Comprehensive Care of the Lung Transplant Patient

Abstract

Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other medical or surgical interventions. With improving survival rates, the number of lung transplant recipients with preexisting and posttransplant comorbidities that require attention continues to increase. A partnership between transplant and nontransplant care providers is necessary to deliver comprehensive and optimal care for transplant candidates and recipients. The goals of this partnership include timely referral and assistance with transplant evaluation, optimization of comorbidities and preparation for transplantation, management of common posttransplant medical comorbidities, immunization, screening for malignancy, and counseling for a healthy lifestyle to maximize the likelihood of a good outcome. We aim to provide an outline of the main aspects of the care of candidates for and recipients of lung transplants for nontransplant physicians and other care providers.

Anesthetic Management of Lung Transplantation: Center Specific Practices and Geographical and Centers Size Differences

“…From the first single lung transplantation performed in 1960 by Hardy 3 to the first successful single lung transplantation in 1986, 4 the medical, surgical, and anesthetic management have been evolving constantly. The development of disease-specific guidelines for referral and listing for transplantation have provided lung transplantation centers the ability to have the time to optimize comorbidities before being listed, 5 and has resulted in the development of the lung allocation score, which prioritizes patients for transplantation on the basis of their mortality without the transplantation in 1 year compared with their expected survival with lung transplantation. Institution of the lung allocation score has resulted in reduced waiting times and wait-list mortality and an increase in the number of organs being implanted.…”

Efeitos da suplementação com creatina na lesão de isquemia e reperfusão após transplante pulmonar unilateral em ratos

“…Em longo prazo, o cuidado com o receptor do transplante é focado na prevenção de complicações, principalmente infecciosas, no reconhecimento de cuidados médicos emergentes, na otimização da imunossupressão e no retorno às atividades normais da vida diária de maneira independente (Adegunsoye et al, 2017).…”

“…O estado nutricional do paciente no período pré-transplante varia de acordo com a doença pulmonar, que pode levar o paciente a estar abaixo do peso, com excesso de peso ou obeso. O índice de massa corpórea é utilizado para classificar esses pacientes (Adegunsoye et al, 2017). A terapia de imunossupressão no pós-operatório exacerba o risco pré-existente de infecção, principalmente daqueles pacientes com marcadores positivos de desnutrição (González-Castro et al, 2006).…”

“…Fatores importantes que devem ser considerados no tratamento pós-transplante de pulmão incluem: alterações do sistema imunológico, denervação do enxerto, e alto potencial para interações medicamentosas (Adegunsoye et al, 2017).…”

“…Tais consequências podem ser irreversíveis e podem resultar na perda do enxerto, na insuficiência de outros órgãos ou mesmo na morte do paciente. Os medicamentos utilizados rotineiramente para minimizar estes riscos são os inibidores de calcineurina (Adegunsoye et al, 2017).…”