Figures
- Figure 1
The number of adult lung transplants reported to the ISHLT each year since 1985. Reproduced from [1] with permission from the publisher.
- Figure 2
Photographs taken at bronchoscopy to show a) anastomotic narrowing due to organised mucous plug and b) the final result after bronchial toileting.
- Figure 3
A chest radiograph depicting an episode of acute rejection.
Tables
- Table 1 Disease-specific indication for transplant
Diagnosis Incidence (n total = 34 102) COPD/emphysema 11 587 (34.0%) Idiopathic pulmonary fibrosis 7925 (23.2%) Cystic fibrosis 5688 (16.7%) Alpha-1 2073 (6.1%) Idiopathic pulmonary arterial hypertension 1064 (3.1%) Pulmonary fibrosis, other 1157 (3.4%) Bronchiectasis 945 (2.8%) Sarcoidosis 865 (2.5%) Re-transplant: obliterative bronchiolitis 513 (1.5%) Connective tissue disease 421 (1.2%) Obliterative bronchiolitis (not re-transplant) 351 (1.0%) LAM 363 (1.1%) Re-transplant: not obliterative bronchiolitis 357 (1.0%) Congenital heart disease 293 (0.9%) Cancer 34 (0.1%) Other 466 (1.4%) Data are presented as n (%) of a total 34,102. LAM: lymphangioleiomyomatosis. Table reproduced from [1] with permission from the publisher.
- Table 2 Absolute and relative contraindications for transplant
Absolute contraindications to lung transplantation Relative contraindications to lung transplantation Active malignancy within the last 2 to 5 years dependent on tumour type# Advanced, untreatable disease of any other organ system Non-curable, chronic extra-pulmonary infection Significant chest wall or spinal deformity Documented non-concordance with therapy Untreatable psychiatric or psychological condition associated with the inability to concord with treatment No reliable social support Substance addiction including smoking (currently or within the last 6 months) Age >65 years Poor functional status with low potential for rehabilitation Colonisation with highly resistant micro-organisms Obesity (BMI >30) Severe symptomatic osteoporosis Mechanical ventilation #: not including basal/squamous cell skin carcinomas.
- Table 3 ISHLT Consensus for the “ideal” lung donor
Age <55 years ABO compatibility Clear chest radiograph PaO2 >40 kPa (FiO2 100% and 5 cmH2O PEEP) Smoking history <20 pack years Absence of chest trauma No evidence of aspiration or sepsis No prior cardiopulmonary surgery Absence of organisms on sputum Gram stain Absence of purulent secretions at bronchoscopy - Table 4 Common post-transplant infections, their sequelae and management
Post-transplant infection Clinical features Pseudomonas aeruginosa -
Can cause asymptomatic colonisation, infective exacerbations or pneumonia
-
Occurs anytime but especially in the first year
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Colonised patients often treated with maintenance nebulised antibiotics
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Associated with increased risk of developing Bronchiolitis Obliterans Syndrome
Cytomegalovirus -
Can cause primary infection or re-activation in a previously infected host
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Typically occurs in first few months, though the first year carries greatest risk
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Higher risk recipients given anti-CMV prophylaxis for 3–6 months after transplant
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Associated with increased risk of developing bronchiolitis obliterans syndrome
Epstein-Barr virus -
Re-activation most common within the first year when immunosuppression at highest levels
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Reactivation known to drive development of post-transplant lymphoproliferative disorder (PTLD)
Aspergillus -
Can cause asymptomatic colonisation, airway infection, invasive or cavitatory disease
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Occurs anytime but especially in the first year
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Those colonised with Aspergillus pre-transplant require anti-fungal prophylaxis for 6–12 weeks after transplant
Data taken from [16, 17].
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- Table 5 Classification of transbronchial lung biopsy results
Classification system Interpretation A0 No evidence of acute rejection A1 Minimal acute cellular rejection A2 Mild acute cellular rejection (treatment required) A3 Moderate acute cellular rejection A4 Severe acute cellular rejection B0 No airway inflammation B1R Mild airway inflammation B2R Moderate–severe airway inflammation C0 No evidence of obliterative bronchiolitis C1 Presence of obliterative bronchiolitis - Table 6 Stages of bronchiolitis obliterans syndrome
BOS stage Lung Function parameters BOS-0 FEV1 >90% and FEF25–75 75% of baseline BOS-0p FEV1 81–90% and FEF25–75 <75% of baseline BOS-1 FEV1 66–80% of baseline BOS-2 FEV1 51–65% of baseline BOS-3 FEV1 <50% of baseline
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- Article
- Abstract
- What does lung transplant offer patients with advanced lung disease?
- Who should be referred for lung transplant assessment and when?
- What are the disease specific indications for referral for lung transplant assessment?
- How are suitable donor lungs identified for patients on the waiting list?
- What can be done to increase the availability of donor lungs for transplantation?
- How do airway complications present after lung transplantation?
- What are the common infections seen after lung transplantation?
- How is immunosuppressive therapy used after lung transplant?
- What are the long-term consequences of immunosuppressive therapy use?
- How does lung transplant rejection present and what can be done for it?
- What new on the horizon for lung transplantation?
- Footnotes
- References
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