Transplant Recipients

Surveillance

Lung transplant recipients have an ongoing risk of acute and chronic rejection as well as septic complications. Therefore, an approach to routine surveillance (that is, monitoring of the clinically and physiologically stable patient) seems appropriate. Different lung transplant centers vary in their approach to surveillance, but the fundamental components include:

Clinical Follow-up

Patients are "released" from the local geographic region of the lung transplant center to return "home" at around three months after transplantation, as long as their post-operative course has been satisfactory. Thereafter, they return to the care of their referring pulmonologist, ensuring that close contact and dialogue must be maintained with the lung transplant center.

Pulmonary Function Tests

The International Society for Heart and Lung Transplantation7 has recommended that spirometry in lung transplant recipients should be performed with equipment conforming to the American Thoracic Society Standards, without bron-chodilator therapy, and ideally monthly in the first year post-transplantation.48 This would allow a baseline value of the FEV1 (the average of the two previous highest consecutive measurements taken 3 to 6 weeks apart) to be established. This baseline value may of course continue to increase over time. Significant al-lograft dysfunction would then be based on a fractional decline in the FEV1 relative to the baseline value. At the Washington University Lung Transplant Program, spirometry is performed weekly in the first three months, then monthly between 3 and 12 months post-transplantation, and then every 2 to 3 months beyond 1 year.49

Chest Radiograph

Chest radiographs are obtained on a schedule similar to that of pulmonary function testing and, of course whenever clinically indicated. Chest CT scanning is not routinely done for surveillance, but can be obtained if clinical, radiographic, or bronchoscopic findings suggest the occurrence of an intra-thoracic complication following the transplantation, such as bronchial dehiscence, pleural effusion or empyema.

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