Overview of Lung Transplantation
description
Transcript of Overview of Lung Transplantation
![Page 1: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/1.jpg)
Overview of Lung Transplantation
Luca Paoletti, MDAssistant Professor of Medicine
Medical University of South Carolina
![Page 2: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/2.jpg)
Objectives
Define indications for lung transplantation Review guidelines for recipient selection for
lung transplantation Review surgical approaches for
transplantation Describe survival outcomes following
transplantation
![Page 3: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/3.jpg)
Transplantation
IPFCF
![Page 4: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/4.jpg)
![Page 5: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/5.jpg)
History of Lung Transplantation
1963- First Transplant 1963-1981 over 40 attempted 1983- First long term successful lung
transplant 1990- First living donor transplant Early 2000’s - Double lung transplant
more common
![Page 6: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/6.jpg)
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
500
1000
1500
2000
2500
3000
3500
4000
5 7 38 89204
450
758970
11601289
1412138915101547 1559
1700178419742012
2218
25692794
29202981
32783519
Total
Bilateral/Double Lung
Num
ber o
f Tra
nspl
ants
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 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 7: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/7.jpg)
LUNG TRANSPLANTS Transplant Recipient Age by Year of Transplant
(Transplants: January 1, 1987 – June 30, 2011)
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0%
20%
40%
60%
80%
100%
0
12
24
36
48
60
0-11 12-17 18-34 35-49 50-59 60-65 >65 Median AgeYear of Transplant
% o
f Tra
nspl
ants
Med
ian
reci
pien
t age
(yea
rs)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 8: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/8.jpg)
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2011)
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650
5
10
15
20
Recipient Age
% o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 9: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/9.jpg)
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2011)
0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650
5
10
15
20
25
30
35
Donor Age
% o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 10: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/10.jpg)
When to consider transplant
Untreatable, advanced stage lung disease
No other significant medical disease Limited life expectancy Poor quality of life Support system Must participate in rehab
J Heart Lung Transplant 2006. 25, 745-755
![Page 11: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/11.jpg)
Absolute Contraindications Extrapulmonic disease HIV infection Malignancy within prior
2 years Hepatitis B antigen
positivity Hepatitis C biopsy
proven liver disease Severe Musculoskeletal
disease
Substance addiction in prior 6 months
Absence of reliable support system
Untreatable psychosocial problems
Non-compliance
J Heart Lung Transplant 2006. 25, 745-755
![Page 12: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/12.jpg)
Relative Contraindications
Age > 65 Critical or unstable
medical condition Systemic or
multisystem extrapulmonic disease
Pan resistant organisms
Symptomatic osteoporosis
Mechanical ventilation
BMI <17 or >30
J Heart Lung Transplant 2006. 25, 745-755
![Page 13: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/13.jpg)
Role of Rehab Pre-op
Dyspnea = inactivity = muscle weakness = difficulty with ADLs
