Preoperative Optimization for Lung Transplant
As the definition of lung transplant (LT) candidacy continues to expand, prospective recipients are presenting with increasing complexity and significant medical comorbidities. While patient selection is essential to developing a successful LT program, it remains equally important to develop systematic and multidisciplinary patient optimization algorithms. Not only must medical comorbidities, such as pulmonary hypertension (PH), be carefully managed, but also mental health and social optimization have proven critical to long-term patient quality of life and survival. This chapter reviews the literature and shares institutional guidelines for optimization of patients before LT in both the outpatient and inpatient settings. In the outpatient setting, integrated pulmonary rehabilitation, dietician, SLP, psychiatry and social work assessments and interventions should be pursued for all patients, allowing for continuity with the inpatient teams from all these disciplines. Depending on the etiology of end-stage lung disease, CAD and PH are common comorbidities which require targeted preoperative intervention.
