Palliative care in lung transplantation

Abstract

The role of palliative care in lung transplantation has grown exponentially in the past two decades. From assisting with evaluating and optimizing candidates for transplant, to playing a crucial role in patients requiring extracorporeal cardiopulmonary life support (ECLS) as a bridge to lung transplant, perioperatively, or even during their first year post-transplant, palliative care has been shown to be an effective if underutilized tool in the armamentarium used to care for lung transplant patients. For patients being considered for primary transplantation and for lung transplant recipients, palliative care can decrease symptom burden and help to lessen the psychological distress experienced by patients and family members.For older patients listed for transplant, palliative care can help address cognitive impairment, depression, and frailty. Patients listed for lung re-transplant also benefit from palliative care involvement to address frequent symptom exacerbations, hospitalizations, and higher morbidity and mortality. Even for organ donors and their families, palliative care can facilitate communication and provide support to the family. While palliative care use in lung transplantation may be gradually increasing, further work is necessary to optimally integrate palliative care into lung transplantation. Barriers to lung transplant patients receiving palliative care are multifactorial and include physician, patient, and institutional factors. The potential role of palliative care in every aspect of lung transplantation has made a knowledge of palliative care principles crucial for the lung transplant practitioner. In this review, we will clearly delineate the potential benefit of palliative care for the perioperative lung transplant patient and make an argument for its increased use in this patient population.

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

“…Patients with ILD were more likely to be delisted or die pre-LTx, and report a higher symptom burden, highlighting the importance of PC in this population. There is increasing support for the role of PC to aid in symptom management in the pre-transplantation period and we suspect that this will only become more important in the future (52,53). The ESAS has a role in identifying severe symptom burden in those with advanced lung disease on the LTx waiting list and may serve as a complement to traditional markers of disease severity.…”

Incorporating transitional palliative care in a bone marrow transplant unit by serious illness conversation: a case report

“…The implementation of PC interventions into malignant hematology/BMT unit is more challenging due to issues with the emerging novel treatments and a lack of understanding between patients’ families and healthcare professionals regarding disease trajectory and prognosis. This will be more complicated in transplant patients when dealing their EOL issues ( 12 ).…”

An update of palliative care in lung transplantation with a focus on symptoms, quality of life and functional outcomes

“…Furthermore, some LTx recipients experience a complex and prolonged hospital course, which can lead to impairments in HRQL or present with symptoms such as dyspnea [22 ▪ ]. Palliative care support can help cope with some of these challenges including physical or mental health concerns, medication side effects, and return to daily function posttransplant [7 ▪▪ ]. Further, given the high readmission rates in the first year posttransplant [23], PC support during these admissions or during transition periods can be beneficial.…”

“…The importance of PC in LTx has been highlighted by the American Thoracic Society and American College of Chest Physicians in adopting a comprehensive and holistic approach to improving symptoms, HRQL and function in patients awaiting LTx [5,6]. Literature suggests increased utilization of PC support in settings such as hospital admissions, those requiring bridging to transplantation, and re-transplants [7 ▪▪ ]. Moreover, PC provides an opportunity to increase communication and support for patients and their caregivers during the transplant process.…”

“…Moreover, PC provides an opportunity to increase communication and support for patients and their caregivers during the transplant process. A recent review in early 2022 highlights the benefits of PC in LTx [7 ▪▪ ].…”