Rehab = improvement in functional capacity
Rehab = comfort with staff pre and post Rehab = group therapy Rehab = assessment of patient and
their support
![Page 14: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/14.jpg)
Role of Rehab post op
Continued muscle strengthening Continued endurance training Improvement in PFTs Improvement in 6MWT Prepares for home program
![Page 15: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/15.jpg)
ADULT LUNG TRANSPLANTSIndications (Transplants: January 1995 - June 2011)
Diagnosis SLT (N = 13,271) BLT (N = 20,831) TOTAL (N = 34,102)COPD/Emphysema 6,048 ( 45.6% ) 5,539 ( 26.6% ) 11,587 ( 34.0% )Idiopathic Pulmonary Fibrosis 4,430 ( 33.4% ) 3,495 ( 16.8% ) 7,925 ( 23.2% )Cystic Fibrosis 219 ( 1.7% ) 5,469 ( 26.3% ) 5,688 ( 16.7% )Alpha-1 741 ( 5.6% ) 1,332 ( 6.4% ) 2,073 ( 6.1% )Idiopathic Pulmonary Arterial Hypertension 82 ( 0.6% ) 982 ( 4.7% ) 1,064 ( 3.1% )Pulmonary Fibrosis, Other 498 ( 3.8% ) 659 ( 3.2% ) 1,157 ( 3.4% )Bronchiectasis 54 ( 0.4% ) 891 ( 4.3% ) 945 ( 2.8% )Sarcoidosis 251 ( 1.9% ) 614 ( 2.9% ) 865 ( 2.5% )Re-Transplant: Obliterative Bronchiolitis 259 ( 2.0% ) 254 ( 1.2% ) 513 ( 1.5% )Connective Tissue Disease 140 ( 1.1% ) 281 ( 1.3% ) 421 ( 1.2% )Obliterative Bronchiolitis (Not Re-Transplant) 91 ( 0.7% ) 260 ( 1.2% ) 351 ( 1.0% )LAM 122 ( 0.9% ) 241 ( 1.2% ) 363 ( 1.1% )Re-Transplant: Not Obliterative Bronchiolitis 166 ( 1.3% ) 191 ( 0.9% ) 357 ( 1.0% )Congenital Heart Disease 45 ( 0.3% ) 248 ( 1.2% ) 293 ( 0.9% )Cancer 6 ( 0.0% ) 28 ( 0.1% ) 34 ( 0.1% )Other 119 ( 0.9% ) 347 ( 1.7% ) 466 ( 1.4% )
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 16: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/16.jpg)
ADULT LUNG TRANSPLANTSMajor Indications By Year (Number)
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
250
500750
1,000
1,2501,5001,750
2,0002,2502,500
2,750CF IPF COPD Alpha-1 IPAH Re-Tx
Transplant Year
Num
ber o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 17: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/17.jpg)
J Heart Lung Transplant 2006. 25, 745-755
![Page 18: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/18.jpg)
COPD
Referral to transplant center:• BODE index of 5
Transplantation:• BODE index 7 – 10 or at least 1 of the following:
PaCO2 > 50mmHg Pulmonary hypertension or cor pulmonale despite O2
therapy FEV1 < 20% predicted and:
DLCO of less than 20% or homogenous emphysema on CT
J Heart Lung Transplant 2006;25:745–55.
![Page 19: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/19.jpg)
BODE score
Variable Points on BODE Index 0 1 2 3
FEV1 (% predicted) ≥65 50-64 36-49 ≤35
6-Minute Walk Test (meters) ≥350 250-349 150-249 ≤149
MMRC Dyspnea
Scale0-1 2 3 4
Body Mass Index >21 ≤21
![Page 20: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/20.jpg)
Idiopathic Pulmonary Fibrosis
Referral Histologic or radiographic evidence of UIP irrespective of
vital capacity Histologic evidence of fibrotic NSIP
Transplantation DLCO < 39% predicted 10% or greater decrease in FVC during 6 months of
follow-up A decrease in pulse oximetry below 88% during a 6-MWT Honeycombing on HRCT Reassess every 3 months
J Heart Lung Transplant 2006;25:745–55.
![Page 21: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/21.jpg)
Cystic Fibrosis
Referral FEV1 < 30% predicted or a rapid decline in FEV1 Young, female patients refer early Exacerbation of pulmonary disease requiring ICU Increasing frequency of exacerbations requiring antibiotics Recurrent hemoptysis not controlled by embolization
Transplantation Oxygen-dependent respiratory failure Hypercapnia Pulmonary hypertension
J Heart Lung Transplant 2006;25:745–55.
