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Early Postoperative Management

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Book cover Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Immediately after successful surgery, the pediatric lung transplant recipient will typically be transferred to the intensive care unit (ICU) for postoperative management. Proper monitoring and management during the early postoperative care is critical for both immediate survival and long-term outcome. There are a number of potential complications in the early transplant period that need to be recognized, prevented if possible, and/or treated appropriately. These complications include, but are not limited to problems with mechanical ventilation, hemodynamic instability and cardiovascular problems. The transplanted allograft is at risk for developing pulmonary edema, infection, acute or hyperacute rejection, and possibly transfusion-related acute lung injury. Surgical complications may include bleeding, pulmonary venous thrombosis, problems with wound healing, and dehiscence of the bronchial airway anastomoses. In addition to routine monitoring and treatment of those complications, the early postoperative period is also the time where immunosuppressive therapy is started or continued, nutrition is reinitiated and optimized to patient needs and physical rehabilitation is a priority. Proper postoperative management by an experienced multidisciplinary team is an important requirement for a successful lung transplantation in children.

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References

  • Albokrinov AA, Fesenko UA (2014) Spread of dye after single thoracolumbar paravertebral injection in infants. A cadaveric study. Eur J Anaesthesiol 31(6):305–309

    Article  CAS  PubMed  Google Scholar 

  • Atkins BZ, Trachtenberg MS, Prince-Petersen R, Vess G, Bush EL, Balsara KR, Lin SS, Davis RD Jr (2007) Assessing oropharyngeal dysphagia after lung transplantation: altered swallowing mechanisms and increased morbidity. J Heart Lung Transplant 26(11):1144–1148

    Article  PubMed  Google Scholar 

  • Bairdain S, Dodson B, Zurakowski D, Waisel DB, Jennings RW, Boretsky KR (2015) Paravertebral nerve block catheters using chloroprocaine in infants with prolonged mechanical ventilation for treatment of long-gap esophageal atresia. Paediatr Anaesth 25(11):1151–1157

    Article  PubMed  Google Scholar 

  • Beer A, Reed RM, Bölükbas S, Budev M, Chaux G, Zamora MR, Snell G, Orens JB, Klesney-Tait JA, Schmidt GA, Brower RG, Eberlein M (2014) Mechanical ventilation after lung transplantation. An international survey of practices and preferences. Ann Am Thorac Soc 11(4):546–553

    Article  PubMed  Google Scholar 

  • Berk Y, van der Bij W, Erasmus ME, Wijkstra PJ (2006) Non-invasive ventilation in phrenic nerve dysfunction after lung transplantation: an attractive option. J Heart Lung Transplant 25(12):1483–1485

    Article  PubMed  Google Scholar 

  • Berkowitz N, Schulman LL, McGregor C, Markowitz D (1995) Gastroparesis after lung transplantation. Potential role in postoperative respiratory complications. Chest 108(6):1602–1607

    Article  CAS  PubMed  Google Scholar 

  • Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA 303(9):865–873

    Article  CAS  PubMed  Google Scholar 

  • Cason M, Naik A, Grimm JC, Hanna D, Faraone L, Brookman JC, Shah A, Hanna MN (2015) The efficacy and safety of epidural-based analgesia in a case series of patients undergoing lung transplantation. J Cardiothorac Vasc Anesth 29(1):126–132

    Article  PubMed  Google Scholar 

  • Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D, ISHLT Working Group on Primary Lung Graft Dysfunction (2005) 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 24(10):1454–1459

    Article  PubMed  Google Scholar 

  • Feltracco P, Barbieri S, Milevoj M, Serra E, Michieletto E, Carollo C, Rea F, Marulli G, Ori C (2010) Thoracic epidural analgesia in lung transplantation. Transplant Proc 42(4):1265–1269

    Article  CAS  PubMed  Google Scholar 

  • Ferdinande P, Bruyninckx F, Van Raemdonck D, Daenen W, Verleden G, Leuven Lung Transplant Group (2004) Phrenic nerve dysfunction after heart-lung and lung transplantation. J Heart Lung Transplant 23(1):105–109

    Article  CAS  PubMed  Google Scholar 

  • Grasemann H, de Perrot M, Bendiak GN, Cox P, van Arsdell GS, Keshavjee S, Solomon M (2012) ABO-incompatible lung transplantation in an infant. Am J Transplant 12(3):779–781

    Article  CAS  PubMed  Google Scholar 

  • Hadem J, Gottlieb J, Seifert D, Fegbeutel C, Sommer W, Greer M, Wiesner O, Kielstein JT, Schneider AS, Ius F, Fuge J, Kühn C, Tudorache I, Haverich A, Welte T, Warnecke G, Hoeper MM (2016) Prolonged mechanical ventilation after lung transplantation – a single-center study. Am J Transplant 16(5):1579–1587

    Article  CAS  PubMed  Google Scholar 

  • Hassan A, Anderson C, Kypson A, Kindell L, Ferguson TB, Chitwood WR Jr, Rodriguez E (2012) Clinical outcomes in patients with prolonged intensive care unit length of stay after cardiac surgical procedures. Ann Thorac Surg 93(2):565–569

    Article  PubMed  Google Scholar 

  • Hoffman TM, Rhodes LA, Wieand TS, Spray TL, Bridges ND (2001) Arrhythmias after pediatric lung transplantation. Pediatr Transplant 5(5):349–352

    Article  CAS  PubMed  Google Scholar 

  • Hutchins J, Apostolidou I, Shumway S, Kelly R, Wang Q, Foster C, Loor G (2016) Paravertebral catheter use for postoperative pain control in patients after lung transplant surgery: a prospective observational study. J Cardiothorac Vasc Anesth pii: S1053–0770(16): 30099–4. doi:10.1053/j.jvca.2016.05.006. [Epub ahead of print]

