Since the first lung transplantation in 1990 at the Nazih Zuhdi Transplant Institute, more than 150 patients have received lung transplantation successfully at INTEGRIS Baptist Medical Center. The NZTI lung transplant program is the only program in the state of Oklahoma and serves the people of Oklahoma, Arkansas, Texas, New Mexico, Kansas and Missouri. The program is Medicare certified. 

Lung Transplant Candidate Work up Consultation and Procedures 

Referral Criteria:

1) General Criteria (Adapted from JHLT 2006; 25:745-755)

Physiological age < 70 (for all types of lung transplants)
Less than 50% 2 to 3 year predicted life expectancy or NYHA III / IV
Within 20% of ideal body weight
Rehabilitation potential, psychosocial stability
Abstinence from smoking > 6 months
Cancer free survival > 5 years
Early referral is highly desirable

Contraindications

Inability to cooperate or comply with medical therapy
Absence of a consistent or reliable social support system
Untreatable advanced dysfunction of another major organ (kidney, heart etc)
Active malignancy within the past 2-5 years
Bone marrow Failure
HIV infection
Liver Cirrhosis, Chronic active Hepatitis B or C infection

Relative Contraindications

Symptomatic osteoporosis
Severe musculoskeletal disease affecting the thorax,
Colonization with pan-resistant organisms
Invasive mechanical ventilation

2) Disease Specific Referral Criteria:

COPD

BODE index exceeding 5
Hospitalization for exacerbation with acute hypercapnia
Pulmonary hypertension or cor pulmonale

Cystic Fibrosis, Bronchiectasis

FEV1 < 30% or rapidly declining FEV1
Exacerbations of pulmonary disease requiring ICU
Increasing frequency of exacerbations
Recurrent hemoptysis not controlled by embolization
Refractory or recurrent pneumothorax

Pulmonary Fibrosis

Referral at the time of diagnosis recommended

Primary Pulmonary Hypertension

NYHA functional class III or IV
Rapidly progressive disease

Sarcoidosis, Lymphangioleiomyomatosis, Eosinophilic Granuloma

NYHA functional class III or IV

After being referred by a doctor, the transplant center evaluates the possible transplant recipient. The transplant center runs a number of tests and consultations.

Patient Evaluation for an Adult Lung Transplant

1. Patient Demographics:
2. Mandatory Laboratory Testing:
   1. General lab: CBC, BMP, BNP, liver function tests, PT/INR, PTT, LDH, calcium, magnesium, and phosphorous.
   2. Hepatitis Screening: Hepatits Acute Panel, Hep B Surface Antibody, Hep B Core Antibody, Hep A Total Antibody.
   3. Autoimmune Screening: Rheumatoid Factor, ANA, Alpha 1 Antitrypsin Level, Ferritin, TSH, Free T4.
   4. Microbiology Screening: EBV serology panel, fungal serologies, UA, 24 hour urine for creatinine clearance, Toxoplasmosis Antibody, CMV Antibody IgG& IgM, Varicella zoster titer, Rubella titers, RPR screen, Herpes IgG & IgM, Sputum gram stain/culture & sensitivity/AFB/fungal/Nocardia.
   5. Special Screening: PSA if ≥ 40 male, Pregnancy test if menstruating female, Stool guiac x 3 if ≥ 50, PPD w/ Controls, Pap Smear, HLA Tissue Typing & PRA, Type & Screen Antibody Crossmatch.
       
3. Mandatory Diagnostic Studies
   1. CT scan of Chest without Contrast
   2. CT scan of sinuses without contrast
   3. CXR PA & Lateral
   4. Abdominal ultrasound, including gallbladder
   5. Renal Ultrasound
   6. Barium swallow
   7. Panorex of mouth
   8. Bone Mineral Density
   9. Mammography (generally for females age 40 or over) done within last 12 months
   10. Colonoscopy
   11. EGD (Upper GI Endoscopy)
   12. VQ Scan w/ differential perfusion & shunt study
   13. Complete PFTs w/ ABGs on room air
   14. MIPs & MEPs
        
4. Immunizations:
   1. PPD with controls (Candida)
   2. Hep B series
   3. Hep A vaccine
   4. Influenza
   5. Pneumovax
       
5. Consultations:
   1. Transplant pulmonologist
   2. Gastrointestinal
      1. EGD/Colonoscopy and biopsy as indicated
      2. 24 hr pH probe
      3. Esophageal Manometry
   3. Cardiology
      1. 12 Lead EKG
      2. 2 D Doppler Echocardiogram w/ PA pressures
      3. Myocardial perfusion study w/ Dobutamine (≥ 40)
      4. Carotid Doppler (≥ 50)
      5. 6 Minute Walk, w/ oxygen titration prn sats < 90%
   4. Gynecologic:
      1. Pap smear
      2. Pelvic exam
      3. Mammography for females age 40 and over
   5. Dental Clearance
   6. Psychosocial:
      1. Social worker interview
      2. Psychologist/psychiatrist
      3. Appropriate substance abuse intervention as indicated prior to listing.
   7. Financial:
      1. Screening by transplant financial coordinator
      2. Clearance must be obtained prior to listing.
   8. Transplant Surgery Consultation: all prospective candidates must be assessed by the designated transplant surgeon.

An informed consent is obtained. [Click here to download informed consent.]