Transplant Nursing Heart Lungs FINAL

TRANSPLANT NURSING
Heart and Lung Transplantation
Copyright 2017. OnCourse Learning Corporation. All rights reserved.

Heart Transplant
•  Why would a heart transplant be considered for a

patient?
–  A patient has poor short term prognosis without receiving
transplant
–  No further medical options for long term survival
–  Current symptoms are unrelieved with medical therapies

Heart Transplant
•  What are indications for heart transplant in a pediatric patient?

–  Congenital heart defects (hypoplastic left heart syndrome)
–  Cardiomyopathy

Heart Transplant
•  When would a child receiving a heart transplant be

contraindicated?
–  Active infection or malignancy
–  CNS abnormalities
–  Diabetes with microvascular complications
–  Lack of support system post-transplant

Heart Transplant
•  What is meant by “heart

failure”?
–  Disorders of how the heart
functions or with the physical
structure heart impairing its
ability to pump efficiently
•  End-stage heart disease
(ESHD) is the height of
malfunction when
transplantation becomes the
only option for patient survival

Heart Transplant
•  What is the pathophysiology that can lead a

patient to develop ESHD?
–  Left ventricular failure
–  Right ventricular failure
–  Systolic failure
–  Diastolic failure

Heart Transplant
•  ESHD can also be caused by:

–  Cardiomyopathy (90%)
–  Myocardial infection
–  Nutritional disorders
–  Side effect of systemic disease
–  Systemic toxins (chemicals/drugs/alcohol)

Heart Transplant
•  What is the criteria used for placing a patient on the organ

donor waiting list?
–  Following the New York Heart Association (NYHA) Classification
of Heart Failure
•  Class I-IV determines patients current functional capacity as they
are placed on the transplant waiting list

Heart Transplant
•  When is a patient classified as Class I-VI?

–  Class I individuals with diagnosed cardiac disease not
interfering with normal ADL and physical activity
–  Class II individuals with diagnosed cardiac disease with
adverse cardiac/respiratory symptoms upon physical
activity
–  Class III individuals have very limited physical activity with
simple activities causing fatigue, SOB or angina
–  Class IV individuals are unable to perform daily activities
without chest pain, dyspnea worsening with activity

Heart Transplant
How are pediatric patients prioritized to

receive heart transplants?
• Children are hospitalized

Status in ICU on mechanical
1A ventilation and high
dose heart medication
Status • Children are hospitalized

1B but not in ICU
• Children
Status are
2 waiting
at home

Heart Transplant
•  How are the American College of Cardiology and

American Heart Association classifications of heart
failure different from the NYHA?
–  Stages of Heart Failure A-D based upon patient symptoms
and development of structural heart damage

Heart Transplant
•  What is criteria for a patient being classified /

staged by the AHA?
–  Stage A patients are at risk for developing heart failure
secondary to disease presence (CAD, DM) not based upon
symptoms
–  Stage B patients do not have signs of heart failure but are
developing structural heart damage
–  Stage C individuals are no longer asymptomatic, heart failure
symptoms (fatigue with activity, SOB) beginning
–  Stage D patients have more severe heart failure symptoms,
advancing structural damage, frequent hospitalizations and
medication therapy

Heart and Lung Transplant
•  When would a heart transplant not be

recommended?
–  Patients with malignancy
–  Patients with poor organ function related to diabetes
mellitus
–  Concurrent liver, pulmonary or kidney disease

Heart Transplant
•  What diagnostic tests need to be performed before diagnosis

of end-stage heart disease?
–  Cardiac catheterization
–  CXR
–  EKG
–  Echocardiogram

Heart Transplant
•  Which diagnostic laboratory

tests should be performed
assessing heart failure?
–  ABGs
–  Cardiac enzymes and creatinine
kinase
–  LFTs
–  Serum electrolytes

