Postoperative management and acute complications after lung transplantation

Abstract

Lung transplantation is an established therapy for select patients with end-stage pulmonary disease, offering prolonged survival and significant improvement in recipient's quality of life. The postoperative care of lung transplant recipients is quite complex and deals with the prevention and management of a wide spectrum of immediate post-operative complications. Since these complications occur frequently and are associated with poor outcomes including increased short and long-term morbidity and mortality, it is extremely important to recognize and manage them early. It is worth noting that the post-operative critical care of lung transplant recipients is multidisciplinary in nature and presents with evolving clinical scenarios that require frequent changes in treatment plans. In addition to the medical and surgical teams, allied health providers like respiratory, physical and nutritional therapists play a pivotal role in the management of patients. Close collaboration and communication between the different teams will eventually translate into a better outcomes and survival. In this review, the first part will highlight the important aspects of the immediate care of the lung transplant recipients following surgery including monitoring, ventilator and hemodynamic management, pain control, immunosuppression and the prevention of infection in addition to other nuances. The second part of the review will discuss the diagnosis and management of acute medical [primary graft dysfunction (PGD), acute allograft rejection] and surgical complications such as those related to the airways, vascular anastomosis or pleural space.

Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID‐19 pulmonary disease

“…Complications reported in acute care were consistent with other reports of patients with COVID‐19, including respiratory failure, hematologic complications, rheumatologic complications, weakness, and renal failure 33,35–37 . Postoperative complications were also consistent with reported complications of patients who underwent BOLT for reasons other than COVID‐19, including infection, pneumothorax, bleeding, renal failure, and weakness 8,34,38,39 . Acute hospital readmissions from IPR are seen among non‐COVID‐19 lung transplant patients with variable readmission rates that can range from 19–40% 8,12 .…”

“…Patients who experience severe illness necessitating prolonged hospitalization and life‐saving measures inevitably experience a period of immobilization. Muscle weakness is not an unusual finding among critically ill patients requiring extended periods of immobility and/or bedrest and can be seen in a variety of clinical scenarios including post‐lung transplant, 8,39 sepsis, corticosteroid exposure, and long‐term ventilator dependence; the patients in this sample experienced one or more of these conditions 33,40,41 . Diaphragmatic weakness, dysfunction, and/or direct phrenic nerve injury are known complications of severe COVID‐19 infection itself and post BOLT 8,42 .…”

“…33,[35][36][37] Postoperative complications were also consistent with reported complications of patients who underwent BOLT for reasons other than COVID-19, including infection, pneumothorax, bleeding, renal failure, and weakness. 8,34,38,39 Acute hospital readmissions from IPR are seen among non-COVID-19 lung transplant patients with variable readmission rates that can range from 19-40%. 8,12 It is not surprising that this patient population had a greater percentage of readmission rates to acute care (47%) given the greater medical complexity of these patients compared to those not infected with COVID-19.…”