New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

Abstract

The management of lung transplant patients has continued to evolve in recent years. The year 2021 was marked by the publication of the International Consensus Recommendations for Anesthetic and Intensive Care Management of Lung Transplantation. There have been major changes in lung transplant programs over the last few years. This review will summarize the knowledge in anesthesia management of lung transplantation with the most recent data. It will highlight the following aspects which concern anesthesiologists more specifically: (1) impact of COVID-19, (2) future of transplantation for cystic fibrosis patients, (3) hemostasis management, (4) extracorporeal membrane oxygenation management, (5) early prediction of primary graft dysfunction, and (6) pain management.

Anaesthesiologic Considerations for Intraoperative ECMO Anticoagulation During Lung Transplantation: A Single-Centre, Retrospective, Observational Study

“…However, ECMO also carries risks of bleeding, infection, and thrombotic complications [10][11][12][13]. The entire team should decide to use intraoperative ECMO on a case-by-case basis, considering the patient's medical history and condition [14,15]. Our study aims to highlight that lower doses of anticoagulants administered during intraoperative ECMO support do not lead to increased risks and may be beneficial for the patient.…”

Current Perspectives and Future Directions in Lung Transplantation

“…In their narrative overview, Fessler and colleagues summarized the most recent data and knowledge in the anaesthetic management of LTx [11]. The authors described several important concerns, including the impact of coronavirus disease 2019 (COVID-19), future of LTx for cystic fibrosis (CF) patients, haemostasis management, expanding role of ECMO in LTx, early prediction of primary graft dysfunction, and pain management [11]. Recently, we have witnessed a reduction in LTx activity with up to 47% of centres limited LTx to only urgent cases, and the mortality on the waiting list has even increased up to 20%.…”