Skip to main content

Postoperative Critical Care of Lung Transplant Patients

  • Chapter
  • First Online:
Anesthesia and Perioperative Care for Organ Transplantation

Abstract

Lung transplantation is the treatment of choice for patients with end-stage lung disease. Such interventions have had a more widespread use due to advances in the understanding of the pathophysiology of this patient population and the immunologic mechanisms involved with rejection and immunosuppressive therapy. There have also been substantial surgical technical advancements as well as development of new pharmacologic agents during the last 30 years. Due to such improvements, lung transplant recipients have now a better survival rate. The role of the multidisciplinary critical care team is paramount in the successful implementation of lung transplantation and in preventing and minimizing morbidity and mortality in this highly complex patient population. In particular, it is important for the critical care professional to have a comprehensive knowledge of the unique complications and issues present in multiple organ systems that can affect the lung transplant recipient patient during the immediate postoperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lung Transplantation Group T. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med. 1986;314:1140–5.

    Article  Google Scholar 

  2. Yusen RD, Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: thirtieth adult lung and heart-lung transplant report – 2013; focus theme: age. J Heart Lung Transplant. 2013;32(10):965–78.

    Article  PubMed  Google Scholar 

  3. Shigemura N, Sclabassi RJ, Bhama JK, Gries CJ, Crespo MM, Johnson B, et al. Early major neurologic complications after lung transplantation: incidence, risk factors, and outcome. Transplantation. 2013;95(6):866–71.

    Article  PubMed  Google Scholar 

  4. McIlroy DR, Sesto AC, Buckland MR. Pulmonary vein thrombosis, lung transplantation, and intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2006;20(5):712–5.

    Article  PubMed  Google Scholar 

  5. Zander DS, Baz MA, Visner GA, Staples ED, Donnelly WH, Faro A, et al. Analysis of early deaths after isolated lung transplantation. Chest. 2001;120(1):225–32.

    Article  CAS  PubMed  Google Scholar 

  6. Schulman LL, Anandarangam T, Leibowitz DW, Ditullio MR, McGregor CC, Galantowicz ME, et al. Four-year prospective study of pulmonary venous thrombosis after lung transplantation. J Am Soc Echocardiogr. 2001;14(8):806–12.

    Article  CAS  PubMed  Google Scholar 

  7. Tsang BK, Kermeen FD, Hopkins PM, Chambers DC. Reversible posterior leukoencephalopathy syndrome: diagnosis and management in the setting of lung transplantation. Intern Med J. 2010;40(10):716–20.

    Article  CAS  PubMed  Google Scholar 

  8. Lichtenstein GR, Yang YX, Nunes FA, Lewis JD, Tuchman M, Tino G, et al. Fatal hyperammonemia after orthotopic lung transplantation. Ann Intern Med. 2000;132(4):283–7.

    Article  CAS  PubMed  Google Scholar 

  9. Lau CL, Patterson GA, Palmer SM. Critical care aspects of lung transplantation. J Intensive Care Med. 2004;19(2):83–104.

    Article  PubMed  Google Scholar 

  10. Dizon JM, Chen K, Bacchetta M, Argenziano M, Mancini D, Biviano A, et al. A comparison of atrial arrhythmias after heart or double-lung transplantation at a single center: insights into the mechanism of post-operative atrial fibrillation. J Am Coll Cardiol. 2009;54(22):2043–8.

    Article  PubMed  Google Scholar 

  11. Nielsen TD, Bahnson T, Davis RD, Palmer SM. Atrial fibrillation after pulmonary transplant. Chest. 2004;126(2):496–500.

    Article  PubMed  Google Scholar 

  12. Lee G, Wu H, Kalman JM, Esmore D, Williams T, Snell G, et al. Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long-term freedom from paroxysmal atrial fibrillation. Eur Heart J. 2010;31(22):2774–82.

