Manual of Lung Transplant Medical Care Book

	Introduction	i
I.	Program Description	3
A.	Program History	3
B.	The Transplant Center	3
1.	What we do	3
2.	How to contact us	3
3.	Clinics	4
4.	Lung transplant professionals	5
5.	Other phone numbers	6
6.	Patient billing questions	6
7.	Patient relations department	7
8.	Social work department	7
9.	Organ donation information	7
II.	Pretransplant Issues	8
A.	Criteria for Referral	8
1.	General considerations	8
2.	Patient characteristics	8
3.	Specific disease considerations	10
B.	Pretransplant Evaluation	14
1.	Consultations	14
2.	Clinical evaluations and vaccinations	14
3.	Laboratory tests	15
4.	Smoking cessation policy	16
5.	Hepatitis	17
6.	Purified protein derivative (PPD)-positive candidates	18
C.	Living Donor Lobar Transplants	18
D.	Periodic Reevaluation While on the Transplant Waiting List	19
III.	Posttransplant Medical Care	20
A.	Routine Posttransplant Care	20
1.	At the transplant center	20
2.	Surveillance tests and procedures	20
3.	Home monitoring of pulmonary function and clinical status	21
4.	Diet	21
5.	Physical rehabilitation	21
6.	Periodic health maintenance	22
B.	Immunosuppression	22
1.	Maintenance immunosuppression	22
2.	Use of specific immunosuppressive medications	23
3.	Management of acute pulmonary rejection	40
4.	Chronic pulmonary rejection/bronchiolitis obliterans	40
C.	Infection Prophylaxis and Treatment	42
1.	Bacterial infection	42
2.	Fungal/yeast infection	42
3.	Viral infection	46
4.	Pneumocystis carinii infection	50
5.	Mycobacterial infection	51
6.	Immunizations	51
D.	Pulmonary Problems after Lung Transplantation	52
1.	Reperfusion injury/acute lung injury	52
2.	Anastomotic complications	53
3.	Bronchiectasis	54
4.	Native lung complications	54
5.	Disease recurrence	54
6.	Bronchiolitis obliterans organizing pneumonia (BOOP)	55
7.	Diaphragm dysfunction	55
8.	Pulmonary embolism	55
9.	Pleural disease	56
E.	Extrapulmonary Medical Problems	56
1.	Hypertension	56
2.	Renal abnormalities	56
3.	Electrolyte abnormalities	57
4.	Gastroenterologic problems	58
5.	Neurologic problems	58
6.	Hyperlipidemia	59
7.	Osteoporosis	59
8.	Lymphoma and posttransplant lymphoproliferative disorder (PTLD)	62
9.	Nonlymphoma malignancies	62
	Appendix
Table 1.	Lung Transplants Performed at the University of Minnesota/Fairview-University Medical Center	63
Table 2.	Pretransplant Diagnoses of Lung Transplant Recipients at the University of Minnesota/Fairview-University Medical Center	64
Table 3.	Lung Transplants Performed at the University of Minnesota/Fairview-University Medical Center According to Pretransplant Diagnoses	65
Table 4.	Management of Lung Transplant Candidates/Recipients According to Purified Protein Derivative (PPD) Status	66
Table 5.	Six-Month and Yearly Tests and Procedures after Lung and Heart-Lung Transplantation	67
Table 6.	Guidelines for the Use of Immunosuppressive Medications in Lung Transplantation	68
Table 7.	Usual Side Effects and Drug Interactions of Commonly Used Immunosuppressive Medications	70
Table 8.	Cyclosporin A (CSA) and Tacrolimus Drug Interactions	72
Table 9.	Azathioprine (AZA) Drug Interactions	80
Table 10.	Mycophenolate Mofetil (MMF) Drug Interactions	81
Table 11.	Sirolimus (Rapamycin) Drug Interactions	82
Table 12.	Prednisone Drug Interactions	86
Table 13.	Use of Immunosuppressive Medications in Dialysis Patients	87
Table 14.	Management of Acute Pulmonary Rejection	88
Table 15.	Use of Polyclonal Antilymphocyte Antibodies after Lung Transplantation	90
Table 16.	Antibiotic Prophylaxis for Invasive Procedures	91
Table 17.	Management of Active Mycobacterium Tuberculosis (TB) Infection	93
	Glossary of Abbreviations and Acronyms	94
	References	98
	Index	119