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LUNG TRANSPLANTATION 2012

LUNG TRANSPLANTATION 2012. דר' לקסר אורי מכון הראה בית החולים האוניברסיטאי הדסה. INDICATION. Lung transplantation is indicated for patients with chronic, end-stage lung disease who are failing maximal medical therapy, or for whom no effective medical therapy exists. COPD IPF PPH CF .

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LUNG TRANSPLANTATION 2012

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  1. LUNG TRANSPLANTATION2012 דר' לקסר אורי מכון הראה בית החולים האוניברסיטאי הדסה

  2. INDICATION • Lung transplantation is indicated for patients with • chronic, end-stage lung disease who are failing maximal • medical therapy, or for whom no effective medical • therapy exists. • COPD • IPF • PPH • CF • . • . The Journal of Heart and Lung Transplantation July 2006

  3. TIMING Ideally, listing for transplantation should occur when life expectancy is greatly reduced but nonetheless greater than the expected waiting time for a suitable organ, and transplantation should be performed when life expectancy after transplantation exceeds life expectancy without the procedure. The Journal of Heart and Lung Transplantation July 2006

  4. AIMS • Survival benefit • Quality of life • Palliation

  5. Absolute contraindications Malignancy in the last 2 years. . Untreatable advanced dysfunction of another major organ system . Non-curable chronic extrapulmonary infection including HBV HCV HIV . Significant chest wall/spinal deformity. . Documented nonadherence . Untreatable psychiatric or psychologic condition . Absence of a consistent or reliable social support . Substance addiction (e.g., alcohol, tobacco, or narcotics) The Journal of Heart and Lung Transplantation July 2006

  6. Relative contraindications • Age >65y • Unstable condition • Limited functional condition • 18 >bmi>30 • Colonization with resistant organism • Ventilation • Osteoporosis • IHD,D.M.,GERD,HTN…. The Journal of Heart and Lung Transplantation July 2006

  7. COPD • Guidelines for Referral • . BODE index exceeding 5 • Guidelines for Transplantation • . Patients with a BODE index* of 7 to 10 or at least 1 • of the following: • . History of hospitalization for exacerbation associated • with acute hypercapnia (PCO2 exceeding 50 mm Hg). • Pulmonary hypertension or cor pulmonale, or both, • despite oxygen therapy. • . FEV1 of less than 20% and either DLCO of less than 20% • or homogenous distribution of emphysema. The Journal of Heart and Lung Transplantation July 2006

  8. Cystic fibrosis and bronchiectasis • Guidelines for Referral • . FEV1 below 30% predicted or a rapid decline in FEV1. • . Exacerbation of pulmonary disease requiring ICU stay. • . Increasing frequency of exacerbations requiring antibiotic • therapy. • . Refractory and/or recurrent pneumothorax. • . Recurrent hemoptysis not controlled by embolization. • Guideline for Transplantation • . Oxygen-dependent respiratory failure. • . Hypercapnia. • . Pulmonary hypertension. • The Journal of Heart and Lung TransplantationJuly 2006

  9. PULMONARY FIBROSIS • Guideline for Referral early,do not wait to treatment • . Histologic or radiographic evidence of UIP irrespective of vital capacity. • . Histologic evidence of fibrotic NSIP. • Guideline for Transplantation • . Histologic or radiographic evidence of UIP and any of the following: • . A DLCO of less than 39% predicted. • . A 10% or greater decrement in FVC during 6 months of follow-up. • . A decrease in pulse oximetry below 88% during 6-MWT. • . Honeycombing on HRCT (fibrosis score of 2). • . Histologic evidence of NSIP and any of the following: • .A DLCO of less than 35% predicted. • . A 10% or greater decrement in FVC or 15% decrease • in DLCO during 6 months of follow-up. The Journal of Heart and Lung Transplantation July 2006

  10. PULMONARY ARTERIAL HYPERTENSION • Guideline for Referral • . NYHA functional class III or IV, irrespective of ongoing therapy. • . Rapidly progressive disease. • Guideline for Transplantation • . Persistent NYHA class III or IV on maximal medical therapy. • . Low (350 meter) or declining 6-MWT. • . Failing therapy with intravenous epoprostenol, or equivalent. • . Cardiac index of less than 2 liters/min/m2. • . Right atrial pressure exceeding 15 mm Hg. The Journal of Heart and Lung Transplantation July 2006

  11. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide. ISHLT 2009

  12. LUNG TRANSPLANTS:Transplant Recipient Age by Year of TransplantTransplants: January 1, 1987 – June 30, 2008 ISHLT 2009

  13. AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS(1/1985-6/2008) ISHLT 2009

  14. DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2008) ISHLT 2009

  15. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2007) ISHLT 2009

  16. ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2008) *Other includes: Sarcoidosis: 2.1% Bronchiectasis: 0.4% Congenital Heart Disease: 0.2% LAM: 0.8% OB (non-ReTx): 0.5% Miscellaneous: 6.3% ISHLT 2009

  17. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD ISHLT 2009

  18. ADULT LUNG TRANSPLANTS(1/1995-6/2007)Risk Factors for 1 Year MortalityRecipient Age ISHLT 2009

  19. ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients(Follow-ups: April 1994 – June 2008) ISHLT 2009

  20. ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients(Follow-ups: April 1994 – June 2008) ISHLT 2009

  21. ADULT LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-upFor follow-ups between January 2002 through June 2008Analysis limited to patients receiving prednisone ISHLT 2009 Analysis is limited to patients who were alive at the time of the follow-up

  22. POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April 1994 - June 2008) ISHLT 2009

  23. FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME For Adult Lung Recipients(Follow-ups: April 1994-June 2008)Conditional on Survival to 14 days ISHLT 2009

  24. FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients(Follow-ups: April 1994-June 2008) ISHLT 2009

  25. FREEDOM FROM MALIGNANCYFor Adult Lung Recipients(Follow-ups: April 1994-June 2008) ISHLT 2009

  26. ADULT LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death(Deaths: January 1992 - June 2008) ISHLT 2009

  27. מה קורה בישראל? • רשימה ארצית לפי LAS SCORE- : שקלול חומרת המחלה וסכויי הצלחת ההשתלה • 11 פרמטרים המרכיבים את הנקוד-תפקודי • ראה,מחלות רקע,מחלת היסוד,מצב תפקודי וכ' • תרומה מתורם עם מוות מוחי מוכרז • אין תרומה מהחי • אין STATUS ONE • ריאה מאופיינת בזמן איסכמיה קצר 4-6 שעות • זמן המתנה עד שנה לערך-70 חולים על הרשימה • אין שיתוף פעולה אזורי או בינלאומי

  28. תודה

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