    Article  PubMed  Google Scholar 

  13. Henri C, Giraldeau G, Dorais M, Cloutier AS, Girard F, Noiseux N, et al. Atrial fibrillation after pulmonary transplantation: incidence, impact on mortality, treatment effectiveness, and risk factors. Circ Arrhythm Electrophysiol. 2012;5(1):61–7.

    Article  PubMed  Google Scholar 

  14. Malik A, Hsu JC, Hoopes C, Itinarelli G, Marcus GM. Elevated pulmonary artery systolic pressures are associated with a lower risk of atrial fibrillation following lung transplantation. J Electrocardiol. 2013;46(1):38–42.

    Article  PubMed  Google Scholar 

  15. Kimblad PO, Sjoberg T, Steen S. Pulmonary vascular resistance related to endothelial function after lung transplantation. Ann Thorac Surg. 1994;58(2):416–20.

    Article  CAS  PubMed  Google Scholar 

  16. Griffith BP, Hardesty RL, Armitage JM, Hattler BG, Pham SM, Keenan RJ, et al. A decade of lung transplantation. Ann Surg. 1993;218(3):310–8. discussion 8-20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest. 1998;113(3):576–83.

    Article  CAS  PubMed  Google Scholar 

  18. Kamler M, Herold U, Piotrowski J, Bartel T, Teschler H, Jakob H. Severe left ventricular failure after double lung transplantation: pathophysiology and management. J Heart Lung Transplant. 2004;23(1):139–42.

    Article  CAS  PubMed  Google Scholar 

  19. Navas B, Cobos MJ, Vaquero JM, Santos F, Cosano A. Cardiac tamponade secondary to pneumopericardium after lung transplantation: a case report. Transplant Proc. 2008;40(9):3123–5.

    Article  CAS  PubMed  Google Scholar 

  20. Denault A, Ferraro P, Couture P, Boudreault D, Babin D, Poirier C, et al. Transesophageal echocardiography monitoring in the intensive care department: the management of hemodynamic instability secondary to thoracic tamponade after single lung transplantation. J Am Soc Echocardiogr. 2003;16(6):688–92.

    Article  PubMed  Google Scholar 

  21. Lasocki S, Castier Y, Geffroy A, Mal H, Brugiere O, Leseche G, et al. Early cardiac tamponade due to tension pneumopericardium after bilateral lung transplantation. J Heart Lung Transplant. 2007;26(10):1069–71.

    Article  PubMed  Google Scholar 

  22. Diamond JM, Lee JC, Kawut SM, Shah RJ, Localio AR, Bellamy SL, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med. 2013;187(5):527–34.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Verbeek GL, Myles PS. Intraoperative protective ventilation strategies in lung transplantation. Transplant Rev (Orlando). 2013;27(1):30–5.

    Article  Google Scholar 

  24. Slinger P. Perioperative lung injury. Best Pract Res Clin Anaesthesiol. 2008;22(1):177–91.

    Article  PubMed  Google Scholar 

  25. Kilpatrick B, Slinger P. Lung protective strategies in anaesthesia. Br J Anaesth. 2010;105 Suppl 1:i108–16.

    Article  PubMed  Google Scholar 

  26. Myles PS, Snell GI, Westall GP. Lung transplantation. Curr Opin Anaesthesiol. 2007;20(1):21–6.

    Article  PubMed  Google Scholar 

  27. Lucangelo U, Del Sorbo L, Boffini M, Ranieri VM. Protective ventilation for lung transplantation. Curr Opin Anaesthesiol. 2012;25(2):170–4.

    Article  PubMed  Google Scholar 

  28. Pottecher J, Falcoz PE, Massard G, Dupeyron JP. Does thoracic epidural analgesia improve outcome after lung transplantation? Interact Cardiovasc Thorac Surg. 2011;12(1):51–3.

    Article  PubMed  Google Scholar 

  29. Granton J. Update of early respiratory failure in the lung transplant recipient. Curr Opin Crit Care. 2006;12(1):19–24.

