TY  - CHAP
M1  - Book, Section
TI  - Lung and Heart–Lung Transplantation
A1  - Shah, Ashish S.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
Y1  - 2014
N1  - 
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyTo  date,  more  than  30,000  lung  and  2600  heart–lung  transplantations  have  been  reported  to  the  International  Society  of  Heart  and  Lung  Transplant  Registry.  Since  2005,  bilateral  lung  transplant  has  been  the  most  commonly  performed  procedure.PathophysiologyLung  and  heart–lung  transplantation  is  performed  for  patients  who  have  end-stage  cardiopulmonary  disease  with  no  contraindications  and  have  the  potential  to  be  rehabilitated  completely.  Most  lung  transplants  are  done  for  chronic  obstructive  pulmonary  disease  (COPD),  cystic  fibrosis,  idiopathic  pulmonary  fibrosis,  and  pulmonary  hypertension.  Primary  pulmonary  hypertension  and  Eisenmenger  syndrome  are  the  most  common  indications  for  heart–lung  transplantation.Clinical  featuresCandidates  typically  experience  severe  dyspnea,  cyanosis,  hemoptysis,  or  multiple  hospitalizations  and  have  New  York  Heart  Association  functional  class  III  and  IV  status.  Lung  transplant  candidates  typically  have  a  life  expectancy  of  24  to  36  months  and  are  usually  less  than  75  years  of  age.  Patients  with  COPD  generally  have  a  forced  expiratory  volume  in  1  second  (FEV1)  of  less  than  20  percent  predicted,  whereas  patients  with  cystic  fibrosis  usually  have  an  FEV1  of  less  than  30  percent  predicted,  an  increasing  oxygen  requirement,  nutritional  decline,  and  an  increasing  requirement  for  hospitalization.  Patients  with  interstitial  lung  diseases  may  have  a  rapidly  progressive  decline  with  increasing  oxygen  requirements  and  reduced  vital  capacity.  Candidates  for  heart–lung  transplant  have  both  pulmonary  and  cardiac  disease  and  are  typically  under  65  years  of  age.DiagnosticsCandidates  for  lung  and  heart–lung  transplants  undergo  an  extensive  workup  to  evaluate  underlying  cardiopulmonary  function  and  exclude  malignancy,  active  infection,  end-organ  dysfunction,  and  vascular  disease.  Diagnostic  modalities  include  pulmonary  function  tests,  endoscopy  (especially  bronchoscopy),  echocardiography,  cardiac  catheterization,  duplex  ultrasonography,  computed  tomography  and/or  magnetic  resonance  imaging,  serologic  screens,  and  metabolic  panels.TreatmentLung  transplantation:  COPD,  cystic  fibrosis,  idiopathic  pulmonary  fibrosis,  and  pulmonary  hypertension.Heart–lung  transplantation:  Eisenmenger  syndrome,  sarcoid  with  both  cardiac  and  pulmonary  involvement.OutcomesLung  transplant  survival  rates  are  82,  55,  and  30  percent  at  1,  5,  and  10  years,  respectively;  best  survival  rates  are  among  patients  with  cystic  fibrosis.  Significant  spirometric  improvement  is  immediate  and  plateaus  at  6  to  12  months.  For  heart–lung  transplantation,  survival  rates  are  71  percent  at  1  year.  Early  morbidity  and  mortality  stem  from  technical  complications,  infections,  and  graft  failure.  Late  complications  are  usually  manifestations  of  bronchiolitis  obliterans  and  malignancy.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/16
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104585736
ER  -