonitis  Increases risk of bacterial and fungal superinfection  Ganciclovir prohylaxis is protective
  18. 18. FUNGAL INFECTION  Aspergillus colonization  Peak after 2 month
  19. 19. REFERENCES  Uptodate  Oxford text book of respiratory medicine
  20. 20. THANK YOU
  • gurpreetsodhi5

    Jul. 12, 2020

lung transplant

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