![Page 22: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/22.jpg)
Pulmonary Arterial Hypertension
Symptomatic progressive disease despite vasodilator treatment
WHO III-IV Right atrial pressure > 15mmHg Low or declining 6 minute walk test
![Page 23: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/23.jpg)
Pre-transplant Evaluation
PFTs 6 minute walk test EKG Echocardiogram Cardiac cath HRCT
Chemistries LFTs Serologies- CMV,
HIV, Hepatitis, EBV V/Q scan Dexa scan GERD
![Page 24: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/24.jpg)
Ideal Donor Selection Donor Age < 55 Smoking History < 20 pk/yrs No history of significant lung disease PaO2/FIO2 > 300 on PEEP of 5 cm H2O CXR clear BAL: No organisms on gram stain Normal endobronchial examination Absence of chest trauma ABO matched Size matched
![Page 25: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/25.jpg)
Good vs. Bad
![Page 26: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/26.jpg)
Bad
![Page 27: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/27.jpg)
Donor Selection Donor Net Alert UNOS website• Potential donor evaluation
Absolutes• Blood type• Donor height• Serology
• HIV• Hepatitis
• Mucus• X-ray (pneumonia)• Antigens
Relative• PaO2 =• Bronchoscopy• Location• Smoking history• Laboratory
values
Provisional Yes
![Page 28: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/28.jpg)
Conventional Mechanical Ventilation• Volume Control• Tidal Volume 8-10cc/kg OF ideal body
weight• Rate to achieve PCO2 35-45• PEEP of 5-8
Donor Ventilator Management
![Page 29: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/29.jpg)
Prevent aspiration:• Inflate ETT cuff to 25 cm H20• Head of bed > 30 degrees
Airway Clearance• Bag ventilation and suction• Therapeutic Bronchoscopy
Donor Ventilator Management
![Page 30: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/30.jpg)
Donor Selection:
![Page 31: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/31.jpg)
Getting the Lungs
![Page 32: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/32.jpg)
Lung Transplant Surgery
![Page 33: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/33.jpg)
Sternotomy
![Page 34: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/34.jpg)
![Page 35: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/35.jpg)
Clamshell Incision
![Page 36: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/36.jpg)
![Page 37: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/37.jpg)
Thoracotomy
![Page 38: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/38.jpg)
![Page 39: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/39.jpg)
Cardiopulmonary Bypass
![Page 40: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/40.jpg)
Anastomosis
![Page 41: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/41.jpg)
Donor Lung
![Page 42: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/42.jpg)
MUSC Team
![Page 43: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/43.jpg)
![Page 44: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/44.jpg)
![Page 45: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/45.jpg)
OR
![Page 46: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/46.jpg)
Possibly the futureEx Vivo Lung Perfusion
![Page 47: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/47.jpg)
![Page 48: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/48.jpg)
![Page 49: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/49.jpg)
![Page 50: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/50.jpg)
Costs
Varies from center to center Median cost in 2007: $140,000 Mean LOS -18 daysRemember… Annual infusion therapy for A1AT/Pulm
HTN is over $100,000
![Page 51: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/51.jpg)
Organ Allocation
![Page 52: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/52.jpg)
Organ Allocation Organ Allocation:
• Shall be based on sound medical judgment;• Shall seek to achieve the best use of donated organs;• Shall be designed to avoid wasting organs
Policies shall be designed to achieve equitable allocation of organs among patients by:• (1) Standardizing the criteria for determining suitable
transplant candidates• (2) Setting priority rankings
• These rankings shall be ordered from most to least medically urgent
Department of Health and Human Services
![Page 53: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/53.jpg)
New Lung Allocation Scheme• Waitlist Urgency measure• Post-transplant survival measure• Transplant benefit (extra days of life) = post-transplant survival minus waitlist urgency• Normalize to scale of 1 - 100 = Lung Allocation Score (LAS)
![Page 54: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/54.jpg)