Heart Transplant
What laboratory values would begin to

elevate as heart failure progresses?
ü BUN > 50mg/dL

ü Creatinine > 2.0mg/dL
ü Increased LFTs and
bilirubin

Heart Transplant
Which laboratory values could be

decreasing as heart failure progresses?
ü Sodium levels from

hyper/hypovolemia
ü Potassium levels from
use of diuretics

Heart Transplant
•  What interventions are necessary for patients to slow

progression of ESHD?
–  Daily exercise
–  Fluid restriction (<2L/day)
–  Sodium restriction (<2G/day)
–  Medication therapy(ies) depending on severity of present
symptoms

Heart Transplant
•  Transplant nurses need to evaluate patients with ESHD

reporting any of the following symptoms:
–  Increase in fatigue
–  SOB
–  Orthopnea
–  Nocturnal dyspnea
–  Fullness of abdomen
–  Poor sleeping patterns

Heart Transplant
•  What are visible signs and

symptoms of advancing heart
failure?
–  Increasing abdominal and/or
peripheral edema
–  Emesis
–  Weight gain
–  Jugular venous distention (JVD)
A man with congestive heart

failure and marked jugular venous
distention. External jugular vein
marked by an arrow
By James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or

GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons;
https://commons.wikimedia.org/wiki/File%3AElevated_JVP.JPG

Heart Transplant
•  What may be present upon

physical exam in a patient
with heart failure?
–  Ascites
–  Peripheral cyanosis
–  Pulmonary crackles,
wheezing or cough
–  Hepato or splenomegaly
–  Heart sounds S3/S4 atrial or
ventricular gallop
Cyanosis of the hand in

someone with low
oxygen saturations
James Heilman, MD (http://creativecommons.org/licenses/by/3.0)], via Wikimedia

Commons; https://commons.wikimedia.org/wiki/File:Cynosis.JPG

Heart Transplant
•  When are patients placed on the ISHLT transplantation list?

–  Age </= 70 years old
–  Ejection fraction < 20%
–  Untreatable arrhythmias or recurring angina
–  Deteriorating cardiomyopathy or congenital heart disease
•  What preoperative laboratory information is important for the

nurse to know?
–  CMV status (+) or (-)
–  Blood type (A,B,O)
–  Hepatitis, EBV titers
–  PT/PTT
–  CBC with differential, platelet count

Heart Transplant
ü Patient’s understanding of
procedure and importance of
post-operative compliance
The nurse is ü Knowledge of invasive

responsible for which hemodynamic monitoring and
areas of patient medications involved with
procedure
education prior to
transplant surgery? ü Discuss psychosocial concerns
or feelings over procedure
and long-term outcome

Heart Transplant
•  What is important to know

about the surgical procedure
itself?
–  Bicaval placement most commonly
used to preserve recipient SA
node functioning
–  Denervation of donor heart
(absence of parasympathetic and
sympathetic nervous activity)

Heart Transplant
•  Why will either of these procedures affect the patient post-

operatively?
–  Denervation of the heart will cause:
•  Poor response to stressors causing abrupt increase in heart rate
(sprinting)
•  Cardiac medications may be obsolete because of their mechanism of
action on the heart:
–  Ex: use isoproterenol instead of atropine for treatment of
bradycardia

Heart Transplant
•  How can this affect patient heart rate following

transplant?
–  Increased resting heart rate due to absence of
parasympathetic stimulation
–  Nurses need to be aware that medications commonly used
in cardiac patients may have no effect on denervated
cardiac organ

Heart Transplant
•  What are areas of concern for post-operative care of the

heart transplant?
–  Maintaining hemodynamic stability of patient
•  Most parameters individualized per person
–  Adequate oxygenation
–  Regaining normal functioning of all body systems

Heart Transplant
•  What other post-operative monitoring is important in heart

transplant patients?
–  Telemetry monitoring for arrhythmias
–  Care of epicardial pacemaker
–  Management of fluids
–  Assessment of drainage from chest tube, dressings over incision,
surgical drains

Heart Transplant
•  When does the nurse need to

monitor for signs of graft
rejection?
–  Patients reporting malaise,
flu-like symptoms
–  Hypotension
–  Low grade fever
–  Development of dysrhythmia,
abnormal heart sounds
–  Edema, JVD
–  Shortness of breath