  • Lasocki S, Castier Y, Geffroy A, Mal H, Brugière O, Lesèche G, Montravers P (2007) Early cardiac tamponade due to tension pneumopericardium after bilateral lung transplantation. J Heart Lung Transplant 26(10):1069–1071

    Article  PubMed  Google Scholar 

  • Lee JC, Christie JD (2011) Primary graft dysfunction. Clin Chest Med 32(2):279–293

    Article  PubMed  Google Scholar 

  • Lee JC, Christie JD, Keshavjee S (2010) Primary graft dysfunction: definition, risk factors, short- and long-term outcomes. Semin Respir Crit Care Med 31(2):161–171

    Article  PubMed  Google Scholar 

  • Lee JC, Diamond JM, Christie JD (2012) Critical care management of the lung transplant recipient. Curr Respir Care Rep 1(3):168–176

    Article  Google Scholar 

  • Lucangelo U, Del Sorbo L, Boffini M, Marco RV (2012) Protective ventilation for lung transplantation. Curr Opin Anaesthesiol 25(2):170–174

    Article  PubMed  Google Scholar 

  • Maziak DE, Maurer JR, Kesten S (1996) Diaphragmatic paralysis: a complication of lung transplantation. Ann Thorac Surg 61(1):170–173

    Article  CAS  PubMed  Google Scholar 

  • Meade MO, Granton JT, Matte-Martyn A, McRae K, Weaver B, Cripps P, Keshavjee SH, Toronto Lung Transplant Program (2003) A randomized trial of inhaled nitric oxide to prevent ischemia-reperfusion injury after lung transplantation. Am J Respir Crit Care Med 167(11):1483–1489

    Article  PubMed  Google Scholar 

  • Minkes RK, Langer JC, Skinner MA, Foglia RP, O'Hagan A, Cohen AH, Mallory GB, Huddleston CB, Mendeloff EN (1999) Intestinal obstruction after lung transplantation in children with cystic fibrosis. J Pediatr Surg 34(10):1489–1493

    Article  CAS  PubMed  Google Scholar 

  • Murty GE, Smith MC (1989) Recurrent laryngeal nerve palsy following heart-lung transplantation: three cases of vocal cord augmentation in the acute phase. J Laryngol Otol 103(10):968–969

    Article  CAS  PubMed  Google Scholar 

  • Orrego CM, Cordero-Reyes AM, Estep JD, Seethamraju H, Scheinin S, Loebe M, Torre-Amione G (2014) Atrial arrhythmias after lung transplant: underlying mechanisms, risk factors, and prognosis. J Heart Lung Transplant 33(7):734–740

    Article  PubMed  Google Scholar 

  • Pilcher DV, Scheinkestel CD, Snell GI, Davey-Quinn A, Bailey MJ, Williams TJ (2005) High central venous pressure is associated with prolonged mechanical ventilation and increased mortality after lung transplantation. J Thorac Cardiovasc Surg 129(4):912–918

    Article  CAS  PubMed  Google Scholar 

  • Prekker ME, Nath DS, Walker AR, Johnson AC, Hertz MI, Herrington CS, Radosevich DM, Dahlberg PS (2006) Validation of the proposed International Society for Heart and Lung Transplantation grading system for primary graft dysfunction after lung transplantation. J Heart Lung Transplant 25(4):371–378

    Article  PubMed  Google Scholar 

  • Shargall Y, Guenther G, Ahya VN, Ardehali A, Singhal A, Keshavjee S, ISHLT Working Group on Primary Lung Graft Dysfunction (2005) Report of the ISHLT working group on primary lung graft dysfunction part VI: treatment. J Heart Lung Transplant 24(10):1489–1500

    Article  PubMed  Google Scholar 

  • Simpson KP, Garrity ER (1997) Perioperative management in lung transplantation. Clin Chest Med 18(2):277–284

    Article  CAS  PubMed  Google Scholar 

  • Solomon M, Grasemann H, Keshavjee S (2010) Pediatric lung transplantation. Pediatr Clin N Am 57(2):375–391

    Article  CAS  Google Scholar 

  • Verbeek GL, Myles PS (2013) Intraoperative protective ventilation strategies in lung transplantation. Transplant Rev (Orlando) 27(1):30–35

    Article  Google Scholar 

  • Yerebakan C, Ugurlucan M, Bayraktar S, Bethea BT, Conte JV (2009) Effects of inhaled nitric oxide following lung transplantation. J Card Surg 24(3):269–274

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Hartmut Grasemann & Melinda Solomon

  2. Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Gary Visner

Authors
  1. Hartmut Grasemann
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  2. Melinda Solomon
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  3. Gary Visner
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Corresponding author

Correspondence to Hartmut Grasemann .

Editor information

Editors and Affiliations

  1. Jefferson Medical College, AI Dupont Hospital for Children Department of Surgery, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Liver & Intestine Transplantation, Seattle Children’s Hospital Liver & Intestine Transplantation, Seattle, Washington, USA

    Simon Horslen

Section Editor information

  1. The Children's Hospital of Philadelphia, Philadelphia, PA, USA

    Samuel B Goldfarb

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© 2017 Springer International Publishing AG

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Grasemann, H., Solomon, M., Visner, G. (2017). Early Postoperative Management. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-08049-9_66-1

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  • DOI: https://doi.org/10.1007/978-3-319-08049-9_66-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08049-9

  • Online ISBN: 978-3-319-08049-9

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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