American Board of Internal Medicine (ABIM) Certification Practice Exam

What factor influences the decision for lung transplantation in emphysema patients?

1. History of lung cancer

2. Presence of pulmonary hypertension

3. Duration of respiratory illness

4. Age alone without other factors

The correct answer is: Presence of pulmonary hypertension

The presence of pulmonary hypertension is a significant factor influencing the decision for lung transplantation in patients with emphysema. This is because pulmonary hypertension can indicate a worsening of the patient's overall condition and may lead to reduced functional capacity, making them less suitable for transplant. High levels of pressure in the pulmonary arteries can suggest that the right side of the heart is struggling to pump blood effectively, complicating the clinical picture and increasing the risks associated with transplantation. In general, the ideal candidate for lung transplantation is someone who has severe emphysema but without significant comorbidities that could jeopardize the success of the surgery or the long-term viability of the transplanted lung. The presence of pulmonary hypertension is often a contraindication for transplantation, as it can suggest a decreased chance of surgical success and increased post-operative complications. Other factors, such as a history of lung cancer, duration of respiratory illness, and age, may also play a role in the overall assessment of a patient's suitability for lung transplantation. However, they do not carry the same level of impact in the decision-making process as does the presence of pulmonary hypertension, which directly correlates with the patient's ongoing health risks and potential outcomes following surgery.