Heart Transplant
•  How does graft failure usually present in children

post-transplant?
–  Increasing pulmonary pressure (>40mmHg) and pulmonary
hypertension
–  Increasing pulmonary capillary wedge pressures

Heart Transplant
•  What are signs of chronic rejection or coronary

artery vasculopathy (CAV)?
–  Symptoms of CHF
–  Dyspnea with exertion or at rest
–  Fatigue
–  Dysrhythmias

Heart Transplant
•  Why is coronary artery vasculopathy (CAV) so important to

diagnose?
–  No. 1 reason for retransplantation of the heart
–  Can progress to occlusion of large and small arteries
–  Develops rapidly weeks to months rather than years for coronary
artery disease (CAD)
–  > 40% of 5-year transplant survivors develop CAV

Heart Transplant
•  What are endomyocardial biopsies?

–  Diagnostic procedure through femoral vein or subclavian
vein used to assess acute rejection (vascular or cellular)
–  Evaluate myocyte damage, presence of cellular infiltrates,
presence of inflammation
•  What complications can develop after an endomyocardial
biopsy?
–  Puncture of arteries or veins
–  Ventricular dysrhythmias
–  Pneumothorax / hemothorax
–  Cardiac tamponade

Heart Transplant
•  How are patients monitored for ventricular failure?

–  Decrease in cardiac output (right/left ventricles)
–  Elevation in CVP (right ventricle)
–  Hypotension (right ventricle)
–  Increased ventricular diastolic pressure (right/left ventricles)
–  Evidence of renal, liver failure (left ventricle)

Heart Transplant
•  What etiology can cause ventricular dysfunction?

–  Left ventricular failure:
•  Ischemic injuries
•  Allograft damage
•  Reperfusion injuries
–  Right ventricular failure: all of the above
•  Donor/recipient size of organ mismatch
•  Pulmonary hypertension of recipient

Heart Transplant
•  What complications
can occur following the
heart transplant?
–  Pericardial effusions:
•  Normal sized,
transplanted organs
placed in an enlarged
cardiac space
–  Cardiac tamponade:
•  Trauma during
transplantation or
from donor death
A CT scan image showing

a pericardial effusion
By James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via

Wikimedia Commons; https://commons.wikimedia.org/wiki/File%3APericaridaleffusionCT.png

Heart Transplant
•  What additional complications can develop following heart

transplant?
–  Hypotension
–  Hypertension (>95% of heart recipients develop HTN after 5
years)
–  Hypovolemia
–  Hypervolemia

Heart Transplant
•  How can changes in cardiac rate or rhythm become

a complication?
–  Develop from electrolyte imbalances, denervation of heart,
surgical trauma
•  Atrial or ventricular dysrhythmias
•  Dysfunction of sinoatrial node

Heart Transplant
•  What other body systems can

be adversely affected by heart
transplantation?
–  Neurological system: ischemic
stroke, encephalopathy, seizure
–  Endocrine system: hypo/
hyperglycemia
–  Gastrointestinal system

Heart Transplant
•  Where is the most common site for infection to

occur?
–  Surgical incision infections (mediastinitis)
–  Pulmonary infections are most common
–  Opportunistic infections (CMV)

Heart Transplant
•  What regimen is used most often for

immunosuppression in heart transplant patients?
–  Tacrolimus or cyclosporine
–  Immuran
–  Atgam
–  Steroid therapy

Heart Transplant
•  What medications are typically used in treatment of rejection?

–  Atgam
–  Antithymocyte (Thymoglobulin)
–  Steroid
–  Rituximab (Rituxan)

Heart Transplant
•  What monitoring is necessary when a patient is on these

medications?
–  CBC, platelets
–  LFTs signs of liver failure
–  BUN/creatinine for signs of renal failure
–  CD3 counts with OKT3
–  Signs of infection

Lung Transplant
•  What are the indications for lung transplant

surgery?
–  Overall poor quality of life secondary to lung disease
–  Oxygen dependency
–  Severity of activity intolerance
–  < 65 years old

Lung Transplant
•  End-stage pulmonary
disease causes are
considered:
–  Cystic Fibrosis
–  COPD (emphysema)
–  Pulmonary hypertension
–  Idiopathic pulmonary
fibrosis
© 2008 A.D.A.M., Inc.

