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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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