lung transplant 1dr.yekehfallah- phd of nursing- 20159/18/2015
TRANSCRIPT
LUNG TRANSPLANT
1Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 First attempt of lung transplantation in 1963 by Hardy amp coworkers1048708 First successful transplantation by Toronto group in 19831048708 1400 transplantations are done worldwide per year1048708 International society of heart-lung transplantation has registered gt 14500 lung transplant recipients
2Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Advances in operative technique amp
immunosuppression led to reduction in mortality rates to lt10
1048708 1 year survival of gt 801048708 Improvement in post-transplant quality of
life is noted1048708 Greatest risk factor for mortality is found
to be ventilator dependency1048708 These patients not considered for
transplantation
3Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Recently various other issues have been
raised - 1) Effect of obesity- high BMI adverse
effect on short term as well as long term survival
2) Effect of gender combination significant risk of primary graft failure is associated with Female to Male but beneficial results with Female to Female
4Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure
(1) Early lung graft dysfunction manifests as persistently marginal gas exchange (ie hypoxia hypercarbia) and pulmonary hypertension in the absence of infection or rejection
5Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure (2) Occurring in less than 15 primary graft failure is usually
caused by ischemia-reperfusion injury and results in pulmonary capillary leak causing alveolar edema impaired lung compliance and elevated pulmonary vascular resistance shortly after ICU admission
(a) Particularly severe cases of pulmonary hypertension can lead to right ventricular failure
(b) This syndrome resembles ARDS with a severe arterial-alveolar gradient (PaO2FiO2 ratio lt150 mm Hg) diffuse interstitial infiltrates on early postoperative chest radiographs and diffuse alveolar damage on histology
(c) The degree of pulmonary edema has been observed to be inversely related to the quality of preservation although the development of severe ischemia-reperfusion injury is still largely unpredictable
6Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 First attempt of lung transplantation in 1963 by Hardy amp coworkers1048708 First successful transplantation by Toronto group in 19831048708 1400 transplantations are done worldwide per year1048708 International society of heart-lung transplantation has registered gt 14500 lung transplant recipients
2Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Advances in operative technique amp
immunosuppression led to reduction in mortality rates to lt10
1048708 1 year survival of gt 801048708 Improvement in post-transplant quality of
life is noted1048708 Greatest risk factor for mortality is found
to be ventilator dependency1048708 These patients not considered for
transplantation
3Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Recently various other issues have been
raised - 1) Effect of obesity- high BMI adverse
effect on short term as well as long term survival
2) Effect of gender combination significant risk of primary graft failure is associated with Female to Male but beneficial results with Female to Female
4Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure
(1) Early lung graft dysfunction manifests as persistently marginal gas exchange (ie hypoxia hypercarbia) and pulmonary hypertension in the absence of infection or rejection
5Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure (2) Occurring in less than 15 primary graft failure is usually
caused by ischemia-reperfusion injury and results in pulmonary capillary leak causing alveolar edema impaired lung compliance and elevated pulmonary vascular resistance shortly after ICU admission
(a) Particularly severe cases of pulmonary hypertension can lead to right ventricular failure
(b) This syndrome resembles ARDS with a severe arterial-alveolar gradient (PaO2FiO2 ratio lt150 mm Hg) diffuse interstitial infiltrates on early postoperative chest radiographs and diffuse alveolar damage on histology
(c) The degree of pulmonary edema has been observed to be inversely related to the quality of preservation although the development of severe ischemia-reperfusion injury is still largely unpredictable
6Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Advances in operative technique amp
immunosuppression led to reduction in mortality rates to lt10
1048708 1 year survival of gt 801048708 Improvement in post-transplant quality of
life is noted1048708 Greatest risk factor for mortality is found
to be ventilator dependency1048708 These patients not considered for
transplantation
3Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Recently various other issues have been
raised - 1) Effect of obesity- high BMI adverse
effect on short term as well as long term survival
2) Effect of gender combination significant risk of primary graft failure is associated with Female to Male but beneficial results with Female to Female
4Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure
(1) Early lung graft dysfunction manifests as persistently marginal gas exchange (ie hypoxia hypercarbia) and pulmonary hypertension in the absence of infection or rejection
5Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure (2) Occurring in less than 15 primary graft failure is usually
caused by ischemia-reperfusion injury and results in pulmonary capillary leak causing alveolar edema impaired lung compliance and elevated pulmonary vascular resistance shortly after ICU admission
(a) Particularly severe cases of pulmonary hypertension can lead to right ventricular failure
(b) This syndrome resembles ARDS with a severe arterial-alveolar gradient (PaO2FiO2 ratio lt150 mm Hg) diffuse interstitial infiltrates on early postoperative chest radiographs and diffuse alveolar damage on histology
(c) The degree of pulmonary edema has been observed to be inversely related to the quality of preservation although the development of severe ischemia-reperfusion injury is still largely unpredictable
6Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Introduction1048708 Recently various other issues have been
raised - 1) Effect of obesity- high BMI adverse
effect on short term as well as long term survival
2) Effect of gender combination significant risk of primary graft failure is associated with Female to Male but beneficial results with Female to Female
4Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure
(1) Early lung graft dysfunction manifests as persistently marginal gas exchange (ie hypoxia hypercarbia) and pulmonary hypertension in the absence of infection or rejection
5Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure (2) Occurring in less than 15 primary graft failure is usually
caused by ischemia-reperfusion injury and results in pulmonary capillary leak causing alveolar edema impaired lung compliance and elevated pulmonary vascular resistance shortly after ICU admission
(a) Particularly severe cases of pulmonary hypertension can lead to right ventricular failure
(b) This syndrome resembles ARDS with a severe arterial-alveolar gradient (PaO2FiO2 ratio lt150 mm Hg) diffuse interstitial infiltrates on early postoperative chest radiographs and diffuse alveolar damage on histology
(c) The degree of pulmonary edema has been observed to be inversely related to the quality of preservation although the development of severe ischemia-reperfusion injury is still largely unpredictable
6Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure
(1) Early lung graft dysfunction manifests as persistently marginal gas exchange (ie hypoxia hypercarbia) and pulmonary hypertension in the absence of infection or rejection
5Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure (2) Occurring in less than 15 primary graft failure is usually
caused by ischemia-reperfusion injury and results in pulmonary capillary leak causing alveolar edema impaired lung compliance and elevated pulmonary vascular resistance shortly after ICU admission
(a) Particularly severe cases of pulmonary hypertension can lead to right ventricular failure
(b) This syndrome resembles ARDS with a severe arterial-alveolar gradient (PaO2FiO2 ratio lt150 mm Hg) diffuse interstitial infiltrates on early postoperative chest radiographs and diffuse alveolar damage on histology
(c) The degree of pulmonary edema has been observed to be inversely related to the quality of preservation although the development of severe ischemia-reperfusion injury is still largely unpredictable
6Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology Early allograft failure (2) Occurring in less than 15 primary graft failure is usually
caused by ischemia-reperfusion injury and results in pulmonary capillary leak causing alveolar edema impaired lung compliance and elevated pulmonary vascular resistance shortly after ICU admission
(a) Particularly severe cases of pulmonary hypertension can lead to right ventricular failure
(b) This syndrome resembles ARDS with a severe arterial-alveolar gradient (PaO2FiO2 ratio lt150 mm Hg) diffuse interstitial infiltrates on early postoperative chest radiographs and diffuse alveolar damage on histology
(c) The degree of pulmonary edema has been observed to be inversely related to the quality of preservation although the development of severe ischemia-reperfusion injury is still largely unpredictable
6Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Pathophysiology
(3) Early lung graft dysfunction is managed by increased FiO2 PEEP sedation neuromuscular blockade and careful diuresis to maintain fluid balance and reduce pulmonary edema
7Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Management issues 1Inotropic and fluid management2Respiratory management aAfter ICU admission anteroposterior chest radiograph initial
ventilator settings FiO2 of 50 tidal volume of 10 to 15 mLKg assist-control rate of 10 to 14 breaths per minute and PEEP of 3 to 5 cm H2O Initial tidal volumes and flow rates are adjusted to limit peak airway pressures to less than 40 cm H2O to minimize barotrauma and high airway pressures which may compromise bronchial mucosal blood flow
