Lung Transplantation in Pulmonary Hypertension: A Multidisciplinary Unit's Management Experience

Quezada-Loaiza, Carlos A.; Gafas, Alicia de Pablo; Pérez, Virginia; Alonso, Raquel Cano; Juarros, Lourdes; Real, M. Isabel; López, E.; Cortes, Marcelino; Meneses, José Carlos; González, Ignacio Hernández; Gude, V. Díaz-Hellín; Subías, Pilar Escribano; Gámez, Pablo

doi:10.1016/j.transproceed.2018.02.073

Cited by 12 publications

(4 citation statements)

References 26 publications

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“…Initiation of extracorporeal membrane oxygenation remains the last resort and has been used perioperatively for management of pulmonary hypertensive crisis and as interim measure while awaiting for definitive treatment with lung transplantation. [ 8 – 10 ]…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists

et al. 2020

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Introduction: Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension. It is often underdiagnosed or misdiagnosed as idiopathic pulmonary arterial hypertension (PAH). Inappropriate treatment may cause worsening of symptoms which may lead to fatal outcomes. Anesthetic considerations and management for pulmonary hypertension are well described, but few anesthesiologists are aware of the entity of PVOD and its management. Patient concerns: We report a case of PVOD in a 73-year-old female who was on concurrent aspirin and anagrelide, requiring emergent open femoral hernia repair. Diagnosis: PVOD and incarcerated femoral hernia Intervention: Combined spinal-epidural (CSE) was performed to enable the surgery. Outcome: Surgery was completed successfully under central neuraxial anesthesia and the patient remained stable and comfortable throughout, avoiding the need for general anesthesia. Due to the concurrent aspirin and anagrelide therapy, significant bleeding from the CSE puncture site was observed immediately post-operatively. This was resolved with external manual compression and withholding the aspirin and anagrelide. Patient remained well without neurological deficit and was discharged postoperative day seven. Lessons: It is important to differentiate PVOD from PAH due to the controversial use of pulmonary vasodilators in PVOD. Pulmonary vasodilator is commonly used to treat acute pulmonary hypertension in PAH but its usage may lead to pulmonary edema in patients with PVOD. Hence, with no ideal treatment available, the avoidance of general anesthesia is crucial to prevent acute pulmonary hypertensive crisis in patient with PVOD. However, this needs to be weighed against the elevated risk of central neuraxial bleeding when performing a CSE in a patient on concurrent aspirin and anagrelide therapy. Calculated decision-making considering the risks and benefits of all alternatives should be carried out in such a scenario, and measures should be taken in anticipation of the potential consequences of the eventual decision. Conclusion: It is important to differentiate PVOD from PAH. PVOD has unique anesthetic considerations due to the controversial use of pulmonary vasodilators. This case also emphasizes the importance of active anticipation of potential issues and adequate follow up.

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Section: Discussionmentioning

confidence: 99%

Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists

et al. 2020

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“…Additionally, patients with phenotypes known to respond poorly to medical therapy, such as pulmonary venoocclusive disease (PVOD), should be referred promptly (9). Ideally, early referral allows time for patients to consider transplantation, and for the transplant teams to fully evaluate patient candidacy, while working to mitigate any potential risks (24).…”

Section: Pre-transplant Managementmentioning

confidence: 99%

Lung transplantation for pulmonary hypertension

Hwalek¹,

Rosenheck²,

Whitson³

2021

J Thorac Dis

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From its identification as a distinct disease entity, understanding and management of pulmonary hypertension has continuously evolved. Diagnostic and therapeutic interventions have greatly improved the prognostic implications of this devastating disease, previously rapidly and uniformly fatal to one chronically managed by multi-disciplinary teams. Improved diagnostic algorithms and active research into biochemical signatures of pulmonary hypertension (PH) have led to earlier diagnosis of PH. Medical therapy has moved from upfront use of continuous intravenous prostaglandins to administration of combinations of oral medications targeting multiple pathways underlying this disease process. In addition to improved medical therapies, recently introduced interventions such as pulmonary endarterectomy and pulmonary artery balloon angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) give patients an increasing array of treatment options. Despite these many advances, lung transplantation remains the definitive treatment for patients with disease refractory to or progressing on best medical therapy. As our understanding of medical therapy has advanced, so to have best practices for lung transplantation. Recipient selection and approach to organ transplantation techniques have continuously evolved. Mechanical circulatory support has become increasingly employed to bridge patients through lung transplantation in the immediate post transplantation recovery. In this review, we give a history of lung transplantation for PH, an overview of PH, discuss current best practices and look to the future for insights into the care of these patients.

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“…Reviews specific to LTx in various disease states included idiopathic pulmonary fibrosis, [51][52][53] scleroderma, [54][55][56][57][58] emphysema, 59,60 chronic obstructive pulmonary disease (COPD), 61 pulmonary veno-occlusive disease, 62 CF, 63,64 pulmonary hypertension, [65][66][67] and occupational lung disease. 68 Cystic Fibrosis.…”

Section: Recipient Managementmentioning

confidence: 99%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.

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Lung Transplantation in Pulmonary Hypertension: A Multidisciplinary Unit's Management Experience

Cited by 12 publications

References 26 publications

Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists

Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists

Lung transplantation for pulmonary hypertension

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

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