    Article  PubMed  Google Scholar 

  30. Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2005;24(10):1454–9.

    Article  PubMed  Google Scholar 

  31. Christie JD, Sager JS, Kimmel SE, Ahya VN, Gaughan C, Blumenthal NP, et al. Impact of primary graft failure on outcomes following lung transplantation. Chest. 2005;127(1):161–5.

    Article  PubMed  Google Scholar 

  32. Whitson BA, Prekker ME, Herrington CS, Whelan TP, Radosevich DM, Hertz MI, et al. Primary graft dysfunction and long-term pulmonary function after lung transplantation. J Heart Lung Transplant. 2007;26(10):1004–11.

    Article  PubMed  Google Scholar 

  33. Meyer DM, Bennett LE, Novick RJ, Hosenpud JD. Effect of donor age and ischemic time on intermediate survival and morbidity after lung transplantation. Chest. 2000;118(5):1255–62.

    Article  CAS  PubMed  Google Scholar 

  34. Wittwer T, Franke UF, Fehrenbach A, Ochs M, Sandhaus T, Schuette A, et al. Experimental lung transplantation: impact of preservation solution and route of delivery. J Heart Lung Transplant. 2005;24(8):1081–90.

    Article  PubMed  Google Scholar 

  35. Steen S, Sjoberg T, Massa G, Ericsson L, Lindberg L. Safe pulmonary preservation for 12 hours with low-potassium-dextran solution. Ann Thorac Surg. 1993;55(2):434–40.

    Article  CAS  PubMed  Google Scholar 

  36. de Perrot M, Liu M, Waddell TK, Keshavjee S. Ischemia-reperfusion-induced lung injury. Am J Respir Crit Care Med. 2003;167(4):490–511.

    Article  PubMed  Google Scholar 

  37. Ng CS, Wan S, Yim AP. Pulmonary ischaemia-reperfusion injury: role of apoptosis. Eur Respir J. 2005;25(2):356–63.

    Article  CAS  PubMed  Google Scholar 

  38. Yerebakan C, Ugurlucan M, Bayraktar S, Bethea BT, Conte JV. Effects of inhaled nitric oxide following lung transplantation. J Card Surg. 2009;24(3):269–74.

    Article  PubMed  Google Scholar 

  39. Tavare AN, Tsakok T. Does prophylactic inhaled nitric oxide reduce morbidity and mortality after lung transplantation? Interact Cardiovasc Thorac Surg. 2011;13(5):516–20.

    Article  PubMed  Google Scholar 

  40. Date H, Triantafillou AN, Trulock EP, Pohl MS, Cooper JD, Patterson GA. Inhaled nitric oxide reduces human lung allograft dysfunction. J Thorac Cardiovasc Surg. 1996;111(5):913–9.

    Article  CAS  PubMed  Google Scholar 

  41. Herrington CS, Prekker ME, Arrington AK, Susanto D, Baltzell JW, Studenski LL, et al. A randomized, placebo-controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation. Clin Transplant. 2011;25(1):90–6.

    Article  CAS  PubMed  Google Scholar 

  42. Keshavjee S, Davis RD, Zamora MR, de Perrot M, Patterson GA. A randomized, placebo-controlled trial of complement inhibition in ischemia-reperfusion injury after lung transplantation in human beings. J Thorac Cardiovasc Surg. 2005;129(2):423–8.

    Article  CAS  PubMed  Google Scholar 

  43. Moreno I, Vicente R, Mir A, Leon I, Ramos F, Vicente JL, et al. Effects of inhaled nitric oxide on primary graft dysfunction in lung transplantation. Transplant Proc. 2009;41(6):2210–2.

    Article  CAS  PubMed  Google Scholar 

  44. Hartwig MG, Walczak R, Lin SS, Davis RD. Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation. Ann Thorac Surg. 2012;93(2):366–71.