Lung Transplant
•  Which patients are considered having contraindications for

lung transplant?
–  Alcohol or substance abuse
–  Active infection or malignancy
–  Steroid dependency (>20mg/daily)
–  Significantly over or under weight
–  Untreatable CAD
–  Age >45 heart/lung, >55 bilateral lungs, >65 lung

Lung Transplant
•  What contraindications
are specific to pediatric
patients?
–  Chest deformities
–  Abnormalities of the
trachea
–  Presence of lower
respiratory infection
–  Scoliosis

Lung Transplant
•  Why is pediatric lung transplantation the least

common transplant procedure?
–  Requires 2 lung donors
–  Bronchial tree differences between adults and children
limit donor availability
–  Higher risk for infection in children pulmonary anatomy

Lung Transplant
•  What additional screenings make pediatric lung transplant

more difficult?
–  Patients with cystic fibrosis can have living donor lung donations
–  Donor lungs must be matched and sized to pediatric height and
weight
•  Abnormal sizing will lead to post-op complications
–  Children less than 6 are not indicated to receive lobes from adult
lungs

Lung Transplant
•  What is included in the pre-transplant education of the

patient?
–  Procedures and follow up testing while on the transplant list
–  Staying healthy while awaiting transplant
–  Surgical procedure and post-op care
–  Immunosuppressive therapy and medications post-operatively

Lung Transplant
•  What testing is done during the transplant evaluation to

measure lung function?
–  Dependent upon primary disease and deteriorating lung
functioning
•  FEV (forced expiratory volumes)
•  CO2 levels
•  O2 levels
•  Vital capacity (VC) / total lung capacity (TLC)
•  Levels of pulmonary hypertension

Lung Transplant
•  What symptoms of progressing lung

failure may a patient report?
–  Increasing activity intolerance
–  Dyspnea
–  Loss of weight
–  More dependence on oxygen
–  Increasing anxiety/depression/fear

Lung Transplant
•  Donors who are generally selected for

transplantation are:
–  Patients without pulmonary disease
–  Non-smokers
–  Less than 55 years old
–  Clear chest X-ray
–  No prior chest trauma

Lung Transplant
•  What is important in initial monitoring of lung

transplant recipients post-operatively?
–  Hemodynamics
–  Respiratory status (O2 >90%)
–  Fluid and electrolytes
–  Glucose levels

Lung Transplant
•  How are pediatric lung transplant patients managed post-

operatively?
–  Knowledge of loss of cough reflex
–  Chest physiotherapy
–  Monitoring of chest tubes and potential pleural effusion
–  Development of chylothorax (lipid lymphatic drainage into
pleural fluid)

Lung Transplant
•  How may complications present

following a lung transplant?
–  Hyper-acute rejection:
•  Hypoxia
•  Desaturation
–  Acute rejection:
•  Fever
•  SOB / cough
•  Malaise

Lung Transplant
•  When is primary graft

dysfunction (PGD) suspected?
–  Patient experiencing recurrent
desaturation
–  Increase in respiratory rate
–  Malaise, tiredness

Lung Transplant
•  How is PGD treated?

–  Treated as acute respiratory distress syndrome (ARDS)
•  Increased oxygenation
•  Addition of positive pressure in ventilated patients
•  Decrease tidal volumes
•  Increased performance of pulmonary toilet

Lung Transplant
•  What are other

pulmonary
complications?
–  Pneumothorax
–  Pleural effusion (most
in 1-month post-op)
–  Inadequate bronchial
anastomosis
–  Tracheal stenosis
(considered a sign of
acute rejection)
© 2008 A.D.A.M., Inc.

