PRE-TRANSPLANT ASSESSMENT

Patient name – ANIL KASPATE

Prepared By - Dr Rahul Kendre Supervised By - Dr M S Barthwal,

PROF & HOD,RESPIRATORY MEDICINE
TRANSPLANT PULMONOLOGIST
Name : Anil Kaspate

Age : 50 years

Gender : Male

Admission date ( DPU) :27 March 2023

Discharge Date(dpu) : 1 April 2023

Address : Wakad, Pune

Nationality: Indian
 Diagnosis

CONGENITAL BRONCHIECTASIS
 HISTORY
 50 years old male, with k/c/o congenital bronchiectasis

 The patient was apparently alright then he started complaining of breathlessness and desaturation since 4-5

months.

 He has been admitted in Ruby hall clinic recently due to the severity of breathlessness increased.

 The patient has been admitted in DPU for pre lung transplant evaluation.

 Non Smoker, NO H/O - DM, HTN, CAD & Pulmonary Tuberculosis.

 PRESENT MEDICATIONS
• R/C DIFIZMA VIA LUPIHALER OD
• T.LASILACTONE 20/50 MG OD
• SYP.OROFER 10 ML HS
• T.SOMPRAZ D BEFORE BREAKFAST AND BEFORE DINNER
• T.MUCINAC 600 MG BD
• CAP.BENZ PEARLS 200 MG TDS
• SYP.LUPITUS SOS
• T.SHELCAL HD NIGHT
• T TAYO 60 K ON SUNDAY
• T.VORICANOZOLE 200 MG MORNING
• T.IBANDRONATE 150 MG ONE MONTHLY
• SYP.CITAL 10 ML
• T.WYSOLONE 5 MG OD
 CLINICAL STATUS

Height : 162cm Spo2 = 99% with 2L 02

Weight : 62kg CVS: S1S2+

RS: B/L Crepts
PR: 76/min
P/A: Soft
BP: 120/80 mmHg
CNS: Conscious, oriented.
Temp: 98.6 F
Blood group - AB Positive
BMI – 23.6Kg/m2
X-RAY DONE ON 27 MARCH 2023
 HRCT THORAX (27 march 2023)
 Marked reduction in left lung volume with mediastinal
and tracheal shift to the left and hyperinflation of middle
lobe of right lung is noted.
 Left lung parenchyma is replaced by cystic spaces
suggestive of cystic bronchiectasis.
 Large emphysematous bulla in upper and middle lobe of
right lung.
 Pigtail tube in anterior chest wall entering with its tip in
apical segment ofright lung.
 Consolidation ,calcified granulomas and pleural
thickening in apical and anterior segment of right upper
lung.
 Traction,cystic and varicoid bronchiectasis cavities is
noted in right lung predominanatly involving apical and
anterior segment of upper and middle lobe.
 Mosaic attenuation in right lung.
ECG -
 2D ECHO (27 MARCH 2023)

 Normal LV size and systolic

function,LVEF-60%
 TAPSE -22mmhg
 No regional wall motion abnormality.
 Grade 1 diastolic dysfunction.
 Mild TR,moderate PAH
 IAS and IVS intact.
 No clot/vegetation/effusion.
 CORONARY ANGIOGRAPHY AND CARDIAC CATHETRISATION
(MARCH 28 2023)

• Coronary angiography :-
IMPRESSION –Normal coronaries

• Cardiac cathetrisation :-
IMPRESSION -Moderate PAH
Normal cardiac output
 USG ABDOMEN (Done on 27 March 2023)

• No abnormality is detected in this study.

 COLOUR DOPPLER OF
BILATERAL LOWER LIMBS
(27 March 2023)

• Impression – NORMAL STUDY

DEXA SCAN ASSESSMENT

• The BMD measured at AP Spine L1-L4 is 0.896 g/cm2 with a T-Score of -2.4 is low

• The BMD measured at Femur neck is 0.666g/cm2 with a T-score of -2.7 is low.

• The BMD measured at Femur neck is 0.667 g/cm2 with a T-score of -2.7 is low

• IMPRESSION –F/S/O OSTEOPOROSIS IN BOTH NECK FEMUR AND LOW BONE MASS
IN SPINE .
GASTROENTEROLOGY REPORTS
PFT (29 March 2023)

PRE %
PREDICTED
FVC 3.37 55
FEV1 2.57 50
FEV1/FVC 75.6 92
PFT(29 March 2023)
 6 MINUTE WALK TEST

• 180 m covered in 6 minutes.

• Spo2 pre test -94% (3 L)
• Spo2 post test -90% (8 L)
 On 2 lit O2

ABG ( 28 MARCH 2023)

pH = 7.39
pCO2 = 54 mm of Hg
pO2 =33 mm of Hg
HCO3 = 32.70 mol/L
 TESTS DATE VALUE REFERRENCES

Hemoglobin 29 March 2023 13.60 13.2-16.6

Packed cell volume 29 March 2023 39.40 38.30-48.60

Rbc count 29 March 2023 4.60 4.35 -5.65 *10^6
Mcv 29 March 2023 85.50 77-95

CBC Mchc 29 March 2023 34.40 31.5-34.5g/dl

Wbc 29 March 2023 6,100 4000-10000
Platelet 29 March 2023 199,000 150000-410000
Neutrophils 29 March 2023 68 40-80
Lymphocytes 29 March 2023 24% 20-40%
Monocytes 29 March 2023 8% 2-6
Eosinophils 29 March 2023 0% 1-6
Basophils 29 March 2023 0% 0-2
 LIVER FUNCTION PANEL

