Recipient Selection

A summary of the general selection criteria is shown in Table 12.1. These have been described in detail by Maurer and associates.2 Only those patients believed to have a limited life expectancy (1 to 2 years) as a result of their underlying pulmonary disease are listed. Absolute and relative contraindications to lung transplantation are listed in Table 12.2. Once a referral is made to the lung transplant center, an initial screening evaluation of medical records, chest-x-rays, and CT scans is done. If this information is deemed satisfactory, then a formal evaluation of the patient takes place at the lung transplant center by a multidisciplinary team. The scheme for this formal on-site evaluation is outlined in Table 12.3. The data gleaned from the formal evaluation allows the lung transplant team to determine whether the patient is a suitable candidate for lung transplantation. Once patients are listed for transplantation (except those with PPH or ES), they are enrolled in a progressive, monitored cardiopulmonary rehabilitation program. Virtually all patients experience a significant improvement in strength, exercise tolerance and well being without any measurable change in pulmonary function. The average wait for a lung transplant in the United States was 19 months as of 2002.

Specific Pre-operative Issues

Ventilator Dependency

Progression to ventilator dependency and even death during the waiting period is not uncommon because of the shortage of donor lungs. Patients who are ventilator dependent at the time of referral are not considered for transplantation. However, patients that develop ventilator dependency while on the waiting list and who remain stable are still considered candidates for transplantation.

Corticosteroid Therapy

Patients who are receiving high-dose corticosteroid therapy (prednisone >40 mg/day) are not considered eligible for transplantation due to the well-documented negative effect on bronchial healing. Low to moderate doses of corticosteroids (prednisone £ 0.2 mg/kg/day) does not contraindicate transplantation.

0 0

Post a comment