Lung Transplant

Overview

  • Indications: end stage, progressive decline despite max medical Rx, <2-y life expectancy; COPD, ILD (IPF), pulmonary HTN, cystic fibrosis, alpha 1-antitrypsin
  • Contraindic: age >65 (rel.), uncontrolled/unRx’d infxn, malig in prior 2 y, severe non-pulm dis., BMI ≥35, active smoking, EtOH/drug depend., med noncompliance, psychosocial

Posttransplant care

  • Immunosuppression: center dependent; no single best regimen. Tacro > cyclosporine (↓ incidence of acute rejection) + steroids + MMF/azathioprine
  • Monitoring: clinic visits, serial PFTs, chest X-ray, bronchoscopy w/ transbronchial biopsy

Complications

  • Primary graft dysfunction (PGD): acute lung injury following txp; assoc w/ early mortality