The Advance Lung Disease Program was established at Royal Perth Hospital (RPH) in Western Australia in 2005. The program, now in operation at Fiona Stanley Hospital (FSH), is one of four Australian transplant centres known for having the highest transplant survival rates in the world.
More than 2,500 lung transplants are performed each year worldwide. Lung transplantation is a generally accepted therapy for a wide range of severe lung disorders with evidence supporting the primary goal, improved quality of life and survival. Studies have shown significant benefit in certain conditions, one of which is cystic fibrosis (CF), however, it remains a non-curative procedure.
The screening and ‘workup’ for transplant is extremely thorough and extensive. All body systems are screened and there is optimisation of lung function, nutrition and psychosocial status. Listing involves a complex discussion of patient information with the transplant team which includes surgeons, lung transplant physician, nurses, physios, OT, social worker, dietician and more. Not all individuals benefit from transplantation.
It is all about the “window of opportunity” with the aim to transplant when the benefit outweighs the risk. The guidelines for consideration of lung transplant in CF are an FEV1 < 30% predicted or a rapid decline, especially in females; exacerbation requiring ICU; increasing requirements for antibiotics; pneumothorax or haemoptysis not controlled by embolisation; and a significant decline in quality of life.
The relative contraindications for lung transplant in the CF community are: a multi-resistant bacteria infection, severe liver or renal disease, nutritional failure or a history of non-adherence or an inability to complete the post-operative regime.
Once a decision is made to add someone to the list the patient must agree to relocate to Perth and be contactable 24/7. They must also agree to participate in pulmonary rehabilitation, which is mandatory, and be compliant with all health appointments and treatments.
Matching donors and recipients is imperative. This involves matching blood group, lung size and recipient must not have any antibodies against the donor lung otherwise rejection will occur.
The long term management of lung transplant involves rejection prevention, achieved by lifelong immunosuppression drugs and infection prevention by the use of prophylactic antibiotics and early detection procedures. There is routine pulmonary function surveillance by biopsy, FEV1 monitoring and regular sputum sampling.
Transplantation improves quality of life and survival in selected patients through careful selection and a complex ongoing management plan involving lifelong immunosuppression and infection prevention and control. FSH continues to perform successful lung transplantation for our CF community bringing a brighter outlook and improved quality of life for many of our members.
Reference:
Lung Transplantation (PowerPoint Presentation 2016)
Sharon Lawrence
Advanced Lung Disease CNC
Fiona Stanley Hospital
Lung Transplantation in Cystic Fibrosis (PowerPoint Presentation 2016)
Jamie Wood
Senior Physiotherapist Cystic Fibrosis
Sir Charles Gairdner Hospital