Which factors affect the selection of lung transplantation procedure?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Other factors that must be taken into account on an individual basis are ventilator dependence, [32, 21] previous cardiovascular thoracic surgery, and preexisting medical conditions (eg, hypertension, diabetes mellitus, osteoporosis). The posttransplantation medical regimen can worsen these illnesses.

A previous thoracic procedure alone rarely precludes lung transplantation; however, if cardiopulmonary bypass (CPB) is required for the transplant procedure, a potential for complications exists. [33] With current surgical techniques, pretransplantation corticosteroid therapy has not been associated with airway complications, and a maintenance regimen of prednisone (10-20 mg/d) is not a contraindication for transplantation.

Despite the chronic infections that occur in patients with cystic fibrosis, the infectious complications after transplantation have been comparable between patients with cystic fibrosis and patients without cystic fibrosis. Posttransplant infection with Burkholderia cepacia can be associated with high mortality rates.

Many transplant candidates also have the risk factors for coronary artery disease; therefore, a cardiac workup (including coronary angiography) is performed commonly. Severe coronary artery disease is a contraindication to lung transplantation; however, coronary artery bypass grafting at the same time as lung transplantation has been performed with a reasonably good outcome in some centers. Less invasive preoperative interventions, such as percutaneous transluminal coronary angioplasty and stenting, are preferred.


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