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.
Fasting Lipid Profile
Fasting Glucose Profile
PSA for Male patients >50 yrs
24 hour Urinary Creatinine clearance
FOB x 3 samples
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
Tissue typing x 2 large bottles to be sent to “Dept of Histopathology & Immunogenetics, Beaumont Hospital, Dublin 9.”
Cytotoxic Antibodies to “Dept of Histopathology & Immunogenetics, Beaumont Hospital, Dublin 9.”
Right and Left Heart Cath
Full Pulmonary Function Tests including FEV1, FVC, DLCO, TLC
Vascular and other:
Pelvic ultrasound for women > 50yrs of age or symptomatic
VQ Scan to assess quantitative perfusion to each lung (this effects the transplant surgery sequence and is independent of any suspicion for PE’s)
Femoral Ultrasound to measure and assess femoral artery and vein for ECMO and or vascular access for CF and PAH patients only
PAP smear in women
Height, weight and BMI
Dentist review and dental clearance letter
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?
DEFINITE UIP/IPF or fibrotic NSIP
Physiologic impairment: FVC < 80%, Dlco < 40%
Any requirement for oxygen
For inflammatory ILD – failure to respond to treatment
> 10% drop in FVC, or > 15% drop in DLco over 6 months
Desaturation below 88% on 6MWT, or distance < 250m or decline of > 50m
Hospitalization for respiratory symptoms
What are the ISHLT lung transplant referral and listing criteria for patients with COPD?
Progressive disease despite maximal treatment
BODE > 5-6
FEV1 < 25%
PaO2 < 8, PCO2 > 6.5
Not a candidate for LVRS
BODE > 7<
≥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)?
FEV1 < 30% predicted or rapid deterioration (esp young female)
6MW < 400m
RVSP > 35
Acute requirement of NIV
Increasing frequency and severity of exacerbations
Refractory pneumothorax or hemoptysis
pO2 <8.0kPa +/- pCO2 > 6.6kPa
WHO Class IV
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.
Solid organ Malignancy (within 5 years, specific details for cutaneous malignancies will be considered)
Untreatable advanced dysfunction of another major organ system Eg. heart, liver, kidneys, brain
Chest wall or spinal deformity causing severe restriction
Non-correctable coronary or other organ ischemia
Acute medical instability (sepsis, MI, liver failure)
Uncorrectable bleeding diathesis
Poorly controlled chronic infection with resistant/virulent organisms
BMI > 28
Inability to follow up or adhere to treatment
Active psychiatric/psychological problems
History of recurrent non-adherence
Inadequate social supports
Severely limited functional status with poor rehabilitation potential
Substance abuse in the last 6-12 months (including tobacco or alcohol)
Age alone is not considered a contraindication in Ireland
BMI must be less than 28 and >17.5 or greater than 17.5 for some indications
Severe symptomatic osteoporosis
Extensive previous chest surgery/resection
Infection or colonization with highly resistant organisms
Burkholderia cenocepacia, Mycobacterium abscessus
HBV, HCV with synthetic dysfunction or portal hypertension
HIV with detectable viral load or AIDS-defining illnesses
Atherosclerosis sufficient to risk end organ damage post-transplant
Other non-optimized medical conditions
History of Lung Transplants
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