Lung Transplant
•  Do lung transplant
patients have a higher
risk of potential
infection?
–  Lungs are most common
site for any organ
transplant post-operatively
–  Lung recipients have
additional risk due to
impaired cough, gag
reflexes and mucociliary CMV
changes from transplant remains
Typical "owl eye" inclusion indicating CMV
No. 1 most
infection of a lung pneumocyte common
infection
See page for author [Public domain], via Wikimedia Commons;

https://commons.wikimedia.org/wiki/File%3ACytomegalovirus_01.jpg

Lung Transplant
•  Why is it necessary for the transplant nurse

monitor fluid and electrolyte balance?
–  Fluid overload can increase chance of pulmonary edema
–  Loss of fluid can be from bleeding, developing renal
complications

Lung Transplant
•  What can be done to treat a patient experiencing

early graft rejection?
–  Use of high doses of steroids
–  Addition of another immunosuppressive agent to present
medications
–  Review of current medication classifications and doses

Lung Transplant
Micrograph showing lung
transplant rejection. Lung
•  How is a diagnosis of biopsy. H&E stain.
transplant rejection
confirmed?
–  Bronchoalveolar lavage
–  Transbronchial biopsy * >90%
sensitivity
By Nephron (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://

www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons;
https://commons.wikimedia.org/wiki/File%3ALung_transplant_rejection_-_intermed_mag.jpg

Lung Transplant
•  What is obliterative
bronchiolitis (OB)?
–  Commonly occurs by the
second year post-transplant
in lung recipients
–  Development of unknown
causes of progressive airway
disease limiting airflow and
eventually developing
scarring and obstruction of
airflow trough the lung
–  Patient showing loss of 20%
FEV1 of previous testing
High resolution CT scan showing bronchiolitis obliterans with glass

pattern, air trapping, and bronchial thickening
By Bo-Qia Xie, Wei Wang, Wen-Qian Zhang, Xin-Hua Guo, Min-Fu Yang, Li Wang, Zuo-Xiang
He, Yue-Qin Tian [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia
Commons; https://commons.wikimedia.org/wiki/File%3ACTBO.png

Lung Transplant
•  What are risk factors for development of OB?

–  CMV (+) donor to (-) recipient
–  Pulmonary infection
–  HLA mismatch
–  Early or late signs of acute rejection
–  High panel of reactive antibodies

Lung Transplant
How does the International Society for Heart and

Lung Transplantation classify patients with OB?
Grade 0: FEV1 >80% over baseline
Grade 1: FEV1 66-79% over baseline
Grade 2: FEV1 51-65% over baseline
Grade 3: FEV1 is <50% of baseline

Lung Transplant
•  What symptoms likely occur with development of

OB?
–  Decrease in tolerance of activity and exercise
–  Shortness of breath progressively worsening
–  Eventual obstruction of breathing

Lung Transplant
•  What immunosuppressants are commonly used

in lung transplant recipients?
–  Induction therapy with antithymocyte globulins, IL-2
receptor medications or antilymphocyte globulins
–  Less use of steroids to avoid complications associated
with use

Lung Transplant
•  Why is there a continued need for

research in lung transplantation?
–  To increase number of eligible
donors
–  Increase longer-term survival
(40% of patients develop BOS
within 2 years)
–  Discovery of immunosuppressive
medications specific to pulmonary
transplant

Bibliography
•  Mehra, M. C. The 2016 International Society for Heart Lung

Transplantation Listing Criteria for Heart Transplantation: A 10-year
update. The Journal of Heart and Lung Transplant, 2016; 1-23.
•  Mulligan MS, Shearon TH, Weill D, Pagani FD, Moore J, Murray S.
Heart and lung transplantation in the United States, 1997-2006. Am J
Transplant. 2008; 8(4 Pt 2):977-987.
•  Nathan SD. Transplantation Criteria for Patients with Severe
Pulmonary Hypertension and Grossly Impaired Right, but Relatively
Normal Left Ventricular Function. Medscape Education Web site.
http://www.medscape.org/viewarticle/574234. Accessed January 16,
2017.
•  Ohler L, Cupples S. Core Curriculum for Transplant Nurses. Second
Ed. St. Louis, MO: Mosby; 2016.

