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LUNG TRANSPLANTATION and PULMONARY FIBROSIS. Maria L. Padilla, MD Associate Prof. of Medicine Director of ILD/IPF and Advanced Lung Disease Program MSSM/MSMC. Organ Transplantation. Lung Transplantation and IPF. Important Questions: What is it? Why? For Whom? When? How?

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lung transplantation and pulmonary fibrosis

LUNG TRANSPLANTATION and PULMONARY FIBROSIS

Maria L. Padilla, MD

Associate Prof. of Medicine

Director of ILD/IPF and Advanced Lung Disease Program

MSSM/MSMC

lung transplantation and ipf
Lung Transplantation and IPF
  • Important Questions:
    • What is it?
    • Why?
    • For Whom?
    • When?
    • How?
    • What are the results?
lung transplantation and ipf1
Lung Transplantation and IPF
  • What is Lung Transplantation?

The operation that replaces diseased, failing lungs with a functional organ.

lung transplantation and ipf2
Lung Transplantation and IPF
  • Thoracic Transplantation
    • Heart-Lung Transplantation
    • Single Lung Transplantation
    • Bilateral Lung Transplantation
    • Lobar Transplantation
lung transplantation and ipf3
Lung Transplantation and IPF
  • WHY?

It offers the opportunity to return to a better functional capacity when all medical therapies have been ineffective.

Ultimate form of treatment

lung transplantation
Lung Transplantation
  • Process:
    • Referral
    • Evaluation
    • Listing with UNOS
    • Waiting time
    • Transplantation
    • Post transplantation care
lung transplantation and ipf4
Lung Transplantation and IPF
  • For whom?
    • Candidate Selection
      • Age less than 65y
      • Absence of other organ dysfunction
      • Non-smoker, non-drinker, no drug abuse
      • Appropriate weight
      • Good support system
      • Stable psychosocial and emotional status
lung transplantation1
Lung Transplantation
  • CANDIDATE EVALUATION
    • Blood type, biochemical panel, serologies
    • Renal function determination
    • Skin testing and sputum cultures
    • PFT’s , ABG’s, 6-min walk, +/-exercise tests
    • Imaging: CXR, HRCT, V/Q, bone densitometry
    • Cardiac tests: echo; stress tests; RHC with hemodynamics and LHC where indicated
lung transplantation and ipf5
Lung Transplantation and IPF
  • When?

When patient is:

medically

physically

psychologically/emotionally,

READY! and lungs become available

lung transplantation2
Lung Transplantation
  • LESS THAN 20% OF DONORS ARE SUITABLE LUNG DONORS:
    • AGE AND SMOKING HX EXCLUDE SOME
    • LUNGS ARE FRAGILE--EDEMA, INFXN, VENTILATOR COMPLICATIONS
    • ALLOGRAFT INTOLERANCE TO PROLONGED ISCHEMIA
lung transplantation and ipf6
Lung Transplantation and IPF
  • When lungs become available, they are offered on the basis of:
    • Time on the waiting list
      • No consideration for severity of illness or urgency
        • Exception: 90 d credit when IPF patient listed
    • Blood type
    • Lung size
    • Other factors (?)
lung transplantation and ipf7
Lung Transplantation and IPF
  • While on Waiting List:
    • Adhere to medical treatment
    • Participate in pulmonary rehabilitation
    • Maintain good nutrition and acceptable body weight
    • Attend support groups
    • Keep a positive attitude and visualize a brighter tomorrow
lung transplantation3
Lung Transplantation
  • Registry:
    • United Network for Organ Sharing and the Organ Procurement and Transplantation Network (UNOS/OPTN)
        • 1988-2000
        • 7764 lung transplants (7625 C, 139 LD)
        • 719 heart-lung transplants
          • Data as of Nov. 2000
lung transplantation and ild
Lung Transplantation and ILD
  • Activity (SLT and BLT)- 1988-1999
    • IPF (LD 5) 972
    • SARCOIDOSIS 148
    • PF (OTHER) 82
    • LAM 47
    • OB (non-retransplant) 46
    • OCCUP. LUNG DIS. 11
    • RHEUMATOID DIS. 5
      • From UNOS/OPTN data as of 2/17/2001
lung transplantation and ipf8
Lung Transplantation and IPF
  • Idiopathic Pulmonary Fibrosis
    • Waiting time too long for some patients
    • At risk for developing 2* PHN
    • Prior Thoracic surgeries (OLB, Ptx)
    • High frequency of osteoporosis, obesity
    • Documented survival benefit
    • H-L, 2.9%; BLT, 7.1%; SL, 19.5% (ISHLT)
lung transplantation5
Lung Transplantation
  • Issues and complicating factors
    • Need for chronic immunosuppression
    • Acute and chronic rejection
    • Infection
    • Side effects of medicines
    • Cost of procedure and follow up care
lung transplantation and ild1
Lung Transplantation and ILD
  • IMPROVED FUNCTIONAL STATUS
  • IMPROVED PHYSIOLOGY(pulm+ cv)
  • SURVIVAL BENEFIT (IPF)
  • COMPARABLE INCIDENCE OF AR, CR INFECTION
  • IMPROVED QUALITY OF LIFE
lung transplantation and ipf ild
Lung Transplantation and IPF/ILD
  • LT is a therapeutic modality of great value
  • Efforts to overcome LT limitations needed:
    • Increase donor pool--review criteria
      • Living donors---Lobar transplantation
    • Prevent CR-improve treatment
  • Earlier listing of candidates with ILD/IPF
  • Explore new therapies as bridge to LT
    • New IPF paradigm
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