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Medical Management of the Lung Transplant Recipient: Extrapulmonary Issues

  • Erika D. Lease
  • Ganesh Raghu
Chapter

Abstract

Following transplantation, medical management of the lung transplant recipient is vital for maintaining the health of the allograft and to promote an overall successful outcome after a lung transplant surgery. This includes vigilant and meticulous monitoring for all lung transplant-related issues, including administering appropriate immunosuppression with antirejection medications while monitoring for associated toxicities and drug interactions as well as prompt detection of infection and lung allograft rejection. In addition, there must be full awareness of the many non-pulmonary complications that may arise following lung transplantation, a large number of which are related to immunosuppressant effects or toxicities. Non-pulmonary complications include but are not limited to renal dysfunction, hematologic abnormalities, gastrointestinal complications, neurologic sequelae, oncologic manifestations, and metabolic derangements. While monitoring lung allograft function following transplantation is critical to overall survival, monitoring of the subsequent non-pulmonary complications is also important to avoid increased morbidity and mortality in lung transplant recipients. The lung transplant pulmonologist must assume the role of a very thorough internist for the lung transplant recipient in order to monitor and address the many complications occurring after lung transplantation. This chapter focuses on the medical management of non-pulmonary issues in the lung transplant recipient.

Keywords

Lung transplant Medical management Complications 

Abbreviations

BCC

Basal cell carcinoma

BMP

Basic metabolic panel

BOS

Bronchiolitis obliterans syndrome

Ca

Calcium

CBC

Complete blood count

CF

Cystic fibrosis

CLAD

Chronic lung allograft dysfunction

CMV

Cytomegalovirus

COPD

Chronic obstructive pulmonary disease

CXR

Chest radiograph (X-ray)

EBV

Epstein-Barr virus

FEV1

Forced expiratory volume in 1 s

GERD

Gastroesophageal reflux disease

GFR

Glomerular filtration rate

HUS

Hemolytic uremic syndrome

IPF

Idiopathic pulmonary fibrosis

ISHLT

International Society for Heart and Lung Transplantation

IU/mL

International units per milliliter

LFT

Liver function testing

MDS

Myelodysplastic syndrome

Mg

Magnesium

MRI

Magnetic resonance imaging

PCR

Polymerase chain reaction

PFT

Pulmonary function testing

PLS

Passenger leukocyte syndrome

PO4

Phosphorus

PRBCs

Packed red blood cells

PRES

Posterior reversible encephalopathy syndrome

PTLD

Posttransplant lymphoproliferative disorder

RBCs

Red blood cells

SCC

Squamous cell carcinoma

SIR

Standardized incidence ration

TTP

Thrombotic thrombocytopenic purpura

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Copyright information

© The Author(s) 2018

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleUSA
  2. 2.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine University of WashingtonSeattleUSA
  3. 3.Center for Interstitial Lung Disease, ILD, Sarcoid and Pulmonary Fibrosis Program, University of Washington MedicineSeattleUSA
  4. 4.Scleroderma Clinic, University of Washington MedicineSeattleUSA

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