Acute Lung Injury After Bilateral Lung Transplantation Due to Contralateral Pulmonary Arterial Anastomotic Obstruction

Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis

“…Of these, a total of 7 were excluded due to the following reasons: nonpulmonary artery complications (n = 2) 16,17 or pulmonary artery issues unrelated to the sequelae of lung transplant surgery (n = 5). [18][19][20][21][22] Thus, from the primary literature search, a total of 30 full-text citations [6][7][8][9][10][11]15, were included in the review. Additional hand searching of conference proceedings, reference lists of included articles, and gray literature revealed an additional 4 citations [46][47][48][49] that satisfied the inclusion criteria.…”

“…Additional hand searching of conference proceedings, reference lists of included articles, and gray literature revealed an additional 4 citations [46][47][48][49] that satisfied the inclusion criteria. Ultimately, a total of 34 [6][7][8][9][10][11]15, full-text citations were included in the systematic review, of which 24 were case reports, 7,8,15,[23][24][25][27][28][29][30][31][32][35][36][37][38][40][41][42][43]45,[47][48][49] 8 were retrospective studies, 6,[9][10][11]33,34,39,46 and 2 were prospective studies. 26,44 For full-text eligibility, the unweighted κ was calculated to be 0.80 between the 2 independent reviewers.…”

“…To assist with interpretation of our secondary outcome data, we stratified published cases of pulmonary artery obstruction by common causes reported after lung transplantation, including distortion of anastomosis from unsuitably sized donor-recipient segments (ie, donor-recipient mismatch), technical narrowing or twisting of the anastomosis, external compression, and intraluminal thrombus formation. 7,15 Furthermore, diagnostic times were classified as intraoperative, early postoperative, and late postoperative. 3 An intraoperative diagnosis was defined as the discovery of pulmonary artery obstruction in the operating room before chest closure; an early postoperative diagnosis was defined as the occurrence of pulmonary artery obstruction within the first 72 hours upon arriving to the intensive care unit (ICU) after completion of the lung transplantation; and a late postoperative diagnosis was defined as the discovery of pulmonary artery obstruction after the initial 72 hours of postoperative ICU care.…”

“…Across all included studies, a total of 1696 lung transplant patients were investigated, of which 552 underwent bilateral lung transplantation 6,7,[9][10][11]15,23,24,28,31,33,35,[39][40][41]44,[46][47][48][49] and 414 underwent single-lung transplantation [6][7][8][9][10][11]26,27,29,30,[32][33][34][36][37][38][39]42,43,45,46 ; the type of lung transplant (ie, single or bilateral) was unspecified in the remaining 747 patients. 33,34 Of the 414 patients who underwent single-lung transplantation, 38 underwent right-sided lung transplantation [6][7][8][9][10][11]…”

“…6,11,39,46 One patient 39 who underwent combined heart-lung transplantation was excluded from this review, because the pulmonary artery anastomosis was done en bloc at the main pulmonary artery, not at the left and right pulmonary arteries. 39 Transplantation was assisted with the use of cardiopulmonary bypass at 8 centers, 7,11,15,23,35,45,47,48 whereas 2 8,11 centers reported performing an off-bypass procedure. Key study variables, including number of patients assessed, patient characteristics, outcomes analyzed, cases reported of pulmonary artery obstruction, and timing and modality of diagnosis, can be viewed in Table 1.…”