Lung transplantation

Question

When should be done a lung transplantion in CF? What happens when a patient refuses or fails to find a donor for 36 years female?

Answer

Dear Mrs.
Lung transplantation is indicated in patients where conservative treatment failed, including long-term oxygen therapy. Also if disease progression is so quick that the patient´s life expectancy is no more than 1,5-2 years. In CF, the number of acute exacerbations, number of needed antibiotic therapies, worsening malnutrition status play an important role. If lung transplantation is indicated, patient´s informed consent is always necessary regarding fully informed patient and family. If the entry criteria are filled - the patient is placed on the lung transplantation waiting list. Inclusion does not automatically mean own transplantation, an appropriate donor may not be found. In this case, as well as lung transplant rejection, we continue with conservative treatment - bronchodilators, mucolytics, antibiotics therapy, physiotherapy, oxygen therapy and also psychosocial help in a CF center.
In any case it would be helpful to talk with your specialist in your CF center about this topic and probably to make an appointment at a transplantation center.
Best regards Branko Takáč

12.05.2009

12.05.09
To give an overview over the current indications for lung transplantation, guidelines are cited here (Orens et al. 2006 in J Heart Lung Transplant 2006; 25:745-55 "International Guidelines for the Selection of Lung Transplant Candidates: 2006 Update - A Consensus Report form the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation."):
"Lung transplantation in indicated for patients with chronic, end-stage lung diseases who are failing maximal medical therapy, or for whom no effective medical therapy exists. ..In general, referral for transplantation assessment is advisable when patients have less than 50%, 2- to 3-year predicted survival or New York Haert Association (NYHA) class III or IV level fo function or both.---Rahter it is recommended to rely on a variety of clinical (e.g., rate of infection, ICU hospitalization, oxygen need, weight loss...) laboratory (e.g. Pa02 and PaC02) and functional findings (e.g. pulmonary function tests, echocardiography, exercise capacity etc).
Guidelines for Referral:
-FEV1 below 30% predicted or a rapid decline in FEV1 - in particular in young female patients.
-Exacerbation of pulmonary diseases requiring ICU stay
-Increasing frequency of exacerbations requirin antibiotic therapy
-Refractory and/or recurrent pneumothorax
-recurrent hemoptysis not controlled by embolization
Guidelines for Transplantation:
-Oxygen dependent respiratory failure
-Hypercapnia
-Pulmonary hypertension"
D. d'Alquen