bArterial blood gases 30 minutes after each ventilator setting change to achieve a paO2 greater than 75 mmHg on an FiO2 of 04 a paCO2 between 30 and 40 mmHg and a pH between 735 and 745
cWeaning to extubation is initiated after the patient is stable awake and alert Generally weaning is conducted through successive decrements in the intermittent mandatory ventilation (IMV) rate followed by a sustained trail of continuous positive airway pressure (CPAP) Extubation is often possible within the first 24 hours posttransplant
8Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Typical Evaluation Criteria
Less than 60 years old for a single lung transplant
Less than 50 years old for a double lung
transplant
Less than 50 years old for a heart and lung transplant
9Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
10Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Types of transplantations1048708 Unilateral Single lung transplant good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size amp older patients) 3) acceptable option in pulmonary hypertension
Experience over past two decades shows that bilateral lung transplants shows better results
11Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
12Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
13Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
14Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
15Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
16Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
17Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
18Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Donor CriteriaStandard 1048708 Agelt55 years1048708 ABO compatibility1048708 Clear CXR1048708 PaO2gt300 on FIO2=10 PEEP- 5 cm H2O1048708 Tobacco historylt20 pack years1048708 Absence of chest trauma1048708 No evidence of aspiration1048708 HIV HepB S Ag Hep C negative1048708 Sputum gram stain-absence of organisms1048708 Absence of purulent secretions at bronch
19Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Selection criteriaCriterias to define end stage lung disease in
various diagnosis are still under way1048708Age limits- Relative1048708 55 years - heart-lung1048708 60 years- bilateral lung1048708 65 years- single lung
20Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
ContraindicationsAbsolute-1) Significant nonpulmonary vital organ dysfunction2) active malignancy within last 2 years3) HBsAg +ve4) HCV with abnormal liver biopsy5) Substance abuse in last 6 months
21Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteriaCOPD-1048708 FEV1 lt 25 predicted ( without reversibility)1048708 PaCO2 gt55 mm of Hg1048708 elevated pulmonary artery pressure (PAP)1048708 cor pulmonale1048708 Other indices shown to correlate mortality- 1)subjective breathlessness 2)weight loss 3)exercise tolerance 4)hospitalization 5) lung morphology
22Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Disease specific selection criteria1048708 all patients requiring hospitalization for exacerberation should be considered for
surgery
1048708 1 year mortality after hospitalization -23
23Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Factors Predisposing to InfectionMechanical 1048708 mucociliary clearance 1048708 cough reflex 1048708 lymphatic drainage 1048708 bronchial stenosis 1048708 bronchiolitis Obliterans1048708 Presence of Source 1048708ldquoinheritedrdquo 1048708ischemic airways 1048708native lung
24Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Rejection1048708 Acute rejection-1048708 lt 7 days onset1048708 low grade fever dyspnoea1048708 CXR- 1) Clear 2) illdefined infiltrates 3) pleural effusion1048708 reduced FEV1
25Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Acute rejection
1048708 Treatment- bolus IV steroids + increase in maintenance immunosuppression
1048708 role of surveillance bronchoscopy to detect rejection early is controversial
26Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Bronchiolitis Obliterans Syndrome BOS ( chronic rejection)
1048708 Predominantly a small airway disease1048708 occurs in 50 patients surviving for 5
years1048708 onset gt 6months1048708 major cause of mortality1048708 CXR- can be normal late cases-
bronchiectesis
27Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Treatment- variable course even without treatment
1048708 various immunosuppressive regimens tried
28Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
BOS
1048708 Factors associated-1) CMV pnuemonitis -no of episodes2) HLA mismatch
29Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Survival statistics1048708 TORONTO GROUP1 year survival ndash 763 year survival ndash 575 year survival - 446 year survival - 347 year survival ndash 29
1048708 Pulmonary fibrosis has worst outcome
30Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
Current Status of Lung Transplantation Long term survivalmdash50 die by 5 years
Bronchiolitis obliterans (chronic rejection)mdashprimary cause of poor survival
Future of lung transplantationmdashprevent bronchiolitis obliterans
31Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923
32Dr yekehfallah- phd of nursing- 2015041923