lung tr - LUNG TRANSPLANTATION : CURRENT STATUS & INDIAN...

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LUNG TRANSPLANTATION : CURRENT STATUS & INDIAN PERSPECTIVE Dr.Amit Raodeo Introduction ± First attempt of lung transplantation in 1963 by Hardy & coworkers ± First successful transplantation by Toronto group in 1983 ± 1400 transplantations are done worldwide per year ± International society of heart-lung transplantation has registered > 14500 lung transplant recipients
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± Advances in operative technique & immunosuppression led to reduction in mortality rates to <10% ± 1 year survival of > 80% ± Improvement in post-transplant quality of life is noted ± Greatest risk factor for mortality is found to be ventilator dependency.( O.R.of 2.4) ± These patients not considered for transplantation . Introduction ± Recently various other issues have been raised - 1) Effect of obesity- high BMI : adverse effect on short term as well as long term survival 2) Effect of gender combination : significant risk of primary graft failure is associated with Female to Male but beneficial results with Female to Female Introduction
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Types of transplantations ± Unilateral / Single lung transplant : good results in patients with 1)pulmonary fibrosis 2)emphysema ( small size & older patients) 3) acceptable option in pulmonary hypertension ± Experience over past two decades shows that bilateral lung transplants shows better results ± Superior late survival ± Simpler early postop management ± Preferred modality in pediatric patients ± Absolute indications for bilateral lung transplantation - 1)cystic fibrosis 2)bronchiectasis Types of transplantations
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Types of transplantations ± Indications of heart-lung transplantation 1) advanced lung disease with poor LV function 2) complex congenital cardiac abnormalities 3) Eisenmengers syndrome Donor supply ± Increasing gap between demand & supply ± Newer strategies A) Marginal donors :- Do not fulfill these rigid criteria- 1. Age < 55 years 2. Clear CXR 3. No smoking history 4. Sputum Gm stain negative 5. Normal gas exchange
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± Donor sputum positivity do not predict post -op outcome ± Majority of the donors are trauma and brain dead patients ± fluid overload is common in prospective donors- diuretics significantly improve gas exchange ± atelectesis common in potential donors- 1) FOB- Aspirate secretions 2) alterations in ventilator settings Donor supply Donor supply ± Trauma victims - chest wall contusion may mimic a shadow in CXR ± Minor pulmonary contusions should not preclude successful transplantation ± Precautions while using these marginal donors ± Should not be used in complicated procedures ± usually are not used for single lung transplantations
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Donor supply B) Living lobar transplantation ± Harvesting left Lower lobe from one healthy donor & right lower lobe from another ± pioneered by university of southern California program.
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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lung tr - LUNG TRANSPLANTATION : CURRENT STATUS & INDIAN...

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