New Lungs I

This show was inspired by a grand rounds lecture on the current state of lung transplant medicine given by Dr. Randall Young. His bio can be found here.

Before you listen to the episode, please check out the talk below! 

Stay tuned for New Lungs II, a 1 on 1 interview with Dr. Young.

 
Bottom line indication for lung transplant: end stage lung disease with functional debility despite maximum, aggressive medical therapy AND no socioeconomic, medical or functional contraindications to transplantation.
 
Some centers pushing limits of who can and who can not receive transplant, especially with advent of extracorporeal membranous oxygenation (ECMO).
 
Lung transplant procedures
  • Single (end stage COPD, IPF, sarcoid, etc.)
  • Bilateral (CF, bronchiectasis, pulm HTN..)
  • Heart-lung (any cause of cardiopulmonary failure i.e. congenital defects, PHTN + RV failure, etc.)
 
Logistics
  • United Network For Organ Sharing - UNOS
  • Organ Procurement Organizations - OPOs
  • Lung Transplant Centers
 
Ex-vivo lung perfusion
 
Read more: Penn Med EVLP
 
Immunosuppression
Lungs tolerance-resistant - very prone to rejection!
 
Complications
  • Hyperacute rejection - resembles ARDS
  • Acute rejection - diagnosed histologically; otherwise asymptomatic
  • Chronic rejection - obstructive physiology; 20% drop in FEV1
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