Care of the lung transplant recipient.(RESPIRATORY CLINICAL)

This column will concentrate on the post operative management of single lung transplant and double lung transplant.

I must note that these life giving measures would not be possible without the acts of compassionate giving by the donor and in most cases, their families. We must remember that the patients we are treating are in our care only because someone made the ultimate sacrifice and literally gave the gift of life.

That said, the ideal donor has a P/F ratio of 300 or greater on 5 of PEEP, a clear chest radiograph, negative fungal cultures, and no gram negative rods in the sputum cultures. The donor must be HIV negative has no purulent secretions, no hepatitis B or C, and preferably less than 1 week on mechanical ventilation. Ideally the donor should be less than 60 years old. When matching donor to recipient the size of the thorax is the limiting factor.

The cause of death of the donor has limited influence on recipient outcomes except in the case of traumatic brain injury where outcomes may be unfavorably influenced. The donor lung resulting from Traumatic Brain Injury may predispose the recipient to acute rejection episodes and Bronchiolitis Obliterans Syndrome. Again, the procedure is defined within the parameters of organ availability and recipient needs. The ideal candidate has a disease process specific to the lung, less than 65 years old for single or under 60 for double lung transplant.

Preoperatively the recipient should be within 10-20% of ideal body weight, be enrolled in a pulmonary exercise program, have completed a psychological workup and be alcohol, drug and tobacco free. If time permits cardiology workup, ventilation/perfusion scans and dental evaluations should be completed. Again, the size of the thorax has been a limiting factor however many innovative procedures are being evaluated to overcome this physical limitation.

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