Patient Information

The Transplant Operation

Consultant Questions

FAQ for referring consultants

What investigations will be required for the Lung Transplant assessment process?
A Transplant is a major operation and as such there are a large number of tests required during the assessment, some of which may need to be repeated again by the Mater Lung Transplant unit even when done in the local hospital.

Laboratory Tests:

  1. FBC
  2. U&E
  3. Coag Screen
  4. Fibrinogen
  5. Renal/Liver/Bone profile
  6. Fasting Lipid Profile
  7. Fasting Glucose Profile
  8. HbA1c
  9. Serum Ferritin
  10. Iron studies
  11. Urate
  12. SPEP
  13. ESR
  14. CRP
  15. Blood Group
  16. PSA for Male patients >50 yrs
  17. TFT’s
  18. 24 hour Urinary Creatinine clearance
  19. FOB x 3 samples
  20. ABG
  21. Quantiferon
  22. Virology to be sent as a clotted serum sample to “UCD National Virus Reference Lab, UCD, Belfield, Dublin 4” and marked as “Pre-Lung Transplant assessment panel”- this includes: Hep A, Hep B surface and Core antigen, Hep C, EBV, CMV, HIV 1 &2, HTLV 1&2, Trep pallidum, EBNA, Toxo, VDRL, VZV, HSV
  23. Tissue typing x 2 large bottles to be sent to “Dept of Histopathology & Immunogenetics, Beaumont Hospital, Dublin 9.”
  24. Cytotoxic Antibodies to “Dept of Histopathology & Immunogenetics, Beaumont Hospital, Dublin 9.”

 

Cardiology:

  1. ECG
  2. Echo
  3. Right and Left Heart Cath

 

Respiratory:

  1. Full Pulmonary Function Tests including FEV1, FVC, DLCO, TLC
  2. ABG

 

Vascular and other:

  1. Carotid Dopplers
  2. Abdominal ultrasound
  3. Pelvic ultrasound for women > 50yrs of age or symptomatic
  4. Orthopantogram
  5. Dexa scan
  6. Chest radiograph
  7. VQ Scan to assess quantitative perfusion to each lung (this effects the transplant surgery sequence and is independent of any suspicion for PE’s)
  8. CT thorax
  9. Femoral Ultrasound to measure and assess femoral artery and vein for ECMO and or vascular access for CF and PAH patients only
  10. Colonoscopy
  11. PAP smear in women
  12. Height, weight and BMI
  13. Dentist review and dental clearance letter

 

Consults:

In addition to the above tests, there are a number of specialists in the Mater Misericordiae University Hospital who will see each patient before listing including the Transplant Physician, 2 Transplant Surgeons, Psychiatrist, Social Worker

What are the ISHLT lung transplant referral and listing criteria for patients with Interstitial Lung disease?
Referral

  • DEFINITE UIP/IPF or fibrotic NSIP
  • Physiologic impairment: FVC < 80%, Dlco < 40%
  • Any requirement for oxygen
  • For inflammatory ILD –  failure to respond to treatment

 

Listing

  • > 10% drop in FVC, or > 15% drop in DLco over 6 months
  • Desaturation below 88% on 6MWT, or distance < 250m or decline of > 50m
  • Pulmonary hypertension
  • Hospitalization for respiratory symptoms
What are the ISHLT lung transplant referral and listing criteria for patients with COPD?
Referral

  • Progressive disease despite maximal treatment
  • BODE > 5-6
  • FEV1 < 25%
  • PaO2 < 8, PCO2 > 6.5
  • Not a candidate for LVRS

Listing

  • BODE > 7<
  • FEV1< 15-20%<
  • ≥3 severe exacerbations in previous year
  • 1 exacerbation with hypercapnic resp failure
  • Moderate-severe pulmonary hypertension

 

What are the ISHLT lung transplant referral and listing criteria for patients with Cystic Fibrosis (CF)?
Referral

  • FEV1 < 30% predicted or rapid deterioration (esp young female)
  • 6MW < 400m
  • RVSP > 35
  • Clinical deterioration
  • Acute requirement of NIV
  • Increasing frequency and severity of exacerbations
  • Refractory pneumothorax or hemoptysis
  • Nutritional status

Listing

  • pO2 <8.0kPa +/-  pCO2 > 6.6kPa
  • Chronic NIV
  • Pulmonary hypertension
  • WHO Class IV
  • Rapid decline

 

What are the ISHLT lung transplant referral and listing criteria for patients with Pulmonary Arterial Hypertension (PAH)?
  • NYHA Class III-IV
  • Rapidly progressing disease
  • Requiring parenteral therapy regardless of NYHA
  • Suspected PVOD or PCH
What are the Irish Lung transplant program absolute and relative contraindications for Lung Transplantation?
The list below serves as a guideline and is not exhaustive. The decision for listing for Lung transplantation is made by the consensus of opinion of an expert panel of Transplant specialists via a multi-disciplinary meeting held regularly in the Mater Misericordiae University Hospital.

Absolute Contraindications:

  1. Solid organ Malignancy (within 5 years, specific details for cutaneous malignancies will be considered)
  2. Untreatable advanced dysfunction of another major organ system Eg. heart, liver, kidneys, brain
  3. Chest wall or spinal deformity causing severe restriction
  4. Non-correctable coronary or other organ ischemia
  5. Acute medical instability (sepsis, MI, liver failure)
  6. Uncorrectable bleeding diathesis
  7. Poorly controlled chronic infection with resistant/virulent organisms
  8. Active TB
  9. BMI > 28
  10. Inability to follow up or adhere to treatment
  11. Active psychiatric/psychological problems
  12. History of recurrent non-adherence
  13. Inadequate social supports
  14. Severely limited functional status with poor rehabilitation potential
  15. Substance abuse in the last 6-12 months (including tobacco or alcohol)

 

Relative contraindications

 

  1. Age alone is not considered a contraindication in Ireland
  2. BMI must be less than 28 and >17.5 or greater than 17.5 for some indications
  3. Severe symptomatic osteoporosis
  4. Extensive previous chest surgery/resection
  5. Mechanical ventilation
  6. Infection or colonization with highly resistant organisms
    • Burkholderia cenocepacia, Mycobacterium abscessus
  7. HBV, HCV with synthetic dysfunction or portal hypertension
  8. HIV with detectable viral load or AIDS-defining illnesses
  9. Atherosclerosis sufficient to risk end organ damage post-transplant
  10. Other non-optimized medical conditions

 



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History of Lung Transplants


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