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  • Single-lung transplant
  • Double-lung transplant
  • Living donor lobar transplant

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  • V42.6 Lung replaced by transplant

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  • Z94.2 Lung transplant status

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Description

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  • Diseased or defective lung (single-lung transplant) or lungs (double-lung transplant), or a portion thereof is removed
  • Healthy partial lung from a living donor or complete donor lung(s) from a deceased person is implanted

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Essentials of Diagnosis

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  • Most common causes in children under 1 year of age is congenital heart disease (CHD), peripheral vascular disease (PVD), and cystic fibrosis (CF)
  • Lung transplants considered when patient death is imminent within 1 to 2 years and all other medical options have been exhausted and are ineffective1

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General Considerations

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  • Timing of transplant for over 12 years of age depends on lung allocation score (LAS)
  • Long term outcomes are limited
  • Contraindications to lung transplant
    • Malignancy
    • Sepsis
    • Tuberculosis
    • Hepatitis
    • Neuromuscular disease

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Demographics2

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  • 44 lung transplants in 2011 at the Mayo clinic in Florida
  • Males more common than females
  • 0.02% pediatric lung transplants (<18 years old)
  • Double lung transplants are 5 to 6 times more common than single lung transplants

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Signs and Symptoms

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  • Respiratory failure
  • Unable to tolerate exercise
  • Hypoxemia
  • Carbon dioxide retention
  • Failure to thrive
  • Abnormal pulmonary function tests (PFTs)
  • Syncope
  • Cyanosis

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Functional Implications

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  • Developmental delays
  • Dependent for ADLs
  • Immunosuppression

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Possible Contributing Causes

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  • Pediatric4
    • Congenital heart disease (CHD)
    • Surfactant dysfunction
    • Idiopathic pulmonary disorders (IPH)
    • Bronchiolitis obliterans (BO)
    • Pulmonary vascular disorder
    • Chronic lung disease of infancy
    • Pulmonary fibrosis
    • Pulmonary vein anomalies
    • Cystic fibrosis
  • Adult
    • Pulmonary hypertension
    • Emphysema
    • Cystic fibrosis
    • Alpha-1 antitrypsin deficiency1
    • Idiopathic pulmonary fibrosis3
    • Interstitial lung disease3
    • Chronic obstructive pulmonary disease3

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Differential Diagnosis

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  • Post surgical issues
    • Rejection
    • Infection
    • Bronchiolitis obliterans

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Laboratory Tests

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  • Complete blood count (CBC)
  • Arterial blood gases
  • Prothrombin time (PT)
  • Liver function test
  • Partial thromboplastin time (PTT)
  • PFTs
    • Forced expiratory volume in one second (FEV1)
    • Arterial oxygen tension (PaO2)
    • Arterial carbon dioxide tension (PaCO2)
  • HIV
  • Immunoglobulin G levels (IgG)

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Imaging

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  • X-ray
  • Chest CT scan
  • Echocardiography

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Diagnostic Procedures

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  • Electrocardiogram (EKG)
  • Lung biopsy
  • Bronchoscopy
  • Transbronchial biopsy to assess for rejection
  • Thoracosternotomy3
  • Cardiac catheterization
  • Thoracotomy

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Medication

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  • Immunosuppressants4
    • Cyclosporin
    • Imuran
    • Cellcept
    • Tacrolimus
    • Corticosteroids
    • Sirolimus

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  • Admittance for graft rejection
  • Pulmonologist
  • Thoracic surgeon
  • Cardiologist

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  • Decreased upper extremity range of motion
  • Decreased strength
  • Decreased endurance

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  • Six-minute walk test
  • Goniometric measurements
  • Pulmonary function test, spirometry and oximetry
  • Strength assessment
  • Forced expiratory volume ...

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