1. LUNG TRANSPLANTATION 2012 דר ' לקסר אורי מכון הראה בית החולים האוניברסיטאי הדסה

2. INDICATION Lung transplantation is indicated for patients with chronic, end-stage lung disease who are failing maximal medical therapy, or for whom no effective medical therapy exists. COPD IPF PPH CF. The Journal of Heart and Lung Transplantation July 2006

3. Ideally, listing for transplantation should occur when life expectancy is greatly reduced but nonetheless greater than the expected waiting time for a suitable organ, and transplantation should be performed when life expectancy after transplantation exceeds life expectancy without the procedure. TIMING The Journal of Heart and Lung Transplantation July 2006

5. AIMS  Survival benefit  Quality of life  Palliation

6. Absolute contraindications Malignancy in the last 2 years.. Untreatable advanced dysfunction of another major organ system. Non-curable chronic extrapulmonary infection including HBV HCV HIV. Significant chest wall/spinal deformity.. Documented nonadherence. Untreatable psychiatric or psychologic condition. Absence of a consistent or reliable social support. Substance addiction (e.g., alcohol, tobacco, or narcotics) The Journal of Heart and Lung Transplantation July 2006

7. Relative contraindications Age >65y Unstable condition Limited functional condition 18 >bmi>30 Colonization with resistant organism Ventilation Osteoporosis IHD,D.M.,GERD,HTN …. The Journal of Heart and Lung Transplantation July 2006

8. COPD Guidelines for Referral. BODE index exceeding 5 Guidelines for Transplantation. Patients with a BODE index* of 7 to 10 or at least 1 of the following:. History of hospitalization for exacerbation associated with acute hypercapnia (PCO2 exceeding 50 mm Hg). Pulmonary hypertension or cor pulmonale, or both, despite oxygen therapy.. FEV1 of less than 20% and either DLCO of less than 20% or homogenous distribution of emphysema. The Journal of Heart and Lung Transplantation July 2006

9. Cystic fibrosis and bronchiectasis Guidelines for Referral. FEV1 below 30% predicted or a rapid decline in FEV1.. Exacerbation of pulmonary disease requiring ICU stay.. Increasing frequency of exacerbations requiring antibiotic therapy.. Refractory and/or recurrent pneumothorax.. Recurrent hemoptysis not controlled by embolization. Guideline for Transplantation. Oxygen-dependent respiratory failure.. Hypercapnia.. Pulmonary hypertension. The Journal of Heart and Lung TransplantationJuly 2006

10. PULMONARY FIBROSIS Guideline for Referral early,do not wait to treatment. Histologic or radiographic evidence of UIP irrespective of vital capacity.. Histologic evidence of fibrotic NSIP. Guideline for Transplantation. Histologic or radiographic evidence of UIP and any of the following:. A DLCO of less than 39% predicted.. A 10% or greater decrement in FVC during 6 months of follow-up.. A decrease in pulse oximetry below 88% during 6-MWT.. Honeycombing on HRCT (fibrosis score of 2).. Histologic evidence of NSIP and any of the following:. A DLCO of less than 35% predicted.. A 10% or greater decrement in FVC or 15% decrease in DLCO during 6 months of follow-up. The Journal of Heart and Lung Transplantation July 2006

11. PULMONARY ARTERIAL HYPERTENSION Guideline for Referral. NYHA functional class III or IV, irrespective of ongoing therapy.. Rapidly progressive disease. Guideline for Transplantation. Persistent NYHA class III or IV on maximal medical therapy.. Low (350 meter) or declining 6-MWT.. Failing therapy with intravenous epoprostenol, or equivalent.. Cardiac index of less than 2 liters/min/m2.. Right atrial pressure exceeding 15 mm Hg. The Journal of Heart and Lung Transplantation July 2006

12. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE ISHLT NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide. 2009

13. LUNG TRANSPLANTS: Transplant Recipient Age by Year of Transplant Transplants: January 1, 1987 – June 30, 2008 ISHLT 2009

14. AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2008) ISHLT 2009

15. DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2008) ISHLT 2009

16. ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1994 - June 2007) ISHLT 2009

17. ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2008) ISHLT *Other includes: Sarcoidosis: 2.1% Bronchiectasis: 0.4% Congenital Heart Disease: 0.2% LAM: 0.8% OB (non-ReTx): 0.5% Miscellaneous:6.3% 2009

18. ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD ISHLT 2009

20. ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Age ISHLT 2009

21. ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2008) ISHLT 2009

22. ADULT LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2008) ISHLT 2009

23. ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2008 Analysis limited to patients receiving prednisone ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

24. POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April 1994 - June 2008) ISHLT 2009

25. FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME For Adult Lung Recipients (Follow-ups: April 1994-June 2008) Conditional on Survival to 14 days ISHLT 2009

26. FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Lung Recipients (Follow-ups: April 1994-June 2008) ISHLT 2009

27. FREEDOM FROM MALIGNANCY For Adult Lung Recipients (Follow-ups: April 1994-June 2008) ISHLT 2009

28. ADULT LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2008) ISHLT 2009

29. מה קורה בישראל ? רשימה ארצית לפי LAS SCORE- : שקלול חומרת המחלה וסכויי הצלחת ההשתלה 11 פרמטרים המרכיבים את הנקוד - תפקודי ראה, מחלות רקע, מחלת היסוד, מצב תפקודי וכ ' תרומה מתורם עם מוות מוחי מוכרז אין תרומה מהחי אין STATUS ONE ריאה מאופיינת בזמן איסכמיה קצר 4-6 שעות זמן המתנה עד שנה לערך - 70 חולים על הרשימה אין שיתוף פעולה אזורי או בינלאומי

35. תודה