LAS calculation
Diagnosis Age Height, Weight Diabetes Oxygen requirement 6MWT Functional Status
PA systolic pressure PA mean pressure PAOP Cr FVC Arterial CO2
![Page 55: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/55.jpg)
![Page 56: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/56.jpg)
![Page 57: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/57.jpg)
Factors that Affect Outcomes
Donor Age Ischemia time Age of Recipient Diagnosis of Recipient Level of illness at transplant
![Page 58: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/58.jpg)
ADULT LUNG TRANSPLANTSKaplan-Meier Survival
(Transplants: January 1994 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 160
25
50
75
100
Bilateral/Double Lung (N=19,566)Single Lung (N=13,276)All Lungs (N=32,842)
Years
Surv
ival
(%)
Double lung: 1/2-life = 6.7 Years; Conditional 1/2-life = 9.4 YearsSingle lung: 1/2-life = 4.6 Years; Conditional 1/2-life = 6.5 YearsAll lungs: 1/2-life = 5.5 Years; Conditional 1/2-life = 7.7 Years
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 59: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/59.jpg)
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Era
(Transplants: January 1988 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
1001988-1995 (N=5,949)1996-2003 (N=12,632)2004-6/2010 (N=17,715)
Years
Surv
ival
(%)
N at risk = 1,055
N at risk = 192
N at risk = 5851988-1995: 1/2-life = 3.9 Years; Conditional 1/2-life = 7.0 Years1996-2003: 1/2-life = 5.3 Years; Conditional 1/2-life = 7.9 Years2004-6/2010: 1/2-life = 5.9 Years; Conditional 1/2-life = NA
1988-95 vs. 1996-2003: p < 0.00011988-95 vs. 2004-6/2010: p <0.0001 1996-2003 vs. 2004-6/2010: p <0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 60: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/60.jpg)
Physiologic results
Near normal spirometry Improved gas exchange Single lung transplant• PFTs plateau at 3-6 months• Most perfusion goes to transplanted lung
Bilateral lung transplant• PFTs plateau at 6-9 months• Perfusion is equally split
![Page 61: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/61.jpg)
ADULT LUNG RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2011)
1 Year (N = 6,935) 3 Years (N = 4,448) 5 Years (N = 2,581)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Assistance Total Assistance
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 62: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/62.jpg)
ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year (N = 11,669)
3 Years (N = 7,276)
5 Years (N = 4,702)
Working (FT/PT Status unknown)
Working Part Time
Working Full Time
Retired
Not Working
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 63: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/63.jpg)
![Page 64: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/64.jpg)
Medications
Typically 10-15 different meds Take pills in AM and PM Take 3 different Immunosuppressants
![Page 65: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/65.jpg)
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: April 1994 - June 2008)
ISHLT
2009
![Page 66: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/66.jpg)
ADULT LUNG TRANSPLANT RECIPIENTSCause of Death (Deaths: January 1992 – June 2011)
CAUSE OF DEATH 0-30 Days (N = 2,504)
31 Days - 1 Year
(N = 4,347)
>1 Year - 3 Years
(N = 3,910)
>3 Years - 5 Years
(N = 2,217)
>5 Years – 10 Years (N = 2,615)
>10 Years (N = 756)
BRONCHIOLITIS 8 (0.3%) 199 (4.6%) 1,018 (26.0%) 647 (29.2%) 659 (25.2%) 157 (20.8%)
ACUTE REJECTION 89 (3.6%) 77 (1.8%) 59 (1.5%) 11 (0.5%) 16 (0.6%) 1 (0.1%)
LYMPHOMA 1 (0.0%) 109 (2.5%) 82 (2.1%) 36 (1.6%) 60 (2.3%) 30 (4.0%)
MALIGNANCY, NON-LYMPHOMA 3 (0.1%) 117 (2.7%) 273 (7.0%) 218 (9.8%) 324 (12.4%) 90 (11.9%)
CMV 0 108 (2.5%) 38 (1.0%) 7 (0.3%) 4 (0.2%) 1 (0.1%)
INFECTION, NON-CMV 503 (20.1%) 1,561 (35.9%) 894 (22.9%) 434 (19.6%) 472 (18.0%) 127 (16.8%)
GRAFT FAILURE 652 (26.0%) 740 (17.0%) 727 (18.6%) 403 (18.2%) 466 (17.8%) 132 (17.5%)
CARDIOVASCULAR 268 (10.7%) 195 (4.5%) 154 (3.9%) 106 (4.8%) 133 (5.1%) 50 (6.6%)
TECHNICAL 262 (10.5%) 146 (3.4%) 35 (0.9%) 15 (0.7%) 25 (1.0%) 8 (1.1%)
OTHER 718 (28.7%) 1,095 (25.2%) 630 (16.1%) 340 (15.3%) 456 (17.4%) 160 (21.2%)
ISHLT 2012 Percentages represent % of deaths in the respective time period
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
![Page 67: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/67.jpg)
Referral to MUSC for Lung Transplantation Evaluation
Sarah Simon (843)792-4773 Email me at [email protected]
![Page 68: Overview of Lung Transplantation](https://reader036.fdocuments.in/reader036/viewer/2022062310/568163bf550346895dd4e00e/html5/thumbnails/68.jpg)