    Article  PubMed  Google Scholar 

  45. Pilcher DV, Scheinkestel CD, Snell GI, Davey-Quinn A, Bailey MJ, Williams TJ. High central venous pressure is associated with prolonged mechanical ventilation and increased mortality after lung transplantation. J Thorac Cardiovasc Surg. 2005;129(4):912–8.

    Article  CAS  PubMed  Google Scholar 

  46. Burns KE, Johnson BA, Iacono AT. Diagnostic properties of transbronchial biopsy in lung transplant recipients who require mechanical ventilation. J Heart Lung Transplant. 2003;22(3):267–75.

    Article  CAS  PubMed  Google Scholar 

  47. Mitchell JB, Shaw AD, Donald S, Farrimond JG. Differential lung ventilation after single-lung transplantation for emphysema. J Cardiothorac Vasc Anesth. 2002;16(4):459–62.

    Article  PubMed  Google Scholar 

  48. Gavazzeni V, Iapichino G, Mascheroni D, Langer M, Bordone G, Zannini P, et al. Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema. Chest. 1993;103(1):96–100.

    Article  CAS  PubMed  Google Scholar 

  49. Dutau H, Vandemoortele T, Laroumagne S, Gomez C, Boussaud V, Cavailles A, et al. A new endoscopic standardized grading system for macroscopic central airway complications following lung transplantation: the MDS classification. Eur J Cardiothorac Surg. 2014;45(2):e33–8.

    Article  PubMed  Google Scholar 

  50. Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009;6(1):79–93.

    Article  PubMed  Google Scholar 

  51. van Berkel V, Guthrie TJ, Puri V, Krupnick AS, Kreisel D, Patterson GA, et al. Impact of anastomotic techniques on airway complications after lung transplant. Ann Thorac Surg. 2011;92(1):316–20. discussion 20-1.

    Article  PubMed  Google Scholar 

  52. Van De Wauwer C, Van Raemdonck D, Verleden GM, Dupont L, De Leyn P, Coosemans W, et al. Risk factors for airway complications within the first year after lung transplantation. Eur J Cardiothorac Surg. 2007;31(4):703–10.

    Article  Google Scholar 

  53. Hartwig MG, Snyder LD, Finlen-Copeland A, Lin SS, Zaas DW, Davis RD, et al. Lung transplantation at Duke University. Clin Transpl. 2009;197–210.

    Google Scholar 

  54. Shofer SL, Wahidi MM, Davis WA, Palmer SM, Hartwig MG, Lu Y, et al. Significance of and risk factors for the development of central airway stenosis after lung transplantation. Am J Transplant. 2013;13(2):383–9.

    Article  CAS  PubMed  Google Scholar 

  55. Murthy SC, Blackstone EH, Gildea TR, Gonzalez-Stawinski GV, Feng J, Budev M, et al. Impact of anastomotic airway complications after lung transplantation. Ann Thorac Surg. 2007;84(2):401–99 e1–4.

    Article  PubMed  Google Scholar 

  56. Jacques F, El-Hamamsy I, Fortier A, Maltais S, Perrault LP, Liberman M, et al. Acute renal failure following lung transplantation: risk factors, mortality, and long-term consequences. Eur J Cardiothorac Surg. 2012;41(1):193–9.

    PubMed  Google Scholar 

  57. Ishikawa S, Griesdale D, Lohser J. Acute kidney injury within 72 hours after lung transplantation: incidence and perioperative risk factors. J Cardiothorac Vasc Anesth. 2013.

    Google Scholar 

  58. Osho AA, Castleberry AW, Snyder LD, Ganapathi AM, Speicher PJ, Hirji SA, Stafford-Smith M, Daneshmand MA, Duane Davis R, Hartwig MG. Determining elegibility for lung transplantation: a natiowide assessment of cutoff glomerular filtration rates. J Heart Lung Transplant. 2014;33(4):138.