TESTS DATE VALUES REFERRENCES

Total bilirubin 27 March 2023 0.43 mg/dl 0-1.2

Direct bilirubin 27 March 2023 0.23 mg/dl 0-0.3

Indirect bilirubin 27 March 2023 0.20 mg/dl 0-0.8

ALT 27 March 2023 18 0-50

AST 27 March 2023 11 17-59
Alkaline
27 March 2023 89.00 38-126.00
phosphatase
 IMMUNOLOGY
TESTS DATE VALUES REFERRENCES
HIV combo 27 March 2023 NON-REACTIVE (0.13) <1.00
HBsAG 27 March 2023 NON-REACTIVE (0.001) <0.5
ANTI HCV Ab 27 March 2023 NON-REACTIVE (0.12) <0.9
HBsAb-Ab to Hep.B
27 March 2023 NON REACTIVE
surface Ag
HBC CORE AB 27 March 2023 NON-REACTIVE (0.08) >1.0
VCA &NA -POSITIVE
EBV IGG 27 March 2023
EA -NEGATIVE
EBV IGM 27 March 2023 NEGATIVE
VDRL (RPR) 27 March 2023 NON-REACTIVE <1.0 REACTIVE
 TESTS DATE VALUE REFERRENCES
FBS 27 March 2023 96 MG/DL 80-120
PPBS 27 March 2023 125 MG /DL

Calcium 27 March 2023 8.90 8.8-10.8

Phosphorus 27 March 2023 3.70 2.6 -4.7
Magnesium 27 March 2023 1.60 1.80-2.40
 INVESTIGATIONS

TESTS DATE VALUES REFERENCE

FREE T3 29 March 2023 0.66 0.80-2.00

FREE T4 29 March 2023 5.93 5.10-14.10
TSH 29 March 2023 0.43 0.27-4.2
HbA1C 29 March 2023 5.40 4-5.7
CREATININE 29 March 2023 0.65 0.74-1.30
UREA 29 March 2023 22 17-49.22
Sr PSA 29 March 2023 1.857
 COAGULATION PROFILE

TESTS DATES VALUES REFERRENCES

PROTHROMBIN
29 March 2023 12.70 8.97-12.91 SECS
TIME
INR 29 March 2023 1.06 0.85-1.15
CONTROL 10.94
aPTT 29 March 2023 22.20 21.67-28.77 Secs
 SEROLOGY

TESTS DATE VALUE REFERENCE

S.PREALBUMIN 27 MARCH 2023 15 mg/dl 20-40 MG/DL

S.IRON 27 MARCH 2023 30.00 50-150 MG/DL
TIBC 27 MARCH 2023 228 250-450 MG/DL
TRANSFERRIN 27 MARCH 2023 13.16 20 -50%
SATURATION
VIT.D 25-OH 27 MARCH 2023 51.60
S.FERRITIN 27 MARCH 2023 116.80 21.81-274.66
VITAMIN B12 27 MARCH 2023 844 187-883
 FASTING LIPID PROFILE

TESTS DATE VALUES REFERRENCES

TOTAL CHOLESTEROL 29 March 2023 111 <200

TRIGLYCERIDES 29 March 2023 50 <150
HDL CHOLESTEROL 29 March 2023 19 40-60
LDL CHOLESTEROL 29 March 2023 82 <100
VLDL CHOLESTEROL 29 March 2023 10 10-30
LDL/HDL RATIO 29 March 2023 4.32 Male -<3.6
 ANA PROFILE

TESTS DATE VALUES REFERRENCES

SSA POSITIVE,
ANA BLOT TEST 29 March 2023 PM-Scl –positive

Antibodies against cell

nuclei-weak positive
ANA BY IF 29 March 2023
Antibodies against
cytoplasmic components-
negative
 INVESTIGATIONS – CULTURES

Urine routine - Normal

Pleural fluid culture –No AFB Seen.klebsiella pneumonia present
Stool occult blood -Negative
Urine culture – Klebsiella pneumonia colony count more than
1,000000cfu/ml
Nasal swab culture - No growth
Blood culture - No growth
PANEL REACTIVE ANTIBODIES
(29 March 2023)

• CLASS 1 ANTIBODIES -
14%

• CLASS 2 ANTIBODIES -43%

HIGH RESOLUTION HLA TYPING
(29 March 2023)
 PHYSIOTHERAPY

Patient covered 180 m in 6 number of laps with increased oxygen support,8L

oxygen.
Post BORA scale :2
Advised – Pulmo rehabilitation.
 INFECTIOUS DISEASE CONSULTATION

 Hep.B 0 th dose, PCV 13 , Tdap and Quadriflu vaccination given

(on 1 April 2023)

 CVTS CONSULTATION

• After reviewing all investigations, the patient has been recognized as

a potential lung transplant candidate .
 CARDIOLOGY CONSULTATION

 Cardiac evaluation completed.

 Recommended Lung transplant.
MEDICAL GASTROENTEROLOGY CONSULTATION

Patient fit from gastroenterology side.

 ENT CONSULTATION

 ENT examination within normal limits

 Patient is fit from ENT side.

 DENTAL CONSULTATION

 Advised :-
• Oral Prophylaxis
• Floride Application.
• Maintain good oral hygiene.
 PSYCHIATRY CONSULTATION

 No significant psychiatric symptoms.

 MSE – within normal limits.

 No major psychopathology,patient is aware of Lung transplant

procedure .

 SIPAT SCORE -0 (Excellent candidate)

 DIETICIAN CONSULTATION

 Nutritional screening and assessment done.

 Patient has been advised to be on Low fat and high protein diet.

• SGA Score -13

THANK YOU