Intraoperative Implications of the Recipients' Disease for Double-Lung Transplantation

Practical considerations for developing a lung transplantation anesthesiology program

“…Transplant specific anesthesia education begins before walking into the operating theater and relies on a strong foundational knowledge of basic anesthesia and physiologic concepts, including the underlying physiology of etiologyspecific disease processes. Recent literature supports tailoring anesthetic management to the underlying etiology in order to improve perioperative outcomes [4,5,8]. As such, it is imperative that the anesthesiologist commands the full ability to optimize the anesthetic management and patient physiology in patients with pulmonary hypertension, obstructive pulmonary disease, suppurative pulmonary disease, and restrictive pulmonary disease.…”

“…Enhanced recovery protocols have been described as a way to coordinate complex care plans among multidisciplinary teams focused on improving outcomes in specific patient populations [4,26]. While no specific protocols exist for lung transplantation patients in the literature, an anesthesiology program should glean principles from both published thoracic enhanced recovery protocols, as well as various focused strategies for optimizing early recovery in lung transplantation [5,9,[27][28][29][30][31][32].…”

“…In addition, the inception of the International Society for Heart and Lung Transplantation (ISHLT) and International Thoracic Organ Transplant (TTX) Registry has created a network for advanced analysis and data exchange, setting forth the framework for increased multidisciplinary teamwork similar to that modeled by the Toronto Lung Transplant Group [4]. Improvements in the science of circulatory support, surgical technique, and intraoperative anesthetic management have contributed to significantly improve the survival and perioperative outcomes in the lung transplant patient population [5,6]. Perioperative care provided by lung transplant anesthesiolo-gists can directly affect patient outcomes through optimized perioperative management aimed to prevent or minimize primary graft dysfunction [4].…”

Multidisciplinary collaboration: the key to advancing lung transplantation outcomes

“…Advancement in outcomes will continue if we recognize the various physician and non-physician members of the transplant team and optimize their contributions. Another aspect of optimization is recognition of not only the diversity of team member backgrounds, but also tailoring care to the diversity of end-stage lung disease (ESLD) leading to lung transplantation as well [7,8]. Clinical, educational, and research efforts across the lung transplant team should focus on elucidating the precise differences between presenting pathologies, and preliminary literature has provided perioperative recommendations specific for patients who present with ESLD in the general categories of restrictive, obstructive, suppurative, or primary pulmonary hypertensive disease [8].…”

The Effect of Pulmonary Disease on the Intraoperative Management of Lung Transplant Patients

“…Based on this work, and since longterm survival after LTX is dependent on the disease, Fessler et al retrospectively compared the intraoperative course in carefully selected patients undergoing double LTX to the presenting lung disease regarding blood transfusion, the need for unexpected VA-ECMO, and possible extubation at the end of the procedure. 1 They studied 429 patients from 2012 to 2019. Two hundred forty-six patients had CF, 117 had chronic obstructive pulmonary disease (COPD)/emphysema (CE), and 66 had pulmonary fibrosis (PF).…”