330.2 🩺 國考版

330.2.1 高頻考點

330.2.1.1 Indications

  • IPF (top)
  • COPD
  • CF
  • PAH
  • α1-antitrypsin deficiency
  • Bronchiectasis
  • ILD (sarcoid, CTD)
  • Eisenmenger (heart-lung)

330.2.1.2 LAS (Lung Allocation Score)

  • Replaced wait-time system 2005
  • Urgency + transplant benefit
  • Priority allocation
  • LAS ≥ 35 considered for listing

330.2.1.3 Bilateral vs Single Lung Transplant

  • Bilateral preferred (most)
  • Single for COPD without infection (older patients)

330.2.1.4 Heart-Lung Transplant

  • Eisenmenger
  • Severe PAH + biventricular failure
  • Rare

330.2.1.5 Contraindications

  • Active malignancy < 5 yr
  • Active infection
  • Substance abuse (within 6 mo)
  • Severe comorbidities
  • Severe psychosocial issues
  • BMI > 30-35

330.2.1.6 Immunosuppression

  • Tacrolimus + MMF + prednisone
  • Induction: basiliximab or ATG

330.2.1.7 Prophylaxis

  • TMP-SMX for PCP
  • Valganciclovir for CMV (high-risk)
  • Voriconazole / itraconazole

330.2.1.8 PGD (Primary Graft Dysfunction)

  • Within 72 hours
  • Bilateral infiltrates + hypoxemia
  • Risk for chronic dysfunction

330.2.1.9 Acute Rejection

  • Cellular (T-cell): treat with pulse steroids
  • AMR: plasmapheresis + IVIG + rituximab + bortezomib

330.2.1.10 CLAD (Chronic Lung Allograft Dysfunction)

  • BOS: bronchiolitis obliterans (obstructive)
  • RAS: restrictive allograft syndrome (worse)
  • 1-5 year after transplant
  • Top cause of long-term graft loss
  • Azithromycin chronic

330.2.1.11 Survival

  • 1-yr: 85%
  • 5-yr: 55%
  • 10-yr: 30%

330.2.1.12 Major Complications

  • PGD (acute)
  • Acute rejection
  • CLAD (long-term)
  • Infection (CMV, fungal)
  • Malignancy (PTLD)
  • Renal dysfunction (CNI)

330.2.2 易混淆比范

Type Indication Preferred Approach
Bilateral lung Most diseases Sequential implantation
Single lung COPD without infection Less morbid
Heart-lung Eisenmenger, severe PH Combined
Living donor lobar Rare Smaller donor pool

330.2.2.1 EVLP (Ex-Vivo Lung Perfusion)

  • Donor optimization
  • Reassess marginal lungs
  • Extended preservation
  • Increasing utilization

330.2.2.2 DCD (Donation After Circulatory Death)

  • After cardiac death
  • Increasing pool
  • Comparable outcomes