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TRANSPLANT NURSING

Heart and Lung Transplantation

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• Why would a heart transplant be considered for a

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What are indications for heart transplant in a pediatric patient?

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• When would a child receiving a heart transplant be

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What is meant by “heart

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What is the pathophysiology that can lead a

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• ESHD can also be caused by:

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What is the criteria used for placing a patient on the organ

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• When is a patient classified as Class I-VI?

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

How are pediatric patients prioritized to

• Children are hospitalized

Status • Children are hospitalized

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• How are the American College of Cardiology and

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What is criteria for a patient being classified /

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• When would a heart transplant not be

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What diagnostic tests need to be performed before diagnosis

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• Which diagnostic laboratory

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

What laboratory values would begin to

ü BUN > 50mg/dL

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

Which laboratory values could be

ü Sodium levels from

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What interventions are necessary for patients to slow

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• Transplant nurses need to evaluate patients with ESHD

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What are visible signs and

A man with congestive heart

By James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What may be present upon

Cyanosis of the hand in

James Heilman, MD (http://creativecommons.org/licenses/by/3.0)], via Wikimedia

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• When are patients placed on the ISHLT transplantation list?

• What preoperative laboratory information is important for the

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

The nurse is ü Knowledge of invasive

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What is important to know

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• Why will either of these procedures affect the patient post-

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• How can this affect patient heart rate following

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

• What are areas of concern for post-operative care of the

Copyright 2017. OnCourse Learning Corporation. All rights reserved.

•  Why would a heart transplant be considered for a

•  What are indications for heart transplant in a pediatric patient?

•  When would a child receiving a heart transplant be

•  What is meant by “heart

•  What is the pathophysiology that can lead a

•  ESHD can also be caused by:

•  What is the criteria used for placing a patient on the organ

•  When is a patient classified as Class I-VI?

• Children are hospitalized

Status • Children are hospitalized

•  How are the American College of Cardiology and

•  What is criteria for a patient being classified /

•  When would a heart transplant not be

•  What diagnostic tests need to be performed before diagnosis

•  Which diagnostic laboratory

ü BUN > 50mg/dL

ü Sodium levels from

•  What interventions are necessary for patients to slow

•  Transplant nurses need to evaluate patients with ESHD

•  What are visible signs and

•  What may be present upon

•  When are patients placed on the ISHLT transplantation list?

•  What preoperative laboratory information is important for the

The nurse is ü Knowledge of invasive

•  What is important to know

•  Why will either of these procedures affect the patient post-

•  How can this affect patient heart rate following

•  What are areas of concern for post-operative care of the

•  What other post-operative monitoring is important in heart

•  When does the nurse need to

•  How does graft failure usually present in children

•  What are signs of chronic rejection or coronary

•  Why is coronary artery vasculopathy (CAV) so important to

•  What are endomyocardial biopsies?

•  How are patients monitored for ventricular failure?

•  What etiology can cause ventricular dysfunction?

•  What additional complications can develop following heart

•  How can changes in cardiac rate or rhythm become

•  What other body systems can

•  Where is the most common site for infection to

•  What regimen is used most often for

•  What medications are typically used in treatment of rejection?

•  What monitoring is necessary when a patient is on these

•  What are the indications for lung transplant

•  Which patients are considered having contraindications for

•  Why is pediatric lung transplantation the least

•  What additional screenings make pediatric lung transplant

•  What is included in the pre-transplant education of the

•  What testing is done during the transplant evaluation to

•  What symptoms of progressing lung

•  Donors who are generally selected for

•  What is important in initial monitoring of lung

•  How are pediatric lung transplant patients managed post-

•  How may complications present

•  When is primary graft

•  How is PGD treated?

•  What are other

•  Why is it necessary for the transplant nurse

•  What can be done to treat a patient experiencing