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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Thresholds for referral to a lung transplant center, as recommended by the Cystic Fibrosis Foundation[1]

Thresholds for referral to a lung transplant center, as recommended by the Cystic Fibrosis Foundation[1]
Referral to a lung transplant center is recommended at or before any of the following milestones are reached:
Patients ≥18 years
FEV1 <50% predicted and rapidly declining (eg, >20% relative decline in FEV1 within 12 months)
FEV1 <40% predicted and*:
  • Any of the following markers of shortened survival:
    • >2 exacerbations per year requiring intravenous antibiotics
    • Massive hemoptysis (>240 mL) requiring intensive care unit admission or bronchial artery embolization
    • Pneumothorax
  • BMI <18 (while working to improve nutritional status)
FEV1 <30% predicted
Patients <18 years
FEV1 <50% predicted and rapidly declining (eg, >20% relative decline in FEV1 within 12 months)
FEV1 <50% predicted with any marker of shortened survival listed above or malnutrition (BMI <10th percentile, while working to improve nutritional status)
FEV1 <40% predicted*
All patients
Any of the following, regardless of FEV1:
  • 6-minute walk test <400 meters
  • Hypoxemia (SpO2 <88% or PaO2 <55 mmHg, at rest or with exertion)
  • Hypercarbia (PaCO2 >50 mmHg, confirmed on arterial blood gas)
  • Pulmonary artery systolic pressure >50 mmHg on echocardiogram or evidence of right ventricular dysfunction in the absence of tricuspid regurgitant jet
  • Any exacerbation requiring positive pressure ventilation
Other factors that warrant earlier consideration for transplant referral, even when other thresholds have not been met
Female sex, especially those who are younger
Short stature (height <162 cm)
Liver cirrhosis or chronic kidney disease (may require consideration of multiple organ transplantation and may affect timing or choice of transplant center)
This table outlines recommendations for referral to a lung transplant center. Earlier in the disease course (eg, when the patient's FEV1 falls to <50% predicted), the cystic fibrosis care team should engage the patient and family in routine periodic discussion of the disease trajectory and lung transplantation as a treatment option. Meanwhile, modifiable barriers to lung transplantation should be addressed to optimize candidacy, including nutritional status, optimal management of cystic fibrosis-related diabetes, physical deconditioning, adherence to the medical regimen, and any psychosocial or mental health challenges.
FEV1: forced expiratory volume in 1 second; BMI: body mass index; SpO2: peripheral arterial oxygen saturation (via pulse oximetry); PaO2: partial pressure of arterial oxygen; PaCO2: partial pressure of arterial carbon dioxide.
* Patients with FEV1 <40% predicted should undergo an annual 6-minute walk test, assessment of need for supplemental oxygen, and venous blood gas to screen for markers of severe lung disease that may warrant transplant referral. To screen for pulmonary hypertension, a baseline echocardiogram should be performed for adult patients with FEV1 <40% predicted, or for younger patients with FEV1 <50% predicted.
¶ Individuals with short stature (<162 cm), regardless of age, have an increased risk of death on the transplant waiting list because of difficulty obtaining appropriately-sized donor lungs. Earlier referral provides more time to find a suitable donor.
Reference:
  1. Ramos KJ, Smith PJ, McKone EF, et al. Lung transplant referral for individuals with cystic fibrosis: Cystic Fibrosis Foundation consensus guidelines. J Cyst Fibros 2019.
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