Deep venous thrombosis and pulmonary embolism after lung transplantation

Abstract

The incidence of deep venous thrombosis or pulmonary embolism after lung or heart-lung transplantation has not been well defined. Pulmonary embolism may be of particular concern in the postoperative period owing to an inadequately developed or absent collateral bronchial circulation and potential risk of pulmonary infarction. Fourteen (12.1%) of 116 patients undergoing either lung (n = 87) or heart-lung (n = 29) transplantation developed thromboembolic complications 10 days to 36 months after operation. Deep vein thrombosis developed in nine patients, including three with upper body thrombosis related to indwelling central venous catheters. Seven patients (6%) had pulmonary embolism, and three of them died. Resolution of pulmonary embolism was successfully accomplished by selective pulmonary artery infusion of urokinase in three patients without complications. Our experience indicates that deep vein thrombosis and pulmonary embolism are significant problems after lung transplantation. Mortality is high in those patients in whom pulmonary embolism develops. Therefore, a comprehensive prevention protocol is warranted.

High Incidence of Venous Thromboembolic Events in Lung Transplant Recipients

“…Our patients were followed over the course of 11 years, whereas previous studies followed patients for only 5.5 to 7.5 years post-trans- plant. 2,4,5 In addition, we followed a larger group of patients over this time period than in the earlier studies. In our study, all diagnostic studies were prompted by clinical symptoms.…”

“…Kroshus et al routinely screened patients with V/Q scans and only performed Doppler ultrasonography if V/Q indicated the presence of a pulmonary embolism. 2 As a result, deep vein thrombosis (DVT) preceding pulmonary embolism (PE) may have been underreported. Similarly, Nathan et al studied PE in patients transplanted for idiopathic pulmonary fibrosis (IPF), but there was no investigation as to incidence of DVT.…”

“…1 The incidence of deep venous thrombosis after major surgery in patients Ͼ40 years of age is at least 30% in the absence of prophylactic measures. 2 Many factors are believed to contribute to the increased risk of post-operative VTE. Trauma to major vessels, prolonged immobilization and anesthetic agents contribute to this risk.…”

“…3 Prior studies have shown a 9% to 12% incidence of VTE in lung transplant recipients (LTRs) followed up to 6 to 7.5 years after transplant. 2,4 However, characterization of risk factors for VTE specific to LTRs is lacking. The purpose of this study was to identify the VTE incidence in LTRs and to characterize the risk factors associated with post-transplant VTE.…”

Development of a Hypercoagulable Status in Patients Undergoing Off-Pump Lung Transplantation despite Prolonged Conventional Coagulation Tests

“…In-hospital rates of VTE after transplantation have been estimated at 6-12%, despite thromboprophylaxis (1,2), and even at 36% in post mortem studies (3). This is elevated in comparison with the general surgical patient population, in which VTE rates are estimated at around 4% (4).…”