LUNG TRANSPLANTATION

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2.3 Causes of death following lung transplantation include: • 0-30 days Nonspecific graft failure, infection, dehiscence, hemorrhage, acute rejection, other. • 31 days to 1 year Infection, non-specific graft failure, bronchiolitis, malignancy, other. • >1 year Bronchiolitis, infection, non-specific graft failure, other. 2.4 Re-transplantation Lung re-transplants account for 2.2 to 3%,of all lung transplants.Only 450 lung re-transplants have been performed worldwide.Actuarial survival is approximately 45% at 1 year and 30% at 3 years. Because of lack of available donors lung and increasing number of waiting for lung transplantation, most of lung transplants center do not offer lung retransplantation.The basic indication for redo lung transplantation are acute and chronic graft failure. 3
3. PREOPERATIVE EVALUATION OF <strong>LUNG</strong> <strong>TRANSPLANTATION</strong> CANDIDATES The goal of preoperative evaluation is the identification of individuals most likely to benefit in terms of survival and rehabilitation following transplantation. Such individuals are those with end-stage pulmonary disease for which no efficacious or clinically proven form of treatment other than lung transplantation exists. Personnel capable of the accurate assessment of such patients include an appropriately trained pulmonologist, thoracic surgeon, with the assistance of a social worker and transplantation coordinator. The general criteria for the selection of potential lung transplantation candidates include: 3.1 Criteria for Candidate Selection 3.1.1 Evidence of advanced physical incapacitation due to lung disease. The patient should be functionally limited. 3.1.2 Life expectancy estimated to be weeks or months. Stated differently, the patient must have less than a 20% likelihood of surviving one year. 3.1.3 An exception to conditions (3.1.1) and (3.1.2) above is the patients with intractable respiratory failure. 3.1.4 Agreement that previous medical therapy has been optimal and that no surgical procedure other than transplantation offers realistic expectation of functional improvement and extension of life. 3.1.5 The absence of sepsis, irreversible renal or liver dysfunction or other disease processes (eg. HIV positivity) that might otherwise cause an early death or be seriously aggravated by transplantation. 3.1.6 Strong family support to aid the patient emotionally during the preand post-operative period, and for the rest of his/her life. 3.1.7 Satisfactory intelligence, motivation and compliance to compulsively follow all medical recommendations including attendance at followup appointments and changes in exercise and dietary regimes. 3.1.8 A reasonable understanding by the patient of his/her current illness with a realistic attitude and understanding of what transplantation can offer as well as the potential complications. 3.1.9 A strong will and desire to live and to return to his/her family and community as a functioning member. 4
Page 1 and 2: LUNG TRANSPLANTATION PROTOCOL Iskan
Page 3 and 4: 11. TREATMENT OF REJECTION 11.1 Rej
Page 5: 2. CURRENT STATUS Lung transplantat
Page 9 and 10: information and all relevant medica
Page 11 and 12: LETTER OF INTRODUCTION TO THE REFER
Page 13 and 14: 3.5 LUNG TRANSPLANTATION REFERRAL G
Page 15 and 16: 4. Has the patient demonstrated the
Page 17 and 18: 3.8 LUNG TRANSPLANTATION WORKSHEET
Page 19 and 20: 15. Serology: HBsAG; Anti-Hepatitis
Page 21 and 22: 4. Studies a. Virology testing: i.
Page 23 and 24: 5. PREOPERATIVE MANAGEMENT OF MULTI
Page 25 and 26: Recognizing that brain death may we
Page 27 and 28: myocardial ischemia and arrhythmias
Page 29 and 30: 5.5 MULTIORGAN DONOR ASSESSMENT AND
Page 32 and 33: Parameters: VITAL SIGNS MEDICATIONS
Page 34 and 35: Organ Clamp on Clamp Off Ischemic T
Page 36 and 37: 5.6 DONOR ORDERS FOR MULTI-ORGAN TR
Page 38 and 39: n) HLA typing and Lymphocytotoxic a
Page 40 and 41: Inform the recipient candidate or c
Page 42 and 43: • On arrival at donor centre, inf
Page 44 and 45: Cardioplegia and pulmonary flush wa
Page 46 and 47: 8. POST-LUNG TRANSPLANT ORDERS AND
Page 48 and 49: Date/Time c. Routine Medication: i.
Page 50 and 51: Date/Time Parameters continued - No
Page 52 and 53: 8.2 Lung Transplantation Transfer O
Page 54 and 55: D O N O T W R I T E I N T H I S S P
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Date/Tim Studies continued (review
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1.5. Cyclosporine 4 to 5 mg per kg
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2. Monitoring MONITOR COMMENTS AZA
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(iv) Watch for anaphylactic reactio
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10.1 Immune Activation While transb
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11. MANAGEMENT OF REJECTION 11.1 In
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For mild acute rejection (Grade A1
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12. PROPHYLAXIS AND TREATMENT OF IN
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undertaken. Herpes simplex ulcerati
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CMV has been isolated from > .2 spe
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Please note: The efficacy of this r
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vi) Viral cultures if indicated. 12
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3. Children with a communicable ill
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15. RENAL FUNCTION Many transplant
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17. POST-LUNG TRANSPLANT ASSESSMENT
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18.2 3-6 MONTH PROTOCOL GUIDELINES
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18.4 1-2 YEAR PROTOCOL GUIDELINES B
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LUNG TRANSPLANTATION

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