    Article  Google Scholar 

  59. Osho AA, Castleberry AW, Snyder LD, Ganapathi AM, Speicher PJ, Hirji SA, Stafford-Smith M, Daneshmand MA, Duane Davis R, Hartwig MG. Optimizing the estimation of renal function in lung transplant candidates. J Heart Lung Transplant. 2013;32(4):217.

    Article  Google Scholar 

  60. Barraclough K, Menahem SA, Bailey M, Thomson NM. Predictors of decline in renal function after lung transplantation. J Heart Lung Transplant. 2006;25(12):1431–5.

    Article  PubMed  Google Scholar 

  61. Singh N, Gayowski T, Marino IR. Hemolytic uremic syndrome in solid-organ transplant recipients. Transpl Int. 1996;9(1):68–75.

    Article  CAS  PubMed  Google Scholar 

  62. Attaya AF, Tang A, Gomes M, Petterson G, McCurry K, Mason DP, Murthy S, Johnston D, Mehta A, Akindipe O, Lane C, Budev M. An analysis of the characteristics of lung transplant patients that develop heparin induced thrombocytopenia type II (HIT) after transplant. J Heart Lung Transplant. 2013;32 Suppl 4:268.

    Article  Google Scholar 

  63. McGugan PLA, Albon D, Hartwig MG. Perioperative venous thromboembolism prophylaxis in lung transplant patients. J Heart Lung Transplant. 2014;33(4):S293.

    Article  Google Scholar 

  64. Lubetkin EI, Lipson DA, Palevsky HI, Kotloff R, Morris J, Berry GT, et al. GI complications after orthotopic lung transplantation. Am J Gastroenterol. 1996;91(11):2382–90.

    CAS  PubMed  Google Scholar 

  65. Gilljam M, Chaparro C, Tullis E, Chan C, Keshavjee S, Hutcheon M. GI complications after lung transplantation in patients with cystic fibrosis. Chest. 2003;123(1):37–41.

    Article  PubMed  Google Scholar 

  66. Hoekstra HJ, Hawkins K, de Boer WJ, Rottier K, van der Bij W. Gastrointestinal complications in lung transplant survivors that require surgical intervention. Br J Surg. 2001;88(3):433–8.

    Article  CAS  PubMed  Google Scholar 

  67. Atkins BZ, Trachtenberg MS, Prince-Petersen R, Vess G, Bush EL, Balsara KR, et al. Assessing oropharyngeal dysphagia after lung transplantation: altered swallowing mechanisms and increased morbidity. J Heart Lung Transplant. 2007;26(11):1144–8.

    Article  PubMed  Google Scholar 

  68. Atkins BZ, Petersen RP, Daneshmand MA, Turek JW, Lin SS, Davis Jr RD. Impact of oropharyngeal dysphagia on long-term outcomes of lung transplantation. Ann Thorac Surg. 2010;90(5):1622–8.

    Article  PubMed  Google Scholar 

  69. Snyder LD, Wang Z, Chen DF, Reinsmoen NL, Finlen-Copeland CA, Davis WA, et al. Implications for human leukocyte antigen antibodies after lung transplantation: a 10-year experience in 441 patients. Chest. 2013;144(1):226–33.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Snyder LD, Gray AL, Reynolds JM, Arepally GM, Bedoya A, Hartwig MG, et al. Antibody desensitization therapy in highly sensitized lung transplant candidates. Am J Transplant. 2014;14(4):849–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Mauricio Del Rio M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media New York

About this chapter

Cite this chapter

Del Rio, J.M., Daneshmand, M.A., Hartwig, M.G. (2017). Postoperative Critical Care of Lung Transplant Patients. In: Subramaniam, K., Sakai, T. (eds) Anesthesia and Perioperative Care for Organ Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6377-5_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-6377-5_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-6375-1

  • Online ISBN: 978-1-4939-6377-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics